№2' 2018


Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine, Dnipro

Dnipropetrovsk Multifield Clinical Hospital № 4, Dnipro, Ukraine
Individualization of antibiotic therapy for pneumonia in patients with hemoblastosis from the perspective of antibiotic resistance
5 - 11
Pulmonary complications often accompany diseases of the blood system and can be both manifestations of the disease itself and chemotherapy, which produces an aggressive effect on the immunity system of the patients. Pneumonia is one of the manifestations of infection complications, which pose a threat to the life of a patient with hemoblastosis. The issues of individualization of antibacterial therapy of pneumonia in patients with hemoblastosis are urgent in clinical practice. This problem can be solved by determining the spectrum of the leading pathogens of the disease and studying their sensitivity to the leading antibacterial drugs. The study performed with this purpose involved the patients with various forms of hemoblastosis and pneumonia. The material for determining the probable pathogens was bronchoalveolar lavage fluid. The microbiological study was carried out by studying native smears with the definition of the main morphological types and also in stages on dense differential−nutrient media. Sensitivity of the isolates to antibacterial drugs was determined by a disco−diffuse method. According to the results of clinical and bacterial efficacy of pneumonia treatment regimens in patients with hemoblastosis, it was determined that monotherapy with cefepime and meropenem was effective. In order to individualize antibiotic therapy of pneumonia, these regimens should be used in patients with hemoblastosis, in which pneumonia developed outside a hospital and without the signs of severe neutropenia. The clinical efficacy of antibiotic therapy of pneumonia with amikacin + meropenem and amikacin + cefepimum regimens was 83.33 % and 86.11 %, respectively. Such schemes should be recommended for individual choice of rational therapy in patients with hemoblastosis, if pneumonia occurred in a hospital and against a background of severe neutropenia.
Key words: antibacterial therapy, pneumonia, hemoblastosis.
Kharkiv National Medical University, Ukraine
Structural and functional myocardial changes in patients with chronic obstructive pulmonary disease combined with hypertension
12 - 15
In modern medicine, combined course of chronic obstructive pulmonary disease and hypertension is an important medical and social problem due to an increase in morbidity, severity of complications, a tendency to increased mortality and loss of working capacity of the patients. Timely prediction of the course of chronic obstructive pulmonary disease, assessment of the future cardiovascular risk, and development of the algorithm for individual prediction of the course of chronic obstructive pulmonary disease with accompanying hypertension on the basis of hemodynamic parameters are necessary. To assess the structural and functional changes in the myocardium in patients with chronic obstructive pulmonary disease in combination with hypertension patients with chronic obstructive pulmonary disease of occupational origin GOLD 2 group B (GOLD 2016) were examined. In one group this disease was accompanied by hypertension. The examination was performed within the period of remission. All patients underwent general clinical and laboratory examination, 6−min walk test, BODE index, pulse oximetry, spirometry, electrocardiography, echocardiography and chest x−ray. The results of this study showed that chronic obstructive pulmonary disease in combination with hypertension is characterized by decreased tolerance to physical activity, a tendency to desaturation during a six−minute walk test and higher values of BODE index. Prognostically unfavorable types of left ventricular geometry and signs of cor pulmonale were more common in patients with a combination of chronic obstructive pulmonary disease and hypertension, which indicates deepening of the processes of remodeling of the left and right parts of the heart and is associated with a high risk of cardiovascular complications.
Key words: chronic obstructive pulmonary disease, hypertension, echocardiography, left ventricle geometry.
