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

Prediction of prolonged course of infectious mononucleosis in children on the basis of structural organization of lymphocytes of blood

Yana Kolesnyk — 2019-09-30

Objectives. The article presents the results of research on the definition of criteria for predicting the adverse course of infectious mononucleosis (IM) in children on the basis of the structural organization of lymphocytes of blood.

Materials and methods. There were 68 children aged three to fifteen years suffering from IM under supervision. The diagnosis of IM was verified by PCR (detection of EBV DNA in the blood) and ELISA (anti-EBV Ig M and Ig G). The biophysical organization of the cytoplasmic membrane of lymphocytes was determined by the method of electron paramagnetic resonance (EPR) of spin probes using the method of additional broadening at microwave parameters 9.39 gHz, amplitude of high-frequency modulation 1 gauge, magnetic field scan time 200 sec, time constants 0.1 milliseconds (ms). Microviscosity of the intracellular environment of lymphocytes was determined by the mobility parameter of a water-soluble probe (nickel ferricyanide), which easily penetrates into the cytoplasm and in combination with extracellular paramagnetic ions, allows to evaluate the microviscosity of intracellular contents in relative units (r.u.).

Results. According to the results of observations, it is established that at the stages of manifestation of the disease there are pronounced violations of the biophysical organization of the structure of lymphocytes in the form of a decrease of viscosity and elastic properties of intracellular content and cytoplasmic membrane of lymphocytes. It was characterized by the fact that the average values of the penetration rate of the electron paramagnetic resonance of the spin probe (PR EPR s.p) in patients of both groups were significantly higher than the normative ones. In the group with smooth course, they exceeded the norm by 1.5 times, and in patients with prolonged course by 1.8 times, and the values of the microviscosity of intracellular contents (MIC) were significantly reduced compared to the control - by 22.1% in patients with a smooth course of the disease and 25.1% - with a prolonged course of IM.

Conclusions. In patients with prolonged course of IM these disorders were more pronounced than in the smooth course of the disease. In the period of convalescence, the indicators of the biophysical organization of the structure of lymphocytes of patients with a smooth course of IM did not differ from the norm, and in patients with a prolonged course of the disease, their reliable deviation was revealed.

Аnalysis of acute and early periods complications of traumatic disease in severe polytrauma

Mariia Matvieienko — 2019-09-30

Objective of the research is to assess the likelihood of complications in the acute and early periods of Traumatic Disease (TD) and primary condition and reserve capability of hemodynamic and homeostasis in patients with polytrauma.

Materials and methods. A retrospective study was carried out on 32 patients suffering from polytrauma. The group of the study included patients with the severity of injury according to the Injury Severity Score (ISS) more than 25 points and on a scale APACHE II 10-25 points at the time of admission. The estimated blood loss was 30-40% of blood volume (BV). The individual assessment of blood loss was calculated by Moor.

Results. The study of 20 (62.5%) men, 12 (37.5%) women aged 18 to 60 years old (35.22 ± 12.66) were done. The mechanical ventilation was performed for 30 patients (93.75%), and 2 patients (6.25%) required oxygen therapy 5 lit per min for 3 days. The duration of mechanical ventilation was in 10 patients - up to 1 day, 8 patients - up to 3 days and at 12 - more than 3 days. Among 12 patients, who used AMV more than 3 days, 10 patients were tracheostomy in 3d day and 2 patients were extubated on 4th day. Among the patients examined thirty patients (93.7%) had posthemorrhagic anemia during first day of injury. Infectious complications like purulent tracheobronchitis and pneumonia were observed in 14 (43.75%) patients. The local infectious complications (abscesses, festering wounds) occurred in 5 (15.6%) patients and bedsores in 3 (9,375%) patients. The catheterization of the bladder lead to the development of urinary tract infection in 3 patients (9,3%).

Conclusion. The most problematic category of victims includes patients with injuries several anatomical regions. Pneumonia, anemia, urinary tract infection and local infectious complications were considered as the most common complications of acute and early periods TD. The factors that influenced the probability of a high degree of complications were AMV, the thoracic component of the injury, more massive blood loss, long-term catheterization of the bladder.

Effect of unicornuate uterus on women's reproductive health

Nataliya Veresnyuk — 2019-09-30

Objectives. The effect of the unicornuate uterus on the reproductive health and quality of life of woman has been analyzed.

Materials and methods. The study included 26 patients with unicornuate uterus aged 25 to 42 years and 20 women without gynecological pathology. Diagnosis of uterine abnomalies was based on patient complaints, medical history and life history, as well as clinical and laboratory and instrumental examinations. The severity of dysmenorrhea was determined using a visual analogue pain scale, women's quality of life was assessed using a short SF-12 health questionnaire.

