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╣3(54) // 2017

 

╬ßŕŰÓńŔÝŕÓ

 

1. Original researches

 

Optimization of lung cancer medical chemotherapy affected by radiotherapy

O. V. Siniachenko1, Yu. V. Dumansky1, O. Yu. Stoliarova2, V. A. Stepko1

1 Donetsk National Medical University, Lyman
2 National Cancer Institute, Kyiv 

╬bjective — ​to evaluate the results of ChT and the number of complications in patients with different variants of lung cancer (LC) course, to determine the most optimal approaches to treatment, to identify prognostic criteria in combined radiation therapy (RT).
Materials and methods. 783 patients with LC at the age of 26 to 86 (mean age — 60 years old), 82.6 % of men and 17.4 % of women, were under supervision. Any patient wasn’t operated on for LC previously, and after the diagnosis all patients received chemoradiotherapy. Lesion of upper lung lobes was found in 27.0 % of cases, lower ones — 15.3 %, upper­bottom localization on the left — in 18.7 %, middle­upper — 25.0 %, middle­bottom — 1.4 %, middle lobe — in 3.7 %. Central form of LC was determined in 78.9 % of the patients and peripheral form in 21.1 %. Small-­cell lung histology variant of the disease was detected in 17.6 % of the cases and non­small — in 82.5 %. IA disease stage was defined in 0.3 % of the patients, IB — 0.6 %, IIA — 1,1 %, IIB — 3.3 %, IIIA — 35.1 %, IIIB — 23.7 %, IV — 36.0 %.
Results and discussion. Platinum preparations, podophyllotoxins, anthracycline antibiotics, vinca alkaloids, antimetabolites, taxanes, camptothecins were used. In connection with RT use of vinca alkaloids, camptothecins and anthracycline antibiotics was the most potent for  LC. Life span of the patients who died was negatively associated with LC location and form, development of paracancerous exudative pleurisy, tumor invasion into the trachea, esophagus and chest wall. High doses of podophyllotoxins, antimetabolites and anthracycline antibiotics had positive influence and increased 3­year survival of the patients. Integral nature of ChT complications of LC was observed in every fourth patient and was significantly associated with combined radical radiotherapy to primary tumor, and only development of thromboembolic pulmonary artery branches was determined by the rate of chemotherapy. The most negative impact on the occurrence of complications had the groups of antimetabolites, anthracyclines, camptothecins, taxanes and podophyllotoxins, and among individual preparations — vincristine, gemcitabine, fluorouracil, cisplatin and etoposide. Parameters of tumor markers in the blood — transforming growth factor b1, C-­reactive protein, fibronectin and vascular endothelial growth factor can be prognostic criteria of side effects of chemotherapeutic agents in LC patients in connection with radiation therapy.
Conclusions. Further development of medical technology for optimal individual ChT of LC in connection with parallel use of radiation therapy will help reduce complications frequency and improve survival of patients, and dynamic study of tumor markers levels in blood can serve as prognostic criteria.

Keywords: lungs, cancer, chemoradiotherapy, treatment optimization.

List of references:  
1.    Ceniceros L, Aristu J, Castanon E, Rolfo C, Legaspi J, Olarte A et al. Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients. Clin Transl Oncol. 2015;55(8):213-9. doi: 10.1186/s13014-015-0417-5.
2.    Chang JY. Intensity-modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer. Semin Radiat Oncol. 2015;25(2): 10-6. doi: 10.1016/j.ijrobp.2016.01.036.
3.    Enomoto Y, Inui N, Imokawa S, Karayama M, Hasegawa H, Ozawa Y et al. Safety of topotecan monotherapy for relapsed small cell lung cancer patients with pre-existing interstitial lung disease. Cancer Chemother Pharmacol. 2015;76(3):499-505. doi: 10.1007/s10147-015-0897-1.
4.    Fan X, Jia C, Yang J, Li G, Mao H, Jin Q, Zhao J. A microfluidic chip integrated with a high-density PDMS-based microfiltration membrane for rapid isolation and detection of circulating tumor cells. Biosens Bioelectron. 2015;71(15):380-6. doi: 10.1016/j.bios.2015.04.080.
5.    Genestreti G, Di Battista M, Trisolini R, Denicolò F, Valli M, Lazzari-Agli LA et al. A commentary on interstitial pneumonitis induced by docetaxel: clinical cases and systematic review of the literature. Tumori. 2015;101(3):92-5. doi: 10.5301/tj.5000275.
6.    GrÓdalska-Lampart M, Karczmarek-Borowska B, Radziszewska AU. Lung cancer in Podkarpackie region in the years 2002-2011. Pneumonol Alergol Pol. 2015;83(2):109-19. doi: 10.5603/PiAP.2015.0018.
7.    Hamada T, Yasunaga H, Nakai Y, Isayama H, Matsui H, Fushimi K, Koike K. Interstitial lung disease associated with gemcitabine: A Japanese retrospective cohort study. Respirology. 2016;21(2):338-43. doi: 10.1111/resp.12665.
8.    Haseeb M, Hussain S. Pharmacophore development for anti-lung cancer drugs. Asian Pac J Cancer Prev. 2015;16(18):8307-11.
9.    Kong FM, Wang S. Nondosimetric risk factors for radiation-induced lung toxicity. Semin Radiat Oncol. 2015;25(2):100-9. doi: 10.1016/j.semradonc.2014.12.003.
10.    Kreuter M, Vansteenkiste J, Fischer JR, Eberhardt WE, Zabeck H, Kollmeier J et al. Three-year follow-up of a randomized phase ii trial on refinement of early-stage nsclc adjuvant chemotherapy with cisplatin and pemetrexed versus cisplatin and vinorelbine (the TREAT Study). J Thorac Oncol. 2016;11(1):85-93. doi: 10.1016/j.jtho.2015.09.014.
11.    Lian C, Li H, Denoeux T, Chen H, Robinson C, Vera P, Ruan S. MO-AB-BRA‑10: Cancer therapy outcome prediction based on dempster-shafer theory and pet imaging. Med Phys. 2015;42 (6):3549. doi: 10.1109/TBME.2017.2688453.
12.    Mądry R, Popławska L, Haslbauer F, Šafanda M, Ghizdavescu D, Benkovicova J et al. Results of a prospective dose intensity and neutropenia prophylaxis evaluation programme (DIEPP) in cancer patients at risk of febrile neutropenia due to myelosuppressive chemotherapy. Wien Klin Wochenschr. 2016;8(1):123-8. doi: 10.1007/s00508-015-0917-1.
13.    Molassiotis A, Bailey C, Caress A, Tan JY. Interventions for cough in cancer. Cochrane Database Syst Rev. 2015;19(5):007881.
14.    Pécuchet N, Legras A, Laurent-Puig P, Blons H. Lung cancer molecular testing, what role for Next Generation Sequencing and circulating tumor DNA. Ann Pathol. 2016;20(1):188-97. doi: 10.1016/j.annpat.2015.11.012.
15.    Santarpia M, Rolfo C, Peters GJ, Leon LG, Giovannetti E. On the pharmacogenetics of non-small cell lung cancer treatment. Expert Opin Drug Metab Toxicol. 2016;13(1):157-66. doi: 10.1517/17425255.2016.1141894.
16.    Shen B, Zhao K, Ma S, Yuan D, Bai Y. Topotecan-loaded mesoporous silica nanoparticles for reversing multi-drug resistance by synergetic chemoradiotherapy. Chem Asian J. 2015;10(2):344-8. doi: 10.1002/asia.201403117.
17.    Siva S, Callahan J, Kron T, Martin OA, MacManus MP, Ball DL et al. A prospective observational study of Gallium‑68 ventilation and perfusion PET/CT during and after radiotherapy in patients with non-small cell lung cancer. BMC Cancer. 2014;14(2):740-50. doi: 10.1186/1471-2407-14-740.
18.    Slotman BJ, van Tinteren H. Which patients with extensive stage small-cell lung cancer should and should not receive thoracic radiotherapy? Transl Lung Cancer Res. 2015;4(3):292-4. doi: 10.1016/j.lungcan.2017.03.007.
19.    Sun LM, Lin CL, Lin MC, Liang JA, Kao CH. Radiotherapy- and chemotherapy-induced myelodysplasia syndrome: a nationwide population-based nested case-control study. Medicine. 2015;94(17):737. doi: 10.1097/MD.0000000000002080.
20.    Surace L, Lysenko V, Fontana AO, Cecconi V, Janssen H, Bicvic A et al. Complement is a central mediator of radiotherapy-induced tumor-specific immunity and clinical response. Immunity. 2015;42(4):767-77. doi: 10.1016/j.immuni.2015.03.009.
21.    Wallerek S, Sţrensen JB. Biomarkers for efficacy of adjuvant chemotherapy following complete resection in NSCLC stages I—IIIA. Eur Respir Rev. 2015;24(136):340-55. doi: 10.1183/16000617.00005814.
22.    Waqar SN, Baggstrom MQ, Morgensztern D, Williams K, Rigden C, Govindan R. A phase i trial of temsirolimus and pemetrexed in patients with advanced non-small cell lung cancer. Chemotherapy. 2016;61(3):144-7. doi: 10.1159/000442147.
23.    Winther-Larsen A, Hoffmann L, Moeller DS, Khalil AA, Knap MM. Evaluation of factors associated with loco-regional failure and survival in limited disease small cell lung cancer patients treated with chemoradiotherapy. Acta Oncol. 2015;23(7):1-8. doi: 10.3109/0284186X.2015.1062135.
24.    Zhang H, Xia H, Zhang L, Zhang B, Yue D, Wang C. Clinical significance of preoperative neutrophil-lymphocyte vs platelet-lymphocyte ratio in primary operable patients with non-small cell lung cancer. Am J Surg. 2015;11(1):150-60. doi: 10.1016/j.amjsurg.2015.03.022.
25.    Zhang Q, Qin N, Wang J, Lv J, Yang X, Li X et al. Crizotinib versus platinum-based double-agent chemotherapy as the first line treatment in advanced anaplastic lymphoma kinase-positive lung adenocarcinoma. Thorac Cancer. 2016;7(1):3-8. doi: 10.1111/1759-7714.12264.
26.    Zhang X, Li H, Chen W, Yang Y, Wang C, Zhang Y. Efficacy and safety of chemotherapy for newly diagnosed advanced non-small cell lung cancer with venous thromboembolism. Thorac Cancer. 2015;6(6):772-7. doi: 10.1111/1759-7714.12278.

