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Current Issue. Articles

4(55) // 2017



1. advanced article


Chronic noncommunicable diseases in migrants from the area of the antiterrorist operation: is it a medical or social problem?

G.D. Fadieienko, G.S. Isaeva, M.M. Vovchenko, T.G. Starchenko

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

One of the important problems is the management of migrants from the area of the anti­terrorist operation. A large number of European countries have also encountered this problem: Germany, Italy, Spain, France, Denmark and Norway. Patients of this group require special attention, as both internal and external migration is associated with the deterioration of the course of all chronic non­communicable diseases. The article summarizes literature data on how the problem of internal and external migration is being solved in other countries of the world. The importance of the various risk factors of chronic non­infectious diseases in migrants has been emphasized, as well as the necessity to create electronic registries, providing the quick access to the medical documentation, regardless of the patients’ referrals for medical assistance.

Keywords: chronic noncommunicable diseases, risk factors, migration.

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Original language: Ukrainian

2. Original researches


The relationship of the severity of carotid arteries atherosclerosis and modifiable and non-modifiable risk factors, coronary atherosclerosis in patients with coronary artery disease depending on the presence of type 2 diabetes mellitus

L.V. Zhuravlyova, N.A. Lopina

Kharkiv National Medical University

Objective —to evaluate the severity of atherosclerosis lesions of carotid arteries and its relationship with the modifiable and non-modifiable risk factors, the severity of coronary atherosclerosis in patients with coronary artery disease (CAD), depending on the presence of type 2 diabetes mellitus (T2DM).
Materials and methods. Examinations involved 131 patients with CAD (89 men, 42 women), the mean age
(59.6 ± 9.11) years. Depending on the presence of T2DM, patients with CAD were divided into 2 groups: 1 group consisted of 70 patients with concomitant T2DM, 2 group included patients 61 with CAD without concomitant T2DM. To verify CAD diagnosis, coronary angiography was performed to all patients. Other investigations included pulse arterial pressure (PAP) assessment, rheography to define the carotid-femoral pulse wave velocity (cfPWV), dopplerography of carotid arteries with estimation of intima media thickness of common carotid artery (TIM CCA).
The parameters of lipid, indicators of short-term and long-term glycemic control, body mass index, markers of endothelial dysfunction (fractalkine, asymmetric dimethyl arginine (ADMA)) were assessed.
Results and discussion. The atherosclerotic plaques of the carotid arteries were reveled in 63 % of patients of the 1st group, and 49 % of the 2nd group. In patients of the 1st group, the average number of plaques per patient were higher than in the patients of the 2nd group (1.2 ± 1.06 vs 0.85 ± 1.01, p = 0.16). In patients of the 1st group the mean number of affected extracranial vessels was higher than in those in the 2nd group (1.09 ± 0.93 vs 0.78 ± 0.66; p = 0.12). In addi­tion, in the patients of the 1st group, TIM CCA was significantly higher in comparison with patients of the 2nd group ((1.22 ± 0.10) vs (1.11 ± 0.15) mm, p = 0.00001). The correlations have been established between TIM CCA, amount of atherosclerotic plaques of carotid arteries, number of affected extracranial vessels and the following parameters: age, BMI, duration of CAD and T2DM, indices of lipid and glucose metabolism, markers of endothelial dysfunction, PAP, cfPWV. Moreover, this correlation was established with hemodynamically nonsignificant amount of stenosis of the coronary arteries, the number of plaques of coronary arteries, the number of diseased coronary arteries, the number of diseased coronary artery segments, the number of hemodynamically significant stenosis of the coronary arteries.
Conclusions. Thus, the obtained data on the nature of the damage to the carotid arteries showed the unfavorable course of atherosclerotic process especially in patients with T2DM, effects of the modifiable and non-modifiable risk factors on the progression of carotid atherosclerosis, and it’s relationship with the severity of coronary atherosclerosis.

Keywords: atherosclerosis of carotid arteries, coronary artery atherosclerosis, coronary artery disease, type 2 diabetes mellitus, modifiable risk factors, non-modifiable risk factors.

List of references:
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4.    Zhuravlva LV, Lopina NA, Kuznetsov YV, Ermolenko TY, Pechenyn AV, Serheev VH, Volkov DE, Lopin DA. Metodyka yzmerenyia karotydno-femoralnoi, aortalno-femoralnoi skorosty rasprostranenyia pulsovoi voln s pomoshchiu [Method of carotid-femoral and aorto-femoral pulse wave velocity measurement using rheography] Liky Ukrainy (Rus).2016;10:22-32.
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Original language: Russian

3. Original researches


The peculiarities of the quercetin therapeutic effects at its long-term administration in the treatment of osteoarthritis patients with high comorbidity, cardiovascular and gastrointestinal risks

L.O. Voloshyna1, S.I. Smiyan2, O.I. Doholich1

1 HSEE of Ukraine «Bukovinian State Medical University», Chernivtsi
2 I.Ya. Horbachevsky Ternopil State Medical University

Objective — to study the age-related peculiarities of the prevalence and severity of comorbid diseases in patients with osteoarthritis (OA) and to explore the impact of the long-term quercetin administration in the treatment of such patients.
Materials and methods. The investigation involved 120 patients with OA of I—III clinical and radiographic stages, in whom the peculiarities of prevalence of the comorbid diseases, pro- and antioxidant systems and indicators of blood lipid metabolism have been studied. Patients of the main group received Quercetin in the complex treatment during three months.
Results and discussion. In patients with OA aged 50 years the following has been established: the progressive manifestations of OA, the increasing levels of severity of comorbidity phenomena with domination of vascular disease, progressive effects of oxidative stress, dyslipidemia and low-intensive inflammation in the blood. The metabolic disorders were considered as common nonspecific pathogenetical link between OA and comorbid processes. Three months quercetin administration promoted the improvement of the overall treatment results for OA and comorbid diseases, significant reduction of the level of oxidative disorders, dyslipidemia and low-intensive systemic inflammation relative to the comparison group.
Conclusions. With the age increment of patients with OA, the progression of OA manifestations, the level and severity of comorbid processes, the effects of oxidative stress and dyslipidemia were observed. The long-term quercetin administration improved the treatment results of the revealed diseases, effectively reduced the manifestations of oxidative stress and dyslipidemia.

