Zaporozhye мedical journal

Dependency between local carotid arterial stiffness and the presence of atherosclerotic plaque in the carotid basin in hypertensive patients with type 2 diabetes mellitus

V. V. Syvolap, A. O. Bohun — Fri, 29 Mar 2024 00:00:00 +0200

Aim. To assess the impact of atherosclerotic plaque (ASP) on the local arterial stiffness of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) in combination with type 2 diabetes mellitus (T2DM).

Materials and methods. The study included 37 patients with stage II HTN and T2DM (mean age 60.4 ± 10.7; 66.7 % male). Patients were divided into two groups: 20 individuals with ASP and <50 % stenosis in the carotid basin, 17 without ASP. The study involved a clinical examination, body weight and percentage of adipose tissue (AT) measurements, analysis of lipid and carbohydrate metabolism laboratory parameters, echocardiography, CCA ultrasound examination with the determination of local stiffness and intima-media complex thickness (IMT). Statistical analysis was performed, significant differences were considered at p < 0.05.

Results. The whole-body AT percentage <39.51 % increases the odds ratio (OR) of ASP by 6 times (p = 0.02), an exceeding compliance coefficient (CC) over 0.68 mm²/kPa – by 12.7 times (p = 0.02), right CCA-IMT of over 639 µm – by 1.012 times (p = 0.001), and the factors are mutually reinforcing in the multivariate models and independent of age, sex, body mass index, and glycated hemoglobin level. Ascending aorta dilatation of over 3.34 cm increases the OR of ASP by 11.6 times (p = 0.0107); the factor is enhanced after adjusting for elevated total cholesterol levels over >6.35 mmol/l (p = 0.036) and independent of age and sex. A greater left CCA diameter of more than 8.59 mm (p < 0.019) and right CCA diameter of more than 8.1 mm (p < 0.0001) increases the OR of ASP by 3.7 times (p = 0.001) and 6.6 times (p = 0.0013), respectively, the factor influence increases after adjusting for elevated total cholesterol levels over >6.35 mmol/l (p = 0.031) and it is also unaffected by age and sex.

Conclusions. In individuals with stage II HTN and T2DM, the presence of CA atherosclerosis with stenosis up to 50 % is associated with a significantly increased CCA and ascending aorta diameter, a decreased percentage of AT, and an increased compliance coefficient of plaque-free wall segments.

Respiratory homeostasis features in female students with idiopathic arterial hypotension and hyperventilation syndrome

L. M. Soltysik, V. A. Levchenko — Fri, 29 Mar 2024 00:00:00 +0200

Aim. To assess the condition of pulmonary ventilation and diaphragmatic excursion in female students with idiopathic arterial hypotension in the context of hyperventilation syndrome and excessive anxiety.

Materials and methods. In total, 62 female students aged 18–24 diagnosed with idiopathic arterial hypotension were examined. The patients were randomly assigned to three groups based on clinical symptoms. Group 1 consisted of 34 students with idiopathic arterial hypotension accompanied by excessive anxiety and hyperventilation syndrome. Group 2 comprised 28 students with arterial hypotension without signs of neurogenic hyperventilation. Group 3, the control one, included 11 apparently healthy age-matched students.

The manifestations of hyperventilation syndrome were determined using the Nijmegen Questionnaire. The level of anxiety was assessed using the Spielberger–Hanin scale. Primary indicators of pulmonary ventilation were examined using a Spirolab spirometer (Italy). The diaphragm dynamic function was evaluated by assessing the excursion of its right dome using a Chison QBIT 5 apparatus (China).

Results. Through the survey, signs of neurogenic hyperventilation syndrome and excessive anxiety have been identified in the students of Group 1 showing changes in pulmonary ventilation parameters, such as significantly decreased vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1), compared to the results obtained in Groups 2 and 3, indicating restrictive respiratory disorders.