V. I. Zaitsev Institute of General and Urgent Surgery, Kharkiv

Kharkiv National Medical University, Ukraine
The use of minimally invasive operations in treatment of patients with colorectal cancer complications with intestinal obstruction
16 - 19
In recent years, the problem of treatment of complicated colorectal cancer has become relevant as the incidence of this disease is steadily increasing and reaching the first place among all malignant tumors of the gastrointestinal tract. Together with the increase in the incidence of colorectal cancer, the frequency of its complicated forms increases making up 60−89 %. These include intestinal obstruction, perforation, intestinal bleeding, perifocal and intratumor inflammation with abscess formation. The most common complication of complicated colorectal cancer is intestinal obstruction, which occurs in 10−85 % of all patients. The literature sources on the use of minimally invasive surgical interventions in patients with complicated colorectal cancer were analyzed. The questions of the choice of the method of surgical treatment are discussed. In order to determine and compare the effectiveness of different minimally invasive techniques in patients with colorectal cancer complicated by intestinal obstruction, the results of surgical treatment of patients operated by video laparoscopic and laparotomic access were compared. It was proven that video−laparoscopic surgery at complicated colorectal cancer had a number of advantages allowing better results, earlier and social labor rehabilitation of patients in the immediate postoperative period. Laparoscopic technology allows intervention in any division of the colon and rectum. At the same time, it is possible to ensure full observance of cancer protocols by volume of resection and lymph nodes. The results showed that the use of video−laparoscopic technique in patients with complicated colorectal cancer contributes to improving the results of their treatment by reducing intraoperative blood loss, more favorable course of the immediate postoperative period, earlier activation and restoration of intestinal motility, less need for narcotic analgesics and intensive care, reduction of frequency of wound and organ complications, reduction of the stay at the intensive care department and hospital stay.
Key words: complicated colorectal cancer, surgical treatment, laparoscopic techniques.
A. A. Shalimov National Institute of Surgery and Transplantology of National Academy of Medical Sciences of Ukraine, Ukraine
Mechanical invaginated esophagogastric anastomosis in prevention of postoperative complications in patients after esophagus resection
19 - 22
Esophagus reconstruction after esophagectomy remains one of the main problems in esophagus surgery, and the reliability of anastomosis with the esophagus is topical to the present day, since anastomosis failure is attributed to the main causes of lethal outcomes of operations. Mechanical suture using staplers, which are constantly being improved, is becoming increasingly popular in esophagus surgery. With regard to postoperative complications of the anastomosis, evaluation of the stapler technique gives equal or better results than the manual one. The mechanical (stapler) method of formation of the esophageal−gastric anastomosis is associated with reduction in the operation time, it reduces the incidence of anastomosis failure as compared with the manual method, but increases the risk of developing postoperative strictures. A new method of formation of esophagogastroanastomosis was proposed and postoperative complications were assessed: its failure in the early postoperative period and the number of cicatricial strictures of this site at different stages after esophagectomy. To evaluate the advantages of forming invagination mechanical esophagogastroanastomosis in patients with esophageal diseases after resection the patients operated for malignant tumors of the esophagus and gastroesophageal junction were examined. They were performed Lewis operation and Osawa−Garloc operations. The number of postoperative complications from anastomoses was assessed: the number of cases of esophagogastroanastomosis leakage in the early postoperative period and the number of cases of esophagogastroanastomosis scar stricture 3, 6 and 12 months after surgery. Esophagogastroanastomosis leakage in the study group was not recorded, in the comparison group, the leakage of EGA was detected in 2 patients. The number of postoperative strictures of the esophagus 3 months after surgery was lower in the study group and was 10 %, in the control group −30 % of cases. Six months after surgery, the number of esophagogastroanastomosis strictures in both groups increased and amounted to 15 % and 40 % of cases, respectively. Twelve months after the operation the number of cases of esophagogastroanastomosis stricture remained lower in the study group and amounted to 20 % of the cases with respect to 40 % of cases of esophagogastroanastomosis stricture in the comparison group. Thus, it was established that formation of invagination mechanical esophagogastroanastomosis in the conditions of esophagus resection reduces the number of cases of esophagogastroanastomosis leakages and the number of esophagogastroanastomosis stricture, which proves its higher reliability and effectiveness in comparison with the classical mechanical anastomosis.
Key words: esophageal cancer, esophagogastric anastomosis, anastomosis stricture, anastomosis failure.