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Original language: Russian

2. Original researches

 

Clinical and functional features of pulmonary hypertension in patients with chronic obstructive pulmonary disease with concomitant ischemic heart disease

╬.╬. Krakhmalova, ╬.└. Hetman

SI «National Institute of Therapy named after L. T. Mala of the NAMS of Ukraine», Kharkiv

Objective — to study the features of clinical symptomatology, course and some functional parameters in patients with chronic obstructive pulmonary disease (COPD) and concomitant ischemic heart disease (▓HD) in the development of pulmonary hypertension syndrome (đH).
Materials and methods. In the study, 121 patients with a diagnosis of COPD and IHD were randomized to undergo all clinical trials, spirography, EchoCS to determine pulmonary arterial pressure (đA), Borg and mMRC questionnaires, and a 6­minute walk test. All patients were divided into two groups: the first group (63 patients) with an increase in the pressure in the đA, the second group of comparison — without đH (58 patients). The study included only patients who at the time of screening received stable therapy according to international and national standards. The study was conducted against the background of previously selected ▓HD therapy, and dose correction or replacement of the drug was not allowed without significant need. Spirometry was performed to all patients according to the standard procedure of determining the volume of forced exhalation for the first second (FEV1) out of the best three spent tests, the forced vital capacity (FVC) and the ratio of FEV1/FVC in % of the proper values.
Results and discussion. The subjects did not differ in sex, body mass index. The median age of the patients in the first group was higher than that of the control group, although the upper quartile of the age was higher in the comparison group, which might indicate that the development of đH with COPD required time. The duration of IHD was comparable in both groups. The duration of COPD at the time of inclusion in the study was not large and amounted to 5.5 (3.5—10.0) years in the first group and 4.0 (1.0—6.0) in the control group (p < 0.05). But in the first group, the presence of LH was statistically significant and  depended on the duration of COPD (U = 1150.0; Z = 3.4; p = 0.0006). This may indicate that even patients  with a short COPD history may suffer from đH.
Conclusions. In the development of pulmonary hypertension syndrome in patients with COPD with concomitant coronary artery disease, tolerance to physical activity is decresed, dyspnea, and atherosclerosis develop more aggressively. Functionally, the indicators of external respiration are lower in the group where the đH has developed. But đH develops with a longer history of COPD. Violation of lipid metabolism is more pronounced in the group with the presence of elevated pressure in the pulmonary artery, which, in turn, is associated with a decrease in the indicators of external respiration and the development of hypoxia. The clinical course of COPD is characterized by a large number of exacerbations in the development of đH compared with the control group.

Keywords: chronic obstructive pulmonary disease, ischemic heart disease, comorbidity, pulmonary hypertension syndrome, clinical features.

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Original language: Ukrainian

3. Original researches

 

Specific acpect of nitric oxide state violations in patients with ischemic heart disease in combination with nonalcoholic steatohepatitis in the dynamics of pathogenic treatment

I. M. Skrypnyk, G. S. Maslova, O. V. Shcherbak

Poltava Ukrainian Medical & Stomatological Academy

Objective — ​to study the nitric oxide (NO) state in patients with ischemic heart disease (IHD) and concomitant nonalcoholic steatohepatitis (NASH) in the dynamics of pathogenic therapy.
Materials and methods. 59 patients with IHD and concomitant NASH were examined. The liver function, lipid metabolism and nitric oxide system state were evaluated. Patients against the background of IHD basic therapy received ursodeoxycholic acid (UDCA) in combination with levocarnitine.
Results and discussion. We observed the most pronounced elimination of cytolysis syndrome, reduction of atherogenic dyslipidemia and endothelial dysfunction in patients with IHD in combination with NASH in the context of UDCA and levocarnitine administration  accompanied the  basic therapy.
Conclusions. Patients with IHD and concomitant NASH receiving basic therapy of IHD and combination of UDCA with levocarnitine had significant improvement of the functional liver state, lipid metabolism and endothelial function.

Keywords: nonalcoholic steatohepatitis, ischemic heart disease, endothelial dysfunction, nitric oxide, nitric oxide synthase, ursodeoxycholic acid, levocarnitine.

List of references:  
1.    Babushkyna YV, Serheeva AS, Pyvovarov YuY, Kurylskaia TE, Koriakyna LB. Strukturnˇe y funktsyonalnˇe osobennosty sosu­dystoho ňndotelyia. Kardyolohyia. 2015;2:82-86.
2.    Huberhryts NB, Klochkov AE, Lukashevych HM, Beliaeva NV, Ahybalov AN■ «Steatel»: ot nauchnˇkh faktov k klynycheskoi praktyke. Suchasna hastroenterolohiia. 2014;2(76):116-119.
3.    Dolzhenko MM, Bazylevych AYa, Volosheniuk IO, Konoplianyk LA. Konstyliatsiia ishemichnoi khvoroby sertsia i nealkoholnoi zhyrovoi khvoroby pechinky: pytannia patohenezu. Novosty medytsynˇ y farmatsyy: Kardyolohyia. 2011;6:1-3.
4.    Dolzhenko MN, Bazylevych AYa. Novˇe aspektˇ prymenenyia ursodezoksykholevoi kyslotˇ: vzghliad kardyoloha. Zdorove Ukraynˇ. 2015;2:56-58.
5.    Zviahyntseva TD, Hlushchenko SV. Lypotoksycheskyi stress y provospalytelnˇe tsytokynˇ kak faktorˇ razvytyia nealkoholnoho steatohepatyta. Farmatsyia. 2014;18(189):46-49.
6.    Zviahyntseva TD, Hlushchenko SV. Nealkoholnˇi steatohepatyt y metodˇ patohenetycheskoi korrektsyy. Hastroňntero­lohyia. 2014;2:29-32.
7.    Kolesnikova OV, Babak OYa, Solomentseva TA, Kurinna OH. Osoblyvosti vuhlevodnoho ta lipidnoho obminu u khvorykh na nealkoholnu zhyrovu khvorobu pechinky zalezhno vid stupenia kardiovaskuliarnoho ryzyku. Suchasna hastroentero­lohiia. 2013;6:7-12.
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9.    Skrypnyk IM, Dubrovinska TV. Komplaientnist do tryvaloi statynoterapii ta naslidky yii prypynennia u khvorykh na infarkt miokarda u poiednanni z nealkoholnym steatohepatytom. Ukr terapevt zhurn. 2014;2:33-39.
10.    Skrypnyk IM, Dubrovinska TV. Optymizatsiia dovhotryvaloho likuvannia rozuvastatynom u khvorykh na infarkt miokarda u poiednanni z nealkoholnym steatohepatytom. Likarska sprava. Vrachebnoe delo. 2014;5-6:60-67.
11.    Fadieienko HD, Chernyshov VA. Komorbidna patolohiia, shcho vplyvaie na sertsevo - ​sudynnyi ryzyk u postinfarktnykh khvorykh. Ukr ter zhurn. 2014;2:10-20.
12.    Kharchenko NV, Anokhyna HA, Kharchenko VV, Opanasiuk ND, Lopukh YYa. Patohenetycheskoe obosnovanye prymenenyia preparata «Hepadyf» u bolnˇkh nealkoholnˇm steatohepatytom. Suchasna hastroenterolohiia. 2011;6(62):66-71.
13.    Shadrychev FE, Hryhoreva NN, Zalevskaia AH, Shkliarov EB. Dyslypydemyia y dyabetycheskaia retynopatyia. Consilium medicum. 2012;6(11):44-46.
14.     Shcherbak OV, Maslova HS. Optymizatsiia likuvannia khvorykh na ishemichnu khvorobu sertsia u poiednanni z nealkoholnym steatohepatytom. Suchasna hastroenterolohiia. 2016;5(91):76-83.
15.     Shcherbak OV, Maslova HS, Skrypnyk IM. Osoblyvosti pato­henezu aterohennoi dyslipidemii u khvorykh na ishemichnu khvorobu sertsia u poiednanni z nealkoholnym steatohepatytom. Visnyk problem biolohii i medytsyny. 2017;2:199-203.
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17.    Chalasani N. The diagnosis and management of nonalcoholic fatty liver disease: Practice guideline by the American Gastro­enterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142(6):1592-1609.
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19.    Hevel JM. Purification of the inducible murine macrophage nitricoxide synthase. J Biol Chem. 1991;266(34):22.
20.    Malaguamera M, Gargante MP, Russo C. L-carnitine supple­mentation to diet: a new tool in treatment of nonalcoholic steatohepatitis - ​a randomized and controlled clinical trial. Am J Gastroenterol. 2010;105(6):1338-1345.

