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SLEEP APNEA IN GOUT PATIENTS: UNDERLYING MECHANISMS AND SHARED PATIENT SUBTYPES
Get PDFAcute and chronic inflammation in gout causes permanent tissue damage, leads to restricted mobility and significantly reduces the quality of life. Obstructive sleep apnea (OSA) is a breath disordered sleep disease, which is a risk factor for respiratory, cardiovascular and cerebrovascular complications, nephropathy and other diseases.
The aim of this paper was to explore the underlying mechanisms and shared pathways, targets and biomarkers of sleep apnea and gout. aiming at providing clear evidence about whether OSAS patients have higher serum uric acid levels and more susceptible to gout.
Materials and methods. We conducted this literature analysis on relevant studies, which were identified via electronic databases from inception to May 30, 2020. Study selection was conducted according to predesigned criteria, and two authors independently extracted data from included studies.
Results. In the period from 2010 to 2020, 4 large-scale population-based studies were conducted to prove that OSA can affect the level of uric acid, resulting in increased incidence of gout in OSA patients. Only one big population-based study during 2010-2020 assessed the development of OSA against the background of gout. The data from these studies showed an undoubted relationship between the two diseases, but to date it is not completely known how much it is due to common risk factors and how interlinked the development mechanisms are.
Conclusions. Relationship between OSA, gout, and pro-inflammatory/metabolic disorders is therefore complex; with some recent studies indicate different mechanisms may play a role in the development of OSA-gout combination. The inconsistency in results may indicate the presence of several patient profiles or subtypes with gout-OSA comorbidity: combined with metabolic syndrome (most common), combined with renal dysfunction without obesity, and others (dietary violations, genetic diseases, acidosis).
This paper reviews the research progress on the relationship between the epidemiological characteristics of OSA and the incidence of gout, with the insight into pathogenetic mechanisms of comorbidity
PROSPECTS FOR INCREASING THE EFFICIENCY OF TREATMENT OF PATIENTS HEAVING OF LOCALLY- DISTRIBUTED BREAST CANCER
Get PDFImproving the efficiency of treatment of locally distributed forms of breast cancer (BC) patients is relevant.
The aim of the study: to determine the possibility of increasing the efficiency of treatment of patients with locally distributed BC by supplementing it with the determination of the expression of TOP2 alpha and beta-tubulin III genes in the primary tumor during various chemotherapy regimens.
Method. 139 patients with locally distributed BC were examined. Patients received 2-4 courses of neoadjuvant chemotherapy (NAChT) according to the TC (docetaxel + cyclophosphamide) and TAC (docetaxel + doxorubicin + cyclophosphamide) regimens, subsequent surgical intervention and 2–4 courses of AchT according to the FAC regimen. Immunohistochemical (IHCh) study of the levels of estrogen receptors (ER), progesterone (PR), epidermal growth factor (HER2) in tumors was conducted. The expression of TOP2 alpha and beta-tubulin class III genes was determined using PCR. Statistical data processing was performed using the program Stastistica for Windows 6. 0, Excel.
Results. In the third cycle of chemotherapy, patients were transferred from the TC scheme to the TAC scheme. The frequency of the FPR increased 4 times in the group of patients with a triple negative tumor subtype compared with patients with luminal B. A combination of low expression of the class III beta-tubulin gene with high expression of TOP2 alpha in tumor tissue was found in 64.5 % of patients treated according to the TAC + cross over regimen and in 56.3 % of cases according to the TC regimen. A change in the receptor status of MLN after NAChT was detected in some cases.
Conclusions. The combination of high expression of TOP2 alpha with low expression of class III beta-tubulins can be considered as a predictive sign of full pathomorphological response when using taxane-containing locally distributed BC. These markers can be recommended for determination in MLN (along with definition of ER, PR, HER2) in order to increase the effectiveness of AchT
CHANGES IN THE MORPHOLOGIC STATE OF RED BLOOD CELLS IN PATIENTS WITH POLYTRAUMA
Get PDFThe measurement of RBC indices is of particular importance as an indirect intermediate component of the recovery process after exposure to hypoxia, ischemia, hypothermia in patients with traumatic disease due to polytrauma.