It has been found that diaphragmatic excursion values (18.29 ± 3.26 mm) at rest in Group 1 were significantly lower compared to those obtained in the control group (26.82 ± 2.32 mm) (p ˂ 0.05). During forced breathing, diaphragmatic excursion (56.86 ± 4.35 mm) in Group 1 was lower than that (80.18 ± 3.19 mm) in the control group (p < 0.05). In Group 2, a significant initial decrease in diaphragmatic excursion was revealed only in 26.67 % of the girls.

Conclusions. In female students with idiopathic arterial hypotension accompanied by hyperventilation syndrome and excessive anxiety, restrictive pattern of decreased pulmonary ventilation parameters and reduced diaphragmatic excursion were observed.

Characteristics of neurovegetative disorders in ischemic heart disease patients after coronavirus disease 2019 (COVID-19)

S. M. Manuilov, N. S. Mikhailovska — Fri, 29 Mar 2024 00:00:00 +0200

The aim of the study. To examine the frequency and spectrum of cognitive, anxiety-depressive, autonomic disorders and their interrelationship in patients with coronary heart disease (CHD) after COVID-19 infection.

Materials and methods. The study involved 71 patients with CHD, stable angina pectoris FC II–III (age 69.0 [64.0; 76.0] years): group 1 (main) – 31 CHD patients after COVID-19; group 2 (comparison) – 40 CHD patients without COVID-19 history. Spectral and temporal HRV parameters were assessed using 24-hour Holter ECG monitoring, anxiety-depressive disorders (ADD) – using the HADS scale, cognitive status of patients – according to the MoCa scale.

Results. CHD patients after COVID-19 had a higher frequency of ADD detection and a greater anxiety level (16 [10; 24] versus 10 [9; 13] points, p < 0.05), depression (14 [8; 20] versus 11 [10; 12] points, p < 0.05) as compared to patients without previous history of COVID-19. At the same time, the predominance of the anxiety component over the depressive one in patients of both groups has been revealed. In CHD patients after COVID-19, a decrease in the total MoCa scale score has been found as compared to patients without COVID-19: 24 [22; 26] versus 28 [26; 30] points, p < 0.05. There was an association between the total level of anxiety and depression and the severity of cognitive impairment (r = -0.36, p < 0.05). CHD patients exposed to COVID-19 showed an increased sympathetic and parasympathetic tone of the central nervous system within 24 hours, an increased LF/HF ratio during the active period, activation of slow-acting humoral regulation mechanisms amid increasing stress index and centralization index. In the group of patients with CHD after COVID-19, a wide range of correlations between the rate of ADD, cognitive disorders and HRV parameters has been found.

Conclusions. Patients with coronary heart disease recovered from COVID-19 have shown an increase in the incidence and degree of ADD and cognitive disorder manifestations which was accompanied by autonomic dysfunction resulting in stress on the functional and adaptive state of the cardiovascular system. The association between ADD, autonomic and cognitive disorders in patients with coronary heart disease after COVID-19 has confirmed the common pathogenetic links of the disorders found.

Study of fatty acid-binding protein and Bacteroidetes and Firmicutes levels in patients with metabolic-associated fatty liver disease in combination with type 2 diabetes mellitus and small intestinal bacterial overgrowth syndrome

V. V. Cherniavskyi, O. K. Didyk — Fri, 29 Mar 2024 00:00:00 +0200

The aim of the study was to examine serum levels of liver and intestinal fatty acid-binding proteins (L-FABP and I-FABP), fecal numbers of Bacteroidetes (B) and Firmicutes (F) in patients with metabolic-associated fatty liver disease (MAFLD) in combination with type 2 diabetes mellitus (Т2DM) and small intestinal bacterial overgrowth (SIBO) syndrome.

Materials and methods. The prospective, interventional, randomized study included 51 patients with MAFLD in combination with Т2DM, who were examined and divided into 2 groups. Group 1 consisted of 24 patients with MAFLD and Т2DM without SIBO. Group 2 was comprised of 27 patients with MAFLD in combination with Т2DM and SIBO. The control group included 20 apparently healthy individuals. Serum levels of L-FABP and I-FABP were measured by ELISA method using the Human L-FABP and I-FABP ELISA Kit test systems, respectively (Elabscience, USA). Fecal numbers of B and F were determined by real-time PCR. Bacterial DNA was detected in a thermal cycler Rotor-Gene 6000 (QIAGEN, Germany) using DNA 16S rRNA primers and NanoDrop ND-8000 reagents (Thermo Scientific, USA).

