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Поліморфізм гену LEPR q223r у хворих на ішемічну хворобу серця з післяінфарктним кардіосклерозом та цукровим діабетом 2 типу
Get PDFAim. To determine the prevalence of mononucleotide leptin receptor gene LEPR Q223R polymorphism in patients having coronary heart disease (CHD) with postinfarction cardiosclerosis depending on type 2 diabetes comorbidity.Materials and methods. 147 patients having stable CHD with postinfarction cardiosclerosis (100% male), the average age of 52, were examined. In 64 (43.5%) patients CHD combined with type 2 diabetes. The CHD diagnosis was established by АНА/АСС (2014) and ESC (2013) recommendations. LEPR Q223R (Gln223Arg, rs1137101) gene polymorphism was determined using allele-specific polymerase chain reaction in real time.Results and discussion. In the group of patients having CHD with postinfarction cardiosclerosis (Podillya region inhabitants) the frequency of LEPR Q223R gene genotypes was as follows: QQ – 25.2 %, QR – 42.4 %, RR – 32.7 %. The frequency of R allele in patients having CHD was significantly higher than in the practically healthy group, and was 53.7 to 41.3% (χ2=4.72, р=0.03). Сomorbidity chances significantly increase in R allele carriers (OR=1.58, 95 % СІ 0.99-2.53), while Q allele carrier state have a protective value (OR=0.63, 95 % СІ 0.40-1.01). RR genotype associated with CHD earlier debut, higher frequency of Q- myocardial infarction (OR=4.3; 95 % СІ 1.51-12.5) and heart failure progression (OR=3.60; 95 % СІ 1.67-7.77).Conclusion. RR genotype LEPR Q223R gene carrier state is a potential unmodified factor that accelerates development and increases the severity of CHD, associated with type 2 diabetes, in malesМетою роботи було встановити поширеність однонуклеотидного поліморфізму гену лептинових рецепторів LEPR Q223R у хворих на ішемічну хворобу серця (ІХС) з післяінфарктним кардіосклерозом залежно від коморбідності з ЦД 2 типу. Результати отримані в когортах хворих показали, що носійство генотипу RR гену LEPR Q223R є потенційним немодифікованим чинником, який прискорює розвиток та підвищує важкість перебігу ІХС, асоційованої з ЦД 2 типу, у чоловікі
Передумови виникнення гострого коронарного синдрому в залежності від показників ліпідного обміну
Get PDFAim. Determination of acute coronary syndrome (ACS) frequency in patients without dyslipidemia (DLP) and the analysis of the profile features of cardiovascular diseases risk factors (CVD RF) among these patients comparing to the patients having lipid metabolism disorders.Materials and methods. Retrospective analysis of 91 medical card of patients having ACS (the average age 60,8±9,9 years) with the further estimation of the traditional CVD RF prevalence. According to the results of lipid blood spectrum, the patients were divided in 2 groups: the patients without DLP were in the first group, and the patients with lipid metabolism disorders were in the second group.Results. ACS in patients without DLP appeared in 38.5% of cases. Reliable differences between the frequency of various forms of ACS, obesity and age among the patients of the both groups were found. Hypertension (AH) and stress were found more often among the traditional CVD RF regardless of DLP.Conclusion. The ACS patients without DLP have greater depth of myocardial damage comparing to the patients with lipid metabolism disorders. The traditional CVD RF can not explain the ACS in patients without DLP. The further research in the area of the search of more (non-traditional) CVD RF in patients without DLP is relevantВ даній статті представлено ретроспективний аналіз медичних карт хворих з гострим коронарним синдромом (ГКС) з визначенням частоти виникнення ГКС на тлі нормальних показників ліпідного обміну, а також порівняльну характеристику найбільш поширених традиційних факторів ризику (ФР) серцево-судинних захворювань (ССЗ), таких як стать, вік, артеріальна гіпертензія, цукровий діабет, ожиріння, гіподинамія, стрес та паління, у пацієнтів з ГКС в залежності від показників ліпідного обмін
Аналіз сучасних методів діагностики у постраждалих з нестабільними пошкодженнями таза і тазових органів при політравмі в гострому періоді травматичної хвороби
Get PDFThe aim of research was improvement of the diagnostic program in patients with unstable injuries of pelvis and pelvic organs at polytrauma based on the trauma severity estimation for the choice of the optimal surgical therapeutic approach in acute traumatic disease period.Materials and methods. The analysis of the diagnostic programs in acute traumatic disease period in 406 patients with unstable injuries of pelvis at polytrauma, who were taken to the Kyiv city clinical emergency hospital, was carried out. 249 (61.3 %) of them died, and 157 (38.7 %) of them survived. Pelvic organs were injured in 98 (24.1 %) cases (in 47 (29.9 %) cases – in survivors, and in 51 (20.5 %) cases – in dead patients). According to the Pape HC., Krettek C. (2003) scale, all patients were divided into