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Original language: Ukrainian

4. Original researches

 

Type 2 diabetes and coronary heart disease in women are comorbid pathology with increased risk of osteoporosis

L. M. Pasiyeshvili, A. A. Zazdravnov, N.╠. Zhelezniakova

Kharkiv National Medical University

Objective — to examine risk factors, prognosis and the specific aspects of osteopenic syndrome course in patients with type 2 diabetes mellitus (DM2) with concomitant stable coronary heart disease (CHD).
Materials and methods. 42 women with DM2 in the post­menopausal period were examined. 15 women with DM2 and concomitant CHD formed the main group; 27 women with DM2 without CHD formed the comparison group. The mean age of the patients in the main group was (56.4 ± 2.16) years, in the comparison group — (56.8 ± 2.22) years.
The duration of the history of DM2 was (7.1 ± 1.91) and (6.9 ± 1.79) years, respectively; the duration of menopause was (4.7 ± 0.91) and (4.4 ± 0.83) years, respectively. The parameters of mineral and lipid metabolism were studied by biochemical methods, bone mineral density (BMD) was studied by ultrasonic densitometry. The 10-­year probability of fractures was determined using FRAX questionnaire.
Results and discussion. Risk factors for osteoporosis (OP) as early menopause and smoking were more common for patients of the main group than in patients from the comparison group. These factors increase the risk of disease of both OP and CHD. High expressivity of these factors in the main group caused the earlier occurrence and progression of atherosclerosis in patients with diabetes, and created the prerequisites for metabolic disorders of bone tissue.
Under biochemical studies, a slight decrease of ionized calcium in the serum of the patients in the main group was detected. However, these changes were not significant but demonstrated a tendency.  Levels of total cholesterol and low­density lipoprotein cholesterol in patients from the main group were increased in comparison with those of the comparison group. BMD by T­test in patients with comorbid course of DM2 and CHD was significantly lower than in patients with uncomplicated DM2. The 10­year probability of development of OP-­dependent fractures of any location was also significantly higher in the main group of patients compared with patients with DM2 without concomitant CHD.
Conclusions. The problem of OP is vital for patients with comorbid course of DM2 and CHD. Risk factors for OP are more often recorded in patients with DM2 and CHD than in patients with isolated DM2. A number of risk factors have similarities and pluripotency for CHD and OP. Smokers with DM2 and CHD with early menopause and elevated levels of cholesterol and low­density lipoproteins form a risk group for OP. Concomitant CHD increases the probability of fractures in patients with DM2. Screening, prevention and treatment of OP in these patients is an important component of medical practice.

Keywords: type 2 diabetes, ischemic heart disease, osteoporosis, risk factors, pathogenesis, diagnostics.

List of references:
1.    Fracture risk assessment tool - ​FRAX [Electronic resource]. Access mode: https://www.sheffield.ac.uk/FRAX/tool.jsp?lang=rs. Title from the screen. Date viewed: 29.07.2017. (Rus).
2.    Klymentyeva GI, Kurnikova IA, Kuznetsova IA, Afonova TM. Type 2 diabetes and the problem of comorbid pathology. Kuban scientific medical bulletin. 2012;1(130):81-84. (Rus).
3.    Larin O, Kyryl│uk M, Tretiak O, et al. Osteoporosis: effect of age, sex, obesity and diabetes mellitus. Clinical endocrinology and endocrine surgery. 2014;1:3-14. (Ukr).
4.    Mistyakov MV, Bardimova TP, Tsyretorova SS. Diabetes mellitus and osteoporosis. Siberian Medical Journal (Irkutsk). 2015;6:47-52. (Rus).
5.    Diabetes mellitus type 2: from theory to practice / Ed. II Dedov, MV Shestakova. Moscow: MIA; 2016:571(Rus).
6.    Sergeeva VV, Dymnova SE. Effect of concomitant comorbid pathology on the development of osteoporosis in elderly patients. Bulletin of the International Scientific Surgical Association. 2017;6(2):5-11. (Rus).
7.    Bijelic R, Balaban J, Milicevic S. Correlation of the Lipid Profile, BMI and Bone Mineral Density in Postmenopausal Women. Mater Sociomed. 2016;28 (6):412-415. doi: 10.5455/msm.2016.28.412-415.
8.    Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation;115(1):114-126. doi: 10.1161/circulationaha.106.179294.
9.    Hough FS, Pierroz DD, Cooper C, Ferrari SL. Mechanisms in endocrinology: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus. Eur J Endocrinol. 2016;174(4):127-138. doi: 10.1530/EJE‑15-0820.
10.    International Osteoporosis Foundation. Fixed risk factors [┼ŰňಭţÝÝŔÚ ­ň˝ˇ­˝]. Access mode: https://www.iofbonehealth.org/fixed-risk-factors. Title from the screen. Date viewed: 29.07.2017.
11.    Lee SN, Cho JY, Eun YM, et al. Associations between osteoporosis and coronary artery disease in postmenopausal women. Climacteric. 2016;19(5):458-462. doi: 10.1080/13697137.2016.1200550.
12.    Lewiecki EM. Fracture Risk Assessment in Clinical Practice: T-scores, FRAX, and Beyond. Clinic Rev Miner Metab. 2010;8:101-112. doi:10.1007/s12018-009-9054-6.
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14.    Salari P, Abdollahi MA. Comprehensive review of the shared roles of inflammatory cytokines in osteoporosis and cardiovascular diseases as two common old people problem: actions toward development of new drugs. Int J Pharmacology. 2011;7(5):552-567. doi: 10.3923/ijp.2011.552.567.
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Original language: Ukrainian

5. Original researches

 

Ultrasound diagnostics of gastroesophageal reflux in the patients with bronchial asthma

I.V. Krasiuk, V.E. Kondratiuk, A.I. Krasiuk, G.V. Fedoryshyn   

╬.╬. Bogomolets National Medical University, Kyiv

Objective — ​to assess the efficacy of ultrasound imaging of the esophagus for diagnosing gastroesophageal reflux disease (GERD) in the patients with bronchial asthma (BA).
Materials and methods. 81 patients with bronchial asthma have been examined. Special diagnostic methods, including ultrasound imaging of the esophagus, have been used for the diagnosis of GERD.
Results and discussion. Contrast-enhanced ultrasound imaging of the esophagus allows to diagnose pathological gastroesophageal reflux in 88,8 % of the patients with clinical pattern of GERD. Moreover, ultrasound imaging of the esophagus demonstrates its efficacy for diagnosing a hiatal hernia that has been detected in 43.8 % of the study patients. The comparative analysis of ultrasound findings with the results of other instrumental studies has shown that pathological changes have been revealed in 3 cases during fibroesophagogastroduodenoscopy (FEGDS) and roentgenography of the esophagus and stomach while sonographic findings have been normal. Conversely, the signs of GERD have been defined in 3 out of 4 patients during the additional ultrasound imaging while FEGDS findings have been normal.
Conclusions. US of the esophagus has proved its high efficacy as the additional method for a primary GERD diagnosis. It is necessary to comprehensively examine the upper digestive tract of the patients with BA by means of ultrasound imaging of the esophagus.

Keywords: ultrasound imaging of the esophagus, gastroesophageal reflux disease, bronchial asthma.