Results. The average age of the surveyed women was 30.2 ± 3.9 years. All patients with unicornuete uterus by subclasses were distributed as follows: subclass U4a (unicornuate uterus with rudimentary cavity) – 69.2% of patients, subclass U4b (unicornuate uterus without rudimentary cavity in the contralateral horn or with its aplasia) – 30.8%. In all patients was confirmed normal karyotype – 46XX. The combination of a unicornuate uterus with a defect of the urinary system (aplasia, doubling, or kidney dystopia) occurred in 23.1% of women. It has been found that in women with unicornuate uterus, clinical symptoms in 76.9% of cases are accompanied by dysmenorrhea. The unicornuate uterus in 69.2% of cases causes negative reproductive outcomes, among which 26.9% – early spontaneous abortions, 11.5% – ectopic pregnancy. In 46.2% of cases the unicornuate uterus is combined with other gynecological pathology, whereby the incidence of concomitant gynecologic pathology is significantly more frequent in U4a patients than in the U4b subclass (˂0.01). The severity of dysmenorrhea in the main group was 5.8 ± 1.8 points (the difference was significant compared with the control group, p = 0.0032).

Conclusions. Due to the low physical subunit, the unicornuate uterus significantly impairs the quality of life of women, which was significantly lower in the group of patients with unicornuate uterus compared to the control group (total SF-12 score: 85.4 ± 11.2 vs. 95.8 ± 12.1; p = 0.002).

Evaluation of an immunity status against measles of health workers in Kharkiv city

Andrii Volyanskiy — 2019-09-30

Objectives. The purpose of this article was to determine the intensity of immunity against measles among health workers in Kharkov to identify and vaccinate susceptible individuals.

Materials and methods. ELISA levels of specific measles IgG in blood serum of health workers were studied.

Results. It was shown that the largest number of measles-susceptible individuals is observed in the age group of 18 to 27 years (9 % do not have a protective level of antibodies (AT); 7.7 % have a dubious level of protection). In the age groups from 28 to 37 years old and from 38 to 47 years old, a rather large number of measles-sensitive health workers was also detected (6.9 % and 6.1 % - with the absence of a protective level of AT and 6.9 % and 5.1 % - with a dubious level of protection, respectively). The minimum number of measles unprotected health workers was determined in the group aged 48 to 57 years (0.9 % of negative and doubtful results), and among physicians older than 57 years, there were no individuals with a lack of protective levels of antibodies to measles virus.

Conclusions. Possible reasons for the prevalence of measles-unprotected health workers in the age groups from 18 to 47 years and the absence of unprotected people in the group of people over 57 are discussed. Doctors are a professional risk group for contracting infections (including measles). The article argues that there is no need for vaccination against measles for medical workers over 57 years old and vaccination of representatives of other age groups is recommended only after determining the strength of measles immunity, since more than 90 % of medical workers have protective levels of IgG.

Level of proinflammatory cytokines in children with various clinical forms of functional dyspepsia

Natalia Shevchenko — 2019-09-30

Objective was to study the level of tumor necrosis factor α (TNF-α) and interleukin 1α (IL-1α) in the blood of children with various forms of functional dyspepsia in accordance with various endoscopic changes of the gastric mucosa.

Materials and methods. 79 school age children with functional dyspepsia were examined. The diagnosis was made in accordance with the recommendations of the Rome Criteria IV (2016). All patients underwent endoscopic examination of the esophagus, stomach and duodenum to exclude destructive changes of the mucous membrane. The level of TNF-α and IL-1α in the blood serum was determined by enzyme immunoassay. Statistical processing of the results obtained was performed using Microsoft Excel 2010.

Results. The average level of TNF-α in the total group was 463.22±27.4 pg/ml, which statistically significantly exceeded this indicator in the control group (26.76±1.10 pg/ml; p<0.01). The IL-1α value in the total group was 148.6±6.06 pg/ml and was significantly higher in comparison with the control group (53.29±3.28 pg/ml; p<0.01). The level of proinflammatory cytokines in the group of children with epigastric pain syndrome was significantly higher than in the group of children with postprandial distress syndrome. Endoscopic examination showed the presence of unchanged mucous membrane in only 25.3% of children. Erythematous gastroduodenopathy was observed in 74.7% of children and was typical mainly for patients with epigastric pain syndrome (97.7%; p<0.05).

Conclusions. The level of pro-inflammatory cytokines in children with functional dyspepsia is increased. When comparing the clinical variants of the disease, a significant increase in the level of TNFα, and IL-1α in children with epigastric pain syndrome was found. In the same group of children, endoscopic changes in the gastric mucosa were more pronounced. Further study of changes in the level of pro-inflammatory cytokines in children with functional dyspepsia may allow this to be used as one of the methods for the differential diagnosis of functional dyspepsia and chronic gastritis

The role of endothelial dysfunction in children with pyelonephritis against fibrylogenesis disorders

Mariana Iskiv — 2019-09-30

Annotation: The prevalence of microbial inflammatory diseases of the urinary system, according to epidemiological studies, is 29.0 per 1000 children. Over the past decades, an unfavourable tendency towards an increase in the pediatric population of chronic pathology has been observed, treatment complicated by a significant pathomorphosis of the disease.