three groups: boundary condition (minor injury, ISS 17–25 points), unstable condition (severe injury, ISS 26–40 points), critical condition (very severe trauma, ISS more, than 40 points). We used general clinical, laboratory, ray (X-ray research, retrograde contrast uretra cystography, spiral CT, ultrasonography in the abridged version), and instrumental methods.Results. In the acute trauma period in patients with unstable injuries of pelvis at polytrauma depending on the severity of trauma, ray diagnostic methods were carried out in the following order: plain radiography of pelvis, multi projection oblique, spiral CT (at stable hemodynamic). In unstable and critical patients (ISS 26–40, more, than 40 points), plain radiography of pelvis is complemented by ultrasonography in the abridged version, which together with the data of clinical examination confirms pelvic ring instability in 67.9 % of cases. The scheme of diagnostic studies in patients with unstable injuries of pelvis at polytrauma considering the severity of trauma allowed reducing the time for patients in unstable condition examination to 13.7±3.5 minutes, for patients in critical condition – to 16.7±4.1 minutes. Informational content of the measures with a minimum amount was 52.3 %, with shorten amount – 75.4 %, with full amount – 92.1 %.The obtained results made it possible to develop the scheme of ray diagnostic of pelvic ring, as well as to reduce the time for detection of injuries of pelvic organs in patients in unstable and critical conditions, which determined the surgical therapeutic approach in acute traumatic disease periodМетою дослідження було удосконалення діагностичної програми у постраждалих з нестабільними пошкодженнями таза і тазових органів при політравмі на основі оцінки тяжкості травми з метою вибору оптимальної хірургічної тактики лікування в гострому періоді травматичної хвороби. Одержані результати дозволили розробити схему променевої діагностики нестабільного тазового кільця, а також скоротити терміни виявлення пошкоджень тазових органів у пацієнтів при нестабільному і критичному стана
Особливості антоксидантної системи захисту у динаміці розвитку гострого респіраторного дистрес-синдрому та при різних методах корекції у щурів
Get PDFTaking into account the pathogenetic role of membrane destructing processes of the oxidative stress and hypoxia in ARDS development, it becomes obvious that it is necessary to use antihypoxants-antioxidants. During the last decade the large number of researchers searched for effective metabolic preparations to treat and prevent ARDS. This work is devoted to this important question of the modern medicine.Aim of research – to determine the indices of the antioxidant protection system in the dynamics of an acute respiratory distress-syndrome development and at different correction methods in rats with a different tolerance to hypoxia.Materials and methods. The study was carried out on 106 white non-linear male rats, kept on the standard ration of the vivarium of Ternopol state medical university, named after I.Y. Gorbachevsky. The experiment on the assessment of an effect of oxygen insufflation, “KD-234” and reamberin was carried out taking into account animals’ individual tolerance to hypoxia, determined by the method of V.Y. Berezovsky. For further studies were taken animals from the group of hypoxia middle tolerable rats HMT) with the survival time 240–360 s and low tolerable rats (HLT) with the survival time less than 180 s. Animals were divided in 5 groups: 1 – control group (n=12; HMT/HLT=6/6), 2 – ARDS modeling without correction, observations in 2 hours. (n=24: 12/12), 3 – ARDS modeling, correction by oxygen insufflation (n=24: 12/12), 4 – ARDS modeling “KD-234” correction (n=24: 12/12), 5 – ARDS modeling, reamberin correction (n=22: 11/11). Animal underwent ARDS modeling by G. Маtute-Bello method. For the correction in 4th studied group for used “KD-234”substance, diluted in distilled water for injections and administered intragastrally through a probe in the dose 50 mg/kg and in 5th studied group – reamberin, administered intraabdominally in the dose 10 ml/kg to animals in 1 hour before ARDS modeling.Results. It was established, that under conditions of the acute respiratory distress-syndrome SOD, catalase activity and SH-groups content in animals with a different tolerance to hypoxia decrease comparing with the control (р<0,05). In HMT animals group this index is more than in HLT animals. The use of oxygen insufflation under conditions of an experimental distress-syndrome leads to normalization of SOD, catalase activity and SH-groups content in animals with a different tolerance to hypoxia. “KD-234” substance administration is attended by the reliable increase of catalase activity and normalization of the antioxidant-prooxidant index in liver tissues of HMT animals. At reamberin administration SOD activity in liver homogenate grows in both studied groups with the index normalization in HMT animals and the antioxidant-prooxidant index of liver tissues increases (р<0,05).Conclusions. These data give grounds to consider the use of the combination of “KD -234” substance and reamberin in the complex treatment of ARDS in the experiment as pathogenetically grounded and prospectiveВстановлено, що в умовах гострого респіраторного дистрес-синдрому активність СОД, каталази та вміст SH-груп у тварин з різною стійкістю до гіпоксії знижуються. Застосування інсуфляції киснем, субстанції “КД-234”і реамберину в даних умовах призводить до нормалізації активності СОД і каталази, вмісту SH-груп у тварин з різною стійкістю до гіпоксі