Keywords: osteoarthritis, comorbidity, metabolic disorders, treatment, quercetin.

List of references:
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2.    Holovach YIu. Osteoartryt: fundamentalnye y prykladnye aspekty etiopatoheneza zabolevanyia. Nychto ne stoyt na meste. (Ukr). Ukr revmatol zhurn. [Ukr revmatol J] (Ukr). 2014;2;56:4-11.
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6.    Mahalias VM, Mikheiev AO, Rohovyi YuI, ta in. Suchasni metodyky eksperymentalnykh i klinichnykh doslidzhen Tsentralnoi naukovo-doslidnoi laboratorii Bukovynskoi derzhavnoi medychnoi akademiii. Navch.-metod. posibnyk (Ukr). Chernivtsi, [Textbook] (Ukr). 2001:42.
7.    Mendel OY, Naumov AV, Vertkyn AL, dr. Osteoartroz y serdechno-sosudystye zabolevanyia u lyts pozhyloho vozrasta: klynycheskye y patohenetycheskye vzaymosviazy (Ukr). Uspekhy herontolohyy. [The successes of gerontology] (Ukr). 2010;23;2:304-313.
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9.    Parkhomenko OM, Kozhukhov SN, Irkin OI, Lutai YaM. Novi mozhlyvosti farmakolohichnoho vplyvu na prohnoz u khvorykh na infarkt miokarda z elevatsiieiu sehmenta ST ta hostroiu sertsevoiu nedostatnistiu. Korvityn dlia iniektsii. (Ukr). Ukr med chasopys. [Ukr med Chasopys] (Ukr). 2004;2:33-37.
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11.    Fadieienko HD, Hridniev OIe, Nesen AO, ta in. Komorbidnist i vysokyi kardiovaskuliarnyi ryzyk - ​kliuchovi pytannia suchasnoi medytsyny. (Ukr). Ukr terapevt zhurn. [Ukr therapist J] (Ukr). 2013;1:102-107.
12.    Fadieienko HD, Nesen AO. Komorbidnist ta intehratyvna rol terapii vnutrishnikh orhaniv. (Ukr). Ukr terapevt zhurn. [Ukr therapist J] (Ukr). 2015;2:7-15.
13.    Iatsyshyn RI, Sukhorebska MIa. Rol biomarkeriv poshkodzhennia suhlobovoho khriashcha u diahnostytsi y otsintsi efektyvnosti likuvannia khvorykh na osteoartroz. (Ukr). Ukr revmatol zhurn. [Ukr revmatol J] (Ukr). 2015;2:36-41.
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Original language: Ukrainian

4. Original researches


Effects of the complex treatment on indexes of T- and B-cell immunity in patients with nonalcoholic steatohepatitis combined with obesity and pathology of the biliary tract

.Yu. Filippova

SE «Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine», Dnipro

Objective — to evaluate the effects of different schemes of complex treatment on the indexes of T-and B-cell immunity in patients with nonalcoholic steatohepatitis combined with obesity and pathology of the biliary tract according to the data of 6-month follow up.
Materials and methods. The study involved 100 patients with nonalcoholic fatty liver disease (NAFLD) in the stage of non-alcoholic steatohepatitis (NASH) associated with obesity (OB) and pathology of the biliary tract (BT). The control group consisted of 30 practically healthy persons. Serological methods were used to evaluate the indices of
T- and B-cell immunity. To assess the effectiveness of different NAFLD treatments, all patients were divided into 3 groups with the use of method of adaptive randomization. Patients of all groups were assigned the 6-months course of lifestyle correction: regiment of nutrition, physical exercises, work and rest. Patients of the 1st group (n = 34) received standard treatment for 30 days. Patients of the 2nd group (n = 33) were prescribed standard treatment combined with the use of ursodeoxycholic acid (UDCA) for 30 days in a dose of 10—15 mg/kg/day. Patients of the 3rd group (n = 33) received standard treatment and UDCA combined with the use of arginine glutamate for 30 days. All immunological tests were performed at baseline and at the end of treatment in all patients, and after 6 post-treatment months in 20 patients from each investigated group.
Results and discussion. It has been established, that addition to standard treatment of UDCA in the 2nd group or arginine glutamate and UDCA in the 3rd group in patients with NASH combined with obesity and pathology of B- and T-cell immunity, resulted in the normalization of cellular immunity indices and restoration of immunological homeostasis. The highest efficacy level was established in patients of the 3rd groups, where normalization of immune disorders were registered within 6 months after treatment in all identified options for immune disorders (excluding I), with a significant difference relative to group 1 (p < 0.05 to p < 0.001). Positive dynamics of immunological parameters during the treatment was observed in almost all patients of the 3rd groups, normalization or activation of immunoregulatory processes in the presence of the first variant of the violations was established. However, on the contrary, immunodeficiency (III or IV variants of immune regulation) remained after the treatment of patients of the 1st and 2nd groups.
Conclusions. Thus, treatment of patients in the 3rd group resulted in the significant reduction in the number of patients with immune status: from 33 (100 %) to 4 (12.1 %) cases after 30 days of treatment and to 2 (10 %) cases after
6 months follow up (p < 0.001 for all comparisons). These results significantly differed from those in patients from the 1st group after follow up (p < 0.001) and from the 2nd group after 30 days of treatment (p < 0.05).

