Antioxidant protection in patients with pulmonary tuberculosis

The literature review summarizes the data on the classification and characteristics of the antioxidant defense system. This model combines a number of different substances. Each of the components of the antioxidant system acts in close connection with its other structural elements, harmoniously complements, and in many cases – enhances the action of each other. The functional basis of the system of antioxidant protection is formed by the glutathione system, the constituent elements of which are actually glutathione and enzymes that catalyze the reactions of its reverse transformation (oxidation ↔ reduction). Most researchers conventionally divide the system of antioxidant protection into enzymatic and non-enzymatic. The enzyme links of the antioxidant defense system include: catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase, glutathione transferase and other enzymes. The non-enzymatic system includes fat-soluble vitamins A, E and K, water-soluble vitamins C and PP, biogenic amines, glutathione, carotenoids, ubiquinone, sterols. Both enzymatic and non-enzymatic antioxidant defense systems are present in the bloodstream. The activity of the enzymatic antioxidant system is very well regulated and depends on age, physiological condition, hormone dynamics, intensity of antioxidant enzyme synthesis, pH, presence of coenzymes, inhibitors, activators and other factors. The non-enzymatic part of the antioxidant system does not require as many regulators as the chemical itself - the antioxidant - reacts chemically with the radical. Only the reaction rate can change. The lungs are directly exposed to oxygen and oxidants of polluted air, they are most sensitive to oxidative damage, so they have an increased possibility of free radical reactions. Protection against the damaging effects of reactive oxygen species and free radicals is provided by anti-radical protective systems, especially the glutathione system and its enzymes. Numerous papers have obtained clinical and experimental data on the important role of free radical oxidation of lipids (FROL) and antioxidant systems (AOS) protection in the development of many diseases, including pulmonary tuberculosis (TB). The review presents modern views on the state of the system of lipid peroxidation (LPO) and antioxidant protection in TB. The main topic of the review is information on the generation of free radical compounds by different populations of leukocytes with further enhancement of LPO and secondary deepening of functional disorders. The article substantiates the feasibility of identifying LPO products as non-specific markers of aseptic inflammation in TB and the need to develop new generations of antioxidants. One of the universal mechanisms of damage to cell membranes is LPO, the excessive activation of which is normally prevented by factors of the antioxidant defense system. Membrane-bound enzymes involved in the formation of LPO products include lipoxy and cyclooxygenases. Lipoperoxidation processes change the structure and phospholipid composition of cell membranes, which negatively affects the cellular immune response due to damage to the mechanisms of information transfer from extracellular regulators to intracellular effector systems.

Status of the collagen metabolism and intracardiac hemodynamics in patients with mitral valve prolapse and diabetes mellitus type 1

Summary. Mitral valve prolapse is a significant cardiovascular risk factor in young adults. Its combination with type 1 diabetes mellitus can influence the nature and development of the disease. Objective – a comparative analysis of free and peptide-bound oxyproline levels and basic echocardiographic parameters (ECP) in patients with mitral valve prolapse, type 1 diabetes and their combination. Materials and methods – 93 people aged 19–33 years were examined, including 24 people with mitral valve prolapse without concomitant pathology; 33 patients with mitral valve prolapse and type 1 diabetes; 36 patients with type 1 diabetes without mitral valve prolapse. Results. The level of free and peptide-bound oxyproline in blood serum and their ratio were assessed as a marker of collagen metabolism. The levels of free oxyproline were significantly higher only for the group of MVP patients with type 1 diabetes (p < 0.05) compared to the control group. Severity of destructive processes was demonstrated by a high level of peptide-bound oxyproline, both in combined pathology compared with control group, and compared with groups of patients with monomorbid diabetes and MVP (p < 0.05). In patients with mitral valve prolapse and type 1 diabetes for more than 10 years in anamnesis were found significant differences in the echocardiography parameters (ventricular septum thickness, posterior wall of the left ventricle thickness) compared with the subgroup of patients with less than 10 years of type 1 diabetes in anamnesis and the group with isolated mitral valve prolapse. Conclusions. The data obtained indicate an aggravation in collagen metabolism disorders in patients with mitral valve prolapse depending on the duration of type 1 diabetes, and demonstrate the effect of carbohydrate metabolism disorders on the risk of developing connective tissue degradation of the heart valve apparatus.