Оцінка ефективності психоосвіти у структурі реабілітації хворих на біполярний афективний розлад
Get PDFAim of research: The assessment of the effectiveness of psychoeducational programs in the complex psychosocial rehabilitation of patients with a bipolar affective disorder.Materials and methods. The study includes the complex clinical-psychopathological, clinical-anamnestic and psychodisgnostic examination of 158 patients with BAD. The main group (which patients took part in the psychoeducational program) included 94 persons. The control group consisted of 64 patients, who received the standard regulated therapy at a hospital.Results of research. There were elaborated the algorithm of the psychoeducational work that includes the use of different information modules, holds of the cognitive-behavior psychotherapy, training interactions (positive self-attitude, compliance improvement, formation of communicative abilities and skills, solution of problems of interpersonal interaction), problem-oriented discussions and also family psychotherapy.The high effectiveness of psychoeducation comparing with the traditional complex treatment and rehabilitation of patients with BAD as to the reduction of psychopathological symptomatology, activation of adaptive coping-strategies, transformation of maladjustment types of an attitude to a disease into adaptive ones, patients’ life quality improvement was established.Conclusions: The offered system of psychoeducation of patients with BAD demonstrated the high effectiveness comparing with the traditional rehabilitation complexПроведена оцінка ефективності психоосвіти в реабілітації хворих, яка включає використання тренінгових впливів когнітивної психотерапії, орієнтованих дискусій.На тлі проведення психоосвітньої програми у системі реабілітації встановлена виражена позитивна динаміка рівня соціального функціонування у хворих на біполярний афективний розлад, позитивна трансформація копінгу, перехід дезадаптивних типів відносини до хвороби в адаптивні, підвищення рівня якості житт
Визначення чинників, які асоційовані з віддаленим прогнозом у хворих з інфарктом міокарда правого шлуночка, за даними метода Каплана-Мейера
Get PDFAim of research. To determine the influence of myocardium infarction (MI) of the right ventricle (RV) on the development of cardio-vascular (CV) events at the long-term observation and to establish the role of factors, associated with the unfavorable prognosis of patients with myocardium infarction of the right ventricle.Materials and methods. There were examined 309 patients with Q-MI of the left ventricle (LV), age 65,5 ± 4,42years old. Patients were divided in 3 groups: 1 group - 155 patients with MI RV on the background of Q-MI of the back wall of the LV, 2 group - 53 patients with MI RV on the background of Q-MI of the circular localization, 3 group - 101 patients with Q-MI of the back wall of LV. The observation period was 30,6 ± 4,5 months. The end points were considered as: unstable angina (UA), repeated MI, acute disorders of the cerebral blood circulation (ADCB), hospitalization because of heart failure (HF) decompensation and CV-death. The statistical researches included the method of Kaplane-Meyer and χ2-Pearson test.Results. After 30,6 months of observation the frequency of CV-complications was reliably higher in both groups of patients with MI RV (р = 0,0039; р = 0,00012) comparing with the third group. There was no any essential difference in the frequency of end points between 1 and 2 group with MI RV (p = 0,053). The planned revascularization is connected with the increase of the life quality of patients after MI RV after the reliable influence of CV-death index. In 30,6 months of rehabilitation men and women in both groups with MI RV had no essential difference in the frequency of repeated MI, ADCB, HF and HF-hospitalizations, but the index of CV-death was reliably higher among female persons (р <0,05).Conclusion. The presence of MI RV in patients with Q-MI LV is connected with the higher frequency of CV-events during 30,6 months of observation. MI RV in women is associated with the essential increase of the risk of CV-mortality during 30,6 months of observation. The delayed revascularization is associated with the decrease of the risk of CV-events development, without influencing CV-death indexДоведено, що наявність інфаркту міокарду правого шлуночка у хворих з Q-інфарктом міокарда лівого шлуночка асоціюється з достовірним збільшенням частоти серцево-судинних ускладнень протягом 30,6 місяців спостереження. Проведення планової реваскуляризації супроводжується покращенням якості життя без впливу на показник смертності. Гендерні особливості перебігу постінфарктного періоду полягають в більш високому показнику смертності серед жіно