Results. To assess the state of intestinal permeability, serum levels of L-FABP and I-FABP were examined and numbers of phylum F and В as well as their ratio were calculated. Patients of both groups have been found to have increased serum levels of L-FABP, I-FABP, numbers of B in fecal samples and decreased numbers of F and F/B ratio.

Conclusions. The study results obtained have revealed increased intestinal permeability and demonstrated an important diagnostic value of serum L-FABP and I-FABP as a biomarker of intestinal permeability in diabetic MAFLD patients with or without SIBO. Increased fecal numbers of Bacteroidetes, decreased numbers of Firmicutes and F/B ratio have been detected in diabetic MAFLD patients with or without SIBO.

Study on the role of tissue-specific and non-specific autoantibodies, matrix metalloproteinase-3 and neuron-specific enolase enzymes in the exacerbation of autoimmune thyroiditis

Fri, 29 Mar 2024 00:00:00 +0200

The aim of the study was to examine the involvement of tissue-specific and non-specific autoantibodies, matrix metalloproteinase-3 and neuron-specific enolase (NSE) enzymes in the development and exacerbation of autoimmune thyroiditis.

Materials and methods. The study enrolled 170 patients with autoimmune thyroiditis (64 males and 106 females aged 18 to 64 years) to comprehensively examine their humoral immune response indicators (IgA, M, G), organ-specific (Ab-TG, Ab-TPO) and organ-non-specific antibodies (Ab-DNA), metalloproteinase-3 and NSE activity. The control group consisted of 65 individuals without thyroid pathologies or other autoimmune diseases, aged 20 to 65 years (26 males and 39 females).

Results. The study has demonstrated changes in the levels of organ-specific and organ-nonspecific antibodies and statistically significantly increased metalloproteinase-3 activity in patients with autoimmune thyroiditis. Positive correlations have been found between elevated levels of IgG, Ab-TG, Ab-TPO, Ab-dsDNA and NSE activity. Negative correlations have been observed between NSE activity and IgA concentrations.

Conclusions. Elevated titers of anti-DNA autoantibodies may indicate an aggravation of the autoimmune process due to cellular structure damage, resulting in gland dysfunction. The findings also suggest that metalloproteinase-3, a marker predicting thyroid tissue damage, may negatively impact the immune response induction, ultimately affecting the activity of neuron-specific enolase. The data have shown that studying biochemical indicators such as antinuclear antibodies (ANA), anti-DNA antibodies, metalloproteinase-3 and neurodegenerative indicators could provide informative markers to determine the nature of the disease development and worsening.

Comparison between intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) and intraperitoneal onlay mesh repair (IPOM) for ventral hernias

H. O. Havrylov, O. V. Shulyarenko, M. O. Yosypenko — Fri, 29 Mar 2024 00:00:00 +0200

Aim. To evaluate the intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) versus intraperitoneal onlay mesh (IPOM) for ventral hernias (VHs).

Materials and methods. A total of 89 patients with VHs with a defect between 3–12 cm who underwent a surgery from 2018 to 2023 years were enrolled in this study. All of them were randomly assigned to two groups. Group 1 included 45 patients after intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus), Group 2 – 44 patients after intraperitoneal onlay mesh (IPOM). The distribution of patients by age, sex, body mass index (BMI), hernia type (primary VH, incisional hernia), American Society of Anesthesiologists (ASA) score was studied.

Results. The differences in sex, mean age, patient distribution based on hernia type, BMI, ASA score and hernia orifice size were not statistically significant between the two groups. Therefore, both groups were comparable. The operative time in minutes was 73.17 ± 7.43 in Group 1 and 70.93 ± 8.84 in Group 2 (not statistically significant). The pain score 12 hours after surgery was 5.24 ± 0.60 in Group 1 comparing to 5.02 ± 0.45 in Group 2 (not statistically significant). The pain score 8 days after surgery was 2.88 ± 0.31 in Group 1 comparing to 2.75 ± 0.43 in Group 2 (not statistically significant).