Keywords: non-alcoholic steatohepatitis, obesity, biliary tract, T-lymphocytes, B-lymphocytes, ursodeoxycholic acid, arginine glutamate.

List of references:
2.    Balan UV. Indicators of lipid peroxidation, endotoxin, cytokine profile and level of microelements in blood of patients with chronic acalculous cholecystitis under the influence of treatment glutarginom, ursoholom and roksilidom (Ukr). Klinichna meditsina  [Clinical medicine] (Ukr). 2009;1(13):18-22.
3.    Bokova TA, Ursova NI. Pathology of the hepatobiliary system in children and teenager with obesity and metabolic syndrome (Rus). Vrach [The doctor] (Rus). 2011;1:56-58.
4.    Virstyuk NG, Cherkashina OE. Glutargina influence on the functional state of liver in patients with chronic heart failure (Ukr). Galitskiy lkar visnik [Galician medical journal] (Ukr). 2015;22:4(2):21-23.
5.    Drapkyna OM, Popova YP. The role of obesity in the development of hypertension and non-alcoholic fatty liver disease (Ukr). Ukrainskyi medychnyi chasopys [Ukrainian Medical Journal] (Ukr). 2013;2:125-128.
6.    Zhuravleva LV, Krivonosova EM, Lopina NA. The use of urso­deoxycholic acid in internal medicine (Ukr). Praktikuyuchiy likar [Practicing doctor] (Ukr). 2014;4:25-32.
7.    Yvashkyn VT. The immune system and liver damage in chronic hepatitis B and C (Rus). Ros zhurn hastroenterol hepatol koloproktol. [Russian Journal of Gastroenterology, Hepatology, Coloproctology] (Rus). 2009;6:4-10.
8.    Lefkovyts Y, Pernys  B. Immunologiya. metody issledovaniy [Immunology. Research methods] (Rus). Moscow: Myr; 1983:188-212.
10.    Sochner AM, Belchenko YE, Burshtein AM. Limfozitatoxic test as a method of identifying subpopulations of T-lymphocytes with monoclonal antibodies (Rus). Lab delo [Laboratory work] (Rus). 1989;3:29-32.
9.    Petrov RV,  Khaytov RM, Pynehyn VV. The immune status of the person in mass surveys: methodological recommendations for researchers and physicians healthcare practice (Rus). Ymmunolohyia [Immunology] (Rus). 1992;6:51-63.
1.    Babak OYa, Fadeenko GD, Frolov VM, Kruglova OV.  Pathogenetic rationale for the use of metabolically active agents L-arginine-L-glutamate when nonalcoholic fatty liver disease, associated with chronic acalculous cholecystitis (Ukr). Liki Ukrayini [Medicines of Ukraine] (Ukr). 2013;2(168):29-33.
11.    Stepanov YuM, Filippova OYu. The features of the changes of T- and B-cell immunity, depending on the body mass index in the patients with the nonalcoholic fatty liver disease in combination with the obesity and the pathology of biliary tract (Ukr). Ukrayinskiy terapevtichniy zhurnal [Ukrainian Therapeutic Journal] (Ukr). 2016;4:46-54.
12.    Cherkashina OE. Changes in the functional state of the liver in hypertensive patients complicated by chronic cardiac insufficiency on the background of nonalcoholic steatohepatitis: avtoreferat dis.  kand. med. nauk: 14.01.02 - vnutrishni hvorobi. Ivano-FrankIv. nats. med. un-t MOZ Ukrayini. - Ivano-Frankivsk (Ukr). 2016:20.
13.    Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterol. 2012;142:711-725.
14.    Dietrich P, Hellerbrand C. Non-alcoholic fatty liver disease, obesity and the metabolic syndrome. Best Pract Res Clin Gastroenterol. 2014;28(4):637-653.
15.    Sydorchuk A, Boychuk T, Sydorchuk R, Sydorchuk L. Immune and metabolic disorders in obese patients with hepatic steatosis and hypertension associate with PPAR-GAMMA2 PRO12ALA and ACE I/D genes’ polymorphisms. United Eur Gastroenterol J. 2015;1:59.
16.    Toouli J, Fried M, Ghafoor KA. Obesity World Gastroenterology Organisation Global Guideline. 2009:30.

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5. Original researches


The efficiency of prokinetic use in the treatment of gastroesophageal reflux disease with concomitant bronchial asthma