Сучасні підходи до фізичної реабілітації хворих з ішемічною хворобою серця та супутньою патологією після хірургічної реваскулярізації міокарду
Get PDFThe aim of the research is to assess the effectiveness of restoration treatment using hydrokinesotherapy in patients with ischemic heart disease (IHD) and concomitant pathology after surgical revascularization of the myocardium (SRM).Methods of the research. 280 patients with IHD and concomitant pathology after SRM were examined. 135 patients (group 1)received the standard treatment. 145 patients (group 2) received differentiated complexes of restoration treatment depending on the concomitant pathology adding hydrokinesotherapy. The groups were divided in subgroups depending on the concomitant pathology: А – concomitant arterial hypertension, B – diabetes mellitus, C – osteoarthritis. We realized the dynamic clinical observation of the objective and subjective patients’ states, instrumental and functional methods of examination (ECG, EchoCS, Holter monitoring of ECG, measurement of arterial pressure, heart rate, veloergometry, six-minute test (SMT).Results. After the course of rehabilitation patients of all groups demonstrated the improvement, but the statistically reliable one was observed in group 2. According to the results of six-minute test of walking (SMT), the increase of the distance by 30,0, 19,6 and 30,0% was observed in subgroup 2А, 2B, 2C corresponding to (p ≤ 0,05). The reliable increase of tolerance to a physical load was observed in patients of 2 group, in subgroup А1- by 80,4, in subgroup 2B - by 62,0, and in subgroup 3B - by 32,2% (p ≤ 0,05).Conclusions. Thus, the inclusion of hydrokinesotherapy in the complex differentiated programs of rehabilitation of patients with ICD and concomitant pathology after SRM is safe and effective, moreover, it favors the myocardium contractile ability and increase of tolerance to a physical loadДослідження присвячене питанням комплексної реабілітації хворих з ішемічною хворобою серця та супутньою патологією (цукровий діабет, артеріальна гіпертензія, остеоартроз), які перенесли хірургічну реваскулярізацію міокарду. Показано, що включення гідрокінезотерапії в диференційовані комплекси відновлювального лікування є безпечним та ефективним, сприяє покращенню скорочувальної функцію міокарду та підвищенню толерантності до фізичного навантаження до 80,4 % (р≤0,05
Дослідження поширеності поліморфізму гену TLR 9 типу у хворих на інфекційний мононуклеоз, викликаний вірусом Епштейна-Барр
Get PDFThere was studied the prevalence of -1486 T/C polymorphism of TLR-9 gene in 52 patients with infectious mononucleosis (IM), caused by Epstein-Barr virus. Three main genotypes of - 1486 T/C of TLR-9 gene: TT, TC, CC were identified based on obtained results. The study of the frequency of appearance of separate genotypes in patients with IM revealed the dominance of CC and TT genotypes compared with the control group. The study of the distribution frequency of -1486 T/C-polymorphism of TLR-9 gene for different genotypes demonstrated the specificity of CC genotype changes in patients with IM and the absence of such changes for TT and TC genotypes.Aim of research. The study of the frequency of - 1486 T/C polymorphism of TLR-9 gene in patients with IM, caused by Epstein-Barr virus.Materials and methods. The study for determining -1486 T / C polymorphism of TLR-9 gene was realized in 52 patients with IM. Among them women - 31 (59,6 %), men - 21 (40,4 %) in the age diapason from 18 to 34 years. The control group for studying the prevalence of - 1486 T/Cpolymorphism of TLR-9 gene consisted of 40 healthy donors. The mean age 24,2 ± 2,4 years, from 18 to 44 years.For revealing DNA of EBV by the method of the reverse transcription of PCR with hybridization-fluorescent detection of amplification products, sets of reagents Amplisens (Russia) were used. The polymorphic zone - 1486 T / C, rs187084 of TLR9 gene was used by PCR amplification in real time by determining the length of restrictive fragments of PCR using Ncol restrictive fragment and oligonucleotide primers.Results. The analysis of results of - 1486 T/C polymorphism of TLR-9 gene allowed to identify three main genotypes - TT, TC, CC. The study of the frequency of separate genotypes detection allowed to establish the prevalence of CC and TT genotypes compared with the heterozygotic TC genotype. The study of the distribution frequency of -1486 T/C-polymorphism of TLR-9 gene for different genotypes demonstrated the specificity of CC genotype changes in patients with IM and the absence of such changes for TT and TC genotypes.Our research established the