Exercise tolerance in school-age children with hypertension based on body weight

Hypertension and obesity are important problems among adolescents. In clinical practice, these diseases are often combined and worsen the quality of life, so the study on indicators of tolerance to exercise is of great scientific and practical importance. The aim. To determine the state of tolerance to physical activity among school-age children with stable hypertension depending on body weight. Materials and methods. The study involved 95 children aged from 9 to 18 years who were divided into four groups: the first – 18 patients with normal blood pressure and body weight; the second – 39 with stable hypertension and normal body weight; the third – 20 with normal blood pressure and obesity; the fourth – 18 children with stable hypertension and obesity. Exercise tolerance was examined during cycling ergometry according to the PWC 170 protocol; the maximum myocardial oxygen uptake index – VO2peak (the “gold standard” for determining tolerance) was evaluated. Results. According to the study results, among children with a combination of primary hypertension and obesity, the clinical picture of the condition is characterized by significantly more frequent complaints of dizziness, heart pain, headache and loss of consciousness. The total score of complaints was 5.8 ± 1.9 points in the combined pathology of primary hypertension and obesity group, which is significantly higher (P < 0.01) than that among children with primary hypertension or obesity. In primary hypertension and obesity, there is a decrease in VO2peak, which is most pronounced in the combination of these conditions (up to 26.4 ± 6.7 ml/min/kg among boys and up to 22.7 ± 3.6 ml/min/kg among girls) indicating a significant decrease in exercise tolerance. Conclusions. It has been proven that the combined pathology of primary arterial hypertension and obesity among adolescents greatly worsens the clinical condition of children and significantly reduces exercise tolerance more pronounced than in primary arterial hypertension or obesity.

Psychophysical training in treatment of sympathicotonic vegetative dystonia syndrome and primary arterial hypertension in children and adolescents

Objective. To evaluate the effectiveness of psychophysical training as a method of non-drug correction of vegetative dystonia syndrome of sympaticotonic type and primary arterial hypertension in children and adolescents. Material and methods. 164 patients aged 717 years with sympathicotonic vegetative dystonia syndrome were examined, of which 47 were diagnosed primary arterial hypertension. The baseline autonomic tone (by cumulative clinical tables of autonomic manifestations), autonomic reactivity (based on the results of variation pulsography in ortho-and clean position), support activities (by clean orthostatic test) were evaluated, the heart rate variability was analyzed. As a method of non-drug correction of the functional state of the autonomic nervous system, psychophysical training (main group, n = 110) and therapeutic physical culture (comparison group, n = 54) were used. To assess the effectiveness of treatment, patients were examined twice: before and after the course. Results. It was found that in the sympaticotonic type of vegetative system, excessive vegetative reactivity and activity maintenance predominate. The use of psychophysical training leads to their normalization in most patients. In patients with primary arterial hypertension, the level of blood pressure decreases. According to the analysis of heart rate variability in the main group there is a significant increase in the total power spectrum of neurohumoral regulation, representation of high-frequency fluctuations with simultaneous reduction of the share of low-frequency waves as well as aligned sympathetic-parasympathetic balance. Conclusion. Psychophysical training is an effective method for non-drug correction of vegetative dystonia syndrome by sympaticotonic type and primary arterial hypertension in children and adolescents.

A specific feature of the diagnosis of primary arterial hypertension in elderly patients

Objective the analysis of a group of factors, leading to the increase of pulse pressure in the direction from aorta to microcirculation vessels, in order to define the diagnostic criterion for exception of primary arterial hypertension. Material and methods.In the study, the modelling of the functions of arteries in cardiovascular system was used. Results.The role of the increase of pulse pressure to the periphery of blood circulation was regarded as the diagnostic attribute of exception of the primary arterial hypertension. It was noted, that physical factors of the increase of pulse pressure to the periphery of blood circulation were insignificant. The cardiovascular reflex has the major influence on the increase of pulse pressure, its deterioration results in the decrease of this pressure. Conclusion.The analysis revealed the fact, that the normal ankle-brachial index allows for exclusion of primary arterial hypertension in a patient, even if the absolute values of arterial pressure are in the limits corresponding to this disease.

The objective: to optimize the treatment of children with the combined course of chronic gastroduodenitis (CGD) and primary arterial hypertension (PH) against the backdrop of hypomagnesemia by including the combined preparation of magnesium and vitamin В6 in the treatment regimen. Materials and methods. We examined 20 children aged 10 to 17 years with a combined course of CGD and PH and a serum magnesium content of ≤0.8 mmol/L. Children received non-drug treatment, treatment of CGD in accordance with the clinical protocol. PH treatment included an ACE inhibitor (enalapril) in an individual dose. Additionally preparation of magnesium and vitamin В6 was assigned. Results. Against the background of combined treatment, after 1 month, complaints of abdominal pain, nausea, headache and a feeling of heaviness in the stomach were decreased most intense in patients. After 3 months, complaints of fatigue significantly decreased and normalized tests of self-assessment of the functional state and subjective assessment of the quality of night sleep. According to the ABPM data, the average daily SBP and SBP load (p<0.001) decreased most distinctly, and the SBP dipping increased (p=0.04). According to endoscopy results, the number of children with erythematous CHD after 3 months decreased from 40% to 10% (χ2=4.8; p=0.03), and erosive CHD was not diagnosed in any child (χ2=8.48; p=0.004 compared with the data before treatment). Conclusions. Children with a combined course of CGD and PН need complex therapy using a combination of magnesium and vitamin В6. This approach contributes to the normalization of serum magnesium levels, the rapid reduction of complaints, the improvement of blood pressure, the quality of night sleep and the endoscopic picture of the gastric mucosa and duodenum. Key words: chronic gastroduodenitis, primary arterial hypertension, children, treatment, magnesium preparations.