There was no significant difference concerning the incidence of early complications between the two groups. 41 (91.11 %) patients of Group 1 and 40 (90.9 %) patients of Group 2 were examined during a 22-month follow-up period. No complications were noted.

Conclusions. Laparoscopic ventral hernia repair provides satisfactory results in terms of safety and efficacy. Thus, IPOM plus repair is safe, feasible and offers possible advantages over the standard IPOM technique as reported in the literature. Poor outcomes described in the literature are probably related to independent variables such as mesh and suture types as well as closure technique.

Immunohistochemical characteristics of epithelial-mesenchymal transition in pancreatic ductal adenocarcinoma

M. A. Shyshkin, V. O. Kabachenko — Fri, 29 Mar 2024 00:00:00 +0200

The epithelial-mesenchymal transition (EMT) plays a crucial role in the development of pancreatic ductal adenocarcinoma (PDAC). There are insufficient and contradictory data in the scientific literature on the peculiarities of epithelial and mesenchymal marker expression in PDAC ducts and EMT zone, which requires further research on the role of EMT in the development and progression of PDAC.

Aim: to conduct a comprehensive assessment of epithelial and mesenchymal markers of EMT in the PDAC ducts and EMT zone at different degrees of differentiation.

Materials and methods. A comprehensive pathomorphological and immunohistochemical examination including 49 cases of surgical material from patients with PDAC, divided into groups of moderate (G2) and low degree of tumor differentiation (G3).

Results. PDAC was characterized by low levels of E-cadherin expression in both ducts and EMT – Me = 22.58 % [12.81; 36.23] and Me = 25.17 % [19.04; 35.37], respectively (p > 0.05). Only membrane expression of the marker was detected in the ducts and membrane-cytoplasmic one – in the EMT zone without significant differences in the groups. There was a significant decrease in the ductal β-catenin expression (p < 0.05) in G2 with membrane-cytoplasmic staining (Me = 15.58 % [10.42; 26.24]), in G3 – with membrane (Me = 4.42 % [2.35; 5.93]); in the EMT zone, only membrane-cytoplasmic expression was observed in both groups without significant difference (p > 0.05). Membrane expression of CK7 was positive in 100 % of PDAC, significantly lower at G2 (Me = 19.51 % [10.70; 27.24]; Me = 26.19 % [20.93; 30.05], p < 0.05), and CK18 (Me = 21.34 % [9.68; 29.96] – in G2, in G3 – Me = 22.50 % [8.24; 40.08], p > 0.05). Expression of α-SMA and Vim was seen in spindle-shaped stromal cells, around tubular and trabecular structures with membrane-cytoplasmic staining. There was no significant difference between α-SMA in G2 and G3, the level of vimentin was significantly lower in G3 (p < 0.05).

Conclusions. The features of PDAC E-cadherin, β-catenin, CK7 and CK18 marker expression indicate a greater EMT process at the periphery of the tumor and its severity increases with tumor progression. The optimal markers to determine the mesenchymal phenotype of PDAC cells are α-SMA and vimentin.

Complex phenotype of Tourette syndrome in a ten-year-old boy (a clinical case)

T. V. Sorokman, N. Ya. Chernei, I. S. Sokolnyk, V. H. Ostapchuk — Fri, 29 Mar 2024 00:00:00 +0200

Aim. The aim of the work is to draw attention to the symptoms associated with Tourette syndrome and to examine the association with comorbid diseases.

Materials and methods. A review of the scientific literature on Tourette syndrome (TS) was conducted using the following Keywords

“tics”, “Tourette syndrome”, “Tourette obsessive-compulsive disorder, TOCD”, “obsessive-compulsive disorder, OCD”, “attention deficit hyperactivity disorder, ADHD” using PubMed, MEDLINE, EMBASE as search engines. Taking into account studies conducted in the last 10 years, the abstracts of 275 articles were analyzed. Articles were selected for the study based on the criterion of their close relevance to the topic. The study results covered in 49 articles were examined in more detail. A description of a TOCD clinical case was prepared from primary medical documentation with parental informed consent.