List of references:
1.    Arutiunov AG, Burkov SG. Gastroesophageal reflux disease in the advanced age and elderly patients (Rus). Klinicheskie perspektivy gastroenterologii, gepatologii [Clinical perspectives of gastroenterology, hepatology] (Rus). 2005;1:31.
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4.    Brinke A, Sterk PJ, Masclee AA. Risk factors of frequent exacerbation in difficult-to-treat asthma. Eur Respir J. 2005;26(5):812-818.
5.    Cinquetti M, Micelli S, Voltolina Đ. The pattern of gastroesopha­geal reflux in asthma children. J Asthma. 2002;39(2):135-142.
6.    Dickman R, Fass R. Noncardiac chest pain. Clin Gastroenterol Hepatol. 2006;4:558-563.
7.    Ivannikov IO. Analysis of the symptoms in the patients with GERD. Eksperimental’ naya i klinicheskaya gastroenterologiya [Experimental and clinical gastroenterology] (Rus). 2004:11-14.
8.    Isakov VA, Morozov SV., Tsodikova OM. Extraesophageal signs of gastroesophageal reflux desease. Kachestvo zshizni. Meditsina [Life Quality. Medicine] (Rus). 2004;2:12-17.
9.    Kalinin AV. Gastroesophageal reflux disease: diagnostics, therapy and prophylaxis. Pharmateka [Pharmateka] (Rus). 2003;7:45-55.
10. Vasilyev YuV. Gastroesophageal reflux disease at the stage of reflux-esophagitis: diagnostics and therapy. Pharmateka [Pharmateka] (Rus). 2004;13: 34-38.

Original language: English

6. Original researches

 

The relationship of dysnatriemia with aldosterone indices, brain natriuretic peptide and parameters of cardiohemodynamics in patients with chronic heart failure and preserved ejection fraction

K.L. Lazidi, Yu. S. Rudyk, L. L. Peteneva

SI «National Institute of Therapy named after L. T. Mala of the NAMS of Ukraine», Kharkiv

Objective — ​to study the relationship of dysnatriemia with aldosterone, potassium ions, brain natriuretic peptide and parameters of cardiohemodynamics in patients with chronic heart failure (CHF) with preserved ejection fraction (PEF).
Materials and methods. The study included 97 patients with CHF II—III FC and LVEF at the age of 39 to 89 years. The results were processed using the statistical software package SPSS 17.0. Statistically significant differences in the data and correlation between them were considered for p ≤ 0,05.
Results and discussion. An increase of sodium concentration in serum of patients  with CHF and PEF was associated with an increase of  aldosterone content and a decreased level of potassium ions. Evaluation of the parameters of heart rate, systolic and diastolic blood pressure in the compared groups did not reveal any differences. Echocardiographic parameters in patients with CHF and PEF were not associated with the level of sodium in  serum.
Conclusions. The sodium increase in serum in patients was accompanied by an increase in the content of heart failure marker NT-­proBNP, which may indicate the likely role of electrolyte disorders in the pathogenesis of heart failure in this category of patients. Parameters of life quality and exercise tolerance are higher in patients with CHF and PEF in the range of serum sodium from 139.4 to 149.7 mmol/l, compared with Na values that go beyond these limits. Assessment of the clinical significance of minor differences in echocardiographic parameters in patients with different levels of serum sodium requires further studies.

Keywords: dysnatriemia, chronic heart failure, preserved ejection fraction, aldosterone, brain natriuretic peptide.

List of references:  
1.    Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1581-1589.
2.    Aronson D, Verbalis JG, Mueller M, et al. Short- and long-term treatment of dilutional hyponatriemia wuthsatavaptan, a selective arginine vasopressin V2-receptor antagonist: the DILIPO study. Eur J Heart Fail. 2010;13:326-336.
3.    Barsony J, Sugimura Y, Verbalis JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem. 2011;286:10864-10875.
4.    Binanay C, Califf RM, Hasselblad V, et al. ESCAPE Investigators and ESCAPE Study Coordinators. Evaluation Study of Congestive Heart Failure and Pulmonary ArteryCatheterization Effectiveness: the ESCAPE trial. JAMA. 2005;294:1625-1633.
5.    Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J. 2007;28:980-988.
6.    Gheorghiade M, Gattis WA, O’Connor CM, et al. Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Congestive Heart Failure (ACTIV in CHF) Investigators. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291:1963-1971.
7.    Gheorghiade M, Gattis WA, O’Connor CM, et al. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291:1963-1971.
8.    Gheorghiade M, Konstam MA, Burnett JCJr, et al. Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials. JAMA. 2007;297:1332-1343.
9.    Gheorghiade M, Niazi I, Ouyang J, et al. Tolvaptan Investigators. Vasopressin V2-receptor blockade with Tolvaptan in patients with chronic heart failure: results from a double-blind randomized trial. Circulation. 2003;107:2690-2696.
10.    Gheorghiade M, Rossi JS, Cotts W, et al. Characterization and Prognostic Value of Persistent Hyponatremia in Patients With Severe Heart Failure in the ESCAPE Trial. Arch Intern Med. 2007;167:1998-2005.
11.    Gottlieb SS, Abraham W, Butler J, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Cardiol Fail. 2002;8:136-141.
12.    Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337:169-172.
13.    Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999;106(4):399-403
14.    Klein L, O’Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation. 2005;111:2454-2460.
15.    Konstam M, Gheorghiade M, Burnett J, et al. Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure: The EVEREST Outcome Trial. JAMA. 2007;297:1319-1331.
16.    Kovesdy CP, Lott EH, Lu JL, et al. Hyponatriemia, hypernatriemia and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125:677-684.
17.    Lee DS, Austin PC, Rouleau JL, et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290:2581-2587.
18.    Mahammed AA, van Kimmenade RR, Richards M, et al. Hyponatriemia, natriuretic peptides, and outcomes in acutely decompensated heart failure: results from the International Collaborative of NT-proBNP Study. Circ Heart Fail. 2010;3:354-361.
19.    Mastorakos G, Weber JS, Magiakou MA, et al. Hypothalamic–pituitary–adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin‑6 in humans: potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endocrin Metabol. 1994;79:934-939.
20.    Park SJ, Shin JI. Inflammation and hyponatremia: an underrecognized condition?. Korean J Pediatr. 2013;56:519-522.
21.    Rusinaru D, Tribouilloy C, Berry C, et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure with preserved and with rediced ejection fraction: an individual patient data meta-analysis. Meta-analysis Global Group in Chronic heart failure (MAGGIC). Eur J Heart Fail. 2012;14:1139-1146.
22.    Schrier RW. Body water homeostasis: clinical disorders of urinary dilution and concentration. J Am Soc Nephrol. 2006;17:1820-1832.
23.    Shah MR, O’Connor CM, Sopko G, et al. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE): design and rationale. Am Heart J. 2001;141:528-535.
24.    Shchekochikhin DY, Schrier RW, Lindenfeld J, et al. Outcome Differences in Community-versus Hospital-Acquired Hyponatremia in Patients with a Diagnosis of Heart Failure. Circulat Heart Fail. 2013;6 (3):379-386.
25.    Wald R, Jaber BL, Price LL, et al. Impact of hospital-associated hyponatriemia on selected outcomes. Arch Intern Med. 2010;170:294-302.

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7. Original researches

 

To the issue of the risk assessment of ischemic heart disease in patients with concomitant pathology after myocardium surgical revascularization at the recovery treatment stage

O.V. Kolodenko

Ukrainian Research Institute of Medical Rehabilitation and Balneology of Ministry of Health of Ukraine, Odesa

Objective — to develop a risk assessment of  coronary heart disease progression(CHD) in patients with concomitant pathology after myocardium surgical revascularization of the (MSR) at the stage of renewal treatment (RT).
Materials and methods. 170 patients with coronary artery disease and concomitant pathology, after the myocardium surgical revascularization, received the standard medicamental therapy complex at the treating­recovery complex «Bila acacia» (Odesa city, Ukraine). Patients of the main group (n = 135) were divided into 3 subgroups, depending on the concomitant pathology: subgroup of 1 to 45 patients with concomitant arterial hypertension (AG); subgroup of 2—50 patients with diabetes mellitus (DM); Subgroup of 3—40 patients with concomitant gonarthrosis. The control group consisted of 35 patients with coronary artery disease who did not have concomitant pathology. The research algorithm (before and after treatment) included the collection of anamnesis, dynamic clinical observation of objective and subjective state of patients, laboratory diagnostics, psychological state (scale HADS), life quality was evaluated by SF 36 scale and integral evaluation before and after the RT. The course of RT included: medical treatment, a mode of motor activity burning­coaching, climatic, diet, physiotherapy (magnetolazerotherapy), balneotherapy («dry» carbonic baths) and exercise therapy. The course of treatment was 21 days.
Results and discussion. In 55.2 % of patients with CHD and concomitant pathology after MSR, who came for RT, were overweight, 65.3 % had dyslipidemia, increased leptin levels was observed in  all patients with coronary heart disease and concomitant pathology after surgical PM, especially in patients with concomitant diabetes mellitus — almost 2.5 times. The integral index in the beginning of RT increased in the group of patients with concomitant diabetes in 2.4 times compared to patients without concomitant pathology, and by 15.7 and 41.1 % compared with patients with concomitant hypertension and OA. After RT there was significan decrease of this indicator in all groups.
Conclusions. Integral assessment of the risk of IHD progression in patients with concomitant pathology after MSR is necessary. RT in these patients reduces the risk of progression of coronary artery disease.

Keywords: ischemic heart disease, myocardium surgical revascularization, renewal treatment, concomitant pathology, integral assessment, risk of progression.

