Medicni perspektivi, 2018;23(1 part 1).
2018 Vol. XXIII N 1 part 1
Key words: pregnancy, parvovirus infection, indicators of systemic immunity, cytokine profile of blood serum
Abstract. Immunological features of parvovirus infection in different pregnancy periods. Bondarenko N.P., Lakatoch W.P., Lakatoch P.W. Parvovirus infection in pregnant women caused the development of immunopathological reactions.129 infected pregnant women and 16 women with physiological pregnancy in the 1st, 2nd and 3rd trimesters were examined. The functional state of neutrophils (Nph) and monocytes (Mc) of peripheral blood was investigated, parameters of cellular and humoral immunity and cytokine profile of serum of pregnant women were studied. In infected pregnant women in different periods of gestation as compared with pregnant women of control groups there were observed 1) an increase of index of phagocytosis Nph and Mc against the background of reducе of their absorption capacity and increasing NBT-activity with a decrease of reserve capacities of phagocytes; 2) an activation of the cellular immunity with an increase of helper mechanisms of the immune response; 3) a reliable increase of IgM level in serum in different periods of pregnancy; 4) a reliable increase of the content of IFN-γ, FNP-α, IL-2, IL-8 in serum against the background of a slight decrease in the level of anti-inflammatory IL-10. The largest deviations from the control indicators were recorded in the 1st trimester of pregnancy.
Key words: indices of disability, occupational diseases, medical-social examination
Abstract. Analysis of disability indicators due to occupational diseases in the Lviv region: problems and perspectives of the decision. Borisova I., Reshota V., Nikolishin Z. Disability is a social phenomenon that can not be ruled out by any society. The potential of society in combating the growth of disability – as a social evil – is determined not only by the degree of understanding of this problem but mainly by economic resources. The risk of developing occupational diseases in the coal industry is 5-10 times higher than in other branches of industry. In Ukraine, about 3 million people work under the harmful conditions of production, 60.0% of them are miners. The study analyzed the dynamics of disability as a result of occupational diseases in the Lviv region for the period 2015-2017. The results of the study prove that the disability indicators due to occupational diseases tend to grow. The ways to overcome this unfavorable tendency should be state measures on improvement of normative and legal documents, coherence between different state institutions and strengthening effective state control over hygiene norms in industries with harmful factors.
Key words: pulmonary aspergillosis, Aspergillus fumigatus, computed tomography, galactomannan test
Abstract. Invasive pulmonary aspergillosis: the state of art and the clinical case. Gashynova K.Yu., Kolisnyk N.S., Dmytrychenko V.V., Kaplan P.Yu., Kuzhevskiy I.V., Hurtovyi V.A., Mizina V.M. Aspergillus species continue to be an important cause of life-threatening infection in immunocompromised patients. The article presents a clinical case of invasive pulmonary aspergillosis in a patient with acute myeloid leukemia.
Key words: vaccination, measles, rubella, elimination
Abstract. Topical issues of vaccination and epidemiological surveillance over measles and rubella in Ukraine. Daragan G.M., Krushinska T.Yu., Stepanskiy D.O., Demchyshyna I.V., Kolesnikova I.P. The analysis of measles and rubella morbidity, the state of their vaccination in Ukraine was carried out. Despite decades of preventive vaccination, there is a 5-6 years’ cyclicity of measles epidemic process at present time. Measles morbidity increased 46.8 times in 2017 in comparison with 2016. Elevated rates of rubella epidemic morbidity were registered in 2004 and 2011. There was decrease of routine measles and rubella immunization coverage in the period from 2009 to 2016. Critically low rates were noted in 2016 – 45.5% (vaccination) and 30.2% (revaccination). In spite of progress in the measles and rubella vaccination in 2017 (93.3% – vaccination and 90.7% – revaccination), Ukraine has not achieved the immunization coverage (≥95.0%) necessary to interrupt these pathogens circulation. The national laboratory and a network of regional ones, in-system of the Global Measles and Rubella Laboratory Network, were established in Ukraine to ensure high-quality performance of epidemiological surveillance. Genotyping of the clinical samples from Ukrainian measles and rubella patients is carried out in the WHO Regional Reference Laboratory (Luxembourg). Different genetic lines of the measles virus with prevalence of D8 genotype were indicated to circulate in Ukraine. The genotype B3 was also identified and the genotype D9 was isolated for the first time. In the furtherance of the goal of rubella and measles elimination in Ukraine, standard international approaches to clinical, laboratory and epidemiological diagnosis of cases, investigation of viruses transmission chains and detection of endemicity cases are in the course of implementation. Quality of the executing activities is assessed according to relevant standard indicators.