correlation between - 1486 TLR-9 C/Cpolymorphism with IM that proves the important role of mediated TLR signalization in the pathogenesis of EBV infection. The study of genes polymorphism among receptors that take part in recognizing a virus is necessary for determining the genetic background, connected with the infection risk, disease course and possible IM results. It allows to reveal risk groups among patients and to carry out the timely therapy.Conclusions: 1. It was proved, that - 1486 T/C polymorphism of TLR-9 gene is detected reliably more often in patients with IM than in the control group.2. The distribution of -1486 Т / С polymorphism of TLR-9 allowed to reveal the association of CC genotype with manifest forms of IMДосліджено поширеність поліморфізму -1486Т/С гену TLR-9 у хворих на інфекційний мононуклеоз, викликаний вірусом Епштейна-Барр. Виявлено три основних генотипи – ТТ, ТС, СС. Встановлено домінування генотипів СС та ТТ, порівняно з контролем. Аналіз розподілу частот поліморфізму продемонстрував специфічність змін для генотипу СС та відсутність таких для генотипів ТТ та Т
Аналіз показників еритропоезу у ВІЛ-інфікованих осіб і хворих на ко-інфекцію ВІЛ/ТБ в залежності від ступеня тяжкості анемії
Get PDFThe aim of the work was the analysis of erythropoiesis (EP) in HIV-infected persons and patients with HIV/TB co-infection depending on anemia severity.Methods of research: the study included 124 patients (62 patients with HIV-infection and 62 patients with HIV/TB co-infection). The control group included 32 practically healthy donors. All patients underwent the determination of anemia severity and erythropoiesis indicators.Results. HIV-infected persons with anemia of III severity degree has erythropoietin (ERO) content 14,3 ± 1,5 iUn/ml that is essentially lower than in the control group and comparison group (р<0,001). ERO content in blood serum of patients with HIV/TB co-infection with anemia I, II and III is essentially higher (135,8 ± 38,7, 203,7 ± 58,3 and 330,1 ± 127,2 iUn/ml) respectively against the same value in the control and main groups (23,7 ± 1,12 iUn/ml and 21,4 ± 1,89 iUn/ml, р <0,001) – in 8 times.Conclusions. The analysis of erythropoiesis indicators revealed the reliably low level of erythropoietin in patients with HIV-infection at severe anemia compared with the control group and patients with HIV/TB co-infection and the reliably high erythropoietin level in patients with HIV/TB co-infection at middle and severe anemia compared with the control and main groupsМетою роботи було визначення показників еритропоезу у ВІЛ-інфікованих осіб і хворих на ко-інфекцію ВІЛ/ТБ в залежності від ступеня тяжкості анемії. Встановлено достовірно низький рівень еритропоетину у ВІЛ-інфікованих осіб та достовірно вищий рівень еритропоетину у хворих на ко-інфекцію ВІЛ/ТБ при анемії з середнім та тяжким перебіго
Порушення ритму серця у хворих на сполучену патологію бронхіальної астми та хронічного обструктивного захворювання легень
Get PDFThe aim of the study was to reveal features of cardiac arrhythmias in patients with the associated pathology of bronchial asthma and COPD, estimation of co-morbid cardiovascular diseases and the cardiovascular risk degree.Materials and methods. The study included patients with the associated of asthma and COPD and also patients with bronchial asthma and COPD without association signs. All patients underwent: the general clinical examination, spirometry, Holter ECG monitoring, echocardiography and determination of the speed of pulse wave distribution.Results. According to the data of day ECG monitoring, there was revealed the high frequency of arrhythmias registration in patients with bronchial obstructive diseases, especially often, ventricular and supraventricular arrhythmias were detected in patients with COPD and ACCS. The analysis of heart rate variability revealed statistically lower temporal indices in patients with COPD and ACCS comparing with ones in patients with BA. Even more negative changes of these heart rate and variability indices were revealed in patients with ACCS with the high level of bronchial obstruction, at expressed symptoms of the main disease and at the concomitant cardiovascular pathology.Patients with ACCS demonstrated essential statistically reliable connections between indices of heart rate variability and hemodynamic parameters.Conclusions. Patients with COPD and associated bronchial obstructive pathology demonstrated more expressed changes of heart rate variability indices compared with patients with BA. More expressed negative changes of the heart rate variability were detected in patients with ACCS with the high level of symptoms and bronchial obstructionВ статті представлені дані про особливості порушень варіабельності та ритму серця хворих на сполучену патологію бронхіальної астми та хронічного обструктивного захворювання легень, а також проведений порівняльний аналіз вказаних параметрів із такими хворих на бронхообструктивні захворювання без ознак сполученн