The Journal of V. N. Karazin Kharkiv National University, series "Medicine"

Circulating endothelial cells as a marker of endothelial dysfunction in patients with psoriatic arthritis

Anastasia Bilukha — 2023-06-27

Abstract. Psoriatic arthritis (PsA) is a chronic progressive inflammatory disease that involves damage of the skin and joints and leads to the development of cardiopulmonary diseases. Mortality among this cohort is 1.28 times higher than the population level. The presence of a prolonged systemic inflammatory process is a significant predictor of the development of cardiovascular (CV) diseases due to the progression of endothelial dysfunction (ED). Objective. To evaluate the role of circulating endothelial cell (CEC) levels as a marker of endothelial dysfunction in patients with psoriatic arthritis. Materials and Methods. We examined 97 patients diagnosed with PsA and 25 clinically healthy patients who formed the control group. All patients underwent diagnostic methods characterizing the course of the disease, assessment of endothelium-dependent vasodilation (EDVD) in response to reactive hyperaemia and CEC levels. Results. The results of the study of endothelial function in patients with PsA demonstrated that reduced EDVD (less than 10 %) was more common among patients with PsA compared to the control group (75.3 % vs. 11.8 %, respectively). The analysis of the CEC content in peripheral blood showed a significant difference (7.15 ± 0.19 and 4.05 ± 0.11, respectively, p < 0.001) between patients with PsA and the control group. In addition, were established the relationships between endothelial dysfunction and the state of endothelial vasodilatory function (rs = -0.91, p < 0.05), disease duration (rs = 0.69, p < 0.05), disease activity (DAPSA (rs = 0.65, p < 0.05), inflammatory process itself (ESR (rs = 0.39, p < 0.05), CRP (rs = 0.52, p < 0.05) and skin lesion prevalence (PASI (rs = - 0.42, p < 0.05)). Conclusions. Our studies suggest a significant prevalence of ED in patients with PsA. The high values of negative correlation between EDVD and CEC are quite expected and comparable to modern studies and allow us to consider desquamated endothelial cells as an independent marker for assessing the state of the endothelium in patients with PsA and are consistent with the literature.

Determinants of short-term blood pressure variability – the value of arterial stiffness

Olena Kanishcheva — 2023-06-27

Abstract. Increased blood pressure variability is a significant parameter that affects the prognosis in patients with arterial hypertension, and is an independent predictor of cardiovascular events and mortality. The arterial elasticity is an important factor in maintaining a constant average blood pressure for adequate blood supply to inner organs against the background of dynamic blood pressure fluctuations. A decrease in the elastic properties of the arteries, and therefore, an increase in the arterial stiffness can be one of the potential mechanisms for the blood pressure variability violation. Objective. The aim of the study was to evaluate the possible relationships between arterial stiffness indicators and blood pressure variability indices in patients with hypertension based on the results of ambulatory blood pressure monitoring. Patients and methods. The results of ambulatory blood pressure monitoring of 172 patients with hypertension were analyzed. Arterial stiffness was assessed using the ambulatory arterial stiffness index - symmetric and asymmetric. SD, SDw, CV, SV, ARV, and BPVR indices were calculated to assess blood pressure variability. Analysis of the obtained results was carried out using Microsoft Excel 2010 and the STATISTICA version 10.0 software. Differences between groups were assessed by the Mann-Whitney method, correlations among blood pressure variability indices and ambulatory arterial stiffness indices were evaluated using Spearman`s rank correlation analysis. Significance was set at p ˂ 0.05. The results. Awake asymmetric ambulatory arterial stiffness index was significantly higher than asleep one, no statistically significant difference between asleep and 24-hour asymmetric ambulatory arterial stiffness index was established. The asleep symmetric ambulatory arterial stiffness index did not significantly differ from the awake one and was significantly higher than the 24-hour one. In comparison with asymmetric, for symmetric ambulatory arterial stiffness index statistically significant relationships were established for a greater number of blood pressure variability indices. In all statistically significant cases, the direction of the established relationship with arterial stiffness was only direct for the systolic blood pressure variability indices. Variability of diastolic blood pressure had a clear inverse relationship with arterial stiffness. Conclusions. The presence of pathogenetic interrelationships between arterial stiffness and blood pressure variability have been proven in the present study. The obtained results allow to state that arterial elasticity is an important component of blood pressure variability.