The aim of this study was to evaluate the parameters of the morphologic state of red blood cells as a reaction of patients with traumatic disease.
Materials and methods.A prospective study was carried out evaluation of 120 patients suffering from polytrauma. The patients were divided into 3 groups according to the principle of using additional substances as a part of IC. The parameters of morphologic state of red blood cells were studied.
Results and discussion. The course of acute and early periods of traumatic disease has accompanied variability morphological forms of red blood cells, as evidenced by a decrease in MCV and RDW increased levels of the 3rd to 5th day. The optimized therapy used in the treatment of patients, has a positive effect on the parameters of red blood cells, contributes to a better recovery of red blood cells after hypoxia resulting multiple trauma.
Conclusion. The study has demonstrated variations in the morphologic properties of red blood cells in the acute and early period of traumatic disease, as confirmed by pathological changes of the erythrocyte indices. The administration of the proposed therapy with the use of D-fructose-1.6-diphosphate sodium salt of hydrate has a positive effect on the parameters of red blood cells, contributes to a better recovery after hypoxia resulting multiple trauma. Given this, the calculations of the red blood cell indices may carry additional diagnostic information, which allows identify trends for not obvious pathological changes and quality of treatment
GASTROESOPHAGEAL REFLUX DISEASE AND BRONCHIAL ASTHMA: MECHANISMS OF COMORBID FORMATION AND COURSE.
Get PDFThe aim of the study: To estimate the level of Galectin-3 with the parallel tracing of the content of pro- and anti-inflammatory cytokines Interleukin-6 (IL-6) and Interleukin-4 (IL-4) for patients with GERD and BA both in case of separate nosologies, and in case of their combined course during the period of exacerbation of the diseases.
Methods. The study was conducted in three groups of patients, homogeneous by gender and age. The first group included 18 patients with GERD. The second group included 19 patients with intermittent or persistent-mild bronchial asthma. The third group included 22 patients suffering from GERD with concomitant BA intermittent or persistent-mild severity. Determination of the level of galectin-3 and interleukins (IL-4 and IL-6) in the blood serum was carried out by enzyme-linked immunosorbent assay.
Results. Analyzing the results of the study, we found that the level of galectin - 3 was increased on average in both groups of patients with isolated GERD (and in patients with BA). In patients of the third group with comorbid pathology, the level of galectin-3 was statistically significantly higher than not only the norm, but also the average of patients with isolated BA and GERD. At the same time, we found the rise in the level of pro-inflammatory (IL-6) and anti-inflammatory (IL-4) cytokines. Moreover, in patients with GERD, the level of IL-6 was increased with a higher degree of reliability, and the level of IL-4 was increased with a lower degree of reliability. In patients with BA, on the contrary, the level of IL-4 was determined more often and higher, and the level of IL-6 was lower.
Conclusions. Analyzing result of the study, a clear correlation and features of changes in the level of galectin-3, IL-4, IL-6 in patients with isolated GERD, BA, as well as with the comorbidity of these diseases, were revealed.
In patients with BA, the level of galectin-3 increases with the same degree of certainty as in the group of patients with GERD. In the cytokine system, on the contrary, the level of anti-inflammatory (IL-4) cytokines increases with a greater degree of certainty than the level of pro-inflammatory (IL-6) cytokines.
In patients with GERD with concomitant BA, the level of galectin-3 increases with a greater degree of certainty. It is observed also a higher rising of pro-inflammatory (IL-6) cytokines and a slightly pronounced increasing of the level of anti-inflammatory (IL-4) cytokines in comparison with the group of patients with isolated GERD
A MULTI-MARKER MODEL FOR PREDICTING DECOMPENSATED HEART FAILURE IN PATIENTS WITH PRIOR ACUTE MYOCARDIAL INFARCTION
Get PDFThe aim of the study was to assess the prognostic value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction and their combination in this category of patients.