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8. Original researches

 

Evaluation of electronic nicotine delivery systems effects on cardiovascular disease risk according to 6şmonth study

Ye. A. Kvasha, O. V. Sribnaya, I. P. Smirnova, I. V. Tretyak, A. A. Boroday

SE «National Scientific Centre “M. D. Strazhesko Institute of Cardiology”, Mas of Ukraine», Kyiv

Objective — to study the dynamics of the the vascular wall endothelium functional state indices and the factors determining it, for smokers of long­term (6 months) use of electronic nicotine delivery systems (ENDS).
Materials and methods. An open local 6­month study included 60 smokers men and women (49 and 11 people respectively) over the age of 18 who were examined within the epidemiological screening of unorganized urban population. All participants had more than 15 years smoking experience and smoked 15 cigarettes and more each day. According to the protocol, three groups of 20 people were formed: Group I, as an alternative to traditional smoking, used the iQOS tobacco heating system, Group II switched to electronic cigarettes Joyetech eGo AIO and Group III continued to smoke traditional cigarettes in their usual mode. The certified ENDS in Ukraine was used. The participants’ survey included: measurement of anthropometric indicators followed by calculation of the Quetelet index (IC), assessment of motivation degree to quit smoking, nicotinic dependence (Fagerstrem test) and the type of smoking behavior (D. Horn questionnaire), recording of an electrocardiogram at rest in 12 standard leads, blood pressure (BP) with a sphygmomanometer. All participants underwent a complete examination in the beginning, and also after 3 and
6 months of the program.
Results and discussion. In a comparative analysis of the groups, a 6­month follow­up showed an increase in flux­dependent vasodilatation (HDV) among all tested subjects, with the exception of those who continued to smoke without reducing intensity. For example, in the iQOS and cigarette sharing group, the increase in HVAC was 15.7 %, while among iQOS only, Δ of this indicator was 20.3 %. Among those surveyed using ES and partially continue smoking, the increase in the level of HVMD was 23.3 %, in a smokers group this index increased only by 8.0 %, but, as a more detailed subanalysis showed, this positivization of the results is due to reduced number of cigarettes smoked. The most impressive indicator of HDV has improved in the group of only electronic systems users: by 20.6 % and 25 % among users of iQOS and ES, respectively. The greatest increase in HDAP in association with a decrease in the level of PSA as an indicator of systemic inflammation (by 25 %) and a decrease in the concentration of KPI (an average of about 20 %) and ET-1 (especially expressively this figure decreased among users only ES — by 14.0 %) are indisputable markers of endothelial function improving, both in the group sharing ES and traditional cigarettes, and among users ES only. At the same time, among the subjects who did not decrease the TC intensity, there was a tendency to increase the S-RP concentration by 5.0 %, KPE by 3.5 %, an increase in the ET­-1 concentration, accompanied by a low level of HDVD (10.1 and 10.3 % at 6 months of follow­up, respectively), indicating a possible progression of endothelial dysfunction under the influence of tobacco smoke components.
Conclusions. The transition to electronic nicotine delivery systems and the introduction of nicotine into the body with the elimination of the damaging effect of cigarette smoke makes it possible to avoid disturbances in the oxygen transport function of the blood, damage of the vascular endothelium, and the development of pro­atherogenic changes in the metabolism of lipids and blood lipoproteins. When combined with traditional smoking, the protective effect is manifested in a weakened form.

Keywords: smoking, electronic nicotine delivery systems, endothelial function, cardiovascular disease.

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9. Original researches

 

Comparative assessment of multidirectional approaches to the treatment of adolescents with psychosomatic disorders

N.V. Ratsiborinska-Polyakova, ╬.▓. Masik

National Pirogov Memorial Medical University, Vinnytsya

Objective — determine the effectiveness of various therapeutic approaches in the treatment of psychosomatic disorders in adolescents.
Materials and methods.  60 (3 groups) adolescents (18 boys and 42 girls) with psychosomatic disorders  were examined with comprehensive clinical psychopathological examination. The mean age of adolescents was (14.9 ± 2.0) years old. The 1-st group consisted of adolescents treated at the regional children’s clinical hospital, who received treatment with Sertraline 25 mg/day at the age from 12 to 16 years  and 50 mg/day — children over 16 years old. The duration of treatment was 1.5—2 months. Adolescents of the 2­nd group received treatment with Lamotrigine in the dosage of 1—3 mg/kg/day. Adolescents of the 3­rd group (14 person) were prescribed Lamotrigine therapy in combination with psychotherapy. Control of therapeutic effectiveness was evaluated by Spielberger anxiety questionnaire (STPI — State Trait Personal Inventory), Phillips’ school anxiety test and CDI scale (Children Depression’s Inventory) by M. Kovacs. Statistical processing of the obtained research results was carried out on the basis of the computer program Statistica 6.1 (Stat Soft Inc., USA).
Results and discussions. The vast majority of children (75.0 %) had low or optimal levels of school anxiety. The anxiety level on all scales of Spielberger anxiety questionnaire moved to an average level of anxiety after medication, except situational negative experiences, which remained at a high level. The anxiety test scores decreased to an average level after complex treatment. At the same time the level of personal cognitive activity remained high, that confirmed the positive effect of combined treatment of psychosomatic disorders due to increased interest, curiosity, interest, which activate cognitive activity of adolescents. The analysis of school anxiety by Philips test identified that in adolescents of the 1­st and 2­nd groups the fear of self­expression decreased significantly comparing it before treatment. Complex treatment of psychosomatic disorders significantly increases the adaptive capacity of an organism to stress factors. The level of depression in the 1­st and 2­nd groups of adolescents after the treatment was (2.16 ± 0.16), which corresponded to the level of subdepression or masked depression with high scores on scale B. Against the background of combined treatment in adolescents the level of depression decreased to (1.71 ± 0.12), which corresponded to slight decrease of mood with high scores on scale B. Adolescents with psychosomatic disorders who responded positively to psychotherapy were characterized by low level of somatization (p < 0.05), but higher specific weight of psychological problems and difficulties in interpersonal relationships (p < 0.01) in the internal picture of the illness with peaks at subclasses of interpersonal sensitivity and hostility.
Conclusions. Pharmacology therapy of psychosomatic disorders with the help of both drugs Sertraline and Lamotrigine, has a positive effect on the severity of mental disorders in adolescents: reduction anxiety and fear of self­expression to average level, depression — to subdepression or masked depression. The combined therapy with the help of medication and psychotherapy of psychosomatic disorders in adolescents provided a surely with better result: it increased the adaptive capacity of the body to stress, the personal cognitive activity, which manifested with low level of somatization, reduced the level of depression to a mild level of mood decreasing and anxiety level decreasing to the average level.

Keywords: psychosomatic disorders, adolescents, psychotherapy, clientşcentered therapy.