.A. Oparin, A.G. Oparin, G.G. Akhvlediani

Kharkv Medical Academy of Postgraduate Education

Objective — ​to study the effect of domperidone prokinetic on the severity  decrease of oesophageal and bronchopulmonary manifestations, the possibility of reducing dosages and the frequency of bronchodilator preparations, as well as reducing the level of inflammatory cytokines IL-1β and IL-4 in BA patients with concomitant GERD on a standard treatment regimen.
Materials and methods. 52 patients (32 men and 20 women) aged 20 to 45 years, suffering from asthma of minor and moderate severity with concomitant GERD were included in the study. The first group included 25 patients
(15 men and 10 women) whose average age was (38.2 ± 4.2) years. The second group included 27 patients (17 men and 10 women) whose mean age was (38.0 ± 4.1) years. Verification of asthma, determination of its severity was carried out in accordance with the recommendations of the WHO (GJNA 2015), using the order of the Ministry of Health of Ukraine (2013), as well as spirography and radiography of chest organs data, external respiration function was determined with spirograph Spirosvit 3000. The diagnosis of GERD was established according to the Montreal Consensus (2006), using the results of esophagastroduodenoscopy of the oesophagus and stomach, as well as pH-metry data. The differences were estimated with Student’s t-test. The level of interleukins (IL-1β and IL-4) was determined by the method of immuno-enzyme analysis using Vector-Best test system. Statistical processing of data was carried out with applied program Statistica 6.
Results and discussion. Analysis of the results obtained showed that in the patients of both the first and second groups, the prescribed treatment caused not only  the elimination of clinical manifestations, but also the decrease in the activity of immune inflammatory processes. In most patients of the second group, who additionally received domperidone (10 mg
3 times a day), the positive dynamics of clinical manifestations and the studied indicators were more evident. Among patients in this group, dyspnea mostly decreased, cough became less frequent, episodes of severe respiration and bronchospasm  disappeared in 96.2 % of patients, due to this fact we could discontinue  (92.5 %) or reduce doses of corticosteroids and short acting β2 agonists. Patients of the first group demonstrated  worse  results: complete disappearance of complaints for the respiratory organs at the end of the course of treatment was established only in 5 (18.5 %) patients.  16 (59.2 %) patients had less pronounced the dynamics of efficacy, and the remaining 4 (14.3 %) patients  were forced to increase the intake frequency of β2-agonists. Data on the dynamics of interleukins was mostly the same. In particular, if in patients of the second group the level of IL-1β and IL-4 decreased from (2.28 ± 0.20) pg/ml to (1.55 ± 0.15) and from (11.57 ± 1.22) to (5.95 ± 0.58) correspondingly, that is, practically approached the norm (p > 0.05), then among the patients of the first group the dynamics of IL-1β decreased (from 2.29 ± 0.22 to 1.80 ± 0.14) and IL-4 (from 11.60 ± 1.21
to 8.1 ± 0.88), the degree of reliability was less pronounced (p < 0.05).
Conclusions. The additional inclusion of domperidone prokinetic in the standard regimen for the treatment of patients with asthma with concomitant GERD reduces the timing of elimination of not only oesophageal and bronchial manifestations of this comorbid pathology, but also allows to  reduce the dose and frequency of bronchodilator intake, and also significantly affects the correction of immune inflammatory processes — the level of IL-1β and IL-4.

Keywords: bronchial asthma, gastroesophageal reflux disease, interleukins, domperidone, comorbidity.

List of references:
1.    Arutyunov AG, Burkov SG, Shcherba EP. Mechanisms of interrelation between gastroesophageal reflux disease and bronchial asthma and management tactics. Klinicheskie perspektivy gastroenterologii, gepatologii. 2004;2:5-9. (Rus.).
2.    Burkov SG, Arutnov AG, Atabekova LA i dr. Gastroesophageal reflux disease and bronchial asthma. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. Prilozhenie 17. Materialy VIII rossiiskoi gastroenterologicheskoi nedeli. 2002;5:5.(Rus.).
3.    Maev IV, Lyamina SV, Kalish SV. Functional activity of alveolar macrophages in patients with bronchial asthma and gastroesophageal reflux disease. Klin Meditsina. 2013;6:41-47. (Rus.).
4.    Maev IV, Lyamina SV, Malysheva EV, i dr. The immune response and phenotype of alveolar macrophages in bronchial asthma, gastroesophageal reflux disease and their combinations. Terapevticheskii arkhiv. 2015;3:34-41. (Rus.).
5.    Oparin AG, Oparin AA, Titkova AV. Place and role of immunoinflammatory processes in the mechanisms of the formation of chronic obstructive pulmonary disease with combined gastroesophageal reflux disease, taking into account the quality of life of patients. Ukrans’kii terapevtichnii zhurnal. 2013; 3:52-58. (Rus.).
6.    Paleev NR, Isakov VA, Ivanova OV. Bronchial asthma and gastroesophageal reflux disease: does the relationship is accidental?. Klinicheskaya meditsina. 2005;1:9-13. (Rus.).
7.    Pikulev DV, Alekseeva OP, Dolbin IV. Coronary heart disease and gastroesophageal reflux disease: features of the combined course. Meditsinskii al’manakh. 2012;1:43-47. (Rus.).
8.    Fadeenko GD, Gridnev AE. Gastroezofageal’naya reflyuksnaya bolezn’: pishchevodnye, vnepishchevodnye proyavleniya i komorbidnost’. Pod red. A.N. Belovola; 2014:376. (Rus.).
9.    Joppa P, Petrasova D, Stencak B, et al. Systemic information in patients with COPD and pulmonary hypertension. ​Chest. 2009;130:326-333.
11.    Laine L, Hennekens C. Proton pump inhibitor and clopido­grelinteraction: fact or ction? Am J Gastroenterol. 2010;105:34-41.
12.    Modanic RD. Proton pump inhibitor side effects and drug intractions: much ado about nothing? ​Cleveland Clin J Med. 2011;78:39-49.
13.    Thomas AD, Su KJ, Chang JC, et al. Gastroesophagal reflux-associated aspiration alerts the immune response in asthma. Surg Endoscony.  2010;24(5):1066-1070.

