Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.274894
О. В. Годований, Н. Л. Чухрай, О. І. Мрочко, О. І. Мартовлос, O. Hodovanyi, B. A
The aim of the work was a preclinical assessment of acute toxicity, skin resorptive, irritant effects, cumulative and catalase activity, as well as sensitizing properties of the local gel composition “Benzidaflaziverdine” (GCB) used for the treatment of periodontal diseases in orthodontic patients. Materials and methods. 119 animals were involved in the experiment, assigned to seven main and two control groups. GCB was administered intragastrically in doses of 300–600 mg/kg and intradermally of 200 μg into the outer surface of the ear. The native solution of GCB was applied to the skin and mucous membranes, administered orally by the method of “subchronic toxicity” and to the surface of the chorioallantoic membrane (CAM) of chicken embryos. The intensity of lipid peroxidation (LPO) was assessed by the level of diene conjugates (DCs) and malondialdehyde (MDA), and the antioxidant system by catalase activity. The specific leukocyte agglomeration reaction (SLAR), the specific leukocyte lysis reaction, and neutrophil damage indicators were used. Results. The median lethal dose LD50 for rats and mice of both sexes exceeded 5000 mg/kg. The irritant effect of GCB on the mucous membranes was manifested by hyperemia on the second day. Symptoms of irritation disappeared after 3–4 days without medical intervention. An analysis of the CAM blood vessels after exposure to GCB in two observations at the 120th second showed the beginning of hemorrhages. In one observation, GCB caused minor hemorrhages at the 300th second of the experiment. It was found that the coefficient of GCB irritant action was 5 (the mean score of Me (Q1; Q3) was 5 (4; 5)). The coefficient of cumulation (Kcum) exceeded 8.2. An insignificant increase in the median or mean values of catalase enzyme activity, DCs, and the amount of LPO end product such as MDA was observed compared to the control group animals. The SLAR test indicated the development of a delayed-type allergic reaction under the influence of GCB in a 1:10 dilution. One-hundred-fold dilution did not cause significant changes in the indicator in the main group compared to the control one. Conclusions. GCB belongs to the 4th class of toxicity – practically non-toxic substances, does not have sex- and species sensitivity, has weak cumulative activity, minimal effect on the system of LPO. GCB can be recommended for the use in clinical periodontology for medical support of orthodontic patients.
{"title":"Preclinical evaluation of a gel composition based on a flavonoid complex for the treatment of periodontal diseases in orthodontic patients","authors":"О. В. Годований, Н. Л. Чухрай, О. І. Мрочко, О. І. Мартовлос, O. Hodovanyi, B. A","doi":"10.14739/2310-1210.2023.4.274894","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.274894","url":null,"abstract":"The aim of the work was a preclinical assessment of acute toxicity, skin resorptive, irritant effects, cumulative and catalase activity, as well as sensitizing properties of the local gel composition “Benzidaflaziverdine” (GCB) used for the treatment of periodontal diseases in orthodontic patients.\u0000Materials and methods. 119 animals were involved in the experiment, assigned to seven main and two control groups. GCB was administered intragastrically in doses of 300–600 mg/kg and intradermally of 200 μg into the outer surface of the ear. The native solution of GCB was applied to the skin and mucous membranes, administered orally by the method of “subchronic toxicity” and to the surface of the chorioallantoic membrane (CAM) of chicken embryos. The intensity of lipid peroxidation (LPO) was assessed by the level of diene conjugates (DCs) and malondialdehyde (MDA), and the antioxidant system by catalase activity. The specific leukocyte agglomeration reaction (SLAR), the specific leukocyte lysis reaction, and neutrophil damage indicators were used.\u0000Results. The median lethal dose LD50 for rats and mice of both sexes exceeded 5000 mg/kg. The irritant effect of GCB on the mucous membranes was manifested by hyperemia on the second day. Symptoms of irritation disappeared after 3–4 days without medical intervention. An analysis of the CAM blood vessels after exposure to GCB in two observations at the 120th second showed the beginning of hemorrhages. In one observation, GCB caused minor hemorrhages at the 300th second of the experiment.\u0000It was found that the coefficient of GCB irritant action was 5 (the mean score of Me (Q1; Q3) was 5 (4; 5)). The coefficient of cumulation (Kcum) exceeded 8.2. An insignificant increase in the median or mean values of catalase enzyme activity, DCs, and the amount of LPO end product such as MDA was observed compared to the control group animals. The SLAR test indicated the development of a delayed-type allergic reaction under the influence of GCB in a 1:10 dilution. One-hundred-fold dilution did not cause significant changes in the indicator in the main group compared to the control one.\u0000Conclusions. GCB belongs to the 4th class of toxicity – practically non-toxic substances, does not have sex- and species sensitivity, has weak cumulative activity, minimal effect on the system of LPO. GCB can be recommended for the use in clinical periodontology for medical support of orthodontic patients.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"250 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86706344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.276009
Y.V. Chobanu, T. Ilashchuk
One of the key pathogenetic aspects of chronic obstructive pulmonary disease (COPD) and chronic coronary syndrome (CCS) is endothelial dysfunction. Further study on this pathological process is relevant for a better understanding of the course and increasing the treatment effectiveness of these diseases. In this context, in recent years, there has been a growing body of evidence about sirtuins which, according to the latest research results, were capable of rebalancing vasoconstrictory and vasodilatory mediators, regulating the balance in the protease-antiprotease system, protecting endothelial cells from oxidative stress and may be useful in relation to the pathogenesis of COPD and CCS. Aim. To study changes in the levels of serum endothelial nitric oxide synthase (NOS3/eNOS) and sirtuin 1 (SIRT1) in patients with a combined course of COPD and CCS and with COPD or CCS alone. Materials and methods. In order to study endothelial dysfunction and the role of SIRT1 in the processes of its development, we examined 60 patients with combined course of COPD and with CCS or COPD alone. The control group included 10 apparently healthy individuals. Levels of SIRT1 and NOS3/eNOS were studied by enzyme-linked immunosorbent assay, and high-sensitivity C-reactive protein (hsCRP) – by immunoturbidimetric method; clinical data and medical records were analyzed. Commonplace statistical analyses were used. Results. The results have shown that the serum level of SIRT1 in patients with COPD and CCS was lower than that in the control group. The level of hsCRP was significantly higher in patients with the studied pathology than that in apparently healthy individuals and was the highest in patients with combined COPD and CCS. The study on serum NOS3/eNOS has showed the highest concentration in COPD patients, and it was significantly higher in all groups of patients with the studied pathology than that in healthy individuals. A direct correlation has been found between the serum level of SIRT1 and hsCRP and an inverse correlation – with the level of NOS3/eNOS. Conclusions. Thus, the pleiotropic effects and multifaceted molecular interactions of SIRT1 are a promising direction in the search for effective new therapeutic strategies in COPD and CCS.