V. T. Zaitsev Institute of General and Urgent Surgery of AMS of Ukraine, Kharkiv, Ukraine
Modern aspects of diagnostic and surgical treatment of pericardial effusion
23 - 28
The review of the literature is devoted to the problems of diagnosis, etiology search and methods of surgical correction of pericardial effusion of various etiologies. Pericardial effusion is the most common disease of the pericardium, which often has a secondary nature and develops due to primary pathological processes: infectious (viral, bacterial, fungal, etc.), autoimmune, neoplastic, metabolic, traumatic, iatrogenic causes, drug−related nature etc. This article overviews the modern literature data on terminology and classification of pericardial effusion, the main diagnostic methods, the possibility of etiological search for the cause of effusion in the pericardial cavity, as well as the main tasks and methods of pericardial surgical interventions and indications to them. Based on the analysis of Ukrainian and foreign literary, we can conclude that at present there is no consensus on the clinical and nosological structure, epidemiology, course, prognosis and the reasons for the unsatisfactory results of treatment of pericardial effusion; instrumental noninvasive diagnostic methods allow establishing the presence and severity of pericardial effusion, but are almost helpless in the etiological search for the causes of its occurrence; there is no consensus on the appropriateness, effectiveness and necessity of using various tests and interventions in the diagnosis of pericarditis. Analysis of literature data on the surgical treatment of pericardial effusion indicates the absence of a systematic and differential approach to choice the treatment tactics based on the objectives of the intervention, patient's condition and related disorders.
Key words: pericarditis, minimally invasive interventions, surgical treatment.
V. T. Zaitsev Institute of General and Urgent Surgery of AMS of Ukraine, Kharkiv, Ukraine
Modern view on the problematic aspects of patent arterial duct in children (literature review)
29 - 34
The review of the literature is devoted to one of the most important directions of modern surgery, the problem of patent arterial duct in children of different age groups. Patent arterial duct is one of the most common congenital malformations of the cardiovascular system, which can occur both as an isolated pathology, and as combination with other heart and vessel defects. Its functioning can both aggravate the course of concomitant pathology and compensate complications which appeared as its result. The review of literature data, existing terminology, classification of patent arterial duct, diagnostic criteria of hemodynamically significant patent arterial duct are presented. Echocardiographic diagnostic criteria are described in detail. The modern approaches to the treatment of patent arterial duct, including conservative, (pharmacological with the use of nonselective inhibitors of cyclooxygenase −− indomethacin, ibuprofen) and various surgical methods are elucidated. It is necessary to note that there are no unified approaches for terminology defining patent arterial duct functioning in the national medical literature, and a number of different terms are used in various sources. The exact frequency of the defect occurrence is unknown; there is no unified classification of patent arterial duct. The study of markers of hemodinamically significant patent arterial duct was carried out mainly in premature newborns or newborns with low birth weight. But study of the signs of hemodynamically significant patent arterial duct has particular priority for improvement of survival, quality of life and prevention of complications development and early disability not only in extremely premature newborns, but also in children of different age groups. Up to date, there are no unified diagnostic and therapeutic approaches to patent arterial duct both in preterm infants and in children of different age groups. Thus, it is necessary to pay more attention to the ways of solving the problem of this pathology with a view to further developing the diagnostic criteria, which will promote effective treatment of children of different ages with this congenital malformation.
Key words: patent arterial duct, hemodynamically significant criteria, echocardiographic signs.
Kharkiv National Medical University, Ukraine
Аromathase activity as an objective marker of necessity of cryotherapy of uterine cavity in hyperplastic endometrial processes
35 - 40
Endometrial hyperplasia is accompanied by excessive proliferation of stromal and glandular components of the mucous membrane of the uterine cavity in connection with the presence in it of specific receptors. Aromatase is a unique enzyme complex that is responsible for the synthesis of estrogens in the female organism. A promising trend in clinical medicine is the determination of the activity of aromatase, not only in the endometrium, but also in the tissues and organs that participate in the production of estrogens. With the aim to develop a method for clinical and laboratory evaluation of aromatase activity in women with endometrial hyperplasia as a marker for determining the risk of cancer and the choice of pathogenetically based medical tactics the patients with glandular and adenomatous disease were examined. To determine the degree of severity of the pathological process and select the optimal and pathogenetically substantiated therapeutic tactics, the coefficient of aromatase activity was evaluated. If the coefficient exceeded 10.0 units, in order to prevent the risk of relapse and possible cancer, it is necessary to recommend ablation of the endometrium with cryosurgical treatment of the uterine cavity. When analyzing the obtained results, it can be concluded that 6 months after ablation of the endometrium and cryosurgical treatment of the uterine cavity in patients with endometrial hyperplasia, the concentration of estrone and estradiol did not differ from those of the control group of women with a normal endometrial structure. The suggested method can be introduced as a marker for determining the severity of the pathological process.
