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

LONG-TERM RESULTS FOR THE TREATMENT OF PATIENTS WITH THE APPLICATION OF ORGAN-PRESERVING OPERATIONS IN PAPILARY THYROID CANCER

A. G. Korkelia — 2019-01-08

Іn order to analyse the changes in the structural and functional state of the thyroid gland, a group of 185 patients (67.8 %) were examined after the surgical treatment of papillary thyroid cancer. Of these, 94 patients belonged to the first group – the comparison group where thyroidectomy was performed, and 91 to the second – the main group where, mainly, organ-preserving operations were performed. The average follow-up was 6.5 ± 5.1 years (varied from 2 to 11 years. Hypoparathyroidism in patients receiving replacement therapy was observed in 20 (16.4 %) patients after thyroidectomy and only in 4 (6.3 %) patients after organ-preserving techniques (the differences are significant, p < 0.05). Side effects of replacement therapy were observed in 21 (17.2 %) patients after thyroidectomy and only in 4 (6.3 %) patients after organ-preserving techniques (the differences are significant, p < 0.05). Disease recurrence was detected in 4 (3.3 %) patients after thyroidectomy and in 1 (1.6 %) patient after organ-preserving techniques (the differences are not significant, р > 0.05). The use of organ-preserving approaches in the main group allowed improving functional results by reducing the frequency of hypothyroidism and side effects of replacement therapy, due to the preservation of thyroid secretion and its regulation, without worsening the results of relapse-free survival

DIAGNOSTICS OF INFLAMMATORY INSIDE THE PLEURAL COMPLICATIONS OF THORACIC INJURY

E. V Kosov — 2019-01-08

The non-specificity of the clinical signs of posttraumatic purulent thoracic complications indicates the importance of instrumental diagnostic methods. There is no generally accepted algorithm for examining an injured person with a chest injury that would allow timely recognition of purulent complications in the posttraumatic period. The results of the examination of patients with intra-pleural complications of thoracic injury using the spiral computed tomography method, which in dynamics allows objectively documenting the dynamics of the pathological process, evaluating the effectiveness of treatment, timely diagnose secondary complications, are presented.

Тhe analysis of the results of the study indicates the need for a comprehensive examination of suspected post-traumatic intra pleural thoracic complications. In the presence of any manifestations of systemic inflammatory response in the posttraumatic period in patients with chest lesions, regardless of the results of the X-ray examination, ultrasound examination and computed tomography of the chest should be performed, which allows to detect the accumulation of pathological contents in the pleural and pericardial cavity, to assess the nature changes in the pulmonary tissue, mediastinum, thoracic wall and decide on the drainage of lesions fester. At the same time, for the correct interpretation of some changes in spiral computed tomography, including the lung abscess that developed in the background of pulmonary hemorrhages and mediastinitis against the background of hemorrhages in the mediastinum and pneumomediastinum, it is necessary to compare them with the baseline data. This testifies to the necessity of performing an early spiral computed tomographic examination in patients with chest lesions in the presence of any focal changes on the review X-ray. Spiral computer tomography of the chest in dynamics allows to objectively document the dynamics of the pathological process, evaluate the effectiveness of treatment, timely diagnose secondary complications. The application of this algorithm allows to diagnose the entire spectrum of intra-pleural complications in the early stages and to avoid diagnostic errors

CANDIDA ALBICANS AND STAPHYLOCOCCUS AUREUS CO-INFECTION IN MICE AFTER ANTIBIOTIC-INDUCED DYSBIOSIS

S. A Muradova — 2019-01-08

Microbial interactions in Staphylococcus aureus–Candida albicans dual-species biofilms is a relevant research topic given the significant contribution of these microorganisms to hospital-acquired infections. Therefore, the purpose of our investigation was to study the interaction of opportunistic C. albicans and S. aureus in vivo and in vitro, both with the participation of normal microflora and in mice with antibacterial dysbiosis. The study of mentioned interactions was carried out on 100 white male mice weighing approximately 18 grams in vivo and using smears prepared from the grown mixed cultures of C. albicans and S. aureus and the Japan JEM 1400 transmission electron microscope for the purpose of electron microscopic study of microorganisms in vitro. Healthy mice forming control groups and mice with antibiotic-induced dysbiosis (after introduction of vancomycin, gentamicin, ampicillin) were divided into groups to create a mono- and associative infection: Ι group was given 1×107 CFU of C. albicans, II group – 1×108 CFU of S. aureus, and III group – a mixture of specified concentrations of C. albicans and S. aureus in the same proportion. Microorganisms causing monoinfection were being isolated from the body of animals treated with antibiotics till the end of the experiments in large quantities unlike in case of the healthy mice. Co-inoculation of these microbes in the same dose to animals (co-infection), which were injected with antibiotics, turned out to be fatal for them, whereas an adhesive bond was seen between the cells of C. albicans vs. S. aureus in vitro. As can be seen, such bacterial-fungal co-infection reduce substantially the effectiveness of antibiotic therapy and the likelihood of successful treatment and can not be ignored when choosing the appropriate treatment

UNIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA AS A POTENTIAL PREDICTOR OF ARTERIAL HYPERTENSION DEVELOPMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

L. L Sherstyuk — 2019-01-08

The article presents the results of studies of markers of connective tissue dysplasia and the content of the main fibroblast growth factor in blood plasma in patients with type 2 diabetes. The presence of significant correlations between the studied parameters with the occurrence and progression of hypertension in patients with type 2 diabetes is established. A regression model for predicting the development of arterial hypertension is proposed in patients with diabetes mellitus.

The development of hypertension in patients with DM type 2 in combination with UCTD occurs earlier, is almost independent of the duration of diabetes, more pronounced hypertension is observed in patients with visceral and skeletal symptoms of UCTD. This is evidence of the role of UCTD in the pathogenesis of hypertension in patients with type 2 diabetes.

Essential role in the emergence and progression of hypertension in patients with DM type 2 is played by metabolic disorders of the connective tissue that manifests as clinical signs of UCTD. FGF2, which content is increased in patients with visceral and/or skeletal symptoms of UCTD, is involved in its pathogenesis.

The regression model of the prediction of hypertension in patients with DM type 2 with an assessment of the presence of UCTD signs and the duration of diabetes has a high prognosticity, specificity and sensitivity, which makes it possible to apply this method in clinical practice to determine patients with high risk of development of hypertension.

CONDITION OF LIPID PEROXIDE OXIDATION AND ANTIOXIDANT SYSTEM IN PATIENTS WITH INFECTIOUS MONONUCLEOSIS

N. F. Shustval — 2019-01-08

The indicators of the activity of lipid peroxidation and the antioxidant system were studied in dynamics in 158 patients with infectious mononucleosis depending on the severity of the clinical course of the disease. It is proved that lipid peroxidation is significantly activated in patients with infectious mononucleosis as the severity of the disease increases and therefore increases the oxidative activity of blood plasma, the concentration of dyne conjugates and malondialdehyde in the blood, decreases the activity of antioxidant enzymes of erythrocytes (catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase), glutathione peroxidase and glutathione reductase activity in plasma and lowering the concentration of total and reduced glutathione in the blood, as well as reduce the antioxidant activity of blood plasma and erythrocytes.

Lipid peroxidation significantly increase and the activity of the antioxidant system decrease in patients with infectious mononucleosis in the acute period of the disease, as evidenced by the increased concentration of dyne conjugates, malonic dialdehyde and total oxidative plasma activity in the blood, reduced activity of the total antioxidant activity of plasma and erythrocytes, the decrease in the activity of antioxidant enzymes of erythrocytes catalase, superoxide dismutase, glutathione peroxidase, glutathione peroxidase and glutathione reductase of blood plasma, the decrease in the concentration of glutathione in the blood.

The most pronounced disorders of lipid peroxidation and antioxidant system activity were found in patients with moderate-severe and severe infectious mononucleosis.

The development of cytolytic syndrome in infectious mononucleosis is associated with the action of reactive oxygen forms species and lipid hydroperoxide.

FEATURES OF CYTOKINE STATUS IN PATIENTS WITH CHRONIC EBV-INFECTIONS

O. G. Sorokina — 2019-01-08

Infections caused by EBV are the most common and occupy an important place in the structure of herpes aetiology diseases. The purpose of this work was to study the characteristics of the cytokine status in patients with chronic EBV infection, depending on the level of viral replication. We examined 78 patients with chronic EBV infection, the main clinical manifestations of which were various immunopathological and immunodeficiency states: Group I – with low, Group II – with medium, Group III - with a high degree of viral replication. The Tiff method was used using the Vector-Best reagent kits (Novosibirsk, Russia) to study the cytokine profile in the serum of patients with EBV infection. The determination of alpha and gamma fractions of serum interferon was carried out using the ELISA method by means of the ProCon IF2 plus reagent kit manufactured by Protein Contour LLC (St. Petersburg, Russia). As a result of a study of the cytokine status in patients with chronic EBV infection, it was found that in all three groups there was a significant increase in both pro-inflammatory (IL-1β, IL-6, TNF-α) and antiinflammatory cytokines (IL-10, IL 4, TGFβ1). However, anti-inflammatory cytokinemia was more compensated in group I patients compared with patients in groups II and III. A decrease in IFN-α and IFN-γ was detected in all patients with chronic EBV infection while studying the interferon status. A correlation was found between the level of viral replication and a decrease in the level of IFN-α and IFN-γ. The identified features of the cytokine status in patients with chronic EBV infection can be used to optimize therapy and help develop a differentiated approach to the immunocorrection of these patients, depending on the level of viral replication.