Features of short-term variability of arterial pressure with different types of circadian rhythm in patients with hypertension disease who have suffered myocardial infarction

Tetyana Kolesnyk — 2023-06-27

Abstract. Blood pressure variability is an important prognostic parameter and is an independent predictor of cardiovascular disease and mortality. Aim. To assess short-term blood pressure variability with regard to the type of diurnal blood pressure profile in hypertensive patients with myocardial infarction. Materials and methods. 78 hypertensive men who had a myocardial infarction were examined. The average age was 58.0 (54.0; 67.0) years, the experience of hypertension was 9.0 (5.0; 18.0) years, the period after the myocardial infarction was 24.5 (12.0; 84,0) months. All patients underwent daily monitoring of blood pressure with the study of average day and night pressure levels, the degree of nocturnal decrease in blood pressure, blood pressure variability with STD calculation, pure and new variability indices. The results. Increased BP variability during the day and at night was registered with all types of circadian systolic BP rhythm. The highest values of systolic BP variability (STD) during the day and at night were in patients with a night-picker circadian profile. Achieving the target level of systolic BP as a whole in the group was observed in 34.6 % of patients during the day and 42.3 % at night. Patients with an over-dipper circadian blood pressure profile, despite having the highest percentage of target blood pressure achievement, had the highest values of variability characteristics calculated by STD, pure and new indices per day (p < 0.05). Conclusions. Increased blood pressure variability and pressure level at night are important criteria for assessing the prognosis of hypertensive patients after myocardial infarction. Daily monitoring of blood pressure provides a unique opportunity to objectify these prognostic parameters at different times of the day, which, together with the assessment of reaching the target level of blood pressure, is necessary to control the effectiveness of treatment.

Characteristics of the course acute thromboembolism of the pulmonary artery in women

Vira Tseluyko — 2023-06-27

Abstract. According to modern ideas, men have a more unfavorable course during the hospital period of pulmonary embolism. However, in recent years, works have appeared that have conflicting results regarding the influence of gender differences on mortality in pulmonary embolism, including publications in which a more severe course is observed for women. Aim of the research: determination of gender characteristics of the course of acute pulmonary embolism in women compared to men. Materials and methods. 243 patients with acute pulmonary embolism were examined. All patients underwent a physical examination, clinical and biochemical blood tests, assessed the risk and prognosis according to generally accepted scales, performed an electrocardiographic and X-ray examination, a standard transthoracic echocardiography, an ultrasound Doppler examination of the veins of the lower extremities, and a multispiral computed tomographic angiography of the pulmonary arteries. Statistical processing also included multivariate regression analysis. Results. According to the results of the study, it was found that the average age of women who were hospitalized with acute pulmonary embolism is four years older than that of men. In women, such risk factors for the occurrence of venous thromboembolism as: advanced age, history of venous thromboembolism, diabetes mellitus, and oncological disease were more likely to occur. Heart rate and cholesterol levels at admission were also likely to be higher in women than in men. Prediction of the severity of the course of pulmonary embolism determined by the sPESI scale index showed that high risk occurs probably more often in women. The mortality rate in the female group was also relatively higher than that of the male group. Conclusion. It was established that, despite similar lesions of the pulmonary arteries (localization, distribution and volume), there are gender differences in the prevalence of the leading risk factors for pulmonary embolism. It was found that women have a more severe course of acute pulmonary embolism, which is evidenced by a higher specific weight of high-risk patients, more pronounced saturation disturbances and a higher heart rate. In-hospital mortality in women with pulmonary embolism is higher than in men, both in the group as a whole and among high-risk patients.

Expression of cytokeratin and vimentin in villi of the chorion with anteintranatal fetal death on the background of complicated pregnancy