Key words: endometrial hyperplasia, cryosurgical treatment of the uterine cavity, blood hormones, aromatase activity.
Zaporizhzhia State Medical University

Zaporizhzhia National University, Ukraine
General clinical, biochemical parameters and peripheral blood hormone level in women at ovarian hyperstimulation syndrome
41 - 45
Introduction into the clinical practice of auxiliary reproductive technologies has fundamentally altered the chances of overcoming the factors of infertile marriage. However, the use of controlled ovarian stimulation as infertility treatment may be complicated by development of ovarian hyperstimulation syndrome, characterized by a wide range of clinical and laboratory manifestations. The main cause of this syndrome is the phenomenon of "increased vascular permeability", the trigger of which leads to fluid transduction. To analyze general clinical, biochemical, hormonal blood parameters, as well as ultrasonography findings of women participating in the short−term protocol for in vitro fertilization, for its timely, individual, adequate correction and complex prevention of ovarian hyperstimulation syndrome, women aged 2−45 were examined. During the study history taking, clinical and biochemical examination, ultrasonography were used. The results of the study indicated a positive statistically significant relationship between the number of follicles and the content of leukocytes, monocytes, progesterone and estradiol, the number of large classes of lymphocytes, and a negative relationship with the level of reaction of lymphocyte blast transformation at the risk of ovarian hyperstimulation syndrome development. It was determined that the risk factors for ovarian hyperstimulation syndrome were the age of the woman under 35, hyperprolactinemia, sclerotic ovarian syndrome, primary infertility. Consequently, a comprehensive survey of women allows determining the risk of developing ovarian hyperstimulation syndrome in order to correct the protocol of controlled ovulation stimulation, timely rendering medical aid at the first manifestations of complications and its prevention in the programs of extracorporeal fertilization.
Key words: ovarian hyperstimulation syndrome, peripheral blood, leukogram, biochemical indices, hormones.
Kharkiv Academy of Physical Culture

Kharkiv National Medical University, Ukraine
Morphofunctional state of hyaline cartilage at reparative techniques of local knee joint cartilage defects treatment
46 - 48
Based on the differences in the morphofunctional state of hyaline cartilage, a surgical reparative technique for the treatment of local knee joint cartilage defects was substantiated. With this purpose three series of experimental studies were performed on 60 mature male rats: study 1 −− of modeled chondromalacia; study 2 −− the prototype of the microfracturing of the bottom of the cartilaginous defect; study 3 −− the prototype of the subchondral tunneling. Microscopic, morphometric, immunohistochemical, and cytomorphometric comparative studies were performed on days 7, 14 and 21. The findings of the work suggest that deep tunneling procedure of the cartilage defect zone provides an adequate number of cells−precursors of chondrogenesis of mesenchymal origin. It is these changes in the morphofunctional state of hyaline cartilage in conditions of chondromalacia that are most significant. When the bottom of the cartilage defect is mechanically damaged, the process of almost complete restoration of the articular cartilage thickness is noted, in contrast to the damage to the bone plate of the defect bottom or tunneling to the spongy substance of the hyaline cartilage, but not in full measure. The zonal structure of the cartilage on the periphery is not disturbed. Mechanical stimulation of the bone marrow by damaging the bone plate corresponds to the reparative technique of surgical treatment of cartilage defects −− microfracturing, to the bone marrow substance −− subchondral tunneling, and only deep tunneling to the bone marrow cavity leads to an adequate flow of reparative chondrogenesis and preservation of the zonal structure of the cartilage in undamaged areas, and thus provides prevention of osteoarthritis. The reparative surgical technique of deep tunneling to the bone marrow cavity has regenerative advantages over reparative methods by microfracturing and subchondral tunneling. Deep tunneling of the bottom of the cartilage defect by invasiveness, traumatism and surgical technology is equivalent to microfracturing or subchondral tunneling. Arthroscopic deep tunneling of local cartilage defects has pathogenetic priority.