Key words: pollinosis, specific immunotherapy, respiratory function, spirometry, bronchial asthma, antileukotrienes
Abstract. Efficacy of combination of antihistaminic agents and blocker of leukotriene receptors in the treatment of pollinosis exacerbation with bronchial asthma attacks. Dytyatkovska Y., Rodkina I., Yevtushenko M., Grybanova L., Bendetska Y., Romanova A., Koretskaia I. We have been observing 60 pollinosis patients at the age of 19 to 64 years with clinical manifestations of rhinitis, conjunctivitis, bronchial asthma. The study was conducted in the design of parallel groups. All patients were divided into 2 clinical groups (main and control), depending on the treatment regimen. The main group included 40 patients who received a combined drug Glencet Advance 1 tab. in the evening for 1 month. 20 patients included in the control group received symptomatic local therapy (eye drops, IGCC), β2-short-acting agonists. Results: integral assessment of symptoms in the main group before treatment was 11.50±0.13 and significantly decreased after treatment to 0.68±0.14 (p<0.001). In the control group differences were much less expressed from 11.15±0.22 before treatment to 3.05±0.29 (p<0.001) after treatment. FEV1 (%) in the main group has been improving more intensively (from 55.5±1.14 to 90.7±1.31 (p<0.01). PEF has been improving from 187.5±4.34 l/sec to 406.3±10.73 (p<0.001). In the control group these changes are less expressed for FEV1 (%) from 56.2±1.72 to 78.5±2.18 (p<0.001). PEF l/sec – (from 195.0±6.75 to 320.0±12.50 (p<0.01)). The histamine level decrease (ng/ml) in the main group was reliable – from 4.29±0.52 to 1.40±0.3 (p<0.5). In the control group – from 3.00±0.33 to 2.82±0.31 (there is no veracious data). Change of the total IgE level in serum: veracious decrease from 487.2 to 367.8 in the main group, no veracious decrease in the control group. Conclusions: the use of combined therapy with antihistamines and antileukotriene drugs in patients with pollinosis gives a good clinical effect, which is confirmed by a veracious decrease of histamine and total IgE levels in blood serum, as well as by veracious improvement in FEV1 and PEF.
Key words: asthma, diabetes mellitus type 2, MCP-1, MMP-9, von Willebrand factor, L-arginine, Tiotropium bromide
Abstract. The treatment of patients with asthma and comorbidity. Yeryomenko G.V., Bezditko T.V. The increasing prevalence of asthma (A) and diabetes mellitus type 2 (DM2T) necessitates administration of the adequate antiasthmatic long-term basic therapy with consideration of comorbid states. The purpose consisted in revealing the therapeutic potential of Tiotropium bromide (TB) and L-arginine (Tivortine) in patients having uncontrolled moderately severe asthma in combination with DM2T (A+DM2T). Forty seven A+DM2T patients underwent an in-depth study before and after their treatment. They were divided into 2 groups: treatment (group 1, n=28) and comparison (group 2, n=19). Both groups received the standard 2-component therapy: budesonide/formoterol fumarate dihydrate – 160/4.5µg by 2 breaths twice a day and metformin at a dose of 500 mg twice a day. The complex of their basic therapy for group 1 additionally included TB (18 µg a day) and arginine hydrochloride preparation (Tivortine® aspartate, Yuriya-Farm) orally by 15 ml twice a day during 3 months (90 days). The patients were followed up 3 months and one year later. Their general condition demonstrated positive dynamics in both groups, the number of exacerbations in group 1 reducing by a factor of 4. The complex use of L-arginine and TB preparations against a background of the basic therapy in A+DM2T patients produced a better control over the disease, a more rapid elimination of obstruction manifestations, achievement and prolongation of the clinical spirographic remission, an improvement of the quality of life, correction of disturbances in haemocoagulation, fibrinolysis and the functional state of endothelium.