Aim of the research: analysis of the frequency of birth defects in the development of organs of the urinary system, as a visceral marker of violation of the fibrillogenase, in children with different variants of pyelonephritis.

Materials and methods: 148 children with pyelonephritis from 3 to 18 years were examined. According to the results of catamnestic observation, they were divided into 2 groups: I - 92 people, children with pyelonephritis, in which catamnesis was diagnosed 3 or more episodes of recurrence of pyelonephritis in 2 years, II - 56 children with pyelonephritis, in which for 2 years no relapse of the disease was noted. The control group consisted of 65 somatically healthy children of the same age. All children had a routine comprehensive clinical and laboratory examination and clinical and laboratory markers of fibrillogenic disorder (phenotypic signs of undifferentiated connective tissue dysplasia (UCTD), excretion of oxyproline with urine) were established.

Results: In children with recurrent pyelonephritis, phenotypic signs of undifferentiated connective tissue dysplasia.

For this purpose, the activity of endothelin-1 fraction, alkaline phosphatase and serum creatine phosphokinase, excretion of creatinine and glycosaminoglycans with daily urine in children with pyelonephritis was studied.

On average, the level of endothelin-1 in blood plasma in practically all children in group I was significantly higher (1.815±0.03 fmol/l, q=0.92, p≤0.01) more than in the 10th time, than in children with APN (0.179±0.02 fmol/l, q=0.78 p≤0.01) and healthy children (0.077±0.01 fmol/l, q=0.03).

Conclusions: In children with recurrent pyelonephritis, compared with the data of children with acute non-recurrent pyelonephritis, phenotypic signs of undifferentiated dysplasia of connective tissue were significantly more marked.

Thus, the negative role of UCTD in the course of pyelonephritis in children has been confirmed. It has been shown that UCTD in children with pyelonephritis is manifested not only by phenotypic features, but also by visceral, such as BD US, which leads to the chronization of the process with frequent relapses.

Bile leak syndrome after laparoscopic cholecystectomy

Yevgen Khvorostov — 2019-10-01

Aim of the study was the assasement of surgical treatment results of patients with cholelithiasis, who had external or internal bile leakage (BL), for the optimization and improvement of diagnostic programme and surgical tactic of minimally invasive techniques usage.

Materials and methods. Results of surgical treatment during the early postoperative period of patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC) were analysed.

Results. In early post-operative period 67 (0,6%) patients, mean aged 56,9 ± 7,4 had BL. 54 (81,0%) of them were women, 13 (19,0%) were men. 21 (31,3%) patients underwent LC due to chronic cholecystitis, 46 (68,7%) patients had acute cholecystitis. In 54 (81,0%) cases there was drainage bile leakage, in 13 (19,0%) cases bile collection in abdominal cavity was identified several days after drains ejection, due to clinical manifestation and ultrasonography data. 23 (34,3%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 35 (52,2%) patients, 9 (13,4%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi’s syndrome type I. 6 (9,0%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (1,5%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,0%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy.

Conclusion. Installation of drainage into the hepatic space and the right flank provide early diagnosis of postoperative complications, one of which is bile flow syndrome. Ultrasound examination of abdominal organs and endoscopic retrograde cholangiopancretography are performed to determine the cause and localization of the syndrome of the BL syndrome, depending on the volume of the BL. Repeated laparoscopy is indicated for the phenomena of bile peritonitis, significant accumulation of bile in the abdominal cavity. The complex usage of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomy operations to correct complications.

Research of dynamics of immune response indicators in patients with infectious mononucleosis caused by Epstein-Barr virus

Tetiana Liadova — 2019-10-01

Objective. The article is devoted to the study of the content of the main immune parameters in patients with infectious mononucleosis (IM) in the dynamics of the disease.

Materials and methods. A clinical examination of IM patients (n = 60) and patients of the control group (n = 20) included the study of complaints, epidemiological history, history of disease and life, objective examination, standard instrumental and laboratory studies in dynamics, detection of EBV DNA in saliva and blood serum, and a comprehensive analysis of immune parameters. The main subpopulations of peripheral blood lymphocytes (CD3 +; CD4 +; CD8 +; CD16 +; CD8 + CD28 +; CD8 + CD28-; CD20 +; CD25 +) were determined by flow laser cytometry on a FACS-Calibur apparatus (USA) using monoclonal antibodies. For identification of INF-γ (Th1-cells), IL-4 (Th2-cells) in the cytoplasm of T-lymphocytes, monoclonal antibodies INF-γ-PC-5, IL-4-PE (eBioscience, Beckman Caulter, R & D System) were used.