Results. The prevalence of TS is quite variable, depends on epidemiological research methods and ranges from 0.3 % to 1.0 % worldwide. Given the methodological limitations of most studies, the actual prevalence may be 10 times higher. TS is a progressive disease and is characterized by regular stages. Tourette syndrome-plus is distinguished, including autoaggressive actions besides the basic symptoms of OCD and ADHD. The etiology of TS is still being studied. In particular, the impact of environmental factors is considered: infection or inflammation, perinatal complications and chronic psychosocial stress in childhood. In 70–80 % of cases, TS is a hereditary disorder, making it one of the most heritable childhood-onset neuropsychiatric diseases. Various approaches have been applied to assess the genetic architecture of TS, including candidate gene studies, segregation analysis, linkage analysis, cytogenetics, copy number variants (CNV), rare variation studies, genome-wide association studies (GWAS), and whole exome sequencing (WES). Currently, there is no specific laboratory or genetic test for TS diagnosis. Pharmacological treatments are available but often ineffective; behavioral and surgical treatments are under development. The clinical case of TS in a 10-year-old boy is described with an onset at the age of 7 years following frequent infections, manifested as cephalocaudal motor tics and several vocal tics (coprolalia, echolalia) with a progression to obsessive-compulsive behavior (mysophobia, compulsive skin picking, self-hitting, self-biting, repetitive compulsions). The presented clinical case is of great interest from the viewpoint of somewhat belated diagnosis of TOCD syndrome, as well as indicates the need to continue the search for effective methods of diagnosis and treatment.

Conclusions. The case of comorbid OCD and tic disorder is a unique endophenotype combining externalized disinhibited TS movements in parallel with internalized distress reminiscent of OCD. Clinicians should consider these features when choosing treatment methods.

Intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice

O. M. Chaika, V. Yu. Ilyina-Stognienko, Daviti Ochigava — Fri, 29 Mar 2024 00:00:00 +0200

Aim: to analyze current literature on the assessment of intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice.

The experience of using intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice is analyzed. The priority areas of the method application are defined, the recent clinical studies in various fields of surgery and urology are reviewed.

Conclusions. The method of intraoperative near-infrared fluorescence imaging of anatomical structures with abundant vascularization and for assessing oncological prognosis is the most promising.

The role of intestinal microbiota in the development of dyslipidemia and cardiovascular disease risk

T. V. Bogoslav — Fri, 29 Mar 2024 00:00:00 +0200

The aim of the study: to summarize the study results on the interaction between intestinal microbiota and the human body in terms of the risk for dyslipidemia and cardiovascular system diseases.

Material and methods. A descriptive and comparative study was conducted based on the analysis of scientific literature focused on the role of intestinal microbiota in the occurrence of dyslipidemia and the development of cardiovascular diseases. The following research methods were used: search, comparative, analysis of scientific literature, generalization, synthesis.

Results. Gut microbiota plays an important role in maintaining health, and its pathology contributes to the risk for cardiovascular diseases. In some cases, monitoring the intestinal microbiota and the preventive use of pre- and probiotics can reduce the risk for developing cardiovascular system diseases.

Conclusions. It has been found that trimethylamine-N-oxide, a microbiota-dependent metabolite, is the first of many existing bacterial products with the proven role in the development of cardiovascular system diseases.

Certain aspects of the systemic etiopathogenesis of dystrophic-inflammatory periodontal diseases (a literature review)

O. M. Nemesh, Z. M. Honta, I. V. Shylivskyi, K. A. Moroz, O. O. Myhal — Fri, 29 Mar 2024 00:00:00 +0200

Aim. To study the main pathogenetic mechanisms in the development of dystrophic-inflammatory periodontal diseases by analyzing scientific research results covered in current specialized literature.

Material and methods. Searching, systematization, processing and analysis of scientific sources, which present modern theories of pathogenesis and development of dystrophic-inflammatory periodontal diseases.