Materials and methods. There were examined 120 patients with acute myocardial infarction and stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V. Kh. and Strazhesko M.D., NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) and non Q MI (60 individuals) were divided into 4 groups depending on the treatment methods.
Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, which served as a basis for inclusion of the patients in the study.
All the patients underwent the six-minute walk test in a quiet 30-50-m long hospital corridor in the morning. N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) and ST-2 were analyzed in all patients.
Results. Promising biomarkers of HF decompensation in the post-infarction period were studied. In the patients with prior Q-QS MI and decompensated HF, NT-proBNP level was (950.38±3.15) pmol/l (p<0.05); in the patients with prior MI without signs of decompensated HF, it was (580.15±3.03) pmol/l (p˂0.05); in apparently healthy individuals, the level of NT-proBNP was found to be (111.20±3.47) pmol/l.
ST2 level was (14.80±1.61) ng/ml, (36.00±1.43) ng/ml and (49.22±1.40) ng/ml in the patients of Group 1, Group 2 and Group 3, respectively (p˂0.05).
Similar changes were found in patients with decompensated HF in postinfarction period after non Q MI.
Conclusions. The increase in plasma concentration of sST2 is associated with the activation of both neurohumoral and fibrous pathways and can help in detecting the patients with decompensated HF in the post-infarction period and predicting the risk of its development.
Our results confirmed the results of other multiple studies reporting ST2 in combination with NT-proBNP to be valuable tools for prognosing the development of decompensated HF in the patients with prior MI. ST2, alongside with NT-proBNP, is a promising biomarker to be included in the diagnostic panel for detecting acute HF and can provide additional information on risk stratification for such patients during hospitalization and at the time of discharge from the hospital
UTERINE FIBROIDS IMPACT ON FERTILITY AND PREGNANCY OUTCOME
Get PDFThe clinical confirmation of the relationship between uterine leiomyoma and female infertility is of interest to scholars.
The aim of our research was to study obstetric history and the level of sex hormones in women of reproductive age with leiomyoma.
Materials and methods. The main group consisted of 90 women of reproductive age with uterine leiomyoma, the control group - 45 healthy women. Gynaecological and obstetric history, hormone content in peripheral blood and pelvic vessels (estradiol, progesterone) were analysed. Statistical processing of clinical material was performed using Microsoft Excel, Statistica 7.0, and Statistica 8.0 for Windows.
Results. The frequency of infertility in the surveyed women with LM was 18.9 %. One in three patients in the main group (33.3 %) did not give birth, which was statistically different from the healthy women group. In this case, 25.6 % of women in the main group did not use any methods of contraception. It was found that 51.11 % of patients with LM had threatened miscarriage in their history, 37.5 % – complicated delivery. Pathological changes in the concentrations of estradiol and progesterone in the preferential blood and blood vessels of women with fibroids have been identified. We have found that the content of sex hormones in the local bloodstream has a reliable relationship with the location of the myomatous node.
Conclusion. The obtained results may indicate that leiomyoma contributes to the reduction of fertility. This is evidenced by the fact that women with LM are more likely to have the risk of miscarriage, complicated delivery and delivery by caesarean section, including complicated one. The findings have made a significant contribution to the further development of effective strategies for the prevention and treatment of infertility in women with fibrotic uterine lesions
ST2 PLASMA LEVEL IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITHOUT ST ELEVATION AND DIFFERENT CLINICAL CHARACTERISTICS
Get PDFThe aim. Estimation of ST2 plasma level in patients with acute myocardial infarction without ST elevation (NSTEMI) and its relationship with different clinical characteristics.
Materials and methods. 165 patients aged from 35 to 79 (average of 60.7±0.8 years) with various forms of coronary artery disease (CAD) with and without arterial hypertension were examined. The variability of plasma ST2 level in different forms of CAD and in NSTEMI group was analyzed depending on gender-age and clinical characteristics and features of the disease course.