Key words: microfracturing, subchondral tunneling, deep tunneling, chondromalacia, hyaline cartilage.
S. P. Grygoriev Institute for Medical Radiology, NAMS of Ukraine, Kharkiv, Ukraine
Immunohistochemical factors of endometrial cancer prognosis
49 - 52
In the structure of malignant tumors in women, endometrial cancer takes the 3rd place, and the growth rate of morbidity is much higher than that in other malignant tumors of the reproductive system. The recent researches show that there are both morphological and immunohistochemical criteria, the part of the spectrum of which is the study of the proliferative activity of cells in hyperplastic processes, atypical hyperplasia and adenocarcinomas as well as hormone dependence, which accompanies progression of these processes. Because of the frequent concomitant pathology, emergence of hormone dependence of endometrial cancer, it is necessary to search for the new ways to solve the problem of etiology and pathogenesis of this disease, the regularities of its development to provide a reliable diagnosis and optimal treatment. To date, a wide range of markers reflecting different manifestations of the biological aggressiveness of the tumors are available. But the group of immunohistochemical markers that characterize the metabolism of endometrial adenocarcinoma (proteins, enzymes, hormone receptors, angiogenesis, apoptosis, proliferative activity, adhesion molecules, proliferative activity, etc.) has not been identified. As the markers of proliferation and apoptosis are directly related to malignant tumors, the research results can be used in the selection of optimal treatment regimens and evaluating the prediction of endometrial cancer in different clinical stages of the disease.
Key words: endometrial cancer, molecular-biological markers, apoptosis, proliferation, angiogenesis.
Kharkiv Medical Academy of Postgraduate Education

Regional Clinical Specialized Dispensary for Radiation Protection of the Population, Kharkiv, Ukraine
Medical rehabilitation in oncology: the current state of the problem
53 - 56
Today the opinion that the indicator of the quality of life of cancer patients is not less, and in some cases, even more important, than the indicators of the effectiveness of treatment has formed in the world literature. Therapeutic methods of modern oncology are quite aggressive to achieve this goal, namely, the number of criteria by which to assess the effectiveness of the treatment, the main of which, until recently, was survival. The specificity of restorative treatment in oncology is the need for correct evaluation of the phase of relationship in the system "organism−tumor" at each stage of rehabilitation to exclude the probability of stimulating tumor growth. The recently revealed lack of negative impact of physical factors, spa treatment, hormone replacement therapy (administered strictly when indicated designated with the account of all contraindications), herbal medicine on cancer course allows contrary to the established tradition, to reconsider the myths about their absolute contraindication in patients with malignant neoplasms. Medical rehabilitation in oncology, depending on its purposes, includes several stages: medical, psychological, professional, social and economic. The main criterion in the system of oncological rehabilitation is the indicator of the quality of life of a patient with a malignant neoplasm. Rehabilitation measures are aimed at maximum recovery of physical and mental health of patients both after the treatment and at the stage from the diagnosis and before the beginning of treatment. However, till now there are no rehabilitation centers, the specialists in the field of rehabilitation of cancer patients are not trained. This problem requires exploring the possibilities of application of different options for medical rehabilitation at the stages of special treatment of patients with malignant tumors of various locations, as well as throughout the relapse−free period.
Key words: medical rehabilitation, oncology, prerehabilitation, quality of life.