List of references:  
1.    Ann LF. Psikhologicheskii trening s podrostkami. SPb. Piter;2007:272.: il. (Seriya Effektivnyi trening).
2.    Burlai VH, Kukhta NM, Misiura LI, ta in. Vehetatyvni dysfunktsii u ditei: pidsumky provedenykh doslidzhen [Tekst]. Pediatriia, akusherstvo ta hinekolohiia. 2006;2:24-27.
3.    Volosovets OP, Savvo VM, Kryvopustov SP. Vybrani pytannia dytiachoi kardiorevmatolohii [Tekst] / za red. OP Volosovtsia. K. NMU;2006:256.
4.    Golovina AG. Farmakologicheskie podkhody k vedeniyu podrostkov s fobicheskimi rasstroistvami. Sovremennaya terapiya v psikhiatrii i nevrologii. 2012;3:13-17.
5.    Dmitrieva TB. Psikhiatriya: natsional’noe rukovodstvo / pod. red. TB Dmitrievoi, VN Krasnova, NG Nezianova, VYa Semke, AS Tiganova. M. GEOTAR-Media; 2009:1000.
6.    Kryhina LO. Diahnostyka rozladiv povedinky (F 91) u nepovnolitnikh pravoporushnykiv (na materiali statsionarnykh kompleksnykh sudovykh psykholoho-psykhiatrychnykh ekspertyz. Arkhiv psykhiatrii. 2013;2(73):97-100.
7.    Kudinova EI. Klinika, diagnostika i terapiya somatoformnykh rasstroistv [Tekst]. Ukrainskii zhurnal Muzhskoe zdorov’e, gendernaya i psikhosomaticheskaya meditsina 2015;1-2(02):45-52.
8.    Lebedeva UV. Osnovy psikhosomaticheskoi meditsiny. Razrabotki k seminarskim zanyatiyam dlya studentov 6 kursa lechebnogo i sportivnogo fakul’tetov / Pol red. UV Lebedevoi, NG Neznanova, LI.Vassermana. SPb: Izd-vo SPbGMU im. akad. IP Pavlova, 2008.
9.    Maidannyk VH, Smiian OI, Bynda TP, Savelieva-Kulyk NO. Kliniko-patohenetychna kharakterystyka vehetatyvnykh dysfunktsii ta yikh likuvannia u ditei: navchalnyi posibnyk [Tekst] / za red. prof. VH Maidannyka. Sumy; Sumskyi derzhavnyi universytet, 2013:173.
10.    Makarycheva GI. Trening dlya podrostkov: profilaktika asotsial’nogo povedeniya. SPb. Rech’; 2008;192.
11.    Maksymova NYu, Hrys AM, Manilov IF, ta in. Psykholohichni mekhanizmy adaptatsii deviantiv do suchasnoho sotsiokulturnoho seredovyshcha: monohrafiia / za red. NYu Maksymovoi. K. Pedahohichna dumka; 2015:254.
12.    Mozghova HP. Psykhosomatychni zakhvoriuvannia u ditei ta pidlitkiv. Diahnostyka ta reabilitatsiia. K; 2009:261.
13.    Mostova OP. Psykhosomatyka v klinitsi vnutrishnikh khvorob Multydystsyplinarnyi pidkhid v likuvanni psykhichnykh i povedinkovykh rozladiv. Novosti meditsiny i farmatsii. 2009;16(290):9.
14.    Rakhmanov VM, Rakhmanov RV, Shchuklina AH, i dr. Somatoformnaia vehetatyvnaia dysfunktsyia y stepeny ee razvytyia [Tekst]. Ukrainskyi visnyk psykhonevrolohii. ​2007;15(1(50)), dodatok. Kharkiv:231.
15.    Rymsha SV, Pypa LV, Svistilnik RV, Lysytsia YuM. Depresiia i poviazana z neiu suitsydalna povedinka v ditei i pidlitkiv: suchasni uiavlennia i stan problemy. Chastyna 2 [Tekst]. Zdorovia dytyny. 2014;7(58):66-70.
16.    Slobodianiuk IA. Osnovy kliient-tsentrovanoi terapii. Navchalnyi posibnyk. K.: Navchalno-metodychnyi tsentr Konsortsium iz udoskonalennia menedzhment-osvity v Ukraini, 2012:136.
17.    Smiian OI, Savelieva-Kulyk NO. Stan mikroelementnoho zabezpechennia pry vehetatyvno-sudynnykh dysfunktsiiakh u ditei: monohrafiia [Tekst]. Sumy. Sumskyi derzhavnyi universytet; 2012:98.
18.    Khaustova OO. Psykhosomatychnyi pidkhid do porushen vehetatyvnoi nervovoi systemy u zahalnii likarskii praktytsi [Tekst]. NeiroNews. 2016;2/1:34-39.
19.    Chernyshov OV. Kompleksnaya psikhofarmokoterapiya dismorfnykh bolevykh oshchushchenii u podrostkov s psikhicheskimi rasstroistvami [Tekst]. Integrated psychopharmacotherapy dismorfing pain in adolescents with psychiatric disorders. Journal of Education, Health and Sport. 2015;5(8):210-218.
20.    Chernyshev OV. Psikhofarmakoterapiya bolevogo sindroma podrostkov pri nepsikhoticheskikh psikhicheskikh rasstroistvakh. Vestnik YuKGFA. 2015;1(70):10-14.

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10. Original researches

 

Rate and possible prognostic factors of pulmonary sarcoidosis regression in the course of glucocorticosteroid therapy

V. K. Gavrysyuk, O. V. Bychenko, E. O. Merenkova, G. L. Gumeniuk

SI «National Institute of Phthisiology and Pulmonology named after F. G. Yanovskiy of NAMS of Ukraine», Kyiv

Objective of the study — an evaluation of the most probable factors of unfavourable prognosis considering the rate of sarcoidosis regression.
According to literature data such factors include: presence of clinical signs of sarcoidosis (respiratory symptoms, fatigue); high density small nodule dissemination in lung parenchyma; lung function disturbances; hypercalcemia.
We performed a retrospective analysis of clinical, spirometry, computed tomography (CT) data, including lung parenchyma densitometry, and serum calcium concentrations in 80 patients  recovered  stage II sarcoidosis, after the completion of standard glucocorticosteroid therapy course. All cases were relatively similar in terms of lung parenchyma lesions morphology: the predominant one was a pattern of small nodule dissemination without atypical findings.
A period of time between the therapy onset and clinical cure was considered as an indicator, reflecting the rate of sarcoidosis regression. It was calculated based on retrospective comparison of CT scans, taken every 3 months of therapy.
It was revealed that one of the factors of unfavourable prognosis, regarding the rate of sarcoidosis regression, was the presence of high density (> –800 HU) dissemination CT scans and/or lung ventilatory function failure. The presence of these factors in the the disease onset slowed down the regression of sarcoidosis by 1.4—1.75 months. The presence of clinical symptoms and hypercalcemia at initial examination had no significant influence on the rate of regression of disease during the course of glucocrticosteroid therapy.

Keywords: pulmonary sarcoidosis, glucocrticosteroid therapy, rate of regression, prognostic factors.

List of references:
1.    Gavrysiuk VK, Gumeniuk GL, Merenkova EA. Kompiuternaya tomograficheskaya densitometriya v algoritme lecheniya bolnikh sarkoidozom (Rus). Ukrainskyy pulmonologichnyy zhurnal [Ukr Pulmonol J] (Ukr). 2015;2:27-31.
2.    Gavrysiuk VK, Gumeniuk GL, Merenkova EA, Bichenko OV. Giperkaltsiemiya ne asotsiiruet so stepeniyu tyazhesti, kharakterom techeniya zabolevaniya I efektivnostyu terapii (Rus). Ukrainskyy pulmonologichnyy zhurnal [Ukr Pulmonol J] (Ukr). 2016;1:10-13.
3.    Sarkoidoz organov dikhaniya. Gavrysiuk VK. Ed. (Rus). Kyiv. 2015:192.
4.    Unifikovanyy klinichnyy protocol pervynnoyi, vtorynnoyi (spetsializovannoyi) ta tretynnoyi (vysokospetsializovannoyi) medychnoyi dopomogy «Sarkoyidoz». Nakaz MOZ ╣ 634 vid 08.09.2014 (Ukr) [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care «Sarcoidosis». Decree of MOH of Ukraine ╣ 634 from 08.09.2014].
5.    American Thoracic Society (ATS), European Respiratory Society (ERS), World Association of Sarcoidosis and Other Granulomatous Disoders (WASOG). Statement on Sarcoidosis. Am J Respir Crit Care Med.1999;160:736-755.
6.    Baughman RP, Drent M. The Treatment of Pulmonary Sarcoidosis. Pulmonary sarcoidosis. Judson ╠└. Editor. Humana Press, brand of Springer. 2014:41-64.
7.    Gibson GJ, Prescott RJ, Muers MF, et al. British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment Thorax.1996;51:238-247.
8.    Judson MA. (Editor). Pulmonary sarcoidosis: A Guide for the practicing clinician. Humana Press, brand of Springer. 2014.
9.    Loddenkemper R, Kloppenborg A, Schoenfeld N, et al. Clinical findings in 715 patients with newly detected pulmonary sarcoidosis — ​results of a cooperative study in former West Germany and Switzerland: WATL Study Group. Sarcoidosis Vasc Diffuse Lung Dis. 1998;15(2):178-182.
10.    Lynch JP, Kazerooni EA, Gay SE. Pulmonary sarcoidosis. Clin Chest Med. 1997;18:755-785.
11.    Pietinalho A, Tukiainen P, Haahtela T, et al. The Finish Pulmonary Sarcoidosis Study Group. Early treatment of study II sarcoidosis improves 5-year pulmonary function. Chest. 2002;121:24-31.
12.    Schutt AC, Bullington WM, Judson MA. Pharmacotherapy for pulmonary sarcoidosis: a Delphi consensus study. Respir Med 2010;104(5):717-723.
13.    Sharma OP. Calcium Metabolism Disorders in Sarcoidosis. Lesions of sarcoidosis: a problem solving approach. Ed. Sharma OP, Mihailovic-Vucinic V. Jayupee Brothers Medical Publishers, 2014:132-137.
14.    Sharma OP. Renal sarcoidosis and hypercalcaemia. Eur Respir Mon. 2005;32:220-232.
15.    Shorr AF, Torrington KG, Hnatiuk OW. Endobronchial involvement and airway hyperreactivity in pulmonary sarcoidosis. Chest. 2001;120(3):881-886.