Uterine fibroids are the most common benign tumors of the female genital tract and are associated with numerous clinical problems. Laparoscopic myomectomy is an absolute altermative to standard open surgical technique with comparable long-term results. Due to the wide use and improvement of operational techniques with laparoscopic access, the pressing issue is possibility of its use in women, who have leiomyomas of the uterus and reрroductive intentions. The attitude to the quality of endoscopic suturing of the uterus after the enucliation of the knot and capability of suture during the next pregnancy is controversial. The technical aspects of suture of uterine incisions and also experience and skill of a surgeon during myomectomy deserves special attention. Uterine ruptures during the pregnancy and delivery are connected with violation of suture techniques – one-row uterine suture is compared with layering, and it’s extremely important for the full recreation of uterine-wall integrity after the removal of leiomyoma; wide use of electrocoagulation, which can lead to burns of myometrium with the further worsening of tissue regeneration.Given the need for an individual approach to each patient with uterine fibroids and reproductive intentions, surgical technique, access, choice of energy and suture are determined by each surgeon depending on the size, localization of uterine fibroids and clinical course to obtain the most effective postoperative result. The article is dedicated to peculiarities of the laparoscopic myomectomy in women of reproductive age. Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique with good results in terms of pregnancy outcome. Key words: uterine fibroids, fibroid, myomectomy, laparoscopy, surgical technique.

The results of using the magnesium and vitamin B6 in children with a combined course of chronic gastroduodenitis and primary arterial hypertension

The objective: to optimize the treatment of children with the combined course of chronic gastroduodenitis (CGD) and primary arterial hypertension (PH) against the backdrop of hypomagnesemia by including the combined preparation of magnesium and vitamin В6 in the treatment regimen. Materials and methods. We examined 20 children aged 10 to 17 years with a combined course of CGD and PH and a serum magnesium content of ≤0.8 mmol/L. Children received non-drug treatment, treatment of CGD in accordance with the clinical protocol. PH treatment included an ACE inhibitor (enalapril) in an individual dose. Additionally preparation of magnesium and vitamin В6 was assigned. Results. Against the background of combined treatment, after 1 month, complaints of abdominal pain, nausea, headache and a feeling of heaviness in the stomach were decreased most intense in patients. After 3 months, complaints of fatigue significantly decreased and normalized tests of self-assessment of the functional state and subjective assessment of the quality of night sleep. According to the ABPM data, the average daily SBP and SBP load (p<0.001) decreased most distinctly, and the SBP dipping increased (p=0.04). According to endoscopy results, the number of children with erythematous CHD after 3 months decreased from 40% to 10% (χ2=4.8; p=0.03), and erosive CHD was not diagnosed in any child (χ2=8.48; p=0.004 compared with the data before treatment). Conclusions. Children with a combined course of CGD and PН need complex therapy using a combination of magnesium and vitamin В6. This approach contributes to the normalization of serum magnesium levels, the rapid reduction of complaints, the improvement of blood pressure, the quality of night sleep and the endoscopic picture of the gastric mucosa and duodenum. Key words: chronic gastroduodenitis, primary arterial hypertension, children, treatment, magnesium preparations.

Diagnostic significance of subjective techniques for the study of the acoustic organ in patients with primary arterial hypertension

Objectives - to evaluate the diagnostic significance of subjective techniques for the study of the acoustic organ in patients with primary arterial hypertension (HT) Material and methods. 40 patients (n = 40) were divided into 2 groups: Group 1 included patients with HT, group 2 - conditionally healthy patients, examined at the Republican Center for Research and Practice in Otorhinolaryngology, in 2018-2019. The mathematical statistics, Student t-test were used. Results. The patients in the group 1 presented the following complaints: the decrease in speech intelligibility 80% (n=16), difficulty in recognizing the speech in polyphony 70% (n=14), tinnitus 60% (n=12), hearing loss 15% (n=3). Otoscopy in both groups was within normal. Whisper test result was 6 m in the conditionally healthy patients. In patients with HT, the whisper test with familiar multi-syllable words resulted as 6±0.5 m. However, the mono-syllable word hearing in all patients was reduced to 4±0.5 m. Type A tympanogram was registered in patients of both groups (n=40) with bilateral acoustic reflex. High-frequency audiometry showed changes in 1/3 of the patients in HT group (n=6). Monoaural speech intelligibility (multi-syllable words) at the comfortable hearing threshold was not significantly different in both study groups. The binaural speech intelligibility tested by alternating binaural speech at the comfortable auditory threshold reached 80±5% (t>0,95), along with extremely low pass percentage (35%) in digital dichotic tests in patients with HT, that can suggest the feasible central mechanism of the auditory analyzer lesion. Conclusion. HT is a systemic disease that causes an impairment of the acoustic organ at the central and peripheral levels. In addition to the standard batch of hearing tests, it is recommended to use the superthreshold speech intelligibility tests in patients with arterial hypertension.