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Analysis of causes of epilepsy pharmacoresistance formation in children and ways of overcoming it
57 - 60
Peculiarities of the developing brain determine clinical specificity of epilepsy in children which often takes a pharmacoresistant course and leads to developmental disorders. The number of therapeutically resistant epilepsy cases varies, according to different authors, from 20 to 60 % of all childhood epilepsies. The purpose of this study was to analyze the factors of formation of pharmacoresistance of epilepsy in children. "Relative" resistance associated with subjective causes from both the patient (asthenogenic) and the doctor (iatrogenic) deserves the greatest attention. Among the asthenogenic factors of the conditional pharmacoresistance formation, the following were noted in our study: irregular antiepileptic medication, unauthorized withdrawal from treatment, violation of regimen, psychosocial problems, unauthorized dose reduction, spontaneous switching from one drug to another, comorbid psychiatric and somatic disorders, consumption of alcohol and energy drinks. When analyzing the factors of forming iatrogenic conditional pharmacoresistance the most typical therapeutic errors that lead to ineffective treatment were identified: incorrect assessment of the type of seizures and the form of epilepsy; the discrepancy between the medication selected and the type of seizures and the form of epilepsy, combination of several drugs before the optimally dosed monotherapy is used, beginning of treatment with second−line drugs; interpretation of instrumental research methods without taking into account clinical data; prolonged monotherapy, maintaining a high daily dose of antiepileptic drugs in the absence of clinical effect; treatment with low doses of antiepileptic drugs; low concentration of antiepileptic drugs in the patients' blood despite the appointment of adequate dosages; use of drugs that activate epileptogenesis; unreasonably fast cancellation of antiepileptic drugs after remission; non−epileptic seizures. Thus, pharmacoresistant epilepsy in children is a serious complex, multidisciplinary medical and social problem. The use of adequate diagnostic and therapeutic tactics can only partially overcome drug resistance.
Key words: children, epilepsy, pharmacoresistance.
Children's City Outpatient Hospital № 6, Odesa, Ukraine
Current issues in classification of vertebrospinal injury
61 - 63
Vertebrospinal injury is a serious disorder of the vital functions of the whole body. It accounts for about 15 % of all types of injuries and is characterized by disorders not only of the musculoskeletal and the nervous systems, but also by cardinal changes in all aspects of the victim's life. The author turns attention to the problem and complexity of the qualified diagnosis of vertebrospinal injury, points out the existence of a problem in the scientific investigations. It is indicated that the problem of classification and diagnosis remains relevant for all countries of the world. The article analyzes modern classifications, diagnostic techniques, and also reports the results of the latest research on this issue. In relation to the spinal cord the injuries are divided into three groups: 1) traumatic lesions of the spine without damage to the spinal cord; 2) traumatic lesions of the spinal cord without damage to the spine; 3) traumatic lesions of the spine with damage to the spinal cord. By the nature of the damage to the spine the following can be distinguished: 1) damage to the ligament apparatus; 2) damage to the vertebral bodies (fractures, compression, fragmentation, transverse, longitudinal, explosive fractures, and secretions of closing plates); 3) fractures of the posterior semicircle of the vertebra (arches, articular processes); 4) fractures, dislocations with damage to the connective−articular apparatus, 5) fractures of the bodies and arches with displacement or displacement. Traumatic lesions of the spinal cord manifest in the form of concussion, slaughter or compression of the spina; cord, as well as brainspinal hemorrhage (hematomyelia). Possible strains or ruptures can be divided into closed and open. The classification of the damage to the spine and spinal cord involves the concept of stability and instability, which largely determines the nature of medical tactics. Instability of spine damage is due to violation of anatomical integrity of vertebras, disks, joints and ligament apparatus, at which re−displacement is possible with additional compression of the spinal cord and roots. Instability is most common in rotary lesions, fractures (blast), axial dislocation of vertebrae and damage to the two joints of the vertebral segment. However, in spite of the number of vertebrospinal injury classifications, there is still no uniform classification that fully addresses all variants of the vertebrospinal injury.
Key words: vertebrospinal injury, classification, spinal cord injury.