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11. Reviews

 

Endothelial dysfunction and its role in the patogenesis of chronic obstructive pulmonary disease. Đhapter I▓

O.I. Lemko, N.V. Vantyukh

GI «The Scientific-practical Medical Center «Rehabilitation» Health Ministry of Ukraine», Uzhhorod

The Ist chapter of the article introduces the relevance of the formulated problem; describes   the role of vascular endothelium in the organism’s regulation and some causes of its disturbances. Inparticular, the significance of tobacco smoking as a major factor damaging the endothelium at chronic obstructive pulmonary disease (COPD) is discussed. The role of lipids peroxidation intensifying with the consequent development of oxidative and nitrosative stresses in conditions of hypoxia is analyzed, that process leads to the vascular wall remodeling and secondary chronic vasoconstriction. The high prevalence of insulin resistance and metabolic disorders, wich are accompanied by comorbid cardiovascular diseases and affect the clinical picture of the dominating disease, is found.
The II chapter of the article presents summarized data about correlation of low long­term systemic inflammatory process and endothelial dysfunction (ED) in patients with COPD; the importance of assessing C-­reactive protein, as the most significant marker of systemic inflammationis,is  emphasized. Its elevated level is observed even in the period of remission even at mild and moderate severity of COPD, determining the necessity of long­term treatment administration, in particular for the prevention of cardio­vascular risk (acute cardiovascular events); the role of cytokines’ imbalance and adhesion molecules in the development and maintenance of ED is discussed.

Keywords: chronic obstructive pulmonary disease, endothelial d│sfunction, systemic inflammatory process, C-şreactive protein, cytokines, adhesion molecules.

List of references:  
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12.    Lemko OI, Reshetar DV. Peculiarities of the cytokine status and in flammatory activity in patients with chronic obstructive pulmonary disease. └sthma and Allergy. 2012;3:12-17.
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16.    Pertseva TO, Myhailichenko DS. Serum level of transforming growth factor-β1 in patients with chronic obstructive pulmonary disease and its correlation with clinical and functional indices (Rus). Ukr Pulmonol J. (Ukr). 2016; 4:33-36.
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23.    Chubarova SV, Sobko EA, Demko IV et al. Clinical, functional and laboratory features of asthma - ​COPD overlap syndrome (Rus). Russian Pulmonology. 2016; 26:649-656.
24.    Yachnyk AI, Svintsitsky AS, Shuper SV. Chronic obstructive pulmonary disease and coronary artery disease: parallels and crossroads of comorbidity (Ukr).Ukr Pulm J (Ukr). 2014; 4:38-42.
25.    Aaron CP, Schwartz JE, Bielinski SJ, Hoffman EA, Austin JH, Oelsner EC, et al. Intercellular adhesion molecule 1 and progression of percent emphysema: the MESA Lung Study. Respir Med. 2015;109(2):255-264. DOI: 10.1016/j.rmed.2014.10.004.
26.    Agarwal R, Zaheer MS, Ahmad Z, Akhtar J. The relationship between C-reactive protein and prognostic factors in chronic obstructive pulmonary disease. Multidiscip Respir Med. 2013;8(1):63. DOI: 10.1186/2049-6958-8-63
27.    Aksu F, Capan N, Aksu K et al. C-reactive protein levels are raised in stable chronic obstructive pulmonary disease patients independent of smoking behavior and biomass exposure. J Thorac Dis. 2013;5(4):414-421. DOI: 10.3978/j.issn.2072-1439.2013.06.27.
28.    Alagappan VK, de Boer WI, Mirsa VK. Angiogenesis and vascular remodeling in chronic airway diseases. Cell Biochem Biophys. 2013;67(2):219-234.
29.    Atamas SP, Chapaval SP, Keegan AD. Cytokines in chronic respiratory diseases // F1000 Biology Reports. 2013;5:3. Available at: http://f1000.com/prime/reports/b/5/3.
30.    Bakaos P, Patentalakis G, Papi A. VasculÓr biomarkers in asthma and COPD. Curr Top Med Chem. 2016;16(14):1599-609.
31.    Gao J, Zhan B. The effects of Ang‑1, IL‑8 and TGF-beta1 on the pathogenesis of COPD. Mol Med Rep. 2012;6(5):1155-1159.
32.    Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from: http://goldcopd.org.
33.    Goldenberg NM, Kuebler WM. Endothelial cell regulation of pulmonary vascular tone, inflammation, and coagulation. Compr Physiol. 2015;5(2):531-559. DOI: 10.1002/cphy.c140024.
34.    Green CE, Turner AM. The role of the endothelium in asthma and chronic obstructive pulmonary disease (COPD) // Respir Res. 2017;18:20. DOI: 10.1186/s12931-017-0505-1.
35.    Groth A, Vrugt B, Brock M et al. Inflammatory cytokines in pulmonary hypertension. Respir Res. 2014;15(1):47. DOI: 10/1186/1465-9921-15-47.
36.    Lee SH, Kim CH, Yang KS et al. Increased expression of vascular endothelial growth factor and hypoxia inducible factor‑1alpha in lung tissue of patients with chronic bronchitis. Clin Biochem. 2014;47(7-8):552-559. DOI: 10.1016/j.clinbiochem.2014.01.012.
37.    Lopez-Campos JL, Arellano E, Calero C et al. Determination of inflammatory biomarkers in patients with COPD: a comparison of different assays. BMC Med Res Methodol. 2012;12:40.
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12. Reviews

 

Future for cardiac diseases prevention: is combined ­olypill the answer?

I. G. Kravchenko, ╠. ╠. Udovychenko, ╬. ╬. Medentseva, ╠. ┼. Chernenok, Ď. V. Lozyk

SI «National Institute of Therapy named after L. T. Mala of the NAMS of Ukraine», Kharkiv

The review is dedicated to the most important health problem — prevention and treatment of cardiovascular diseases and major complications associated with them — myocardial infarction and stroke, by applying a new concept, so­called ­olypill. According to the results of a meta­analysis of the numerous large international randomized multicenter studies, a long­term use of a ­olypill, containing a fixed combination of antiplatelet drug (aspirin 75 mg), statin (simvastatin 40 mg or atorvastatin 10 mg) and a half­dose combo antihypertensive drug (β-­blockers, ACE inhibitors and diuretics), provides the reduction of  CHD risk by 88 % and stroke — by 80 %.

Keywords: ­olypill, cardiovascular disease, prevention.

List of references:
1.    Karpov Yu A. Evropeiskie rekomendatsii po diagnostike i lecheniyu arterial’noi gipertonii 2013 g.: novyi tselevoi uroven’ arterial’nogo davleniya i kak ego dostich’ v real’noi praktike. Atmosfera. Novosti kardiologii. 2013;3:2-8.
2.    Orlov RG, Timofeeva TN, Koltunov IE i dr. Epidemiologiya arterial’noi gipertonii v Rossii. Rezul’taty federal’nogo monitoringa 2003-2010. Kardiovask terapiya i profilaktika. 2011;10(1):9-13.
3.    Tarlovskaya EI, Mal’chikova SV. Sravnitel’nyi analiz «obshchei stoimosti bolezni» patsientov s arterial’noi gipertenziei v ramkakh otkrytoi mnogotsentrovoi observatsionnoi programmy PRORYV. Ros kardiol zhurn. 2012;6(98):78-83.
4.    Tronina OA, Gendlin GE, Storozhakov GI. Optimal’naya strategiya lecheniya AG - ​fiksirovannaya kombinirovannaya terapiya. Sovremennye aspekty ispol’zovaniya. Med zhurn. (online). 2008;1(2). Elektronnyi resurs. Rezhim dostupa: http://www.inmedin.ru/mjol2008_02_03/tronina001.php
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6.    Castellano JM, Sanz G, Peñalvo JL et al. A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol. 2014;64(20):2071-2082.
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11.    Mancia G et al. 2013 ESH / ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013. doi:10.1093/eurheartj/eht151.
12.    Boushey CJ, Beresford SA, Omenn GS et al. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 1995;274:1049-1057.
13.    McCully KS. Homocysteine and vascular disease. Nat Med. 1996;2:386-389.
14.    Prevention of Cardiovascular Disease Guidelines for assessment and management of cardiovascular risk. World Health Organization 2007.
15.    Selak V, Elley CR, Crengle S et al. IMProving Adherence using Combination Therapy (IMPACT): design and protocol of a randomised controlled trial in primary care. Contemp Clin Trials. 2011;32(6):909-915.
16.    The Heart Outcomes Prevention Evaluation (HOPE) 2. Homocysteine lowering with folic acid and B vitamins in vascular disease. NEJM. 2006;354:1567-1577.
17.    Thom S, Field J, Poulter N et al. Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE): rationale and design of a randomised controlled trial of a cardiovascular preventive polypill-based strategy in India and Europe. Eur J Prev Cardiol. 2014;21(2):252-261.
18.    Toole J et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction and death. The vitamin intervention for stroke prevention (VISP) randomized controlled trial. JAMA. 2004;291:565-575.
19.    Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80 %. BMJ. 2003;326:1419-1423.

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13. Reviews

 

Effect of pharmacological therapy for coronary heart disease on chronic periodontitis

M.╠. Vovchenko1, D.V. Emelyanov2

1 SI «National Institute of Therapy named after L. T. Mala of the NAMS of Ukraine», Kharkiv
2 Dental Đlinic «RISUS», Kharkiv

The article presents an overview of some literature data on the comorbidity of such nosological forms as coronary heart disease and chronic periodontitis. Possible effects of traditional therapy of coronary heart disease on the course of periodontitis, taking into account their pathogenetic relation, are analyzed. The beneficial effect of drugs used in the therapy of coronary heart disease on the condition of the periodontal complex is determined. It creates a good background for successful dental treatment in this category of patients.