{"title":"Implementation of pro- and anti-inflammatory mechanisms of sirtuin-1 in patients with chronic obstructive pulmonary disease and chronic coronary syndrome and their combination","authors":"Y.V. Chobanu, T. Ilashchuk","doi":"10.14739/2310-1210.2023.4.276009","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.276009","url":null,"abstract":"One of the key pathogenetic aspects of chronic obstructive pulmonary disease (COPD) and chronic coronary syndrome (CCS) is endothelial dysfunction. Further study on this pathological process is relevant for a better understanding of the course and increasing the treatment effectiveness of these diseases. In this context, in recent years, there has been a growing body of evidence about sirtuins which, according to the latest research results, were capable of rebalancing vasoconstrictory and vasodilatory mediators, regulating the balance in the protease-antiprotease system, protecting endothelial cells from oxidative stress and may be useful in relation to the pathogenesis of COPD and CCS.\u0000Aim. To study changes in the levels of serum endothelial nitric oxide synthase (NOS3/eNOS) and sirtuin 1 (SIRT1) in patients with a combined course of COPD and CCS and with COPD or CCS alone.\u0000Materials and methods. In order to study endothelial dysfunction and the role of SIRT1 in the processes of its development, we examined 60 patients with combined course of COPD and with CCS or COPD alone. The control group included 10 apparently healthy individuals. Levels of SIRT1 and NOS3/eNOS were studied by enzyme-linked immunosorbent assay, and high-sensitivity C-reactive protein (hsCRP) – by immunoturbidimetric method; clinical data and medical records were analyzed. Commonplace statistical analyses were used.\u0000Results. The results have shown that the serum level of SIRT1 in patients with COPD and CCS was lower than that in the control group. The level of hsCRP was significantly higher in patients with the studied pathology than that in apparently healthy individuals and was the highest in patients with combined COPD and CCS. The study on serum NOS3/eNOS has showed the highest concentration in COPD patients, and it was significantly higher in all groups of patients with the studied pathology than that in healthy individuals. A direct correlation has been found between the serum level of SIRT1 and hsCRP and an inverse correlation – with the level of NOS3/eNOS.\u0000Conclusions. Thus, the pleiotropic effects and multifaceted molecular interactions of SIRT1 are a promising direction in the search for effective new therapeutic strategies in COPD and CCS.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"572 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90471718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.262510
В. Л. Підлубний, В. С. Макоїд, V. L. Pidlubnyi, EF V. S. Makoid A
Depressive disorders are among the most widespread forms of mental pathology with significant medical and social consequences and require adequate and timely medical assistance. It is known that algorithms are effective methods of optimizing the provision of psychiatric care in order to prevent the development of therapy-resistant forms of mental pathology and reduce their treatment costs, which is particularly relevant in the case of a primary depressive episode (PDE). The aim of the work is to develop algorithms for rapid diagnosis and therapy of the PDE. Materials and methods. During 2018–2021, 131 patients (49 men and 82 women) with the PDE who sought outpatient psychiatric help were clinically examined. All subjects were tested to determine the level of depressive disorder, according to the unified clinical protocol of highly specialized medical care, according to the Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and the Clinical Global Impressions Scale. The clinical-ethological description consisted of three stages: at the first stage, at a patients’ first visit, a general description within the framework of a clinical and psychopathological examinations; at the second stage, the clinical-ethological characteristics of non-verbal behavior were studied; at the last, third stage, non-verbal behavior was recoded into ethological elements according to A. A. Korobov’s glossary (1991). Statistical analysis was performed using the Statistica 10 license package of application programs. Results. An algorithm for the PDE diagnosis has been developed based upon four stages: the first one – the symptomatic state diagnosis; the second – clinical-ethological analysis of depressive phenomenon signs and a neurophysiological electroencephalographic (EEG) examination; the third – psycho-experimental examinations using appropriate tools; the fourth – structuring of the obtained diagnostic data, diagnosis verification and development of therapeutic intervention tactics. A therapeutic algorithm for the PDE treatment was also developed and proposed: at the first stage – use of existing antidepressants with proven clinical effectiveness; at the second – switching from a drug in case of its ineffectiveness within 3–4 weeks to another drug with a different mechanism of action; at the third – in case of the previous stage ineffectiveness, using a combination antidepressant therapy (combining drugs of different groups); at the fourth – application of therapeutic schemes using diuretics, pathogenetic psychotherapy and electroconvulsive therapy. Conclusions. The proposed diagnostic and treatment algorithms are reliable enough to detect and treat such a category as the primary depressive episode. The effectiveness of personalized comprehensive diagnostic and treatment methods for these conditions should be based on the principles of phasing, comprehensiveness, using integrated approaches, combining therapies aimed at developing an adequate attitu
抑郁症是最普遍的精神病理形式之一，具有严重的医疗和社会后果，需要充分和及时的医疗援助。众所周知，算法是优化精神病护理提供的有效方法，以防止治疗抵抗性精神病理的发展并降低其治疗成本，这在原发性抑郁症发作(PDE)的情况下尤其相关。这项工作的目的是开发快速诊断和治疗PDE的算法。材料和方法。在2018-2021年期间，131名寻求门诊精神科帮助的PDE患者(49名男性和82名女性)接受了临床检查。根据高度专业化医疗护理的统一临床协议，根据汉密尔顿抑郁评定量表，汉密尔顿焦虑评定量表和临床总体印象量表，对所有受试者进行测试以确定抑郁障碍的水平。临床行为学描述包括三个阶段:第一阶段，在患者第一次就诊时，在临床和精神病理学检查的框架内进行一般性描述;第二阶段，研究非言语行为的临床行为学特征;最后，即第三阶段，根据A. A. Korobov的词汇表(1991)，非语言行为被重新编码为行为学要素。使用应用程序的Statistica 10许可包进行统计分析。本文提出了一种基于四个阶段的PDE诊断算法:第一阶段-症状状态诊断;抑郁现象体征的第二阶段临床行为学分析和神经生理脑电图检查;第三-使用适当的工具进行心理实验检查;第四部分是对获得的诊断数据进行结构化、诊断验证和制定治疗干预策略。还开发并提出了PDE治疗的治疗算法:在第一阶段-使用已证实临床有效性的现有抗抑郁药;在第二次-如果药物在3-4周内无效，则切换到另一种具有不同作用机制的药物;在第三阶段-在前一阶段无效的情况下，使用联合抗抑郁药治疗(联合不同组的药物);第四，应用利尿剂、病理心理治疗和电休克治疗。所提出的诊断和治疗算法足够可靠，可以检测和治疗原发性抑郁发作。针对这些疾病的个性化综合诊断和治疗方法的有效性应基于分阶段、全面、采用综合方法、结合治疗的原则，旨在培养对疾病状态的适当态度，减轻负面情绪的强度，恢复患者的内外资源。