Results. The conducted data analysis from modern literary sources proves that the progression of dystrophic-inflammatory periodontal diseases depends not only on the development of local inflammation in the periodontal tissues caused by the dental plaque microflora, but also it is a reaction to the influence of systemic factors. They lead to profound changes in the body internal environment and, as a result, to structural damage of the periodontal tissues. At the same time, the results obtained do not allow the authors to clearly assess the nature of these relationships and require further in-depth studies.

Conclusions. Understanding the pathogenetic mechanism of periodontal diseases allow developing optimal measures for their diagnosis, prevention and treatment.

Optimisation of the composition of safe dental gel with IL-1β antagonist for the treatment of inflammatory periodontal diseases

О. О. Dmytriieva, I. F. Belenichev, B. S. Burlaka — Fri, 29 Mar 2024 00:00:00 +0200

Aim. The study aims to develop the composition of the oromucosal gel with the IL-1β interleukin antagonist for complex treatment of inflammatory periodontal diseases.

Materials and methods. Experimental studies were conducted based on the Department of Medicines Technology of Zaporizhzhia State Medical and Pharmaceutical University and the Training Medical and Laboratory Center of Zaporizhzhia State Medical and Pharmaceutical University of the Ministry of Health of Ukraine.

As an active component, in the recipe of oromucosal gel, used antagonist of the interleukin IL-1B. Excipients: D-panthenol (the plasticizer), carboxymethylcellulose sodium salt (the viscosity modifier and mucoadhesive component), Tween-80 (the enhancer absorption), benzalkonium chloride (the preservative), sodium hydrophosphate + citric acid (the phosphate buffer solution), purified water. The experiments used existing and auxiliary ingredients of pharmaceutical purity, which were obtained from Sinbias LLC, Istok-Plus LLC, LLC “Mobile Medical”. For the design of the experiment, the methodology of the response surface (Box-Behnken Design) is used: Na CMC, Tween-80, D-panthenol; and four answers: pH, viscosity test, system type, mucoadhesive properties.

Research methods: rheological research (viscosity test, amplitude test, frequency test, mucoadhesive test, thixotropy test) performed in oscillation mode on the modular compact Rheometer Anton Paar MCR 302 (CP50-1 SN71317), which, compared to cylindrical devices, requires a much smaller amount of gel sample and allows the planned tests in the oscillation mode, the temperature in the experiments was provided with a built-in thermostat (Peltier Temperature Control, C-PTD 200).

Pharmaco-toxicological studies were conducted on 46 white outbred rats of both sexes, weighing 160–180 grams, which were received from Vivarium by the Institute of Pharmacology and Toxicology. The studies were performed on enough animals, all manipulations were carried out by the provisions on the use of animals in biomedical experiments. The results of the study were calculated using the standard statistical package of the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J), as well as SPSS 16.0, Microsoft Office Excel 2003.

Results. According to the design of the experiment, it is established that the components of the system do not change the value of pH in experimental oromucosal gels (6.5500 ± 0.0334). The Anova for Quadratic Model statistical analysis data certify the significant impact of Na CMC, and Tween-80 factors on the viscous characteristics of oromucosal gels (F-value > p-value). Comparison of mucoadhesive characteristics of the studied samples of oromucosal gels was made using dynamic mechanical analysis and the results of statistical analysis of ANOVA for Quadratic Model highlight the significant influence of Na CMC, D-panthenol, Tween-80. Optimized oromucosal gel test data is obtained that its structure is restored after the applied effort, namely the restoration of the structure after 10 seconds occurs by 69.5 %, after 30 s by 76.1 %, after 180 s by 85.4 %, after 180 s which allows to predict the stability of the dosage form, both after manufacture and after use.

Conclusions. The composition of the oromucosal gel of anti-inflammatory action with the IL-1β interleukin antagonist for the complex treatment of inflammatory diseases of periodontal is developed. The optimized composition of the oromucosal gel obtained has satisfactory performance of kinetic stability and thixotropic properties. The developed gel for dentistry meets all the requirements for harmlessness and safety for dosage forms of this group toxicity, lack of local irritant and allergic action.