Kharkiv National Medical University, Ukraine
Lipid metabolism features in HIV−infected persons with chronic hepatitis C and in patients with HIV/HCV co−infection
64 - 67
Worldwide hepatitis C virus and human immunodeficiency virus (HIV) are the causative agents of two of the most important and most common viral infections, causing significant morbidity and mortality. Acting synergically these two viruses accelerate liver damage progression. To assess the status of lipid metabolism indices in HIV−infected individuals, patients with hepatitis C and HIV/HCV co−infection, total cholesterol, triglycerides, high−density lipoproteins, low and very low density were determined in the blood serum; atherogenicity coefficient was calculated. Patients of all groups had a significant increase in serum levels of triglycerides, lipoproteins, low and very low density lipoproteins, reduction of high density lipoproteins. In patients with HIV/HCV co−infection a higher level of triglycerides was detected, as well presence of a moderate direct relationship between CD4+ cell level in the peripheral blood and the increase degree of a serum triglycerides as well as atherogenicity coefficient. This indicates a disorder of lipid profile in HIV−infected persons with chronic hepatitis C and patients with HIV/CHC co−infection, which necessitates their identification, recording and monitoring during the course of illness, including life−long administration of antitetroviral therapy.
Key words: HIV-infection, chronic hepatitis C, co-infection HIV/HCV, lipid metabolism.
Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine, Dnipro, Ukraine
Cerebrospinal fluid and blood serum beta−2−microglobulin in HIV−associated neurological diseases
68 - 73
Despite antiretroviral therapy, patients with HIV often develop neurological disorders, which significantly increase the risk of mortality. The frequency of neurological disorders in HIV−infected patients determines the relevance of the search for effective biomarkers, one of which may be beta−2−microglobulin (B2MG). Increase in its level correlates with HIV progression. In order to determine the content of B2MG in cerebrospinal fluid and serum in HIV−associated neurological diseases and its association with the immunological status and viral load of HIV RNA, 48 non−antiretroviral patients were studied. The content of B2MG in the blood serum and cerebrospinal fluid was determined at the time of maximal manifestation of neurological manifestations using immunoassay. The results of the study indicate that the level of B2MG in the blood and CSF in all HIV−infected patients with neurological diseases significantly exceeded normal values (p < 0.001). The linear regression equation built according to the results of the study: B2MG = 2.298 + 0.5786 * B2MG (blood) is adequate with p = 0.002 (Fischer F−criterion) and allows calculation of the mean value of B2MG concentration in the liquor at specific values of B2MG in the blood of the patient with HIV and neurological diseases. Differences in the level of B2MG in the CSF were determined depending on the etiology of the central nervous system disease: the highest content of B2MG was observed in patients with fungal lesions and CNS tuberculosis, and the smallest in patients with viral encephalitis, which, with more observations, may have a differential diagnostic value. Thus, the obtained data demonstrate the promising use of beta−2−microglobulin as a prognostic and diagnostic biomarker in HIV−associated neurological diseases.
Key words: HIV infection, HIV-associated neurological diseases, beta-2-microglobulin, viral load, HIV RNA, spinal fluid.
Kharkov National Medical University, Ukraine
Present−day clinical and laboratory characteristic of acute meningococcal and pneumococcal neuroinfections in adults
74 - 78
Acute bacterial neuroinfections remain a significant problem due to the severe course and high mortality. Studies in this area are mainly devoted to the investigation of meningitis in children. However, up to 35−40 % of meningitis cases develop in adults. The questions of etiological structure, clinical and laboratory features and results of treatment of these diseases remain insufficiently studied. In the structure of bacterial neuroinfections, meningococcal and pneumococcal etiology predominates. To determine the clinical and laboratory features of acute meningococcal and pneumococcal neuroinfections in adults, clinical−anamnestic and laboratory data of patients with acute neuroinfection with confirmed meningococcal and pneumococcal etiology of the disease were analyzed. Acute meningococcal and pneumococcal neuroinfections were characterized by rapid onset and rapid development of complications like cerebral edema and encephalitis. The highest mortality rate (17.78 %) was registered in patients with pneumococcal infection. After the first day of treatment, clinical blood count was characterized by leukocytosis with a stab shift left and an increase in ESR, which are more significant in patients with severe course. The most significant increase in the level of leukocytes in the CSF was observed in patients with meningococcal meningitis, and the number of leukocytes less than 1 thousand in 1 μL CSF is a prognostically unfavorable sign. Thus, a detailed analysis of routine clinical and laboratory data makes it possible to assess severity of the patient's condition and predict the course of the disease.