{"title":"Algorithms of diagnosis and therapy of a primary depressive episode","authors":"В. Л. Підлубний, В. С. Макоїд, V. L. Pidlubnyi, EF V. S. Makoid A","doi":"10.14739/2310-1210.2023.4.262510","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.262510","url":null,"abstract":"Depressive disorders are among the most widespread forms of mental pathology with significant medical and social consequences and require adequate and timely medical assistance. It is known that algorithms are effective methods of optimizing the provision of psychiatric care in order to prevent the development of therapy-resistant forms of mental pathology and reduce their treatment costs, which is particularly relevant in the case of a primary depressive episode (PDE).\u0000The aim of the work is to develop algorithms for rapid diagnosis and therapy of the PDE.\u0000Materials and methods. During 2018–2021, 131 patients (49 men and 82 women) with the PDE who sought outpatient psychiatric help were clinically examined. All subjects were tested to determine the level of depressive disorder, according to the unified clinical protocol of highly specialized medical care, according to the Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and the Clinical Global Impressions Scale. The clinical-ethological description consisted of three stages: at the first stage, at a patients’ first visit, a general description within the framework of a clinical and psychopathological examinations; at the second stage, the clinical-ethological characteristics of non-verbal behavior were studied; at the last, third stage, non-verbal behavior was recoded into ethological elements according to A. A. Korobov’s glossary (1991). Statistical analysis was performed using the Statistica 10 license package of application programs.\u0000Results. An algorithm for the PDE diagnosis has been developed based upon four stages: the first one – the symptomatic state diagnosis; the second – clinical-ethological analysis of depressive phenomenon signs and a neurophysiological electroencephalographic (EEG) examination; the third – psycho-experimental examinations using appropriate tools; the fourth – structuring of the obtained diagnostic data, diagnosis verification and development of therapeutic intervention tactics. A therapeutic algorithm for the PDE treatment was also developed and proposed: at the first stage – use of existing antidepressants with proven clinical effectiveness; at the second – switching from a drug in case of its ineffectiveness within 3–4 weeks to another drug with a different mechanism of action; at the third – in case of the previous stage ineffectiveness, using a combination antidepressant therapy (combining drugs of different groups); at the fourth – application of therapeutic schemes using diuretics, pathogenetic psychotherapy and electroconvulsive therapy.\u0000Conclusions. The proposed diagnostic and treatment algorithms are reliable enough to detect and treat such a category as the primary depressive episode. The effectiveness of personalized comprehensive diagnostic and treatment methods for these conditions should be based on the principles of phasing, comprehensiveness, using integrated approaches, combining therapies aimed at developing an adequate attitu","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"30 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83399533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.277338
Т. І. Vykhtiuk, Y. Orel, O. M. Slabyi, Yuriy Z. Khorkavyi, H. Y. Orel, A. Savchenko
The aim of the work is to review current national and foreign specialized literature on various complications associated with the treatment of chronic limb-threatening ischemia. Atherosclerotic lesion of the lower limb arteries is the most common cause of tissue perfusion deficiency of the lower limbs and can lead to their loss. A radical method of treatment for chronic limb-threatening ischemia (CLTI) remains revascularization. Despite the modern possibilities of surgical treatment and many years of experience in such treatment, the percentage of surgical complications is still substantial. The level of providing qualitative care to patients with CLTI consists in the successful correction of the mentioned complications. That is why the analysis of this problem is an urgent issue of modern angiosurgery. Conclusions. Most complications after surgical treatment of atherosclerotic lower limb lesions could cause both a limb loss and a severe systemic disorder development in general. The presented data of the professional literature review of clinical and experimental studies justify the need for an early management of complications associated with surgical treatment of chronic limb-threatening ischemia. It would contribute not only to the limb preservation, but also prevent the occurrence of severe general somatic complications.
{"title":"Complications associated with the treatment of chronic limb-threatening ischemia","authors":"Т. І. Vykhtiuk, Y. Orel, O. M. Slabyi, Yuriy Z. Khorkavyi, H. Y. Orel, A. Savchenko","doi":"10.14739/2310-1210.2023.4.277338","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.277338","url":null,"abstract":"The aim of the work is to review current national and foreign specialized literature on various complications associated with the treatment of chronic limb-threatening ischemia.\u0000Atherosclerotic lesion of the lower limb arteries is the most common cause of tissue perfusion deficiency of the lower limbs and can lead to their loss. A radical method of treatment for chronic limb-threatening ischemia (CLTI) remains revascularization. Despite the modern possibilities of surgical treatment and many years of experience in such treatment, the percentage of surgical complications is still substantial.\u0000The level of providing qualitative care to patients with CLTI consists in the successful correction of the mentioned complications. That is why the analysis of this problem is an urgent issue of modern angiosurgery.\u0000Conclusions. Most complications after surgical treatment of atherosclerotic lower limb lesions could cause both a limb loss and a severe systemic disorder development in general. The presented data of the professional literature review of clinical and experimental studies justify the need for an early management of complications associated with surgical treatment of chronic limb-threatening ischemia. It would contribute not only to the limb preservation, but also prevent the occurrence of severe general somatic complications.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"37 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81666560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.277503
O. Iaremenko, H. M. Mykytenko
The aim of the work is to study the possibility of glucocorticoid (GC) discontinuation or their target dose achievement in patients (pts) with rheumatoid arthritis (RA) receiving conventional synthetic disease-modifying antirheumatic drugs (DMARDs). Materials and methods. 270 pts with RA (women – 86.6 %) aged 51.2 ± 0.71 years, with a disease duration of 50.20 ± 3.82 months were examined. Rheumatoid factor was found in 64.8 % of individuals, anti-cyclic citrullinated peptide (ACCP) antibodies – in 66.6 %. DMARD therapy included methotrexate (n = 91), leflunomide (n = 95), sulfasalazine (n = 51), hydroxychloroquine (n = 3) or its combination (n = 126). The SPSS (version 22.0) software was used for the statistical analysis. Results. During the 3-year study, GC was withdrawn in 33 % of pts in the period from 3 to 30 months (mostly in the first 6 moths). Among those who continued to take GC, the target dose (<7.5 mg/d) was achieved only in 32.6 % of pts. Among pts continuously receiving GC, compared with pts who discontinued GC therapy, there were significantly more women (89.5 % vs. 80.8 %), ACCP-positive pts (88.4 % vs. 55.0 %), with higher DAS-ESR values (5.29 ± 0.10 vs. 4.84 ± 0.15) and more pronounced structural changes on the SHS scale (43.40 ± 2.42 vs. 32.40 ± 2.71). According to the logistic regression analysis, female sex (OR 2.39), elderly pts (OR 1.02), ACCP-positivity (OR 3.73), disease activity by DAS-ESR (OR 1.19) and structural joint changes (OR 1.01) were significantly associated with the risk of continuing GC treatment. Only the initial dose of GC ≥7.5 mg/d was associated with the inability to reach the target dose of GC during the entire follow-up period (OR 6.32). Conclusions. Despite of the treatment with conventional synthetic DMARD, only a third of RA pts can withdraw GC, mostly in the first 6 months. For the pts who continue taking GC, the target dose can be achieved in 33 % of them. Independent predictors of the impossibility to withdraw GC are female sex, old age, ACCP-positivity, higher RA activity according to DAS-ESR and more pronounced joint destruction in early stages. An initial GC dose ≥7.5 mg/d is a negative prognostic factor in achieving the target dose.