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6. Original researches


The prevalence of metabolic syndrome among inpatients of therapeutic department with essential hypertension

N.P. Masik, K.Ya. Kalandey

National Pirogov Memorial Medical University, Vinnytsya

Objective — to determine the frequency of metabolic syndrome (MS) in the in-door patients of the therapeutic department, as well as risk of cardiovascular complications in patients with essential hypertension (EH) combined with MS.
Materials and methods. The study involved 47 patients with EH, the mean age  (63.28 ± 11.36) years. All patients were surveyed with the questionnaire. They investigations included measurements of height, body weight, waist circumference, indices of lipid spectrum, fasting glucose level and glucose level after the glycemic load, total cardiovascular risk according to the SCORE, European risk chart, were determined and BMI was calculated. Statistical analysis of the results was carried out using Student’s t-test (probable results were considered with the exponent p < 0.05).
Results and discussion. Arterial hypertension of I degree was diagnosed in 6.38 % of patients, and of II to III degree in 46.81 % cases. No significant gender-related difference was established in the lipid spectrum in men and women, hence further studies were conducted depending on the degree of obesity. The highest level of total lipids were found in patients with the first degree of obesity, but in patients with the second and third degree there were a noticeable decrease in these indices, which is probably related to the use of lipid-lowering therapy, which is much more effective for patients with a second degree of obesity. Metabolic syndrome was diagnosed in 44.68 % of hypertensive patients, among them, in 41.18 % of women and 53.85 % of men. Grade II hypertension was established in 41.91 % of patients, and grade III in 54.55 %. High and very high cardiovascular risk were detected in half of patients with grade II and in all (100 %) subjects with grade III hypertension, among them 67.65 % women and 61.54 % men. Moreover, a high cardiovascular risk were found in 62.5 % of people with normal body weight, in 63.64 % of patients with overweight, 60.0 % with I and II degrees of obesity, in all (100.0 %) with third degree of obesity and in 76.19 % of people with MS. Therefore, the frequency of high cardiovascular risk increases with the increasing body weight, and with the MS is the highest and amount 76.19 %. Gender differences in indicators were not established.
Conclusions. Metabolic syndrome was diagnosed in 44.68 % of hypertensive patients, while 65.96 % of them had high and very high cardiovascular risk, which indicates its significant prevalence. The high frequency of the MS among patients of the therapeutic department with hypertension, as compared with the average statistical data, as well as the presence of high cardiovascular risk in these patients confirms the need for inpatient treatment, and, therefore, indicates a more severe course of hypertension.

Keywords: hypertension, metabolic syndrome, obesity, insulin resistance, hyperlipidemia.

List of references:
1.    Aleksandrov OV, Alekhina PM, Grigor SP. i dr. Metabolicheskii sindrom. Rossiiskii meditsinskii zhurnal (Rus). 2006;6:50-55.
2.    Handziuk VA. Analiz zakhvoriuvanosti na ishemichnu khvorobu sertsia v Ukraini. Ukrainskyi kardiolohichnyi zhurnal (Ukr). 2014;3:45-52.
3.    Hidzynska IM, Moroz HZ, Lasytsia TS, Bezuhla MV. Metabolichnyi syndrom ta sertsevo-sudynnyi ryzyk: suchasnyi pohliad na problemu. Arterialna hipertenziia (Ukr). 2012;2:22.
4.    Horbas IM. Shkala SCORE v klinichnii praktytsi: perevahy ta obmezhennia. Arterialna hipertenziia (Ukr). 2009;2:4.
5.    Diahnostyka metabolichnoho syndromu, tsukrovoho diabetu, prediabetu ta sertsevo-sudynnykh zakhvoriuvan Ukrainskoi asot­siatsii kardiolohiv i Ukrainskoi asotsiatsii endokrynolohiv / uporiad. OI Mitchenko ta in. (Ukr). K, 2009:40.
6.    Kovalenko VM, Talaieva TV, Kozliuk AS. Metabolichnyi syndrom: mekhanizmy rozvytku, znachennia yak faktora sertsevo-sudynnoho ryzyku, pryntsypy diahnostyky ta likuvannia. Ukrainskyi kardiolohichnyi zhurnal (Ukr). 2013;5:80-87.
7.    Kovalova OM, Ambrosova TN, Vinogradova SV. Metabolicheskii sindrom: problemy diagnostiki i prognosticheskie kriterii. Vnutrennyaya meditsina (Rus). 2008;1:7.
8.    Kostina VM, Ziuzin VO, Zinchenko TM. Metabolichnyi syndrom: metody diahnostyky ta reabilitatsii. Naukovi pratsi. Chor­nomorskoho derzhavnoho universytetu imeni Petra Mohyly kompleksu «Kyievo-Mohylianska akademiia». Seriia: Ekolohiia (Ukr). 2011;152(140):76-78.
9.    Kryvenko VI, Fedorova OP, Pakhomova SP, Kolesnyk MYu, Nepriadkina IV, Kachan IS. Osnovni syndromy, poviazani z metabolichnymy porushenniamy, u praktytsi likaria zahalnoi praktyky: navch. posib. Zaporizhzhia (Ukr). ZDMU, 2016:98.
10.    Mamedov MN, Oganov RG. Neobkhodimo li opredelenie insuli­norezistentnosti dlya diagnostiki metabolicheskogo sindroma v klinicheskoi praktike? Kardiologiya (Rus). 2005;4:92-97.
11.    Mitchenko EI. Metabolicheskii sindrom: sostoyanie problemy i lechebnye podkhody. Medichnii portal — ​Zdorov’ya Ukrani (Rus). 2015. Rezhim dostupa: http://health-ua.com/articles/1216.
12.    Pankiv VI. Insulinorezystentnist yak kliuchovyi patofiziolohichnyi mekhanizm rozvytku metabolichnoho syndromu. Praktychna anhiolohiia (Ukr). 2012;5-6:54-55.
13.    Rutovskyi YaA, Kachmarska MO. Metabolichnyi syndrom, tsukrovyi diabet: epidemiolohiia i naslidky dlia zdorovia. Ukraina. Zdorovia natsii (Ukr). 2012;2-3:163-167.
14.    Svintsitskyi AS, Kozak NP, Ostafiichuk AS. Osoblyvosti perebihu podahry na foni metabolichnoho syndromu. Ukrainskyi revmatolohichnyi zhurnal (Ukr). 2011. Rezhym dostupu: http://www.rheumatology.kiev.ua/wp/wp-content/uploads/2011/12/713.pdf?upload.
15.    Shilov AM, Chubarov MV, Melnik MV, Rybkina TE. Arterial’naya gipertenziya i metabolicheskii sindrom Kh. RMZh (Rus). 2003;21:1145.
16.    Kaur JA Comprehensive Review on Metabolic Syndrome. Cardiology Research and Practice. 2014;2014:21.
17.    Perk J, Backer GD. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J. 2012;33:1635-1701.