MODERN FEATURES OF CHICKEN POX COURSE IN ADULTS

O. V Volobuieva — 2019-01-08

The article presents the epidemiological and clinical data of the modern course of chickenpox. A high incidence among adults with a bright manifestation of the clinical picture was shown. Recurrent episodes of chicken pox were marked.

The modern course of varicella in Ukraine is characterized by an increase in the incidence among the adult population. Infection is manifested by a long prodromal period, a pronounced intoxication syndrome, lymphadenopathy, and an abundant polymorphic rash. At the same time, the rash had a pustular character in 54.3 % of patients; exanthema was observed with scleritis and conjunctivitis in 45 % of cases. There are repeated cases of chickenpox, the interval between these episodes ranged from 5 to 12 years.

Taking into account the epidemiological situation in the country it remains relevant to study main features of the course of chickenpox in individuals against the background of pulmonary tuberculosis, depending on the age and duration of the underlying disease.

PARAMETERS OF THE HEMODYNAMIC AFTER ABLATION ATRIAL FIBRILLATION AND/OR FLUTTER DEPENDING ON THE FUNCTIONAL CLASS OF CHRONIC HEART FAILURE

T. V. Zolotarova — 2019-01-08

Evaluated parameters of the hemodynamic before and after ablation atrial fibrillation and/or flutter depending on the functional class of chronic heart failure in 74 patients. It was found that patients with the I functional class of chronic heart failure have significantly lower left atrium size compared to III functional class, which is associated with the better efficiency of the radiofrequency ablation in the remote period. Patients with the I and III functional class of chronic heart failure are having increasement of QTc duration in acute period of radiofrequency ablation that could be used as an independent predictor of arrhythmia recurrence. Patients with the I functional class chronic heart failure who failed drug therapy for atrial fibrillation and/or flutter alternative treatment in the form of the radiofrequency ablation should be considered as choice therapy.

The levels of heart rate and pulse decreases in I and III functional class of the chronic heart failure in the acute period radiofrequency ablation; systolic and diastolic blood pressure, QRS, left ventricle end-diastolic and left ventricle end-systolic diameter do not change after radiofrequency ablation.

Patient I and III functional class of the chronic heart failure are having increasement of QTc duration in acute period of radiofrequency ablation that could be used as an independent predictor of arrhythmia recurrence.

Patients with I functional class of the chronic heart failure have significantly lower left atrium size compared to III functional class of the chronic heart failure, which is associated with the best outcome of effectiveness of radiofrequency ablation in the late period.

ANGINA PECTORIS AND MYOCARDIAL ISCHEMIA IN THE ABSENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE: CLINICAL CASE

M. M Karavanova — 2019-01-08

Our clinical case shows patient with worsening clinical signs of angina without obstructive lesions of coronary artery which requires further control. Recommendations for lifestyle modification as well as further treatment tactics are described.

This case is іnterestіng іn the development of decompensatіon (oedema of the lower extremities, reduced tolerance to stress) in a patient with cardiac syndrome X.

Management of patents with angina and evidence of myocardial schema on stress testing without obstructive coronary artery disease by angiography (previously referred to as cardiac syndrome X, or CSX) is a challenge.

Key points for the clіnіcіan include recognition of schema and deployment of guideline-endorsed therapy for angina and reduction of cardiac risk factors.

Systemic hypertension is often associated with mіcrovascular angіna. Several pathogenic mechanisms have been іdentіfіed which represent suitable targets for treatment. Mіcrovascular dysfunction needs to be іnvestіgated (and treated if present) іn patents with systemic hypertension, angina and angіographically normal coronary arteries.

ABDOMINAL COMPARTMENT SYNDROME IN BURN PATIENTS

I. V. Belozorov — 2019-01-09

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. Despite a large number of special publications devoted to this problem, very little attention is paid to the ACS in patients with severe burn injuries. Severe burns have been shown to be a risk factor for developing IAH. Fluid resuscitation practices used in burns management further predispose patients to increase intra-abdominal pressure. The incidence of intraabdominal hypertension in patients with severe thermal injury is, according to different authors, 57.8–82.6 %. The mortality associated with IAH in severe burns is very high once organ dysfunction occurs. The purpose of this work is to collect and analyze the problem of abdominal hypertension in burn patients, as well as to draw conclusions on the prevention of this condition and improve the results of treatment of patients with severe burn injury.