{"title":"Is it possible to discontinue glucocorticoids in rheumatoid arthritis with the use of synthetic disease-modifying antirheumatic drugs?","authors":"O. Iaremenko, H. M. Mykytenko","doi":"10.14739/2310-1210.2023.4.277503","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.277503","url":null,"abstract":"The aim of the work is to study the possibility of glucocorticoid (GC) discontinuation or their target dose achievement in patients (pts) with rheumatoid arthritis (RA) receiving conventional synthetic disease-modifying antirheumatic drugs (DMARDs).\u0000Materials and methods. 270 pts with RA (women – 86.6 %) aged 51.2 ± 0.71 years, with a disease duration of 50.20 ± 3.82 months were examined. Rheumatoid factor was found in 64.8 % of individuals, anti-cyclic citrullinated peptide (ACCP) antibodies – in 66.6 %. DMARD therapy included methotrexate (n = 91), leflunomide (n = 95), sulfasalazine (n = 51), hydroxychloroquine (n = 3) or its combination (n = 126). The SPSS (version 22.0) software was used for the statistical analysis.\u0000Results. During the 3-year study, GC was withdrawn in 33 % of pts in the period from 3 to 30 months (mostly in the first 6 moths). Among those who continued to take GC, the target dose (<7.5 mg/d) was achieved only in 32.6 % of pts. Among pts continuously receiving GC, compared with pts who discontinued GC therapy, there were significantly more women (89.5 % vs. 80.8 %), ACCP-positive pts (88.4 % vs. 55.0 %), with higher DAS-ESR values (5.29 ± 0.10 vs. 4.84 ± 0.15) and more pronounced structural changes on the SHS scale (43.40 ± 2.42 vs. 32.40 ± 2.71).\u0000According to the logistic regression analysis, female sex (OR 2.39), elderly pts (OR 1.02), ACCP-positivity (OR 3.73), disease activity by DAS-ESR (OR 1.19) and structural joint changes (OR 1.01) were significantly associated with the risk of continuing GC treatment. Only the initial dose of GC ≥7.5 mg/d was associated with the inability to reach the target dose of GC during the entire follow-up period (OR 6.32).\u0000Conclusions. Despite of the treatment with conventional synthetic DMARD, only a third of RA pts can withdraw GC, mostly in the first 6 months. For the pts who continue taking GC, the target dose can be achieved in 33 % of them. Independent predictors of the impossibility to withdraw GC are female sex, old age, ACCP-positivity, higher RA activity according to DAS-ESR and more pronounced joint destruction in early stages. An initial GC dose ≥7.5 mg/d is a negative prognostic factor in achieving the target dose.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"44 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85647001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.277403
V. Syvolap, A. Bohun
Aim: To compare the results of distributing left ventricular (LV) remodeling patterns according to two classifications and identify their advantages and disadvantages. Materials and methods. The study involved 2019 patients, aged from 18 to 94 years with a mean of 57.6 ± 16.4 years, 51 % males, apparently healthy and with cardiovascular and respiratory system pathology. Echocardiography was performed using an Esaote MyLab Seven device (Italy) according to generally accepted standards. The distribution of patients according to four classic LV remodeling patterns and according to the classification proposed by W. Gaasch and M. Zile was studied. Statistical analysis was performed using Statistica for Windows 13.0 (StatSoft Inc., USA; license No. JPZ804I382130ARCN10-J). Qualitative variables were given as absolute and relative frequency (n (%)). Results. The distribution of patients according to 4 classic LV remodeling patterns was as follows: 53.0 % had normal LV geometry; 10.2 % – concentric remodeling; 15.6 % – concentric hypertrophy; 21.2 % – eccentric hypertrophy. At the same time, in the group of normal LV geometry, 25.2 % of people had LV dilatation. When distributing the patients by remodeling patterns according to the W. Gaasch and M. Zile classification, the following data were obtained: 26.9 % of people had normal LV geometry, concentric remodeling – 10.2 %, concentric hypertrophy – 12.4 %, mixed hypertrophy – 3.1 %, physiological and dilated hypertrophy – 11.8 %, eccentric hypertrophy – 5.5 %, eccentric remodeling – 11.4 %. In addition, 3 more groups of patients were formed, who did not have a terminological definition based on the W. Gaasch and M. Zile classification and, in total, accounted for 18.6 % of the examined. Conclusions. The missing options of dilated left ventricle should be recognized as a limitation of the classic classifications of left ventricular remodeling patterns. The imposition of additional criteria covering the cavity dilatation in determining the left ventricular remodeling patterns improves the assessment of the patient’s prognosis and contributes to a more individual selection of pathogenetic therapy.