Olha Zats — 2023-06-27

Abstract. Approximately 3–10 % of all pregnancies are complicated by premature rupture of membranes (PRM). Pregnancy in the presence of preeclampsia, gestational iron deficiency anemia, and acute chorioamnionitis increases the risk of PRM development. These complications of pregnancy are etiologically related to the factors causing PRM, the most important of which are oxidative stress with the subsequent development of sterile inflammation, droplet bleeding with the formation of a posterior placental hematoma, and inflammation of the placenta and fetal membranes. Aim. To determine the expression of cytokeratin and vimentin in chorionic villi with ante-intranatal death of fetuses against the background of complicated pregnancy. Materials and methods. The first studied group included 8 cases of PEN; in the second group – 8 PED observations; in the third group – 8 cases of AN; on the fourth – 8 cases of AD; in the fifth – 10 observations of KHAN; in the sixth – 16 cases of HAD. For the immunohistochemical (IGH) study, an indirect immunoperoxidase method was used using MCA for cytokeratin pan (AE-1/AE-3) (DAKO, Denmark) – epithelial cells were identified, and MCA for vimentin (V9) (DAKO, Denmark) - mesenchymal cells were identified cells. Results. In clinical groups with preterm pregnancy, the intensity of the reaction was well expressed in the epithelium of normal villi and unevenly expressed or absent in immature and sclerosed villi. The level of expression of cytokeratin by the epithelium of the villi in these groups was significantly higher compared to the CG group. In the groups with full-term pregnancy, the intensity of the IHC reaction was weakly expressed in the epithelium of normal villi and weakly expressed or absent in immature and sclerosed villi. The level of expression of cytokeratin by the epithelium of the villi in these groups was significantly lower compared to both the CG group and premature pregnancy in the case of similar pathology. In clinical groups with full-term pregnancy, the expression level of vimentin in mesenchymal cells of villi increased significantly compared to clinical groups with similar pathology of prematurity and compared to the CG group. Conclusions. In the villi of the chorion, some cells of the syncytial epithelium are transformed into mesenchymal cells with fibroblast-like properties, which can be confirmed by the appearance of vimentin-positive epithelial cells in the syncytiotrophoblast of the villi.

Masticatory myofascial pain syndrome provoked by SARS-COV-2 infection in a patient with orofacial pathology (clinical case)

Volodymyr Lychko — 2023-06-27

Abstract. Myofascial pain syndrome (MFPS) is a chronic pain condition characterised by the appearance of myofascial trigger points (MTP) in muscles. The condition can be caused by various factors and is diagnosed through clinical examination and palpation of MTPs. Recent studies have shown that infections like SARS-CoV-2 can cause MFPS, along with other symptoms. Dentists often encounter the problem of MFPS in patients with temporomandibular joint dysfunction, but it can also develop in patients with a normally functioning joint. Symptoms include pain, sensitivity, and abnormalities in mandible mobility. In this article, the case of MFPS in a person with orofacial pathology after SARS-CoV-2 diagnosis is presented. Materials and methods of research. Describes a person who has the instability of the bite caused by the absence, destruction and disposition of the chewing teeth led to disorders of the chewing muscles. The patient was found to have appearing MFPS symptoms after COVID-19. The systematic online search of articles utilising the search terms «Coronavirus, SARS-COV-2 and Myofascial pain syndrome», published between January 2020 and October 2023, was performed. Results. The patient was diagnosed with SARS-CoV-2 in October 2021 and was hospitalised for 10 days. After discharge, she went to the dentist with complaints of headache and stiffness in the area of masticatory muscles, absence and destruction of lateral teeth, difficulty in chewing food, mobility and displacement of individual teeth, periodic bleeding gums, as well as aesthetic disorders. During the objective examination, secondary partial adentia was revealed, which led to instability of the bite, defects of the hard tissues of the chewing teeth, pathological wear of the frontal group, and traumatic occlusion phenomena. During palpation, trigger points were found in the area of the masticatory and temporal muscles. The patient underwent a series of ten trigger point injections (dry needling) in her chewing muscles, with about 30 % immediate relief. Conclusion. MFPS can be caused by various factors, including infections like SARS-CoV-2. The diagnosis is based on clinical examination and palpation of MTPs, and treatment may include trigger point injections, physical therapy, and non-invasive therapy methods. In the presented case, the patient had partial adentia, leading to instability of the bite and MFPS symptoms after SARS-CoV-2 diagnosis. Prompt diagnosis and management of MFPS are necessary to improve the patient’s quality of life.

Right thoracoabdominal stab injury penetrating with injury of the internal thoracic artery: case report and lessons in penetrating knife wounds to the chest and abdomen