Keywords: chronic periodontitis, ischemic heart disease, combined pathology, periodontitis microcirculation disturbance, acetylsalicylic acid.

List of references:
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2.    Blashkova SL, Vasylevskaia EM. Patohenetycheskye aspekti formyrovanyia zabolevanyi parodonta u patsyentov s yshemycheskoi bolezniu serdtsa. Praktycheskaia medytsyna. 2013;7(76):154-156.
3.    Blashkova SL, Vasylevskaia EM. Sovremennie podkhodi k profylaktyke obostrenyi zabolevanyi parodonta u patsyentov s yshemycheskoi bolezniu serdtsa. Fundam. yssledovanyia. 2015;1:32-35.
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7.    Elyseeva AF, Tsymbalystov AV, Shtoryna HB. Rol smeshannoi ynfektsyy v razvytyy khronycheskoho heneralyzovannoho parodontyta y yshemycheskoi bolezny serdtsa. Ynstytut stomatolohyy. 2012;2:78-79.
8.    Elyseeva AF. Sochetannoe porazhenye parodonta y serdechno-sosudystoi systemi, klynyko-morfolohycheskye y mykrobyolohycheskye yssledovanyia: avtoref. dys. … kand. med. nauk: 14.01.14;14.03.02. SPb., 2014:26 s.
9.    Emelianov DV, Komyr YR. Klynyko-morfometrycheskye yzmenenyia parodonta patsyentov, prynymaiushchykh preparati atsetylsalytsylovoi kysloti. Ukr stomatolohichnyi almanakh. 2012;5:24-27.
10.    Emelianov DV, Halchynskaia VIu. Klynyko-ymmunolohycheskye osobennosty řpytelyia desni y ykh korrektsyia u patsyentov s yshemycheskoi bolezniu serdtsa pry dlytelnom pryeme atsetylsalytsylovoi kysloti. Novii armianskyi medytsynskyi zhurnal. 2013;7(2):66-74.
11.    Emelianov DV, Kutsevliak VF. Sovremennie predstavlenyia o sviazy porazhenyi orhanov y tkanei polosty rta s yshemycheskoi bolezniu serdtsa. Ukr ter zhurn. 2012;1:105-110.
12.    Ziulkyna LA, Sabaeva MN, Yvanov PV, Shastyn EN. Mykrotsyrkuliatsyia v tkaniakh parodonta: prychyni narushenyi y mekhanyzmi korrektsyy. Sovremennie problemi nauky y obrazovanyia. 2017;2: 61.
13.    Yhnatyady ON, Syrak AH, Demurova MK. Lechenye stomatolohycheskykh bolnikh s heneralyzovannim parodontytom vzvesiu ybuprofena v 10 % rastvore dymeksyda. Sovremennie problemi nauky y obrazovanyia. 2014;6:978.
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16.    Kniazkova AS, Semkyna OA, Fateeva TV. Razrabotka sostava y tekhnolohyy yzghotovlenyia dentalnoho helia kombynyrovannoho deistvyia. Fundamentalnie yssledovanyia. 2014;9:110-113.
17.    Kovalenko VN, Lutai MY. Analyz řffektyvnosty ambulatornoho lechenyia bolnikh YBS v sochetanyy s arteryalnoi hypertenzyei v Ukrayne. Evrazyiskyi kardyol zhurn. 2012;2:17-29.
18.    Leonova LE, Pavlova HA, Tabolyna EN, Kolomoitsev VF. Mestnaia medykamentoznaia terapyia u bolnikh parodontytom s yspolzovanyem preparata «Kholysal». Parodontolohyia. 2006;2:70-76.
19.    Lupanov VP. Lechenye y vedenye patsyentov s yshemycheskoi bolezniu serdtsa posle revaskuliaryzatsyy myokarda. Ateroskleroz y dyslypydemyy. 2016;1(22):15-21.
20.    Lupanov VP. Prymenenye rozuvastatyna u bolnikh YBS dlia korrektsyy narushenyi lypydnoho obmena s tseliu profylaktyky y lechenyia ateroskleroza. RMZh. 2011;5(19):334-337.
21.    Medykamentozne likuvannia stabilnoi stenokardii. Metodychni rekomendatsii Robochoi hrupy z problem aterosklerozu ta khronichnykh form IKhS Asotsiatsii kardiolohiv Ukrainy, 2010 r.
22.    Metelskaia VA, Hazdanova LR, Koltunov YE. Vlyianye kurenyia na pleiotropnie řffekti symvastatyna pry lechenyy bolnikh YBS s hyperlypydemyei. Ţffektyvnaia farmakoterapyia. 2011;12:72-76.
23.    Mykhailov AE, Kuznetsova NL, Blokhyna SY. Osobennosty soputstvuiushchei patolohyy u patsyentov s khronycheskym heneralyzovannim parodontytom. Klynycheskaia stomatolohyia. 2009;2(50): 34-37.
24.    Nedohoda SV. Ynhybytori APF v lechenyy YBS: pochemu sredy nykh est pryorytetnie?. Serdtse: zhurnal dlia praktykuiushchykh vrachei. 2009;4:189-191.
25.    Volf HF, Rateitskhak EM, Rateitskhak K. Parodontolohyia / Per. s nem.; Pod red. prof. HM Barera. M.: MEDpress-ynform, 2008:548.
26.    Nykolaev AY, Tsepov LM. Praktycheskaia terapevtycheskaia stomatolohyia: ucheb. posobye. 9 yzd. M.: MEDpress-ynform, 2014:928.
27.    Samyhullyna LY, Tamyndarova RR. Vlyianye nesteroydnikh protyvovospalytelnikh sredstv na rezorbtsyiu alveoliarnoi kosty pry khronycheskom parodontyte. Sovremennie problemi nauky y obrazovanyia. 2013;2:83.
28.    Serdechno-sosudystaia zabolevaemost y smertnost: statystyka po evropeiskym stranam (2008). Medicin Rewiew. 2009;1(6):6-12.
29.    Trukhan DY, Trukhan LIu. Nekotorie aspekti komorbydnosty parodontyta y serdechno-sosudystikh zabolevanyi. Medytsynskyi sovet. 2015;17:12-16.
30.    Fuks EY, Kareva Yu.A, Halyzyna OA, Tabolyna ES. Sovremennie aspekti řtyolohyy y patoheneza zabolevanyi parodonta. Rossyiskyi medyko-byolohycheskyi vestnyk ymeny akad. YP Pavlova. 2013;3:153-159.
31.    Tsepov LM, Tsepova EL, Tsepov AL. Parodontyt: lokalnii ochah sereznikh problem. Parodontolohyia. 2014;3(72):3-6.
32.    Tsepov LM, Holeva NA. Rol mykroflori v voznyknovenyy vospalytelnikh zabolevanyi parodonta. Parodontolohyia. 2009;1:7-12.
33.    Chaikovskaia YV. Ţffektyvnost provedenyia řtyopatohenetycheskoho lechenyia bolnikh khronycheskym heneralyzovannim parodontytom III stepeny tiazhesty. Ukrainskyi stomatolohichnyi almanakh. 2009;6:31-32.
34.    Shcherban EA, Zaslavskaia RM, Lohvynenko SY. i dr. Sostoianye hemodynamyky patsyentov s arteryalnoi hypertonyei y yshemycheskoi bolezniu serdtsa na fone tradytsyonnoi terapyy v sochetanyy s melatonynom. Nauchnie vedomosty Belhorodskoho natsyonalnoho unyversyteta. 2015;22(219):33-38.
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14. Reviews

 

On the problem of pharmacoşeconomic assessment of probiotocs

P.B. Melekhov1, V.M. Troyanova2, A.M. Gudim-Levkovich2

1 Pharmascience Inc., Montreal, Canada
2 Representative office of Pharmascience Inc. in Kyiv, Ukraine

Presently the attention of medical professionals to probiotics use in the different areas of medical treatment is increasing.Correspondingly, the number of different probiotic drugs and food supplements (BAS) is growing as well. Many of them are now available in Ukraine. In order to identify the most efficient product considering its cost and pharmacological parameters, it is necessary to assess two most important efficiency criteria: the combination (and a ratio) of different bacterial strains in the formulation of the product and their total count  in one therapeutic dose. Altogether they represent the probiotic potential of the product. International experts recognize, that the minimal significant number of live (lyophilized) bacteria in one therapeutic dose is one billion cells.

Keywords: probiotics, probiotic potential.

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Original language: Russian

Current Issue Highlights

╣3(54) // 2017

I. G. Kravchenko, ╠. ╠. Udovychenko, ╬. ╬. Medentseva, ╠. ┼. Chernenok, Ď. V. Lozyk

P.B. Melekhov1, V.M. Troyanova2, A.M. Gudim-Levkovich2

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