目的:比较两种类型左室重构分布的结果，并分析其优缺点。材料和方法。该研究纳入2019例患者，年龄18至94岁，平均57.6±16.4岁，51%男性，表面健康，心血管和呼吸系统病变。超声心动图使用Esaote MyLab Seven设备(意大利)按照普遍接受的标准进行。根据W. Gaasch和M. Zile提出的四种经典左室重构模式，研究患者的分布。统计学分析采用Statistica for Windows 13.0 (StatSoft Inc.， USA;许可证没有。JPZ804I382130ARCN10-J)。定性变量以绝对频率和相对频率(n(%))给出。4种典型左室重构型患者分布如下:53.0%左室几何形态正常;10.2%为同心重塑;15.6% -同心肥厚;21.2% -偏心肥厚。与此同时，在正常左室几何形状组中，25.2%的人出现左室扩张。根据W. Gaasch和M. Zile分类，将患者按重构模式进行分布，得到以下数据:左室几何形态正常者26.9%，同心重构者10.2%，同心肥厚者12.4%，混合性肥厚者3.1%，生理性和扩张性肥厚者11.8%，偏心肥厚者5.5%，偏心重构者11.4%。此外，还形成了另外3组患者，他们没有基于W. Gaasch和M. Zile分类的术语定义，总计占检查的18.6%。缺少扩张左心室的选项应该被认为是左心室重构模式经典分类的限制。在确定左心室重构模式时，附加的标准包括腔扩张，提高了对患者预后的评估，并有助于更个性化的病理治疗选择。
{"title":"Modern opportunities for assessing the left ventricle remodeling","authors":"V. Syvolap, A. Bohun","doi":"10.14739/2310-1210.2023.4.277403","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.277403","url":null,"abstract":"Aim: To compare the results of distributing left ventricular (LV) remodeling patterns according to two classifications and identify their advantages and disadvantages.\u0000Materials and methods. The study involved 2019 patients, aged from 18 to 94 years with a mean of 57.6 ± 16.4 years, 51 % males, apparently healthy and with cardiovascular and respiratory system pathology. Echocardiography was performed using an Esaote MyLab Seven device (Italy) according to generally accepted standards. The distribution of patients according to four classic LV remodeling patterns and according to the classification proposed by W. Gaasch and M. Zile was studied. Statistical analysis was performed using Statistica for Windows 13.0 (StatSoft Inc., USA; license No. JPZ804I382130ARCN10-J). Qualitative variables were given as absolute and relative frequency (n (%)).\u0000Results. The distribution of patients according to 4 classic LV remodeling patterns was as follows: 53.0 % had normal LV geometry; 10.2 % – concentric remodeling; 15.6 % – concentric hypertrophy; 21.2 % – eccentric hypertrophy. At the same time, in the group of normal LV geometry, 25.2 % of people had LV dilatation. When distributing the patients by remodeling patterns according to the W. Gaasch and M. Zile classification, the following data were obtained: 26.9 % of people had normal LV geometry, concentric remodeling – 10.2 %, concentric hypertrophy – 12.4 %, mixed hypertrophy – 3.1 %, physiological and dilated hypertrophy – 11.8 %, eccentric hypertrophy – 5.5 %, eccentric remodeling – 11.4 %. In addition, 3 more groups of patients were formed, who did not have a terminological definition based on the W. Gaasch and M. Zile classification and, in total, accounted for 18.6 % of the examined.\u0000Conclusions. The missing options of dilated left ventricle should be recognized as a limitation of the classic classifications of left ventricular remodeling patterns. The imposition of additional criteria covering the cavity dilatation in determining the left ventricular remodeling patterns improves the assessment of the patient’s prognosis and contributes to a more individual selection of pathogenetic therapy.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"34 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72921738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.284248
M. Dolzhenko, S. Bondarchuk, L. Lobach
The aim of the work is to assess the effectiveness of prescribing a fixed-dose combination of amlodipine with the ACE inhibitor lisinopril or with the angiotensin 2 receptor blocker valsartan in patients with coronary artery disease, acute coronary syndrome with hypertensive disease regarding the impact on the structural and functional parameters of the heart and extracranial branches of the brachiocephalic arteries. Materials and methods. General clinical examination of 108 patients with postinfarction cardiosclerosis and hypertension was done within 12 months. The patients were allocated to two groups. Patients in the first group (n = 50) were assigned a fixed-dose combination of lisinopril and amlodipine (20 mg and 5 mg, respectively), and patients in the second group (n = 58) received a fixed-dose combination of valsartan with amlodipine (160 mg and 5 mg, respectively). The patients were monitored for 12 months, including general clinical examinations, measurements of office blood pressure (BP), 24-hour BP monitoring, echo-dopplerographic examination of the heart and brachiocephalic arteries, determination of the composite endpoint. Statistical analysis of the obtained data was performed using Microsoft Excel, IBM SPSS Statistics v.23. Results. A significant difference in echocardiographic data has been proved (p < 0.05) regarding left ventricle (LV) dimensions in both study groups. A significant decrease in the E/A ratio and an insignificant decrease in E/E’ (p > 0.05) have been found in the first group. When analyzing the indicators of diastolic function in the second group, a highly significant (p < 0.05) decrease in E/A, E/E’, IO of the LA has been revealed; data analysis on the morphofunctional state indicators of the extracranial arteries has shown a CIM reduction and a decrease in PSV and RI. Conclusions. Prescriptions of the fixed-dose combination of amlodipine with the ACE inhibitor lisinopril was more effective in terms of the LV measurements (p < 0.05) and LV diastolic function as evidenced by decreased E/A, E/E’ and IO of the LA (p < 0.05) as compared to the data in the group of amlodipine with the angiotensin 2 receptor blocker valsartan. Both fixed-dose combinations were effective in reducing the CIM thickness, decreasing PSV and RI when analyzing the morphofunctional state findings of the extracranial arteries.
{"title":"Effects of combination antihypertensive therapy on intracardiac hemodynamics and blood vessels in patients with coronary heart disease, post-infarction cardiosclerosis and arterial hypertension","authors":"M. Dolzhenko, S. Bondarchuk, L. Lobach","doi":"10.14739/2310-1210.2023.4.284248","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.284248","url":null,"abstract":"The aim of the work is to assess the effectiveness of prescribing a fixed-dose combination of amlodipine with the ACE inhibitor lisinopril or with the angiotensin 2 receptor blocker valsartan in patients with coronary artery disease, acute coronary syndrome with hypertensive disease regarding the impact on the structural and functional parameters of the heart and extracranial branches of the brachiocephalic arteries.