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7. Original researches


The genderrelated aspects of changes in the life of quality indices depending on the arterial hypertension degree

. . Alifer

O. O. Bogomolets National Medical University, Kyiv

Objective — to determine effects of various degrees of arterial hypertension on the quality of life (QoL) indices in male and female patients with arterial hypertension.
Materials and methods. Investigations involved 126 patients with AH, including 86 women (68 %), and 40 men
(32 %) aged from 40 to 81 years. The mean age of the examinees was (61.9 ± 0.3) years. AH of the 1st degree was defined in 19 persons (15.1 %), AH degree II in 65 subjects (51.6 %), and AH of III degree was established in 42 persons
(33.3 %). The control group consisted of 43 practically healthy persons, who did not differ from the main group by demographic indices. Surveys of patients on the evaluation of the QoL was conducted using the SF 36 questionnaire at each visit.
Results and discussion. The analysis of the QoL parameters in the healthy group showed that level of QoL was significantly higher in men than in healthy women (1—2 (BP, RF) > 0.5, 1—2 (PP) < 0.001, 1—2 (physical func­tioning (PF)) > 0.5)), with exception of the general health scale, where 1—2 (GH) < 0.05 (77,2 ± 3.02 vs 63.75 ± 2.81).
The QoL of male patients with hypertension did not significantly differ from the QoL in women with hypertension, with the exception of the index of physical functioning (PF) of 72.63 ± 5.12 vs 55.64 ± 2.03, which was 24 % higher in men than in men from women. This may be due to the better physical development of men in general.
Conclusions. Analysis of the QoL indicators in the component of «psychological health» with different degrees of hypertension revealed significantly higher QL values in patients with AH I degree compared with grade II AH on such scales as VE — (80.0 ± 3.93) and RF — (77.1 ± 4.04) points. There was a decrease in the indicators of SF and MH — (48.7 ± 7.35) and (47.41 ± 2.39) points, respectively. The analysis of the QoL indicators (a component of «physical health») of patients with hypertension depending on sex showed that QoL in men with hypertension did not significantly differ from the QoL in women with hypertension, with the exception of the PF index of 72.63 ± 5.12 against 55.64 ± 2.03, which was 24 % higher in men than in women. Analysis of the QoL indicators (component of mental health) in patients with hypertension, depending on sex, resulted in the significant (3—4 < 0.5) reduction of the RF index, which was 2 times higher in men with hypertension than in women with AH ((53.8 ± 0.01) vs (23.4 ± 0.03) points). It should be noticed that the presence of high SF in both hypertensive men and women ((62.7 ± 0.01) vs
( 63.6 ± 0.02) points (3—4 < 0.5) indicated preservation of the social contacts in hypertension, despite the disease progression.

Keywords: arterial hypertension, quality of life, gender aspect, SF-36 questionnaire.

List of references:
1.    Adherencetolong-termtherapies: Evidence for action. Geneva, WHO, 2003:198.
2.    Asadujjaman M, Mishuk AU, Hossain MA, et al. Medicinal potential of Passiflora foetida L. plant extracts: biological and pharmacological activities. J Integr Med. 2014;12(2):121-126.
30.    Bardage C, Isacson D. Hypertension and health related quality of life: an epidemiological study in Sweden. J Clin Epidemiol. 2001;54:172-181.
4.    Barnason S, Zimmermann L, Anderson A, et al. Functional status outcomes of patients with a coronary artery by pass graft over time. Heart Lung. 2000;29:33-46.
5.    Baroletti S, Dell’Orfano H. Medication Adherence in cardiovascular disease. Circulation. 2010. 121:1455-1458.
6.    Battersby C, Hartley K, Fletcher A, et al. Quality of the life in treated hypertension: a cause-control community based study. J Hum  Hypertens. 1995;9:981-986.
7.    Bernatoniene J, Kopustinskiene DM, Jakstas V, et al. The effect of Leonurus cardiaca herb extract and some of its flavonoids on mitochondrial oxidative phosphorylation in the heart. Planta Med. 2014;80(7):525-532.
8.    Dalfó A Baqué, Badia X Llach, Roca A-Cusachs Coll, et al. Validation of the quality of life questionnaire in arterial hypertension (HQALY) for its use in Spain. Relationship between clinical variables and quality of life. Investigator Group of the HQALY study. Aten Primaria. 2000;26(2):96-103.
9.    Deeks A, Lombard C, Michelmore J, Teede H. The efects of gender and ageon health related behaviors. BMC Public Health. 2009;9:213.
10.    Gee M.E, Bienek A, McAlister F.A, et al. Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension. Can J Cardiol. 2012;28(3):375-382.
11.    Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am J Hypertens. 2008;21(7):789-798.
12.    Gu Q, Paulose-Ram R, Dillon C, Burt V. Antihypertensive medication use among US adults with hypertension. Circulation. 2006;113:213-221.
13.    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). Journal of Hypertension. 2013;31:1281-1357.
14.    Hadley S. Valerian, Petry JJ. Am Fam Physician. 2003;67;8:1755-1758.
15.    Mancia G, Fagard R, Narkiewicz K, et al. ESH / ESC Guidelines for the management of arterial hypertension. Eur Heart Jour. 2013;34:2159-2219.
16.    Noguchi Shinohara M, Ono K, Hamaguchi T, et al. Pharmacokinetics, Safety and Tolerability of Melissa officinalis Extract which Contained Rosmarinic Acid in Healthy Individuals: A Randomized Controlled Trial. PLoS One. 2015;10(5):e0126422.
17.    Ooi HHL, Coleman PL, Duggan J, O’Meara YM. Treatment of hypertension in the elderly. Current Opinion in Nephrology and Hypertension. 1997;6(5):504-509.
18.    Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S. Trends in hypertension prevalence, awareness, treatment, andcontrol in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc. 2007;55:1056-1065.
19.    Roca-Cusachs A, Ametlla J, Calero S, et al. Quality of life in arterial hypertension. Med Clin (Barc). 1992;98:486-490.
20.    Roca-Cusachs A, Dalfo A, Badia X, et al. Relation between clini-cal and therapeutic variables and quality of life in hypertension. J Hypertens. 2001;19:1913-1919.
21.    Sang Hui Chu, Ji Won Baek, Eun Sook Kimetal. Gender Differences in Hypertension Control Among Older Korean Adults: Korean Social Life, Health, and Aging Project. J Prev Med Public Health. 2015;48:38-47.
22.    Schulz RB, Rossignoli P, Correr CJ, et al. Validation of the short form of the Spanish hypertension quality of life questionnaire (MINICHAL) for Portuguese (Brazil). Arq Bras Cardiol. 2008;90(2):127-131.
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8. Original researches