Results. A comprehensive study of the state of the subpopulations of reacting immune cells revealed significant violations of cellular parts of the immune response compared to the control group. It was established that the immune response in patients with IM during the height of the disease is characterized by an imbalance in the cell link (as evidenced by an increase in the content of CD3⁺, CD4⁺, and a simultaneous increase in the content of CD16⁺, CD25⁺). In the period of convalescence, violations have been identified that will persist without reaching the levels of the control group in a larger number of IM patients.

Conclusion. The results obtained indicate significant changes in the structural characteristics of the cellular immunity system and the multidirectional immune response in IM. The progressive character of changes in immune parameters in IM indicates the formation of a secondary cellular immune imbalance, a change in the balance of immunoregulatory mediators towards the Th2 link during the formation of protracted and chronic forms of EBV-infection.

Autoimmune reactions in the bronchial asthma in children induced heterophilic antigenes of microorganism of bronchopulmants

Viacheslav Chernuskyi — 2019-10-01

Introduction. At the present stage of development of the problem in the etiopathogenesis of bronchial asthma (BA) in children, regardless of form, one of the leading places belongs to the microbial factor.

Aim. The aim of the work was to study the development of autoimmune reactions to the cellular tissue structures of the trachea, bronchi and lung tissue, stimulated by heterophilic antigens of the microbiota of the bronchopulmonary system of children with BA.

Materials and methods. A total of 97 children with BA aged 7 to 15 years were examined. The diagnosis of the disease was established according to GINA (2017) and the order of the Ministry of Health of Ukraine dated 08.10.2013 No. 868. Heterophilic antigens of bronchopulmonary structures in microbiota were determined using hyperimmune organ-specific rabbit sera to antigens of the trachea, bronchi and lung tissue. Lipopolysaccharide antigens from homologous cell-tissue structures of the trachea, pulmonary bronchi were determined, water-salt antigens from the structures of the trachea, bronchi, and lung tissue were obtained from accidentally dead children with I (0) blood group. The level of autoantibodies to antigens of the bronchopulmonary system with the quantitative calculation of the indicator Qφ was determined in the nephelometric reaction.

Results. In the work it was shown experimentally that microorganisms, isolated from sputum of children, patients with asthma in the period of exacerbation, varying their antigenic potential, are able to include in their structure heterophilic antigens of cell-tissue structures of the bronchopulmonary system. Microorganisms including in their structure heterophilic antigens of the trachea, bronchi and lung tissue not only determine the induction of the pathological process in the bronchopulmonary system, but also translate it into an autoimmune basis, exacerbating the severity of the course of the disease.

Conclusions. The study showed that the proposed methods are important for clarifying the etiopathogenesis of BA in children and disclosing the mechanism for switching the pathological process in the bronchopulmonary system to an autoimmune basis and can be used to develop new approaches for the etiopathogenetic treatment of the disease.

Сongenital diseases of the heart among newborn children: genetic aspects

Yevgenia Shargorodska — 2019-10-01

Congenital heart defects are a heterogeneous group of diseases that occur as isolation or a part of multiple birth defects, gene disorders or chromosomal abnormalities. Chromosomal abnormalities and its underlying syndromes are the cause of 6 to 36% of cases of congenital heart defects. Monogenic etiology is proven in about 8% of cases, and the main group - about 90% of the congenital heart defects is the result of an unfavorable combination of genetic predisposition and external factors.

The causes of early neonatal infant mortality are dominated by incompatible birth defects: almost 26% of perinatal and neonatal deaths are associated with congenital child pathology. Heart defects compose about 30% of all birth defects. They rank first place among the diseases that lead to perinatal mortality and early disability.

World statistics show that the incidence of birth defects in the world is 9 per 1000 newborns, in Europe - 8/1000, which is 4 times more frequent than neural tube defects and 6 times higher than chromosomal abnormalities. In Ukraine, about 5,000 children with congenital heart defects are born each year, and the total number of those children on dispensary records reaches more than 45,000.

Knowledge about the prevalence of birth defects in the region is needed to develop new information markers of the risk of congenital pathology of the circulatory system for women of reproductive age. Data on the incidence of congenital heart defects of fetuses and newborns in the region will allow the creation of a database for follow-up studies, which will facilitate the timely identification of pregnant women at risk. This will improve the prognosis of pregnancy, reduce the level of perinatal pathology, which will have a significant medical and social effect. The data obtained will allow to create preconditions for improvement of approaches to the definition of risk groups of perinatal pathology, perfection of specialized care for pregnant women with risk of congenital heart defects of the fetus.