Key words: scleroderma, pulmonary pneumosclerosis, general clinical methods
Abstract. The indicators of general clinical methods as prognostic markers of the severity of systemic scleroderma complicated by the development of pneumosclerosis. Karaseva O.V., Rodionova V.V. Purpose: to define clinical prognostic markers for evaluation of inflammation activity and prognosis of complications development in patients with systemic scleroderma. Materials and methods: The study included 32 people, all women, the average age – 43.2±2.23 years. All the examined patients (n=32) were divided into two groups: the main group (n=21) – patients with systemic scleroderma and concomitant pulmonary tissue involvement – pneumosclerosis. Group II (n=11) included patients with systemic scleroderma without signs of pneumosclerosis. The duration of the disease was 8.1±0.03 years. Patients underwent clinico-laboratory and anthropometric studies, chest radiography in two projections, questionnaire of mMRС for assessing the symptoms of dyspnea, blood saturation was measured with a pulse oximeter EchoCG, if necessary – computed tomography of light high resolution was performed and other general clinical studies in accordance with diagnosis, if necessary. Results and discussion: Patients of groups I and II had bilateral reinforcement of the pulmonary pattern mainly in the lower and middle sections. In Group I patients in the basal regions there were also single cyst-like changes, sometimes sections of the honeycomb lung, bronchiectasis, pleural adhesions. Patients of group II showed signs of focal pneumofibrosis (3 patients), who had pneumonia in anamnesis. There was a tendency of increased pressure in the pulmonary artery in patients with the presence of pulmonary tissue lesions, a decrease in the CSR of the left ventricle. When analyzing the data of the rheumatic complex and individual immunogram indices, the level of CIC and rheumatoid factor was higher in patients of group II, and the level of cryoglobulins was significantly increased in group I patients. In patients of group I, in addition to the increase in cryoglobulins, index of С-reactive protein (CRP) and ESR was increased. Conclusion: The affection of the lungs with the development of pneumosclerosis in patients with systemic scleroderma complicates the course of the disease, contributes to worsening of patients’ condition and formation of unfavorable prognosis. The increase in the level of cryoglobulins and CRP can be used not only to assess inflammation activity but also to predict the development of complications, it requires revision of the treatment of the main disease.
Key words: molecular genetic testing, children, IL4 gene C-33T polymorphism, repeated episodes of acute obstructive bronchitis
Abstract. Molecular-genetic testing of single-nucleotide polymorphism C-33T of IL4 gene in children with recurrent episodes of acute obstructive bronchitis. Kens O.V., Gnateyko O.Z., Lukyanenko N.S., Bergtravm V.I. The molecular genetic testing of the IL4 gene of a single nucleotide polymorphism C-33T was performed in 35 children with recurrent episodes of acute obstructive bronchitis and 35 children with acute bronchitis. It has been proved that the presence of a child's genotype 33СT IL4 increases the risk of recurrent acute obstructive bronchitis by 4 times.
Key words: germanium citrate, lipopolysaccharide, oocytes, granulosa cells, DNA damage, apoptosis, necrosis
Abstract. Protective effect of germanium citrate in endotoxin-induced ovarian dysfunction in mice. Kondratska O.A., Grushka N.G., Kaplunenko V.G., Pavlovych S.I., Sribna V.O., Yanchii R.I. Now it is known that endotoxin of gram-negative bacteria – lipopolysaccharide (LPS) is associated with disturbances of reproductive function in women. To simulate an ovarian dysfunction in endotoxemia and to explore a possible protective action of germanium (Ge) citrate obtained via nanotechnology we used LPS administration into female mice (3 mg/kg). Treatment with LPS caused pathological changes in mouse ovaries at 24h post-injection: an impairment of oocyte maturation in vitro, DNA damage in granulosa cells (as estimated by DNA-comet assay) and a decrease in their viability by increasing both necrosis and apoptosis. Pretreatment of mice with Ge citrate (i.p. 100 mkg/kg, 2 injections: 24 h and 1 h before LPS) was effective to reduce genotoxic stress and cell death. Ge citrate administration to LPS-treated mice significantly enhanced oocyte quality (as indicated by improvement in oocyte maturation) that may be due to cytoprotective effect of this compound on surrounding follicular cells. Our results support potential therapeutic application of Ge citrate to improve reproductive function in endotoxemia.