Use of platelet autologous plasma in the treatment of post-traumatic knee osteoarthritis

L.V. Khimion, G.O. Havryliuk

P.L. Shupyk National Medical Academy of Postgraduate Education, Kyiv

Objective —  to determine the efficacy and safety of platelet autologous plasma () in the complex treatment of post-traumatic knee osteoarthritis (OA) in younger patients.
Materials and methods. The study was conducted at the Department of Family Medicine of the Shupyk National Medical Academy of Postgraduate Education on two groups of patients with post-traumatic OA of knee joints aged
18 to 44 years. The study included 46 patients who were divided into 2 groups. The 1st group consisted of 28 patients with I—II radiographic stage post-traumatic OA of knee (J. Kellgren and J. Lawrence classification), who received a comprehensive OA treatment according to the current recommendations (non-steroidal anti-inflammatory drugs, therapeutic exercises, physiotherapy) in combination with intraarticular AP injections (2 courses of 3 injections with an interval of 3—5 days with a total plasma volume of 12—15 ml and an average content of thrombocyte ((280—320 ± 22.1) × × 109 ml). The group 2 (control group) included 18 patients with the same diagnosis, which received complex treatment of OA.
Results and discussion. During the treatment period, in both groups, a trend was observed for regression of the indices, which were assessed according to the WOMAC index. However, patients of group 1 who received complex treatment for post-traumatic OA using intraarticular AP injections showed a better result than group 2.
Conclusions. The use of intra-articular injection of AP in the complex treatment of young patients with symptomatic post-traumatic OA knee joints can improve the effectiveness of therapy for reducing pain and stiffness, improving physical activity compared with the results of standard treatment. This method of treatment is possible for use by doctors of various specialties, including family doctors in outpatient practice, due to the simple method of use.

Keywords: post-traumatic osteoarthritis, platelet autologous plasma, treatment.

List of references:
1.    Davydkina IL, Shchukina YuV. Poliklinichna terapiia / Pid red. IL Davydkinoi. M: HEOTAR-Mediia, 2013:688.
2.    Kovalenko VN, Bortkevych OP. Osteoartroz. K.: Moryon; 2003:448.
3.    Nasonova VA. Osteoartroz kolennoho sustava: prychyn razvytyia, dyahnostyka, profylaktyka. Consilium medicum. 2003;5(2):90-95.
4.    Anitua E, Sanchez M, Zalduendo MM, et al. Fibroblastic response to treatment with different preparations rich in growth factors. Cell Prolif. 2009;42:162.
5.    Brown TD, Johnston RC, Saltzman CL, et al. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma. 2006;20(10):739-744.
6.    Cerza F, Carni S, Carcangiu A. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Sports Med. 2012;40:822-827.
7.    Cross. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Annals of the rheumatic diseases. 2014;73:1323-1330.
8.    Drengk A, Zapf A, Sturmer EK, et al. Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells. Cells Tissues Organs. 2009;189:317.
9.    Frobell RB, Roos HP, Roos EM, et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232.
10.    Gelber AC, Hochberg MC, Mead LA, et al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133(5):321-328.
11.    Haynes S, Gemmell H. Topical treatments for osteoarthritis of the knee. Clin Chiropractic. 2007;10(3):126-138.
12.    Kieswetter K, Schwartz Z, Alderete M, et al. Platelet derived growth factor stimulates chondrocyte proliferation but prevents endochondral maturation. Endocrine 1997;6:257.
13.    Kon E, Buda R, Filardo G. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy. 2011;27:1490-1501.
14.    Kon E, Buda R, Filardo G. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):472-479.
15.    Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26-35.
16.    Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756-1769.
17.    Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50(10):3145-3152.
18.    Lotz M. Cytokines in cartilage injury and repair. Clin Orthop Relat. 2001;391:108-115.
19.    Lotz M. New developments in osteoarthritis. Posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options. Arthritis Res Ther. 2010;12(3):211.
20.    Otsuki S, Brinson DC, Creighton L, et al. The effect of glycosaminoglycan loss on chondrocyte viability: a study on porcine cartilage explants. Arthritis Rheum. 2008;58:1076-1085.
21.    Petrera M, De Croos JN, Iu J, et al. Supplementation with platelet-rich plasma improves the in vitro formation of tissue-engineered cartilage with enhanced mechanical properties. Arthroscopy. 2013;29:1685.
22.    Riegger J, Joos H, Palm HG, et al. Antioxidative therapy in an ex vivo human cartilage trauma-model: attenuation of trauma-induced cell loss and ECM-destructive enzymes by N-acetyl cysteine. Osteoarthritis Cartilage. 2016;24(12):2171-2180.
23.    Roos H, Lauren M, Adalberth T, et al. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998;41(4):687-693.
24.    Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008;1(3-4):165-174.