Intra-abdominal hypertension is a frequent complication in severe burn patients requiring massive fluid resuscitation. Development of ACS in burn patients is associated with high mortality. Prevention, early detection and proper management may avoid this usually fatal complication. Fluid resuscitation volume is directly responsible for the development of ACS in severe burned patients. Thus, optimal fluid resuscitation can be the best prevention of IAH and ACS.

AUTOLOGOUS PLATELET‐RICH PLASMA: A REVIEW OF SCIENTIFIC ARTICLES ON THE STUDY OF EFFICIENCY IN TREATMENT OF ANDROGENETIC ALOPECIA IN MEN AND WOMEN

Yu. S Ovcharenko — 2019-01-09

This article is an analysis of scientific publications that reflect the experience of using autologous plateletrich plasma in patients with androgenic alopecia (AGA), a multifactorial genetically predisposed disease caused by the influence of exogenous or endogenous triggers responsible for the clinical manifestations of pathology. Attention to this topic is due to the significant prevalence of AGA, as well as unsatisfactory results in achieving a positive therapeutic effect.

Positive results were obtained during the 12 clinical studies among the conducted ones, no positive dynamics were observed in the end of other 2 studies. It can be noted that different methods and parameters of centrifugation were used to perform these experiments: PRP used differ or PRP activators were not used at all, variations were observed in methods for evaluating the obtained results, the multiplicity of procedures and intervals between them, the procedure technique (using a mezoroller, anesthetics, injections, etc.). Studies with a negative result were characterized by the smallest number of procedures performed (1 or 2 procedures), and methods for evaluating the results cannot be called sufficiently reliable (a magnifying glass). It is obvious that the use of PRP has a positive effect on the state of AGA and can be used with approved methods of this disease treatment. However, the published results of only a small number of clinical trials on the effectiveness of PRP for hair growth cannot be considered objective. In addition, there is no published agreed protocol for the standard use of PRP, and the use of growth factors and stimulants in the expression of their genes still requires comparative evaluation with preparations approved for the treatment of hair. Thus, the method of PRP using can be considered as a method of treating AGA, however, it is necessary to continue research for further study and standardization of this technique.

ENDOGENOUS RETROVIRUSES AS GENETIC MODULES THAT SHAPE THE GENOME REGULATORY NETWORKS DURING EVOLUTION

M. M. Popov — 2019-01-09

Endogenous retroviruses (ERV) are the descendants of exogenous retroviruses that integrated into the germ cells genome, fixed and became inheritable. ERVs have evolved transcriptional enhancers and promoters that allow their replication in a wide range of tissue. Because ERVs comprise the regulatory elements it could be assume that ERVs capable to shape and reshape genomic regulatory networks by inserting their promoters and enhancers in new genomic loci upon retrotransposition. Thus retroransposition events can build new regulatory regions and lead to a new pattern of gene activation in the cell. In this review we summarize evidence which revealed that ERVs provide a plethora of novel gene regulatory elements, including tissue specific promoters and enhancers for protein-coding genes or long noncoding RNAs in a wide range of cell types. The accumulated findings support the hypothesis that the ERVs have rewired the gene regulatory networks and act as a major source of genomic regulatory innovation during evolution.

PATTERN-RECOGNIZING RECEPTORS AND THE INNATE IMMUNE RESPONSE TO VIRAL INFECTION

K. A. Veklych — 2019-01-09

The innate immune response to viral pathogens is crucial in mobilizing defensive reactions of an organism during the development of an acute viral infection. Cells of the innate immunity system detect viral antigens due to genetically programmed pattern-recognition receptors (PRRs), which are located either on the cell surface or inside the certain intracellular components. These image-recognizing receptors include Toll-like receptors (TLRs), retinoic acid-inducible gene I-like receptors (RIG-I-like receptors), nucleotide oligomerization domain-like receptors (NOD-like receptors), also known as NACHT, LRR and PYD domains of the protein, and cytosolic DNA sensors. The trigger mechanisms for these receptors are viral proteins, and nucleic acids serve as activators. The presence of PRRs that are responsible for the determination of viral antigens in cellular components allows the cells of innate immunity to recognize a wide range of viral agents that replicate in various cellular structures, and develop an immune response to them. This article summarizes the disparate data presented in modern English literature on the role of PRRs and the associated signaling pathways. Understanding the recognition of viral pathogens required triggering a cascade of cytokine and interferon production provides insights into how viruses activate the signal paths of PRRs and the effect of the interaction of viral antigens and these receptors on the formation of the antiviral immune response.