Key words: pollinosis, allergen-specific immunotherapy, dialysate leukocyte lyophilized
Abstract. Dynamics of cytokines level under the influence of lyophilized dialysate of leucocytes (Immodin) on the background of allergen-specific immunotherapy (ASIT) by pollene allergens in patients with pollinosis. Koretskaia Ye. The analysis of IL-4, INF-γ has been performed on the background of lyophilized dialysate of leucocytes (Immodin) in the course of the ASIT with pollen allergens among patients with pollinosis. 104 people of both genders were examined, average age was 34.3±1.0 years. All patients took the ASIT course before. It is denoted that prior to treatment half of the patients with hay fever (n=58 (55.8±4.9)%) had blood IL-4 level above the norm. The level of INF-γ in blood serum, in contrast, was lower and beyond the reference range. After preseasonal ASIT under the influence of lyophilized dialysate of leukocyte (Immodin) a significant decrease of IL-4 content in blood serum comparing to initial level – by 1.7 times or 40.2% (p<0.001) is observed. IL-4 content in blood serum of the main group after treatment was lower by 32.0%, comparing to the control group (p<0.001). IFN-γ level increased by 2.4 times among patients of the main group and by 1,9 times among patients of the control group. Hence, in presence of comparable levels of INF-γ before treatment in both groups, under the influence of ASIT the INF-γ concentration in blood serum in the main group is 33.9% higher than in control group. Studies indicate that ASIT effects on Th2 inhibitors, disenabling its activity, although under the influence of Immodin it proceeds reliably more efficiently already after the first course.
Key words: chronic obstructive pulmonary disease, overweight, IL-6, C-reactive protein
Abstract. Diagnosis and prognosis of COPD exacerbations in overweight patients. Korzh N.V. Increasing incidence of chronic obstructive pulmonary disease (4th place among all causes of death within the general population) and overweight, as one factor for progression of respiratory tract pathologies (more than 30% of world population suffers from overweight) suggests that further study of pathogenetic characteristics of their combined course and search for new ways of differential pathogenetic therapy are important nowadays. The aim if the investigation is the diagnosis and prognosis of COPD exacerbations in overweight patients. The results of this investigation demonstrate, that overweight is the predictor of COPD progression, that is accompanied by elevations of CRP and IL-6 levels in peripheral blood serum.
Key words: primary specialization, out-of-class work, clinical immunology, clinical allergology, qualitive successes
Abstract. The role of out-of-class work of doctor-interns in improving qualitive academic progress on clinical immunology and allergology under the primary specialization “Internal diseases”. Kuz'mina G.P., Potabashniy V.A., Fesenko V.I., Knjazjeva O.V., Azarenko V.Je., Knjazjeva O.V., Vasylenko A.M., Khatsko V.E. The use of independent out-of-class work of interns on the specialty "Internal diseases" in the section of clinical immunology and allergology promoted the improvement of the qualitative success of interns.