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9. Original researches


The combination of gastroesophageal reflux disease with coronary heart disease: a non-invasive method of diagnosis

G.D. Fadeenko, .. Nesen, .. Krakhmalova, O.V. Izmailova

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

Objective — to work out non-invasive method of diagnosis of the endoscopic form of gastroesophageal reflux disease (GERD) by means of measurements of a number of clinical and anamnestic indices, detections of the levels of melatonin metabolite 6-, and questioning to define GERD severity, insomnia and  anxiety-depressive disorders of the patient.
Materials and methods. The examinations involved 94 patients with isolated GERD and GERD in combination with coronary heart disease (CHD). All patients were divided into two groups: the first included 65 patients with GERD and CHD combination, the second group consisted of 29 patients with isolated GERD. The first group included 54 men
(83 %) and 11 women (17 %). The age of patients in the first group varied from 32 to 89 years; the mean age
(61.57 ± 11.37) years. The second group included 17 men (59 %) and 12 women (41 %). The age of patients in the second group varied from 34 to 79 years; the mean age was (59.52 ± 11.18) years. In the process of research were used clinical and instrumental, laboratory and biochemical assays and statistical methods.
Results and discussion. The GERD and CHD combination is known to be the mutually burdening pathological conditions, affecting such indices as sleep and psycho-emotional condition of a patient. Insomnia disorders are registered in 61.54 % of patients with GERD and CHD combination and depend on the age, CHD duration, body mass index (BMI) and GERD severity. The obstructive sleep apnea (OSA) is diagnosed in 73.84 % of patients with comorbid pathology, its severity depends on the age, BMI, intensity of clinical, endoscopic GERD manifestations and CHD duration. The GERD and CHD combination results in the significant violations of dopplerographic parameters of blood flow in the area of the lower esophageal sphincter, including reduction of speed performance and increase of the resistance indices of arteries, responsible for its blood supply: the celiac trunk and the superior mesenteric artery. The received data prove that chronic ischemia of the lower third of the esophagus caused by CHD, affects the morphological state of its mucous and muscular walls and endoscopic GERD form.
Conclusions. It has been proved that patients with GERD and CHD combination have a significant decrease in the melatonin level, which adversely affects the severity of morphological GERD manifestations. The relationship has been established between the M metabolite 6- levels and GERD form (not erosive or erosive) and endoscopic stage of erosive GERD.
The designed non-invasive method for the diagnosis of endoscopic GERD form has a high diagnostic value and can be used as an alternative invasive endoscopic method to assess and monitor GERD severity in patients with concomitant CHD.

Keywords: gastroesophageal reflux disease, coronary heart disease, comorbidity, sleep disorders, obstructive sleep apnea/hypopnea syndrome, melatonin.

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10. Reviews


Dyslipidemia in oncopathology: is it a risk factor or a consequence of cancerogenesis?

V.A. Chernyshov

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

The review is devoted to summarizing of existing data about an association between dyslipidemia (DLP) and oncopathology from the position of consideration of DLP as a risk factor or a consequence of cancerogenesis. The aim of the review is to emphasize an attention of physicians to association of DLP with a risk of development of different types of cancer as well as to discuss a possible role of lipids and lipoproteins of human blood in stimulation of cancerogenesis.
The association of hypocholesterolemia, hypoalphacholesterolemia, and hypertriglyceridemia with a high total risk of development of cancer of any location is discussed. A significance of tumor tissue consumption of blood lipids and lipoproteins in the changes of patient’s lipid profile is shown. A role of lipogenesis de novo as well as adipocyte lipolysis and a start of mevalonate mechanism in supply of cancer cells with lipids is accentuated. A possible role of hypocholesterolemia induced by statins in elevation of oncopathology risk is discussed. An importance to investigate a possible role of DLP as a risk factor of oncopathology and a relationship between the values of lipid and lipoprotein blood spectrum and oncomarkers and also to assess their interactions in progression of tumor growth is stressed in the present review.

Keywords: lipids, lipoproteins, oncopathology.

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11. Reviews


Endothelial dysfunction and its role in the pathogenesis of chronic obstructive pulmonary disease. Part II

O.I. Lemko, N.V. Vantyukh

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

In the Part I of the article the relevance of the problem has been outlined, the role of vascular endothelium in the organism’s regulation underscored, and some causes of its disturbances at chronic obstructive pulmonary disease (COPD) have been presented. In particular, the significance of tobacco smoking and intensifying of the lipids peroxidation has been discussed, and emphasis given to the high prevalence of insulin resistance, metabolic disorders and comorbid cardiovascular diseases, negatively affecting the clinical picture of the underlying disease.
Part II of the article presents summarized data concerning relationship between long-term systemic inflammatory process of low intensity and endothelial dysfunction (ED) in patients with COPD; the importance of assessing C-reactive protein as the most significant marker of systemic inflammation is emphasized; the role of cytokines’ imbalance and adhesion molecules in the development and maintenance of ED is discussed.
In Part III, the relationship is outlined between immune disorders and presence of ED at COPD, the peculiarities of the cell and humoral immunity indices in COPD patients with comorbidities highlighted. The specific features of the disturbances in apoptosis and hemostasis processes with the progression of ED are emphasized; the role of vibration appearing with severe cough in ED formation is considered; some genetic aspects leading to the ED development are presented.

Keywords: chronic obstructive pulmonary disease, endothelial dysfunction, immune disorders, apoptosis, hemostasis, genetic factors.

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