Results:
The results of the present investigation were that the ST2 level in the main cohort was in range from 5.5 to 233.9 (in the middle – 49.8±3.5 ng / ml (median indicator – 34.7 and the interquartile range – 21.9 and 59.1 respectively).
Significantly higher ST2 levels were found in patients with NSTEMI, unlike the comparison group, in the median analysis (35.9 vs. 27.7 ng/ml, p=0.047) and no statistical differences were observed in the mean values.
In patients with NSTEMI, a certain association of ST2 level in plasma with the MI course was detected. A higher level of neurohormone is registered with anterior unlike posterior ECG localization of MI; at high unlike moderate risk on the GRACE scale; when complicated unlike the uncomplicated course of MI; in the case of acute HF and cardiac arrhythmias unlike patients with the absence of these manifestations in the acute period of MI.
Conclusions. High variability of ST2 level in plasma was demonstrated in patients with NSTEMI on the first day after destabilization (minimum and maximum values – 12.7 and 233.9 respectively, median – 35.9 and interquartile range – 25.9 and 55.7 ng / ml).
It is shown that significantly higher ST2 level in plasma is determined in patients with acute MI regardless of its variant among different clinical forms of CAD.
It is found that significantly higher level of ST2 in patients with NSTEMI is recorded in the case of concomitant HTN and type 2 diabetes, with smoking and heavy cardiovascular heredity. Proved influence of the character of MI course on the level of ST2 in plasma, significantly higher level of neurohormone was determined with anterior localization of MI, high risk on the GRACE scale (≥ 140 points), complicated course of MI, development of cardiac arrhythmias and HF in the acute period of MI
EARLY COMPLICATIONS AFTER RADICAL OPERATIONS IN BREAST CANCER PATIENTS
Get PDFBreast cancer is one of the most common malignancies in women. In many cases, a major component of complex treatment for breast cancer is surgery - radical mastectomy or radical breast resection.
The aim of the work – to investigate the frequency and structure of complications after radical surgery with dissection of axillary lymph nodes in breast cancer patients.
Material and methods. The baseline and surgical results of 147 women with breast cancer who underwent radical mastectomy or radical breast resection with lymph node dissection were analysed.
Results. Complications in the early period after surgery for breast cancer were found in 76 (51.7 %), including postoperative extremity edema in 60 (40.8 %); lymphorrhea – in 37 (25.2 %), seroma – in 33 (22.4 %); wound infection in 18 (12.2 %), necrosis of the wound edges – in 15 (10.2 %) patients. Correlation of postoperative edema with almost all other complications was found, lymphorrhea and seroma were most associated with swelling and with each other; necrosis of edges with postoperative edema. Wound infection was significantly associated with lymphorrhea. Patients' age, stage of disease, and immunohistochemical type of tumour did not affect the development of complications. With increasing BMI, the incidence of complications increased significantly (χ2=9.530; p=0.009). The tendency to decrease the frequency of complications during reconstructive surgery was revealed (42.6 % versus 58.1 %, p=0.064), and adjuvant radiotherapy, on the contrary, contributed to the increase of complications (57.8 % versus 43.8 %, p=0.090).
Conclusion. Radical operations with lymph node dissection in patients with breast cancer are characterized by a high frequency of early postoperative complications, mainly associated with disorders of lymphatic outflow, which indicates the need for a set of measures of preoperative preparation, improvement of surgical techniqu
DOES THE TERM OF DEFINITIVE OSTEOSYNTHESIS OF MULTIPLE LONG BONE FRACTURES OF LOWER EXTREMITIES IMPACT ON TREATMENT OUTCOMES IN POLYTRAUMA PATIENTS
Get PDFThe aim: to determine the timing impact of definitive multiple long bone fracture osteosynthesis of lower extremities on complications development, duration of Mechanical Ventilation (MV), Length of Stay in Intensive Care Unit (LOS-ICU), Hospital length of Stay (H-LOS) in patients with polytrauma treated according to Damage Control Orthopedics (DCO).