Key words: postinfarction chronic heart failure, metalloproteinase, galectin-3
Abstract. Serum matrix metalloproteinase-2,9 activity, galectin-3 and systemic inflammation in patients with postinfarction heart failure with preserved ejection fraction. Kuryata O., Zabida A., Sirenko O. The available data suggest that heart failure (HF) after myocardial infarction (MI) is a very frequent event. Recent meta-analysis showed that restrictive mitral filling pattern, the most severe form of diastolic dysfunction, was presented in approximately 10% of the patients with preserved ejection fraction. In addition, restrictive pattern was associated with poor outcome. However, the true prevalence and relevance of diastolic dysfunction after MI remains to be elucidated. Objective: study was designed to evaluate the serum level of MMP-2,9, galactin-3 and C-reactive protein (C-RP) in postinfarction heart failure with preserved ejection fraction (HFpEF) patients. Methods: We divided all included patients into two main groups: 1st group – 20 patients with HFpEF and history of myocardial infarction. 2nd group – 18 patients with HFpEF and stable angina. Standard laboratory blood tests for erythrocyte sedimentation rate (ESR), C-RP, haematological parameters, lipid profile, glucose, renal and liver function tests were performed and calculated body mass index (BMI) for all patients. MMP activity assay and galectin-3 serum level was detected for all patients. Results: It was established significant differences between study groups in MMP-2, MMP-9 levels. Particularly, patients with HFpEF with MI in anamnesis had significantly higher MMP-2, MMP-9 levels on 21.8% and 20.7% respectively. The C-RP and leucocytes levels were significantly higher in 1st group pts. Significant differences in MMP-2, MMP-9 were established in 1st group patients in different age groups (p<0.05) (tab. 3). The MMP 2 level was positively correlated with MMP 9 level (R=0.73, p<0.05), the MMP 9 level – with age (R=0.68, p<0.05). There were no significant differences between galectin-3 level in study group. But we estimated significant differences in galectin-3 level between 1st and 2nd subgroups (p<0.05). Conclusion: Serum MMP-2, MMP-9, CRP and galactin-3 were significantly increased in pts with postinfarction heart failure with preserved ejection fraction compare to pts without myocardial infarction in anamnesis.
Key words: function of external respiration, kidney transplantation, immunosuppressive therapy, cyclosporine, tacrolimus
Abstract. Function of external respiration in patients after kidney transplantation under conditions of immunosuppressive therapy. Kuryata O.V., Shtepa O.O., Halushchak O.V. The aim of our study was to evaluate the changes in the parameters of the function of external respiration in patients after kidney transplantation due to chronic kidney disease and to assess the relationship between the level of cyclosporin A and tacrolimus in the blood with FVD indices. The study included 37 patients after kidney transplantation. The first group included 27 patients who received cyclosporine at an average dose of 225 [175-350] mg/day under the immunosuppressive therapy regimen, the second group included 10 patients who received tacrolimus at an average dose of 8.25 [5.0-9.0] mg/day. A significant difference (p˂0.05) between the indicators of the VCmax (78 [71-90]% and 76.5 [72-78]%), FVC (93 [85-99]% and 95 [91-98]%), PEF (82 [64-94]% and 80 [69-84]%), MEF25-75 (75 [66-112]% and 82.5 [67-90]%) was found in patients of the first and second groups relative to the FVD of the comparison group: VCmax (102.5 [98-113]%), FVC (107.5 [105.5-124]%), PEF (99.5 [95-102.5]%), MEF25-75 (98.5 [97.5-101.5]%). In both groups, a statistically significant negative correlation between the indicators of the VCmax, FVC and the level of cyclosporin A (R=-0.69, p<0.0001 and R=-0.4, p<0.037) in the blood in the first group and FVC and tacrolimus (R=-0.72, p<0.018) in the second group was found. A moderate decrease in the VCmax values in patients after kidney transplantation requires monitoring of the function of external respiration and managing such patients by nephrologists together with specialists in the pulmonological profile.
Key words: epithelial lesions, cervix, "small forms", human papillomavirus, microRNA
Abstract. Immunological changes at "small" forms of lesion of the cervical epithelium. Lipko O.P., Bobrytska V.V., Potapova L.V., Tkachova N.V. In order to study immunological parameters, including cervical mRNA in patients with persistent papillomavirus infection, 35 patients of the main group (HPV positive) and 42 patients of the control group (HPV negative) were examined. Patients of the main group were divided into three subgroups according to the process prescription and the results of previous immunotropic therapy: IА subgroup – (12 patients) HPV was first isolated, IB (16 patients) - persistence of the virus from one to three years, IC (7 patients) – persistence of the virus from one to three years, immunotropic therapy is ineffective. The level of IL-1, IL-6, IL-8, IL-10, TNF-ɑ, serum interferon, as well as mir25 microRNA expression level was determined. Data have been obtained that the persistence of papillomavirus infection is possible in conditions of deficiency in the level of cytokines IL-1 (45.5%, p<0.05), IL-6 (48.5%, p<0.05), IL-8 (24.2%, p<0.05), increase in the level of TNF-α (37.3%, p<0.05) and a reduced level of serum IFN up to 78.2%. The absence of the effect of HPV elimination is observed in the decrease of the indices from the conventional norm: IL-1 (73.6%, p<0.05), IL-8 (81.3%, p<0.05), IL-10 (25, 0%, p<0.05), TNF-α (77.8%, p<0.05). At the same time, the level of mRNA expression increases by 5.5 (p<0.05) from the median values of the control group. A decrease in the level of humoral immunity along with an increase in mRNA expression can serve as a marker of the resistance of HPV to therapeutic measures and determination the tactics of further therapy of patients with "small” forms of cervical epithelial lesions.