Vasyl Pronin — 2023-06-27

Abstract. Thoraco-abdominal and transmediastinal injuries are the most challenging injuries faced by surgeons. Aim. To acquaint medical practitioners with a clinical case of diagnosis and treatment of a rare variant of damage to the right internal thoracic artery in a thoraco-abdominal injury. Materials and methods. We present a clinical case of a rare variant of damage to the right internal thoracic artery in a thoraco-abdominal injury, which was complicated by a massive hemothorax, shock and DIC syndrome. Results. The work presents data on the examination and treatment of a patient with a thoraco-abdominal stab wound. A preliminary diagnosis was established: thoraco-abdominal stab wound on the right, hemorrhagic shock. The diagnosis was established based on the patient's complaints, medical history, physical examination data, available at the time of the examination, the results of laboratory and instrumental research methods. Damage to the liver, diaphragm, and internal thoracic artery was established intraoperatively. Clinical interest is not only the rarity of this injury - injury of the internal thoracic artery, but also the therapeutic and diagnostic tactics. Conclusions. We consider this case interesting and instructive. Each wound should be evaluated from the point of view of possible injury of large vessels, in the projection of which location it is localized. The primary surgical treatment of the wound should be carried out under the strict control of an experienced surgeon, especially if the wound is located in the projection of a large vessel. The integrity of the vessel and the absence of bleeding must be confirmed! Intraoperatively, any finding should be taken into account, correlated with possible injuries, and interpreted clinically (provide a logical explanation that satisfies the clinical situation). The decision regarding treatment tactics should be made by the operating surgeon (or a board of surgeons), immediately based on the clinical situation. The surgeon must be reactive and flexible, and have the ability to quickly change the approach according to the findings.

Influence of microbial colonization of the endometry on its function and development of hyperproliferative conditions

Dmytro Khaskhachikh — 2023-06-27

Abstract. The article provides an overview of literary sources that describe research on the microbiome of the endometrium in women of reproductive age. Thus, in many works, data is given indicating that the uterine cavity is not sterile. Various microorganisms can be found on the surface of the endometrium. So far, there is not enough research on microorganisms that can be considered a normal microbiome of the endometrium and its influence on the function and development of hyperproliferative processes of the endometrium in women. Many studies have proven the undoubted role of the uterine microbiome in the development of endometrial hyperplasia and other proliferative diseases. The cited studies indicate that 60 % of examined women with signs of microbial colonization caused by an infection of viral, bacterial, or fungal origin developed endometrial dysfunction, which led to the development of hyperproliferative processes. The study of the microbiocenosis of the uterine cavity in patients of reproductive age with various types of endometrial pathology indicates the role of certain pathogenic microflora in their occurrence. In all cases of atypical proliferation of the endometrium, an increase in the number of anaerobes up to 30 % was found among all isolated microorganisms, in particular, anaerobic bacteria of the genus Bacteroides spp. Representatives of the Enterobacteriaceae family (E. coli) and Gram-positive cocci (staphylococci and streptococci) prevailed among the aerobic flora. The largest spectrum of isolated microorganisms was found in patients with endometrial polyps. Studies of the immune system of the endometrium, which is formed to a greater extent due to the microbiome and directly participates in the cyclic changes of the endometrium, which are necessary for its physiological function during reproduction, are also presented. The immune system of the endometrium participates in the cyclic changes of the endometrium necessary for its physiological function in the process of reproduction. A proven factor is cells of the immune system and proper remodeling of spiral arteries, NK (neutrophil killer), T-lymphocytes and antigen-presenting cells (APC – antigen-presenting cell). A very important factor in the interaction between the gut microbiome and the immune system is the gut mucosa, and from this it can be inferred that similar connections may exist for the endometrium and its microbiome. Further studies of the state of the microbiome of the uterine cavity will allow adding information about its participation in functional processes and the pathogenesis of the development of hyperproliferative endometrial conditions.

The influence of transient loss of consciousness in children on the health-related quality of life indicators

Tetiana Kovalchuk — 2023-06-27

Abstract. Any acute, recurrent or inflammatory disease can cause numerous changes in various areas of a child's life from daily duties to emotional and cognitive development, self-esteem, and relationships with other people, as well as can negatively affect his/her contacts with peers, functioning in school or family. The aim of the study was the search for modern scientific achievements in the field of research on the quality of life among children with transient loss of consciousness and their families for a better understanding of the state of the possibilities of using this indicator in the evaluation of the effectiveness of the carried-out treatment and prevention measures. Materials and methods. The following terms were used for the search: «syncope», «epilepsy», «psychogenic transient loss of consciousness», and «quality of life», and «children» in the PubMed Medline and Scopus databases. Only English-language full-text articles published between January 2013 and December 2022 were included in the search. Results. During the past 10 years numerous studies have been published on health-related quality of life in children with epilepsy, and there was only one study among children with vasovagal syncope. Given the typically benign etiology of this disease, children are at high risk of psychological health worsening after experiencing a syncope episode. A diagnosis of epilepsy in early childhood has a profound effect on the child's psychological and physical development. It is important that epilepsy slows down the achievement of children's independence and complicates social relationships and cognitive processes. A number of authors drew attention to the lack of relationship between the quality of life and the frequency of psychogenic non-epileptic seizures in children and proved the key influence of depression and somatoform disorders on the reduction of quality of life. Conclusions. Health-related quality of life study is an important tool for the understanding of disease impact on child’s daily life and family members, which allows you to effectively recognize symptoms for the purpose of their timely correction, and is the final point in assessing the effectiveness of treatment and prevention measures, as well as quality of public health services. The relevance of further quality of life studies in children under the various types of syncope is due to the extremely limited results of observations in this group of patients.