Viscose and Thrombocytic-Aggrega-Tion Disorders On Patients With Myocardial Infarction With Stable Elementation of ST Segment

Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro- and microcirculation. The aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease. Materials and methods. The study used 4 tactical and treatment-diagnostic approaches during the year of observation. Results. Patients with myocardial infarction with persistent ST-segment elevation were found to have hyperviscosity and hypercoagulability syndromes, manifested in the first weeks by a compensatory increase in platelet count, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Conclusions. Carrying out additional in-depth examination of coronary circulation (coherent tomography and intravascular sonography) as the main methods of detailed assessment of atheromatous process and further application of delayed stenting of infarct-independent arteries in group 1, contributed to lower amplitude of fluctuations, due to the systemic step-by-step improvement of arterial blood supply, to optimize the state of viscosity and processes of adhesion / aggregation of platelets. Traditional tactical and medical-diagnostic principles of this category of patients do not allow to fundamentally improve the state of viscosity and coagulation-aggregation parameters, even with the use of dual antiplatelet therapy.

Structure of abdominal injury and its consequences

Introduction. Mechanical injuries are a leading cause of disability and premature death among the working-age population in most countries worldwide. Injuries to the abdominal and retroperitoneal organs (abdominal trauma) significantly aggravate the course of trauma and are a frequent cause of death. The aim of the study was to analyse the structure and outcome of the treatment of abdominal trauma victims. Materials and methods. On the basis of the polytrauma department of the municipal non-profit enterprise «Municipal clinical hospital of emergency and urgent medical care named after A. I. Meshchaninov» of Kharkiv City Council councilаnalysis damage structure and the results of treatment of 240 patients with abdominal trauma were carried out, the main causes of lethal outcomes were determined. Results. Most of the patients with abdominal trauma were male (78,7%), and they were young (18 to 44 years old) (72,5 %). The cause of injury in 95 (39.6 %) victims was road traffic accident, in 58 (24.2 %) – catatrauma; in 65 (27.1 %) – domestic injury. In the abdominal cavity, parenchymatous organs (spleen and/or liver) were injured most frequently, identified in 66.7 % of victims. In 26.3 % of patients revealed damage to the small or large intestine, in some cases, trauma to the stomach and gallbladder was detected. In 37 (15.4 %), mesenteric injury was detected, and in 32 (13.3 %), omental injury was detected. Among retroperitoneal organs the renal trauma was frequent – 46 (19.2 %), pancreatic and urinary bladder injuries were revealed in 27 (11.2%) and in 13 (5.4%) cases, retroperitoneal haematoma was revealed in 63 (26.7 % ) victims. In 178 (74.2 %) victims a combined trauma was diagnosed: thoracic in 129 (53.8%) cases, skeletal in 96 (40 %), craniocerebral in 84 (35 %). Combined injuries of one anatomofunctional region were diagnosed in 80 (33.3 %), two in 67 (27.9 %), and three in 31 (12.9 %) victims. During in-hospital treatment, 34 (14.2 %) victims died, of which 12 (35 %) during the first week after injury. The duration of inpatient treatment for the victims who were discharged was 15.0 [12.0; 25.0] beds/day. The causes of mortality and prolonged hospitalization (more than 14 days) in most cases were cardiovascular, respiratory, purulent-septic and renal complications. Conclusion. Abdominal parenchymal injuries predominate in the structure of abdominal trauma, occurring in 66.7 % of victims. Combined (thoracic, skeletal and/or craniocerebral) trauma occurs in 74.2 % of victims. The fatality rate for isolated abdominal trauma was 4.8 %, with a significant increase in cases of combined trauma, up to 41.9 % for combined thoracic, skeletal and craniocerebral trauma.

Interleukin-31 new biomarker of infectious skin diseases

Introduction. The introduction of antiretroviral therapy has significantly improved the long-term prognosis of AIDS patients, but opportunistic infections can still be life-threatening for this population. Among them, a large group constitutes of herpesvirus infections, which are frequent manifest forms of dermatological manifestations of HIV. The researching of IL-31, as a prospective diagnostic predictor of dermatological diseases, has been actively conducted in recent years. This is due to the interest in its biological action, which extends primarily to the skin. Тhe identification of molecular targets underlying inflammatory and infectious dermatoses is promisingly for the development of new, targeted treatments. Objective: to study the role of IL-31 in the immunopathogenesis of herpesvirus infections associated with HIV infection. Research objectives: 1) to compare the levels of IL-31 in the blood serum in patients with herpesvirus skin diseases associated with HIV infection and in healthy subjects; 2) to determine the presence of a relationship between the levels of IL-31 in the blood serum and the clinical stage of the disease. Materials and methods. The study included patients with herpesvirus infection caused by HSV-1, HSV-2, VZV-3, EBV and HHV-8 associated with HIV infection and healthy individuals. Serum IL-31 levels were measured by ELISA using commercial kits (Human IL-31 ELISA Kit, Abcam, Cambridge, MA, USA). Were collected the baseline clinical characteristics, assessment of the activity of the infectious process and the degree of immunosuppression. Results. Our study involved 39 patients with herpesvirus infection associated HIV and 31 patients of the control group. In patients with herpesvirus infection against the background of HIV infection, the average level of IL-31 in the blood serum was significantly higher than that of healthy subjects. Serum IL-31 levels in patients with herpesvirus infection did not differ significantly depending on the severity of the process and the degree of immunosuppression. Conclusion. The levels of IL-31 in the blood serum of patients with herpesvirus infection were differed by statistically significant validity in comparison with similar indicators of healthy individuals, which confirms its role in the pathogenesis of infectious skin diseases.