\u0000Materials and methods. General clinical examination of 108 patients with postinfarction cardiosclerosis and hypertension was done within 12 months. The patients were allocated to two groups. Patients in the first group (n = 50) were assigned a fixed-dose combination of lisinopril and amlodipine (20 mg and 5 mg, respectively), and patients in the second group (n = 58) received a fixed-dose combination of valsartan with amlodipine (160 mg and 5 mg, respectively). The patients were monitored for 12 months, including general clinical examinations, measurements of office blood pressure (BP), 24-hour BP monitoring, echo-dopplerographic examination of the heart and brachiocephalic arteries, determination of the composite endpoint. Statistical analysis of the obtained data was performed using Microsoft Excel, IBM SPSS Statistics v.23.\u0000Results. A significant difference in echocardiographic data has been proved (p < 0.05) regarding left ventricle (LV) dimensions in both study groups. A significant decrease in the E/A ratio and an insignificant decrease in E/E’ (p > 0.05) have been found in the first group. When analyzing the indicators of diastolic function in the second group, a highly significant (p < 0.05) decrease in E/A, E/E’, IO of the LA has been revealed; data analysis on the morphofunctional state indicators of the extracranial arteries has shown a CIM reduction and a decrease in PSV and RI.\u0000Conclusions. Prescriptions of the fixed-dose combination of amlodipine with the ACE inhibitor lisinopril was more effective in terms of the LV measurements (p < 0.05) and LV diastolic function as evidenced by decreased E/A, E/E’ and IO of the LA (p < 0.05) as compared to the data in the group of amlodipine with the angiotensin 2 receptor blocker valsartan. Both fixed-dose combinations were effective in reducing the CIM thickness, decreasing PSV and RI when analyzing the morphofunctional state findings of the extracranial arteries.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"13 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78581804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.269875
S. M. Zavhorodnii, O. I. Kotenko, M. Danyliuk, M. Kubrak
Aim: to assess the treatment effectiveness in patients with soft tissue gunshot shrapnel injuries by applying primary delayed sutures in combination with platelet-rich autoplasma injections into wounds. Materials and methods. The study included 60 (100.0 %) patients with soft tissue gunshot shrapnel wounds. All wounded were divided into two groups. The comparison group consisted of 30 (50.0 %) patients admitted to a hospital with primary delayed sutures (6–7 days). The main group included 30 (50.0 %) patients whose local treatment modification consisted in a combination of primary delayed suturing with platelet-rich autoplasma injection into a wound. A wound channel was observed on the 8th, 11th –14th days from the moment of injury using visual inspection, linear measurements and diagnostic ultrasound system (Mindray M6, 220A). Results. 60 (100.0 %) patients were urgently hospitalized to the third stage of medical evacuation and treated according to standard treatment protocols for this pathology at the third stage of evacuation. According to a wound defect localization, the wounded of the comparison groups, 30 (50.00 %), were distributed as follows: a lower limb wound – 22 (73.33 %) patients, an upper limb wound – 6 (20.00 %), and a trunk wound – 2 (6.67 %). The main group also included 30 (50.00 %) wounded, whose treatment at the third stage of medical evacuation was modified by using a combination of primary delayed sutures and platelet-rich autoplasma injection. On the 8th day after an injury, a visual inspection of the wounds detected no hyperemia or suppuration in both groups. The visual inspection of wounds in the comparison group at 11.0 ± 3.9 days post-injury revealed 24 (80.00 %) patients with complications such as seromas in 17 (56.67 %) cases, hematomas with wound suppuration – in 7 (23.33 %). In the main group, 2 (6.67 %) cases of wound suppuration were detected (U = 120.00, p = 0.000001). The basic parameters of wound linear measurements according to the diagnostic ultrasound system data at the 11th–14th day post-injury after primary and delayed suturing in the studied groups: in the comparison group, upper limb wounds – S (mm2) 43.3 ± 12.6, V (mm3) 53.3 ± 13.9; lower limb wounds – S (mm2) 194.7 ± 50.7, V (mm3) 706.3 ± 190.4; trunk wounds – S (mm2) 20.5 ± 7.2, V (mm3) 22.5 ± 5.4. In the main group, upper limb wounds – S (mm2) 28.2 ± 8.5, V (mm3) 23.2 ± 7.1; lower limb wounds – S (mm2) 56.4 ± 19.6, V (mm3) 102.4 ± 21.1; trunk wounds – S (mm2) 12.3 ± 3.2, V (mm3) 10.4 ± 2.9. The total duration of inpatient treatment at the 3rd stage of medical evacuation in the comparison group wounded was 30.0 ± 2.3 days, and in the main group it was 12.0 ± 3.1 days (U = 290.00, p = 0.0354). Conclusions. In the structure of gunshot shrapnel wounds in both groups, there were 43 (71.67 %) lower limb traumatic injuries, 11 (18.33 %) upper limb, and 6 (10.00 %) trunk injuries. The use of platelet-rich autoplasma in combination with primary delayed suturi
目的:探讨原发性延迟缝合联合富血小板自体浆注射治疗软组织枪弹弹片伤的疗效。材料和方法。本研究包括60例(100.0%)软组织弹片伤患者。所有伤员被分成两组。对照组包括30例(50.0%)因原发性延迟缝合(6-7天)入院的患者。主要组包括30例(50.0%)患者，其局部治疗修改包括原发性延迟缝合与富血小板自体浆注射到伤口的组合。采用目视检查、线性测量和超声诊断系统(迈瑞M6, 220A)，于伤后第8、11 - 14天观察创面通道。60名(100.0%)患者在医疗后送的第三阶段紧急住院，并在后送的第三阶段根据该病理的标准治疗方案进行治疗。根据创面缺损定位，对照组30例(50.00%)伤情分布如下:下肢伤情22例(73.33%)，上肢伤情6例(20.00%)，躯干伤情2例(6.67%)。主组还包括30例(50.00%)伤员，他们在医疗后送的第三阶段采用原发性延迟缝合和富血小板自体浆注射相结合的治疗方法。在损伤后第8天，两组的伤口目视检查均未发现充血或化脓。对照组伤后11.0±3.9 d伤口目视检查发现24例(80.00 %)出现并发症，血清肿17例(56.67%)，血肿伴创面化脓7例(23.33%)。主组创面化脓2例(6.67%)(U = 120.00, p = 0.000001)。各组初缝合和延迟缝合后伤后第11 ~ 14天根据诊断超声系统数据测量创面线性基本参数:对照组上肢创面- S (mm2) 43.3±12.6,V (mm3) 53.3±13.9;下肢创面- S (mm2) 194.7±50.7,V (mm3) 706.3±190.4;躯干伤口- S (mm2) 20.5±7.2,V (mm3) 22.5±5.4。主组上肢创面- S (mm2) 28.2±8.5,V (mm3) 23.2±7.1;下肢创面- S (mm2) 56.4±19.6,V (mm3) 102.4±21.1;躯干伤口- S (mm2) 12.3±3.2,V (mm3) 10.4±2.9。对照组伤病员第3期住院总时间为30.0±2.3 d，主组伤病员住院总时间为12.0±3.1 d (U = 290.00, p = 0.0354)。两组枪弹弹片伤结构中，下肢外伤43例(71.67%)，上肢外伤11例(18.33%)，躯干外伤6例(10.00%)。富血小板自体浆联合初次延迟缝合刺激创面愈合，加速创面愈合过程，主要组创面缺损面积和体积在伤后11 - 14天较对照组显著减少。我们开发的枪弹弹片伤的治疗方法减少了术后并发症的发生，对照组有24例(80.00 %)患者出现并发症，而主组仅有2例(6.67%)患者出现并发症(U = 120.00, p = 0.00001)。富血小板自体血浆的使用使患者在医疗后送第三阶段的住院时间缩短:对照组为30.0±2.3天，主组为12.0±3.1天(U = 290.00, p = 0.0354)。