Key words: pulmonary tuberculosis, thyroid, immunity, cytokines
Abstract. Cytokine profile and efficacy of chemotherapy depending on thyroid state in patients with pulmonary tuberculosis. Matvyeyeva S.L., Shevchenko O.S. Objective of the study is definition of cytokine balance and the outcomes of chemotherapy of tuberculosis patients depending on their thyroid state. Materials and methods: 60 tuberculosis patients with pulmonary: 30 persons with unchanged thyroid gland and 30 persons with autoimmune thyroiditis and followed subclinical hypothyroidism were compared for the structure and the function of thyroid gland, cytokine balance and outcomes of antituberculosis chemotherapy. Thyroid glands of all patients were scanned by ultrasound. The levels of free thyroxine, thyroid stimulating hormone and antibodies to thyroglobulin and thyroid peroxidase in the serum were defined. At the same time the levels of tumor necrosis factor-α, interferon- γ and interleukins-2, -6, and -4 were measured. Outcomes of chemotherapy was estimated on the ground of general criterions: term and rate of stopping of bacilli excretion and healing of caverns in lungs. Results and discussion: In a comparative analysis of the data obtained, it was found that in tuberculosis patients with autoimmune thyroiditis and subclinical hypothyroidism compared with tuberculosis patients without thyroid pathology free thyroxine values in average decrease, the level of thyroid-stimulating hormone increases and levels of antibodies to both thyroglobulin and especially to thyroid peroxidase increase. In patients with concomitant autoimmune thyroiditis with subclinical thyroiditis, levels of pro-inflammation cytokines TNF-α, INF-γ, IL-2, IL-6 were significantly lower when compared with patients without thyroid pathology, and the level of anti-inflammation cytokine IL IL-4 was higher in a group of patients with autoimmune thyroiditis. Efficacy of chemotherapy was better in tuberculosis patients without thyroid pathology. These changes can be explained by a lower level of T4 in the systemic circulation of people with autoimmune thyroiditis and subclinical hypothyroidism. Conclusion: subclinical hypothyroidism accompanying concomitant autoimmune thyroiditis suppresses cytokine response in tuberculosis patients. That is followed worsening of treatment response during antituberculosis chemotherapy. Screening of thyroid state is recommended for TB patients for timely definition of thyroid pathology and its compensation if needed for improvement of the outcomes of antituberculosis chemotherapy.
Key words: community-acquired pneumonia, chronic diseases of internal organs
Abstract. Chronic comorbidity of internal organs as a risk factor of complications and fatal outcome of community-acquired pneumonia. Mostovoy Y.M., Demchuk A.V., Konstantynovych T.V., Chichirelo-Konstantynovych K.D. With the purpose to estimate influence of comorbidity at the risk of complications and death due to community-acquired pneumonia (CAP) the retrospective analysis of 1587 case histories of inpatients with CAP (mean age – 48.5±18.4, males – 815 (51.4%), women – 772 (48,6%)) was performed. Comorbidity was observed in 1114 (70.2%). More frequently complications of CAP were developed in patients with chronic diseases than without them (p=0.013). Increased risk of pleural effusion was associated with chronic diseases of digestive system (OR=1.85 (95%CI 1.30-2.26)) and diabetes mellitus (OR=2.35 (95%CI 1.40-3.96)). Risk of sepsis development is higher in patients with nervous system diseases (OR=3.62 (95%CI 1.37-9.56) and drug or alcohol addiction (OR=19.08 (95%CI 7.30-49.82). Risk of pulmonary edema rose in patients with drug or alcohol addiction (OR=24.16; 95%CI 8.07-72.34), malignancy (OR=8.97; 95%CI 1.94-41.49), diabetes mellitus (OR=4.04; 95%CI 1.48-11.01), diseases of nervous (OR=4.04; 95%CI 1.17-13.94), urinary (OR=3.39; 95%CI 1.33-8.64) and cardiovascular (OR=2.29, 95%CI 0.98-5.34) systems. Higher risk of death in patients with CAP was associated with the presence of cardiovascular diseases (OR=2.17; 95%CI 1.11-4.25), diabetes mellitus (OR=2.95; 95%CI 1.20-7.21), drug or alcohol addiction (OR=38.40; 95%CI 15.05-97.98).