Treatment, rehabilitation and assessment of the quality of life of patients operated for complications of diabetic foot syndrome

Introduction. One of the complications of diabetes mellitus (DM) is diabetic foot syndrome (DFS), which develops in 6–11 % of patients and requires surgical treatment in 40–70 % of them. Various types of amputations and large necrectomies lead to a redistribution of the load on the foot with the development of violations of its support function and deformity. As a result, the soil arises for the development of purulent-necrotic processes, the quality of life of patients decreases. Rehabilitation is an important part of postoperative care. It should be carried out both in the hospital and at the outpatient stage of treatment and is an important measure in preventing complications and improving the quality of life of patients. Aim. To analyze the results of treatment of patients with purulent-necrotic complications (PNC) of DFS, for whom postoperative rehabilitation measures were included in the treatment complex. Materials and methods. The results of treatment of 128 patients operated on for PNC of DFS were studied. The examination and treatment were carried out according to the standards. At the outpatient stage, 45 patients underwent complex rehabilitation using a set of physical exercises in combination with physiotherapy methods of treatment. Determination of the degree of foot deformity was performed using plantography and X-ray of the foot bones. The dynamics of life quality indicators were studied using the Manchester-Oxford foot questionnaire (MOXFQ). Results and discussion. The obtained results showed that in conditions of rehabilitation treatment, after 6 months the number of complications in the main group was less than in the comparison group by 12.6 %, and after a year – by 25 %. The study of the quality of life using the MOXFQ questionnaire 6 months after rehabilitation showed a significant difference in indicators (p < 0.05) between the comparison and the main groups on pain and social interaction scales and the MOXFQ index in general, which indicates a positive effect of the used rehabilitation treatment on the quality life of patients. At the same time, after a year, the reliability of the difference in indicators on all scales and the MOXFQ-index of the main and comparison groups was not revealed, despite the best absolute figures. The result obtained indicates the need for repeated courses of rehabilitation measures in the complex of treatment. Conclusions. Treatment of patients with complications of DFS should be organ-preserving and complex. Treatment should include a set of rehabilitation measures aimed at restoring the motor function and support ability of the foot to prevent its deformation. The use of rehabilitation treatment can reduce the number of complications in the postoperative period and improve the quality of life of patients.

Threat of hiv infection for public health: 40 years of confrontation

Introduction. HIV infection is a very dangerous disease and due to the lack of specific prevention methods and effective treatment methods leads to early disability or death. Now this problem is actual for every state, especially for ours, because Ukraine has the highest rate of the epidemic in Europe, therefore, humanity is alarmed by what is happening to the country, which is located in the center of Europe. If this disease is not stopped, the threat of a demographic, economic and social crisis will also increase for other states. Aim – the study of epidemiological features and reasons for the further spread of HIV infection in Ukraine according to open sources of medical statistics in Ukraine and other countries of the world. Results. The article provides data on the study of the problem of the global spread of HIV infection, which has not lost its relevance over the past 40 years. Detailed official statistical information on the social significance of the prevalence of HIV infection in our country and in the world has been provided. The main measures for the prevention of this disease, which is the most dangerous for adolescents, are given. A characteristic feature of the current stage of the spread of infection is that transmission and infection are associated with populations including children of HIV-infected people, members of their families and victims of violations of safety standards in certain medical institutions. Numerous "secondary risk groups" are formed, the emergence of which has a completely social nature. Conclusions. Nowadays, it is understood that diseases that are dangerous to society, such as HIV infection, are phenomena in the fight against which exclusively medical measures are ineffective. Solution to the problem of HIV infection should be a priority of state policy; it should be aimed, first of all, at preventive and elucidating work with young people, who are, without exaggeration, the main risk group. The authors substantiated the need to strengthen control by state institutions and to develop and implement a system of special measures to protect the rights and legitimate interests of citizens and society to preserve the national security of Ukraine.