{"title":"Surgical treatment of isolated soft tissue gunshot shrapnel injuries by combining primary delayed sutures with platelet-rich autoplasma injections into mine-explosive wounds","authors":"S. M. Zavhorodnii, O. I. Kotenko, M. Danyliuk, M. Kubrak","doi":"10.14739/2310-1210.2023.4.269875","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.269875","url":null,"abstract":"Aim: to assess the treatment effectiveness in patients with soft tissue gunshot shrapnel injuries by applying primary delayed sutures in combination with platelet-rich autoplasma injections into wounds.\u0000Materials and methods. The study included 60 (100.0 %) patients with soft tissue gunshot shrapnel wounds. All wounded were divided into two groups. The comparison group consisted of 30 (50.0 %) patients admitted to a hospital with primary delayed sutures (6–7 days). The main group included 30 (50.0 %) patients whose local treatment modification consisted in a combination of primary delayed suturing with platelet-rich autoplasma injection into a wound. A wound channel was observed on the 8th, 11th –14th days from the moment of injury using visual inspection, linear measurements and diagnostic ultrasound system (Mindray M6, 220A).\u0000Results. 60 (100.0 %) patients were urgently hospitalized to the third stage of medical evacuation and treated according to standard treatment protocols for this pathology at the third stage of evacuation. According to a wound defect localization, the wounded of the comparison groups, 30 (50.00 %), were distributed as follows: a lower limb wound – 22 (73.33 %) patients, an upper limb wound – 6 (20.00 %), and a trunk wound – 2 (6.67 %). The main group also included 30 (50.00 %) wounded, whose treatment at the third stage of medical evacuation was modified by using a combination of primary delayed sutures and platelet-rich autoplasma injection. On the 8th day after an injury, a visual inspection of the wounds detected no hyperemia or suppuration in both groups. The visual inspection of wounds in the comparison group at 11.0 ± 3.9 days post-injury revealed 24 (80.00 %) patients with complications such as seromas in 17 (56.67 %) cases, hematomas with wound suppuration – in 7 (23.33 %). In the main group, 2 (6.67 %) cases of wound suppuration were detected (U = 120.00, p = 0.000001). The basic parameters of wound linear measurements according to the diagnostic ultrasound system data at the 11th–14th day post-injury after primary and delayed suturing in the studied groups: in the comparison group, upper limb wounds – S (mm2) 43.3 ± 12.6, V (mm3) 53.3 ± 13.9; lower limb wounds – S (mm2) 194.7 ± 50.7, V (mm3) 706.3 ± 190.4; trunk wounds – S (mm2) 20.5 ± 7.2, V (mm3) 22.5 ± 5.4. In the main group, upper limb wounds – S (mm2) 28.2 ± 8.5, V (mm3) 23.2 ± 7.1; lower limb wounds – S (mm2) 56.4 ± 19.6, V (mm3) 102.4 ± 21.1; trunk wounds – S (mm2) 12.3 ± 3.2, V (mm3) 10.4 ± 2.9. The total duration of inpatient treatment at the 3rd stage of medical evacuation in the comparison group wounded was 30.0 ± 2.3 days, and in the main group it was 12.0 ± 3.1 days (U = 290.00, p = 0.0354).\u0000Conclusions. In the structure of gunshot shrapnel wounds in both groups, there were 43 (71.67 %) lower limb traumatic injuries, 11 (18.33 %) upper limb, and 6 (10.00 %) trunk injuries. The use of platelet-rich autoplasma in combination with primary delayed suturi","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"10 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77379625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.280957
P. P. Bidzilya, V. H. Kadzharian, M. Bychko
Aim. To investigate the obesity paradox by studying the impact of overweight and abdominal obesity on the prognosis in chronic heart failure (CHF) patients with moderately reduced or preserved left ventricular ejection fraction (LVEF) by five-year follow-up results. Materials and methods. A prospective, open, parallel-group study included 314 CHF patients with moderately reduced or preserved LVEF, average age was 65.3 ± 11.2 years. Group 1 – 66 patients with normal weight; Group 2 – 67 overweight patients; Group 3 – 90 patients with I degree abdominal obesity; Group 4 – 91 subjects with II–III degrees of obesity. Adverse cardiovascular events (CVEs) were studied as a cumulative endpoint, cardiovascular death, and rehospitalization due to decompensated CHF. Results. It has been found that excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF. In overweight patients, compared to I degree obesity group, the incidence of cumulative end point (by 15.4 %; χ2 = 3.95, p < 0.05) and cases of re-hospitalization (by 19.0 %; χ2 = 5.6, p < 0.05) were more often observed. Concomitant overweight was associated with an increased risk for faster onset of the cumulative end point (HR 1.46, 95 % CI 1.1–2.2, p < 0.05) and re-hospitalization (HR 1.53, 95 % CI 1.1–2.4, p < 0.05). Conclusions. The presence of excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF during the five-year follow-up. In the presence of overweight, in comparison with I degree abdominal obesity, the incidence of cumulative end point and re-hospitalization due to the disease decompensation were more often observed, which could be evidence for the existence of the obesity paradox. The most adverse effect on the prognosis in CHF patients with moderately reduced and preserved LVEF caused by concomitant overweight, in the presence of which, there was a significant increase in the risk for more faster onset of cumulative end point and re-hospitalization due to decompensation of the disease.
的目标。通过对左心室射血分数(LVEF)中度降低或保持的慢性心力衰竭(CHF)患者进行5年随访，研究超重和腹部肥胖对其预后的影响，探讨肥胖悖论。材料和方法。一项前瞻性、开放性、平行组研究纳入了314例中度降低或保留LVEF的CHF患者，平均年龄为65.3±11.2岁。组1 - 66例体重正常;2组- 67例超重患者;3 - 90例I度腹部肥胖患者;4 - 91例II-III级肥胖。不良心血管事件(CVEs)作为累积终点、心血管死亡和因失代偿性chf引起的再住院进行了研究。研究发现，在LVEF中度降低和保持的CHF患者中，体重过重(超重和I-III级腹部肥胖)并不影响不良cve的患病率和频谱。在超重患者中，与1度肥胖组相比，累计终点发生率(提高15.4%;χ2 = 3.95, p < 0.05)，再住院例数为19.0%;χ2 = 5.6, p < 0.05)。合并超重与累积终点更快发作的风险增加(HR 1.46, 95% CI 1.1-2.2, p < 0.05)和再次住院(HR 1.53, 95% CI 1.1-2.4, p < 0.05)相关。在5年随访期间，体重过重(超重和I-III级腹部肥胖)并不影响中度降低和保持LVEF的CHF患者不良cve的患病率和频谱。在存在超重的情况下，与腹部I度肥胖相比，累积终点和因疾病失代偿而再次住院的发生率更高，这可能是肥胖悖论存在的证据。伴有超重对中度降低和保持LVEF的CHF患者的预后影响最大，在伴有超重的情况下，累积终点更快发作和因疾病失代偿而再次住院的风险显著增加。
{"title":"Obesity paradox in chronic heart failure with moderately reduced or preserved left ventricular ejection fraction: impact on a prognosis for patients according to a five-year follow-up","authors":"P. P. Bidzilya, V. H. Kadzharian, M. Bychko","doi":"10.14739/2310-1210.2023.4.280957","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.280957","url":null,"abstract":"Aim. To investigate the obesity paradox by studying the impact of overweight and abdominal obesity on the prognosis in chronic heart failure (CHF) patients with moderately reduced or preserved left ventricular ejection fraction (LVEF) by five-year follow-up results.\u0000Materials and methods. A prospective, open, parallel-group study included 314 CHF patients with moderately reduced or preserved LVEF, average age was 65.3 ± 11.2 years. Group 1 – 66 patients with normal weight; Group 2 – 67 overweight patients; Group 3 – 90 patients with I degree abdominal obesity; Group 4 – 91 subjects with II–III degrees of obesity.\u0000Adverse cardiovascular events (CVEs) were studied as a cumulative endpoint, cardiovascular death, and rehospitalization due to decompensated CHF.\u0000Results. It has been found that excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF. In overweight patients, compared to I degree obesity group, the incidence of cumulative end point (by 15.4 %; χ2 = 3.95, p < 0.05) and cases of re-hospitalization (by 19.0 %; χ2 = 5.6, p < 0.05) were more often observed.