Key words: community acquired pneumonia, NLR, disease severity, mortality prediction
Abstract. Neutrophil-to-lymphocyte ratio in predicting prognosis and course of community community-acquired pneumonia in hospitalized patients. Pertseva T.O., Kirieieva T.V., Bielosludtseva K.O., Krykhtina M.A. Currently, a marker which could be used both to assess the severity of community acquired pneumonia (CAP) and determine the risk of complications is being searched. According to some authors, Neutrophil-to-Lymphocyte Ratio (NLR) could be such a marker. Therefore, the aim of our research was to determine the diagnostic significance of NLR in patients with CAP and to establish the relationship of NLR with other clinical and laboratory parameters. We conducted a retrospective analysis of 171 case histories of patients with CAP of 3 and 4 clinical groups, with the calculation of NLR (according to the common blood count). In the course of the work, it was found that NLR reflects a balance between the response of neutrophils and lymphocytes and this parameter is associated with the severity of systemic inflammation in patients with CAP. NLR has good diagnostic value in determining the mortality risk in patients with CAP, specially an increase in the level of NLR (more than 10) is associated with a high risk of life-threatening complications.
Key words: community-acquired pneumonia, fatty liver disease, hepatic steatosis, macrophage phagocyted system
Abstract. The influence of non-alcoholic fatty liver disease on the state of the macrophagal phagocytosis system in patients with community-acquired pneumonia. Razumnyi R.V. More and more attention of researchers is attracted by the so-called "syndrome of mutual burdening" in combined (comorbid) pathology. The aim of the study was to analyze the effect of nonalcoholic fatty liver disease on the functional state of the macrophagal phagocytic system (MPS) in patients with community-acquired pneumonia (CAP). 85 patients with CAP of III-IV clinical group aged 18-55 years were examined. All patients were divided into two representative groups: group I (44 patients) who had CAP comorbid with hepatic steatosis (HS), group ІІ (41 patients) without chronic liver pathology. For evaluation of the functional activity of MPS, phagocytic activity of peripheral blood monocytes with analysis of phagocytic index (FI), phagocytic number (FN), index of attraction (IA) and index of digestion (ID) was studied. The results of the study revealed that in the acute period of CAP, more expressed decrease in the capacity of monocytes/macrophages to phagocytosis, the incompleteness of the phagocytic reaction, and in general, the decline in the functional activity of MPS was observed in patients with CAP comorbid with HS. After the completion of the standard treatment of patients with CAP combined with HS, moderate disturbances in the functional activity of MPS persisted. On the assumption of findings, it can be advisable to consider a further study of the effectiveness of immunotropic medicines usage, with the purpose of correcting MPS disturbances in the complex treatment and medical rehabilitation of patients with CAP comorbid with HS.