Vacuum-therapy in the complex treatment of gunshot wounds: current aspects and prospects (review)

Kyrylo Parkhomenko — 2023-06-27

Abstract. Nowadays an effective treatment of gunshot wounds is an extremely urgent problem of the health care system. Ballistic injuries occupy a leading position in the structure of combat wounds. Moreover, they are associated with purulent-infectious complications, disability, which causes a long-time healing and rehabilitation of the patients. The vacuum-therapy method is used in clinical practice for reducing the frequency and severity of complications and cuttingthe wound process’s stages duration. At the same time, there is no consensus in the scientific community regarding the feasibility of vacuum therapy application for this type of injuries. The aim of our study was to analyze scientific literature data regarding the feasibility of vacuum therapy using in the complex treatment of gunshot wounds. Materials and methods. Open sources of scientific literature were processed, in particular, but not exclusively, the results of clinical studies, data from several studies to summarize and analyze information aboutvacuum therapy effect on cytological, biochemical, hematological, morphological and other parameters in patients with gunshot wounds. Results and discussion. The data of studied papers indicate that the vacuum-associated therapy method’sapplication allows almost two times accelerationof granulation tissue formation, more effective wound cleaning from necrotic tissues and microbial contamination, thereby significantly reducing of healing period duration. The mechanisms of these effects realization are multifactorial and include reduction of edema and exudate amount, normalization of local blood flow, change of local expression of growth factors related to angiogenesis, etc. Conclusions. Based on the data presented in the scientific literature, it is possible to conclude that vacuum therapy has a significant positive effect on the course of the wound process, compared to traditional schemes for gunshot wounds therapy, which reduced the frequency of complications and allowed to cut convalescence period in patients with gunshot wounds.

Emergent infection: atypical clinical cases of monkeypox (updated review)

Aniuta Sydorchuk — 2023-06-27

Abstract. The international emergency caused by monkeypox has forced the world to pay attention to this infection, as it has spread beyond endemic regions and no control measures have been developed. The virus began to be transmitted to humans not only by contact, but also by airborne droplets, fecal-oral, and vertical. There have been cases of in-hospital spread, outbreaks after eating contaminated animal meat, and swimming in water. Pregnant women, children under 8 years of age, and HIV-infected people require special attention due to the risk of complications. Therefore, it is important for doctors of all levels to be aware of new ways of spreading the infection, atypical manifestations of the disease for differential diagnosis, timely detection and further treatment. Aim. To conduct an up-to-date literature review of clinical cases of monkeypox in people at increased risk of developing atypical course and complications - in HIV-infected people (due to the virus's damage to the immune system) and children under 8 years of age (due to insufficiently formed immunity). Materials and Мethods. Scientific articles from the google scholar database were analyzed, among which 7 articles with 9 different case descriptions were selected to conduct an in-depth study of clinical cases among people from different non-endemic countries who have insufficient immunity (WHO experts consider African and Asian countries to be endemic). Results. Most of the atypical cases were observed among homosexual men receiving antiretroviral therapy or pre-exposure prophylaxis for HIV infection. The characteristic rash appeared after unprotected oral or anal sex on the corresponding body parts. As for the disease in young children who do not have their own immunity, the mechanism of transmission was contact or vertical. Conclusions. Our analysis of the literature shows the prevalence of monkeypox in the male gender group with non-traditional sexual orientation. Based on the analysis, HIV-infected homosexuals, mostly men, are the main risk group for infection with this emergent orthopoxvirus. At the same time, people with primary and secondary immunodeficiency conditions remain particularly vulnerable. It is important that the atypical clinical course complicates timely clinical and laboratory diagnosis and even the initiation of treatment, which can lead to severe and fatal complications (in endemic regions among children and debilitated HIV-infected persons). It is advisable to take timely anti-epidemic measures with the implementation of specific prophylaxis for vulnerable categories of persons (listed above, as well as occupational risk groups), along with an increase in epidemic surveillance and strict infection control in compliance with International Health Regulations at checkpoints along the entire state border.