\u0000Concomitant overweight was associated with an increased risk for faster onset of the cumulative end point (HR 1.46, 95 % CI 1.1–2.2, p < 0.05) and re-hospitalization (HR 1.53, 95 % CI 1.1–2.4, p < 0.05).\u0000Conclusions. The presence of excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF during the five-year follow-up. In the presence of overweight, in comparison with I degree abdominal obesity, the incidence of cumulative end point and re-hospitalization due to the disease decompensation were more often observed, which could be evidence for the existence of the obesity paradox.\u0000The most adverse effect on the prognosis in CHF patients with moderately reduced and preserved LVEF caused by concomitant overweight, in the presence of which, there was a significant increase in the risk for more faster onset of cumulative end point and re-hospitalization due to decompensation of the disease.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"41 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83589622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.14739/2310-1210.2023.4.278576
Ye. I. Haidarzhi, M. H. Holovko, H. O. Okhrimenko
From year to year, wide spread of gastroesophageal reflux disease (GERD) is attracting greater attention of specialists in the field of this pathology diagnosis and treatment. In-depth studies on etiological and pathogenetic factors in the GERD development are being conducted. Of particular interest is the role of humoral factors, one of which is vasoactive intestinal peptide (VIP). There are currently no data on the dynamics of this hormone during surgical treatment of GERD. The aim of the study was to examine the dynamics of plasma VIP during surgical treatment of GERD and its influence on the lower esophageal sphincter (LES) function. Materials and methods. Surgical treatment in the Nissen modification was performed for 35 patients with GERD. There were 26 women (74.3 %), men – 9 (25.7 %). mean age – 55.3 ± 11.3 years. Comparison group – 20 apparently healthy individuals: women – 14 (70.0 %); men – 6 (30.0 %), mean age – 56.7 ± 10.6 years. VIP was measured in venous blood plasma by an enzyme immunoassay (Vasoactive intestinal peptide ELISA, S-1201, BCM Diagnostics) using an immunoenzyme complex ImmunoChem-2100 (USA). The sampling of the studied samples in the main group was carried out before the operation and 2–3 months post-surgery. Results. In the main group before the surgery, the level of VIP was 3.1 ± 1.1 ng/ml, after the surgery – 2.2 ± 1.0 ng/ml. In the comparison group, VIP was determined at the level of 2.1 ± 1.1 ng/ml. In GERD before the surgery, the VIP level was statistically different from the indicators in the comparison group and from postoperative values. After surgical treatment, VIP values were decreased to the level of apparently healthy individuals. There was a positive correlation between the VIP level and acid exposure time (AET), the total number of refluxes, the number of reflux events longer than 5 minutes, the maximum duration of refluxes and the degree of esophageal inflammation. Conclusions. In the surgical treatment of GERD, the statistically significant decrease in the VIP level to that of apparently healthy individuals is determined. The moderate positive correlation between the levels of VIP, AET, the average number of refluxes, the number of reflux events longer than 5 minutes, and the maximum duration of refluxes confirms the inhibitory effect of VIP on LES tone. The relationship between the degree of esophageal inflammation and the VIP level confirms the indirect, through the action of VIP, inhibitory effect of the esophagitis severity on the LES tone.
{"title":"Vasoactive intestinal polypeptide level in gastroesophageal reflux disease before and after surgical treatment","authors":"Ye. I. Haidarzhi, M. H. Holovko, H. O. Okhrimenko","doi":"10.14739/2310-1210.2023.4.278576","DOIUrl":"https://doi.org/10.14739/2310-1210.2023.4.278576","url":null,"abstract":"From year to year, wide spread of gastroesophageal reflux disease (GERD) is attracting greater attention of specialists in the field of this pathology diagnosis and treatment. In-depth studies on etiological and pathogenetic factors in the GERD development are being conducted. Of particular interest is the role of humoral factors, one of which is vasoactive intestinal peptide (VIP). There are currently no data on the dynamics of this hormone during surgical treatment of GERD.\u0000The aim of the study was to examine the dynamics of plasma VIP during surgical treatment of GERD and its influence on the lower esophageal sphincter (LES) function.\u0000Materials and methods. Surgical treatment in the Nissen modification was performed for 35 patients with GERD. There were 26 women (74.3 %), men – 9 (25.7 %). mean age – 55.3 ± 11.3 years. Comparison group – 20 apparently healthy individuals: women – 14 (70.0 %); men – 6 (30.0 %), mean age – 56.7 ± 10.6 years. VIP was measured in venous blood plasma by an enzyme immunoassay (Vasoactive intestinal peptide ELISA, S-1201, BCM Diagnostics) using an immunoenzyme complex ImmunoChem-2100 (USA). The sampling of the studied samples in the main group was carried out before the operation and 2–3 months post-surgery.\u0000Results. In the main group before the surgery, the level of VIP was 3.1 ± 1.1 ng/ml, after the surgery – 2.2 ± 1.0 ng/ml. In the comparison group, VIP was determined at the level of 2.1 ± 1.1 ng/ml. In GERD before the surgery, the VIP level was statistically different from the indicators in the comparison group and from postoperative values. After surgical treatment, VIP values were decreased to the level of apparently healthy individuals. There was a positive correlation between the VIP level and acid exposure time (AET), the total number of refluxes, the number of reflux events longer than 5 minutes, the maximum duration of refluxes and the degree of esophageal inflammation.\u0000Conclusions. In the surgical treatment of GERD, the statistically significant decrease in the VIP level to that of apparently healthy individuals is determined. The moderate positive correlation between the levels of VIP, AET, the average number of refluxes, the number of reflux events longer than 5 minutes, and the maximum duration of refluxes confirms the inhibitory effect of VIP on LES tone. The relationship between the degree of esophageal inflammation and the VIP level confirms the indirect, through the action of VIP, inhibitory effect of the esophagitis severity on the LES tone.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"169 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73144471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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