Archive of Clinical Medicine
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Epigenetic Regulation of Gene Activity in Epithelial Cells of Nasal Mucous Membrane in Patients with Polypous Rhinosinusitis
Get PDFNowadays, a wide clinico-laboratory polymorphism of “polypous rhinosinusitis” is observed. It suggests the potential role of heredity in the formation of the disease indicating the necessity of studying the role of genetic factor in the formation of various clinico-pathogenic variants of polyposis in detail.The objective of the research was to study the degree of functional abnormalities in the epithelial cell genome of the nasal mucous membrane in patients with polypous rhinosinusitis using the cytogenetic methods.Materials and methods.The article presents the results of cytogenetic study of 70 patients with various types of polypous rhinosinusitis (aspirin-intolerant and allergic). Hereditary predisposition to the disease was determined applying clinical and genealogical analysis.Results.Significant differences in the quantitative characteristics of the functional state of the nasal epithelial cell genome by the criterion of chromatization indices, the nucleolar index, the indices of the heteropyknotic X chromosome and pathologically altered nuclei were found in patients with aspirin-intolerant polypous rhinosinusitis as compared to those with allergic polypous rhinosinusitis as well as the control group.The identified changes serve as a criterion of the reduction in the activity of the transcriptional-translational processes in aspirin-intolerant polypous rhinosinusitis.Conclusions.The studied changes in the parameters of the functional state of the epithelial cell genome in the nasal mucous membrane provided an objective confirmation of hypothesis about epigenetic nature of pathology formation
Clinical and Informational Assessment of the Effectiveness of Treatment of Maxillofacial Area Inflammatory Diseases: the Results of Perioperative Monitoring
Get PDFApplication of methodology of clinical and informational assessment of comprehensive treatment effectiveness was showed to provide an opportunity to consider multiple-factor effects (both positive and negative) of the chosen rehabilitation approach impact in the system of comprehensive treatment. Increase in specific contribution of psychophysiological components into entropy of clinical and informational system and, consequently, the increase in order of adaptation mechanism were proven. Absolute entropy of clinical and informational system was proven to decrease as a result of comprehensive treatment of patients with maxillofacial area inflammatory diseases. This determined 20.0 % of effectiveness of pathognomonic changes pathogenetic correction
Indicators of Energy Metabolism in Patients during the Early Recovery Period of Ischemic Stroke under the Influence of Complex Therapy Using Neuroprotectors and Vasoactive Drugs
Get PDFIschemic stroke remains one of the most urgent health and social problems as well as the leading cause of disability in neurological patients.The objective of the research was to study and evaluate the efficiency of complex therapy using choline alphoscerate and vincamine in patients during the early recovery period of ischemic stroke considering the processes of energy metabolism.Materials and methods. The study involved 66 patients in the early recovery period of primary hemispheric ischemic stroke being randomized into 2 groups. Group 1 received basic therapy for secondary prevention of stroke. Patients of Group 2 received choline alphoscerate and vincamine for 2 months in addition to basic therapy. The evaluation of neurological deficit and functional status of patients was carried out using the NIH Stroke Scale, the Scandinavian stroke scale (SSS) and the Barthel Index; the concentration of lactic and pyruvic acid in serum was determined.Results. After treatment the NIH Stroke Scale score decreased significantly by 17.7%, the SSS score increased by 22.7% and the Barthel Index increased by 16.2% in Group 2 (p<0.05). There was detected a moderate correlation (r=0.34; p=0.031) between the lactate level and the NIH Stroke Scale score as well as a moderate inverse correlation between the lactate level and the SSS score (r=-0.42; p=0.032) one month after stroke. In addition, 3 months after stroke increased initial lactate level correlated inversely with the SSS score (r=-0.41; p=0.036) and the lactate-to-pyruvate ratio correlated with the SSS score (r=-0.47; p=0.039) and the Barthel Index (r=-0.29; p=0.046).Conclusions. Early recovery period of ischemic stroke is characterized by the disorders of energy metabolism, signs of activation of anaerobic glycolysis with increased serum levels of lactate and lactate-to-pyruvate ratio which may be predictors of unfavourable functional outcome. Complex therapy using choline alphoscerate and vincamine can contribute to the normalization of energy metabolism as well as to the reduction in clinical manifestations of neurological disorders
Features of Blood Coagulation System in Patients at High and Very High Cardiovascular Risk According to the SCORE Charts in the Presence of Heart Rate Turbulence