Effectiveness of the concept of fast-trak surgery for simultaneous laparoscopic hernioplastics and cholecistectomy

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

Peculiarities of structural-functional indicators of the heart in the combined of hypertension and gastroesophageal reflux disease in liquidators of consequences of Chornobyl accidents

The Chornobyl accident in Ukraine affected more than 3 million people. The impact of the disaster on human health is multifaceted and is associated with both the direct effects of ionizing radiation and other negative factors of the accident. Diseases of the circulatory system are one of the leading causes of death in this population. The combination of hypertension disease and gastroesophageal reflux disease reveals forms of structural and functional indicators of the heart, characterized by a higher level of left ventricular myocardial hypertrophy, regardless of the stage of HD and the degree of blood pressure. The aim was to determine the features of structural and functional indicators of the heart in the combined course of HD and GERD in the liquidators of the Chornobyl accident, as well as to establish differences from the indicators of patients with isolated HD. Materials and methods of research. A comprehensive survey of 105 liquidators of the Chornobyl accident aged 52 to 69 years (mean age 58.5 ± 0.8 years), 85.7 % of men and 14.3 % of women was conducted. All of them were hospitalized in therapeutic and / or observed on an outpatient basis in the outpatient departments of the «Regional Clinical Specialized Dispensary for Radiation Protection of the Population» of Kharkiv. Patients were divided into 2 groups. The first group – 52 patients with a combined course of HD and GERD, 44 (84.6 %) men and 8 (15.4 %) women. The second – 53 patients with isolated HD, 46 (86.8 %) men and 7 (13.2 %) women. All patients in outpatient settings underwent a comprehensive medical examination, including Doppler echocardiography. Results and conclusions. When comparing the structural and functional parameters of the heart in the combined course of HD and GERD in the liquidators of the Chornobyl accident with an isolated course of HD, it was found that almost all indicators of systolic, diastolic and pumping heart function are statistically significantly increased, p ≤ 0.05, except for aortic pressure size gradient and diameter of right ventricule. Thus, patients with a combined course of pathology have more pronounced changes in the structural and functional parameters of the heart, thereby increasing the risk of cardiovascular complications. Prospects for the study are relevant and necessary for further prediction of the risk of complications and individual therapeutic approach in comorbid pathology in the liquidators of the Chernobyl accident.

The role of the muscular system in the pathogenesis of thrombotic complications of the lower extremities in cancer patients

Introduction. Thrombosis occurs in 15 % of cancer patients, most of these thrombosis is localized in the venous system of the lower extremities. In addition to biological and chemical factors that increase thrombosis, changes in the muscles of the lower extremities play an important role. Disorders of hemodynamic and metabolic processes in the muscles of the lower extremities lead to morphological changes and increase the risk of thrombosis in cancer patients. The aim of the study. Investigate morphological changes in the muscles of the lower extremities and evaluate their role in the formation of thrombosis in cancer patients. Materials and methods. Histological examination of 90 patients, which were divided into four groups depending on the location of the cancer process and the cause of death. The first group A – 34 patients with colon cancer, the second group B – 20 patients with pancreatic cancer, patients from these groups died as a result of thromboembolism. Group B – 19 patients, and group G – 17 patients - people whose cause of death was not thromboembolism. The analysis of biomaterial by means of histological and polarization methods of research is carried out. Additionally, electron microscopy of the obtained biopsy materials was performed. The number of citrate blood endothelial cells was determined in all subjects according to the method of J. Hladovez. Research results and their discussion. The study revealed a large number of morphological changes in blood vessels and muscle fibers. The data obtained indicate that patients with cancer of the pancreas and colon have significant changes in the endothelial lining of the venules and areterioles. All cells have signs of interstitial edema, changes in organelles and signs of hemodynamic disturbances. In some areas, there were complete atrophy of some muscle fibers and compensatory hypertrophy of others. Studies have shown areas of sarcoplasmic homogenization and myocytolysis. Conclusions. In the case of cancer of the pancreas or/and colon, there is significant damage to the endothelium of the vessels of the lower extremities, there are dystrophic-atrophic changes in the muscles with impaired function. Cells suffer from interstitial and perivascular edema, there are contractures of change, myocytolysis. Morphological changes lead to disruption of their function of damage, myocytolysis and remodeling of muscle fibers. The result is an increased risk of thrombosis with subsequent thrombus consideration and a possible risk of pulmonary embolism.