Key words: acute meningitis, meningococcal infection, pneumococcal infection, diagnosis.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Prediction of chemoresistant pulmonary tuberculosis severity depending on Mycobacterium Tuberculosis genotypes
79 - 83
Today, the problem of Mycobacterium Tuberculosis (MTB) resistance to antimycobacterial drugs (AMBD) becomes increasingly important, resulting in the reduction in effectiveness of patients treatment and the prevalence of chemoresistant tuberculosis. To develop the methods for predicting the clinical course of the pulmonary chemoresistant tuberculosis depending on the MTB genotypes during the intensive phase of treatment using the VNTR−genotyping method, the patients with primary resistance of MBT were examined. The dynamics of the clinical course was assessed by the dynamics of intoxication syndrome, the closure of destruction of the lung parenchyma and termination of mycobacterial excretion. The obtained results showed the dependence of the clinical laboratory indicators dynamics on the MTB genotype in patients with chemoresistant pulmonary tuberculosis during the intensive phase of treatment. Among the patients with Beijing genotype, the conversion of sputum culture was 2.5 times less than in patients with the other genotypes. They were recorded three times less cases of healing cavities of destruction of the pulmonary parenchyma. In patients with Beijing genotype, intoxication syndrome was observed 3 times more often than in patients with the other genotypes. Thus, determination of the genotypes of Mycobacterium tuberculosis at the stage of diagnosis and during the intensive phase of treatment is of great importance for predicting the course and effectiveness of treatment of chemoresistant pulmonary tuberculosis
Key words: Mycobacterium tuberculosis, chemoresistant pulmonary tuberculosis, VNTR-genotyping, intensive phase of treatment, prediction.
N. A. Lopatkin Research Institute of Urology and Interventional Radiology, Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, D. D. Pletnev City Clinical Hospital, Department of Health of Moscow, Russian Federation
How to reduce the risks of multicomponent drug therapy
84 - 88
The majority of patients receive combinations of medications. On the one hand, this is due to the presence of several diseases in the patient, since with the population aging the problem of comorbidity becomes more urgent, on the other hand, monotherapy of many diseases is significantly inferior in effectiveness to multicomponent treatment regimens. The effects of concomitant medications can be added, and can be potentiated, that is, strengthen each other's action. Potentiating the effects often underlies successful and time−stable multicomponent therapy protocols. However, not only desirable effects, but also undesirable side effects, can develop and become potentiated. With this purpose, potentially unsafe variants of multicomponent drug therapy were analyzed, the main risks and ways to minimize them were reflected. Simultaneous use of two drugs of one group, as a rule, does not solve the problem of low effectiveness of therapy, but very easily gives severe overdoses or potentiates side effects. Administration of two drugs with unidirectional toxicity often leads to the realization of this risk, in spite of carefully calculated and justified doses of each of the medicines individually. The use of a drug that has toxicity to the affected organ is accompanied by a high risk of adverse effects, even if the failure of the function is moderate, completely compensated and does not determine the general condition of the patient, being an accompanying or background condition in relation to the underlying disease. It is undesirable that the preparations have unidirectional side effects associated with undesirable pharmacological effects (not with toxicity). This rule is not strict, as the risks are usually low and their implementation is not always accompanied by a threat to the life of the patient. It is advisable, if possible, to avoid a combination of drugs that compete with each other for metabolic systems. The combination of a narrow therapeutic interval and hepatic metabolism at least in one of the drugs included in the therapy protocol leads to a huge number of drug interactions, which greatly complicates the real use of the drug and increases the risk of adverse effects. Drugs should not have a multidirectional effect. Unequivocally, it is impossible to combine direct antagonists, for example, β−adrenoblockers and β−adrenomimetics. However, in the case of drugs with opposite effects, but different mechanisms of action, the ban is not rigid. The use of the presented indicators by the attending physician in everyday work does not obscure the shortcomings in order to complicate the work of the expert, but eliminates these shortcomings, increasing the quality of drug therapy.
Key words: multicomponent drug therapy, drug toxicity, side effects of drugs.
Go on Top