Get PDFThe objective of the research was to determine the features of the blood coagulation system in patients at high and very high cardiovascular risk according to the SCORE charts in the presence of heart rate turbulence.Materials and methods. 603 patients were examined to determine the role of heart rate variability in the cardiovascular continuum; 319 patients were examined to study the role of heart rate turbulence in the formation and progression of sudden death in the cardiovascular continuum based on the Holter monitoring. All patients were divided into 4 groups: Group 1 included patients with coronary heart disease without concomitant risk factors such as smoking, obesity, metabolic syndrome; Group 2 consisted of patients smoking tobacco for more than 2 years; Group 3 included patients with metabolic syndrome without existing coronary heart disease or arterial hypertension; Group 4 consisted of patients with metabolic syndrome and arterial hypertension. The control group included 149 people. In patients with ventricular extrasystoles of different degrees according to V. Lown’s and M. Wolf’s scale the phenomenon of heart rate turbulence was observed and the parameters of the blood coagulation system were determined.Results. There was no significant difference between indices of coagulation among studied groups and the control group. In patients with post-infarction cardiosclerosis hematocrit was lower due to regular intake of antiplatelet drugs to prevent the progression of coronary heart disease. It can be stated that the phenomenon of heart rate turbulence itself does not affect the change in the coagulation system of the human body. When determining the advisability of administering anticoagulants to patients with heart rate turbulence, we should be guided by not only the presence of ventricular ectopy the total cardiovascular risk should be considered as well.Conclusions. The presence of isolated heart rate turbulence phenomenon in a patient does not require a special approach to anticoagulant therapy
Gender-Based and Age-Related Peculiarities of Lipid Metabolism in Chronic Heart Failure Secondary to Overweight and Obesity
Get PDFChronic heart failure is often accompanied by comorbidities including obesity being the major one. It significantly aggravates the course of the disease and clinical outcome. Changes in the plasma concentration of lipids in chronic heart failure were demonstrated by many studies. Recently a considerable number of works has appeared in which a negative influence of both high and low levels of lipids on the course, consequences and survival in patients with chronic heart failure was observed. The objective of the research was to study gender-based and age-related peculiarities of lipid metabolism in chronic heart failure secondary to overweight and obesity. Material and methods. There were examined 212 patients with chronic heart failure functional class I-III having normal body weight, I-III degree abdominal obesity or being overweight. Patients underwent complete blood count and biochemical blood analysis; instrumental examination was performed according to the existing guidelines for the diagnosis and treatment of chronic heart failure. Statistical processing of the obtained material was performed using an advanced analytics software package Statistica 6.0. Results and discussion. Both atherogenic and antiatherogenic components of lipid metabolism predominated in females. Age-related changes were presented by higher levels of atherogenic indices and prevalence of dyslipidemia in young patients reducing with age in parallel with the deepening of chronic heart failure
Role of Toll-Like Receptor 4 (TLR4) in the Development of Inflammatory Process in Skin of Psoriasis Patients
Get PDFThe objective of the research was to study the mechanisms of developing local immune inflammation considering changes in immunohistochemical expression of Toll-like receptor 4 (TLR4) in skin of psoriasis patients after systemic immunosuppressive therapy.Materials and methods. Immonohistochemical dynamic analysis of biopsy material taken from psoriaform skin areas in 62 psoriasis patients receiving systemic immunosuppressive therapy was made. Beyond that, to compare the results of the appropriate immunohistochemical examinations biopsy material from anterior abdominal wall taken after surgical intervention (e.g. hernia repair) in practically healthy persons of an appropriate age (5 patients) was studied. To determine the nature and area of local cellular immune and inflammatory reactions in skin of psoriasis patients, immunohistochemical techniques for determining TLR4 marker expression were used.Results and discussion. While studying TLR4 expression, background diffuse cytoplasmic and nuclear staining of epidermis, vascular endothelium and single macrophage cells were identified in psoriaform skin areas. The number of positive-stained epidermis cells was about 80%. After a course of systemic suppressive therapy with Etanercept during 3 months, immunohistochemical reaction to identify TLR4 expression allowed us to establish that both the number of positive-stained cells and response intensity in epidermis considerably reduced. The number of cells expressing TLR4 in the epidermis was up to 60%. Even after treatment, a considerable number of TLR4-positive dendrite cells with a greatly increased size and extended with their processes up to the horny layer were identified in the epidermis.Conclusions. The ligands activating toll-like receptors of macrophages and subsequent inflammatory reaction probably concentrate in epidermis dendrite cells as evidenced by immunohistochemical reactions. TLR4-positive macrophages after activation in dermal papilla migrate to the papilla base to be then included as a component of inflammatory perivascular infiltrates. After treatment, the number of cells (both dendrite and macrophage) with TLR expression significantly decreased. However, the background readiness to a burst of activity of toll-like receptors persists.