Materials and methods: a prospective controlled non-randomized trial in parallel groups conducted in polytrauma department of Kyiv City Clinical Hospital No. 17 from February 2016 to January 2020, which included 107 adult patients with polytrauma, multiple long bone fractures of lower extremities, one of which femur treated according to DCO.
The patients were divided into two groups: Group I included 51 patients who underwent definitive osteosynthesis of long bone fractures of lower extremities after patient condition stabilization ≥24 hours ≤5 days; Group II included 56 patients who underwent definitive osteosynthesis of long bone fractures of lower extremities during the period >5 days after injury.
Results: there were no statistically significant differences between Group I and Group II patients in demographics, injury mechanism, trauma severity and general patient condition. Group I patients who underwent osteosynthesis from 2nd to 5th days after injury had lower pneumonia incidence, compared to Group II patients (17.6 % vs. 26.8 %, p=0.047), shorter MV duration (9.3±6.9 vs. 14.9±9.1, p=0.048), ICU-LOS (13.5±8.3 vs. 19.1±11.0, p=0.037), and H-LOS (30.3±13.9 vs. 38.9±15.5, p=0.046).
Conclusion: performing definitive multiple fracture osteosynthesis of lower extremity long bones after polytrauma patient stabilization from 2nd to 5th days after injury allowed to reduce the frequency of pneumonia, shorten the duration of MV, LOS-ICU and H-LOS, compared with its implementation after 5th day
MECHANISMS OF AUTONOMIC DYSFUNCTION REALIZATION DURING COMORBID GASTROESOPHAGEAL REFLUX DISEASE AND NEUROCIRCULATORY DYSTONIA WITH INSOMNIA AMONG YOUNG PEOPLE
Get PDFThe aim of the study: to optimize diagnostics and treatment of comorbid gastroesophageal reflux disease (GERD) and concomitant neurocirculatory dystonia (NCD) with insomnia among young people by studying autonomic dysfunction and mechanisms of its realization.
Methods. The study was conducted in three groups of patients, homogeneous by gender and age. The first group included patients with GERD and insomnia, the second group counted those with NCD and insomnia, and the third group consisted of GERD with NCD and insomnia. We studied the quality of life (SF-36), quality of sleep (PSQI), the presence and severity of depression (PHQ-9), psychosomatic condition (Spielberger-Khanin scale), and determined the presence and severity of autonomic dysfunction syndrome (Wayne questionnaire), acidity of the stomach, ultrasound examination of the esophagus and stomach.
Results. The first group revealed sympathicotonia and increase of gastric juice aggression (in the stomach body 0.89±0.05) and reactive (47.2 points) and personal anxiety (52.7 points), which suggests the advisability of use PPI (omeprazole 20 mg 2 times a day for 5 weeks), and melatonin 3 mg per night during 3 weeks. The second group showed parasympathicotonia predominant, a more pronounced decrease in vitality scale (31.5±4.2), and a moderate increase in indicators of reactive (44.0 points) and personal anxiety (46.5 points), which suggests the advisability of use 3 mg of melatonin per night during 3 weeks. The third group demonstrated predominance of parasympathicotonia, motor disorders, a decrease in alkalizing function of antrum (5.4±0.17), depression (81.8 %), and the greatest decrease in indicators of sleep quality (11.7) and quality of life, which suggests the advisability of use PPI (omeprazole 20 mg 2 times per day during 5 weeks), with prokinetics (domperidone 10 mg 3 times per day during 5 weeks), and melatonin 3 mg per night during 3 weeks.
Conclusions. Autonomic dysfunction has a key influence on the main pathogenetic factors in the formation of both GERD and NCD and insomnia, and the type of autonomic tone determines the features of the clinical course of both isolated and combined pathology