Dynamics of Recovery of Functions of the Nasal Cavity in Patients with Aspirin-Intolerant Polypous Rhinosinusitis in the Postoperative Period
Get PDFSurgical interventions in the nasal cavity are accompanied by reactive phenomena in the postoperative period. On their background the process of physiological regeneration is disorganized resulting in impaired physiological functions of the nasal cavity.The objective of the research was to study the recovery process of the main physiological functions of the nasal cavity in patients with aspirin-intolerant polypous rhinosinusitis in the postoperative period.Materials and methods. 80 patients with aspirin-intolerant polypous rhinosinusitis at the age of 24-57 years were operated on.All the patients were divided into 2 groups: the control group included 30 patients; the main group comprised 50 patients.Patients of the control group received nasal cavity cleaning, nasal mucosa anemisation, irrigation therapy since the first day of the postoperative period.Patients of the main group received an herbal drug BNO-101 additionally. The effectiveness was assessed on the 3rd, 7th and 10th days of treatment.Results. The postoperative rehabilitation with the inclusion of botanical preparation BNO-101 provided a significant improvement of nasal breathing, mucociliary transport rate and indicators of nasal peak flowmetry compared to the control group. Despite subjective improvement of nasal breathing the indicators of the peak expiratory flow rate in the main group were 34.2% lower than the norm while in the control group they were 54.7% lower than normal ones thereby justifying further treatment.Conclusions. The postoperative rehabilitation of patients with aspirin-intolerant polypous rhinosinusitis provided more rapid improvement of the main functions of the nasal cavity compared to the control group
Analysis of the Dynamics of Cardiovascular Health in the Population of Ivano-Frankivsk Region over the Past Seventeen Years
Get PDFThe key to increase the level of life expectancy is good health. To study the indicators of cardiovascular health in the population of the Carpathian region, the analysis of the indicators of cardiovascular disease prevalence over the period 1998-2014 was made. The analysis was conducted based on statistical data of the Regional Information-Analytical Center of Medical Statistics and medical records of the Ivano-Frankivsk Regional Clinical Cardiology Dispensary over the period 1998-2014.To identify the population structure in Ivano-Frankivsk region, the analysis of the main demographic indices over the period 1998-2014 was made. The analysis revealed that in 2007, the total population of the Carpathian region was 1,386,000 people while in 2014, it was 1,379,400 people that was 1.05% and 5.76% lower compared to the total population in 1998 (1,463,600 people). Similar tendency was observed across the whole country. During the studied period, the indicators of the overall prevalence of hypertension (all forms) increased by 2.89 times while the indicators of primary disease incidence increased by 1.89 times. The indicator of the overall prevalence of ischemic heart disease among the adult population of Ivano-Frankivsk region during the studied period increased by 2.11 times ranging from 9780.3 to 20629.1 cases per 100,000 population. It should be noted that since 2012 a reduction in the prevalence of angina pectoris from 6545.7 to 6126.2 cases per 100,000 population (by 1.07 times) was observed. The increase in the incidence of acute myocardial infarction from 81 to 108.2 cases per 100,000 population (by 1.34 times) was detected as well. Cardiovascular diseases are known to be the most urgent problem of modern health care system having no geographical, socioeconomic and sexual preferences. They remain to be the major cause of mortality accounting for about 17,300,000 cases per year.Conclusions. Thus, important factors affecting life expectancy of Ivano-Frankivsk region residents include morbidity and mortality due to cardiovascular diseases which have increased recently
Aneurysmal Disease of the Main Arteries
Get PDFThe high incidence of aneurysms of different arterial systems in case of abdominal aortic aneurysm causes the need for the examination of all patients with aortic aneurysm in order to detect aneurysmal process in all main arteries. The use of the mentioned predictors of aneurism wall failure in daily clinical practice provides an opportunity to improve the results of surgical treatment. Active surgical approach in relation to aortic aneurysm and main arteries is indicated in the presence of aneurismal disease. The choice of treatment depends on the severity of the patient’s condition, clinical manifestations, localization of the aneurysm and its morphology, with the preference for endovascular approach
Analysis of the Impact of Doctors’ and Health Care System Credibility on Patients’ Satisfaction with Health Care
Get PDFForming a patient-oriented health care system, patients’ participation in health care quality assessment has become the imperative of our time.The objective of the research was to analyze the impact of doctors’ and health care system credibility on satisfaction with health care.Materials and methods. Sociological survey of 530 patients was conducted. The patients completed their treatment in the surgical departments of inpatient facilities in Ivano-Frankivsk region. According to its results the patients were divided into two groups: satisfied (372 people) and not satisfied (158 people) with the level of health care services in the department and the hospital as a whole.Results of the research. Nearly 60% of the surveyed patients were determined not to trust their doctors and one third of respondents did not know their primary care physician. This significantly increased the chances of dissatisfaction with health care (OR= 4.11; 95% CI: 1.67–10.14, p<0.001 and OR=1.96; 95% CI: 1.33–2.90 respectively; p<0.001) and promoted inefficient use of the health care system resources as a result of unreasonable hospitalization (in 18.8% cases). Conclusions. Patients who do not trust doctors in general and do not know their general practitioner remain dissatisfied with inpatient care by 1.5-10 times more often