Key words: lactobacilli, intestine, oxidative stress, cytokines, recurrent pyelonephritis
Abstract. The effects of gut indigenous microbiota on intensity of oxidative stress and the cytokine immunity in women with recurrent pyelonephritis. Stepanova N.M., Driyanska V.E., Korol L.V., Mihal L.Ya., Savchenko V.S. The aim of our study was to investigate the oxidative stress (OS) intensity and concentration of tumor necrosis factor alpha (TNF-α) and interleukin 10 (IL-10) depending on the content of Lactobacillus spp. in the colon of patients with recurrent pyelonephritis. Materials and methods. The observational study involved 64 women with recurrent pyelonephritis, aged 39.5±3.2 years. According to the quantitative content of Lactobacillus spp. in the patients’ intestine, the women were divided into two groups: the first group of the patients (n=38) had a deficit of Lactobacillus spp. in the intestine, and the second one (n=26) didn’t have any disorders. The intensity of OS was estimated by determining the OS index (OSI) as the ratio of total changes in the activity of oxidative processes to the total antioxidant capacity of blood. The blood concentration of TNF-α and interleukin 10 was determined. The local inflammation was characterized by the determination of the content of C-reactive protein (CRP), malondialdehyde (MDA) and the activity of N-acetyl-β-D-hexosaminidase (HEX) and β-galactosidase (β-gal) in urine. Results. The blood levels of OSI, MDA and TNF-α in the women with the deficit of Lactobacillus spp. in the gut were significantly higher compared with the deficit-free patients (р=0.03, р=0.01and р=0.007, respectively). Moreover, in the patients with the deficit of intestine lactobacillus spp., we observed high levels of CRP (р=0.045), HEX and β-gal (р=0.045) in the urine. In addition, a significant regression was found between IL-10 in the blood and HEX in the urine (p=0.003), as well as MDA and TNF-α in the blood (p=0.02). Conclusions. Thus, the results of our work confirm the experimental studies data which demonstrate the leading role of gut indigenous microbiota in the development of the OS and inflammatory process.
Key words: Churg-Strauss syndrome, diagnosis, treatment
Abstract. Experience in managing patients with Churg-Strauss syndrome. Khanyukov A.A., Lakiza Т.V., Simonova Т.А., Pryazhnikova L.S., Poleshko V.Yu., Romuz N.A. Our goal was to analyze the possibilities of improving the diagnostics of CSS and to improve the effectiveness of treatment according to the existing literature and our own experience of long-term care for patients with eosinophilic granulomatosis with polyangiitis or Churg-Strauss syndrome (CSS). The medical histories of three female patients aged 26 to 46-years and a 20-year-old male patient were considered. The duration of the disease before the established diagnosis was 5-17 years. Anamnesis and medical documents analysis showed a typical CSS debut in the form of allergic rhinitis, nasal polyps, which were recurrent after polypectomy, and respiratory disorders, which were regarded as bronchitis or bronchial asthma – corresponding to the first phase, also called the prodromal or allergic stage of CSS. The prodromal period lasts up to 10 years or more and is characterized by various allergic manifestations, more often – pollinosis or bronchial asthma, that is difficult to control. But CSS can be suspected because of low effectiveness of the therapy with inhaled steroids, lack of effect of antibiotics and eosinophilia more than 10% that occurs periodically. Even in the third stage of CSS in systemic manifestations of vasculitis and severe secondary lesions of organs and tissues with functional impairment, constant intake of maintenance doses of corticosteroids and cytostatics allows to achieve stabilization of the process in patients with CSS.
Key words: community-acquired pneumonia, cytomegalovirus pneumonia, immunosuppression, PORT
Abstract. Immunological aspects of cytomegalovirus infection in community-acquired pneumonia among young adults. Chichirelo-Konstantynovych K.D., Moroz L.V., Konstantynovych T.V., Demchuk A.V. The problem of comorbidities and mutual influence due to progressive immunological suppression occupies an important place in the morbidity structure among young population. This fact is usually considered to be a result of existent immunodeficiency in the process of studying respiratory comorbidities with subsequent chances of immunological reactivities. The purpose of our research is to investigate the features of immunological reactivity changes among young patients with community-acquired pneumonia and cytomegaloviral persistence. Received data showed a high level of cytomegaloviral persistence prevalence which increases the levels of cellular and humor immunodeficiency in patients with community-acquired pneumonia. Such influence on the immunity state is associated with the worse clinical course of CAP according to PORT-scale.
Key words: children, allergic diseases, atopic march, association, non-atopic diseases, digestive system
Аbstract. Association between atopic and non-atopic diseases at children. Abaturov O., Dytiatkovsky V., Naumenko N., Kulieva A., Bovsunovska K., Filatova I. The paper presents the data of the association analysis between the diseases composig the atopic march (AM) in children – atopic dermatitis (AD), seasonal rhinoconjunctivitis (SARC) and perennial allergic rhinitis (PAR), bronchial asthma (BA), with non-atopic allergic diseases – acute and recurrent urticaria (AcU/RecU), Quincke edema (QE), and also with diseases of the digestive system (DS) – functional disorders of the biliary system (FDBS) and reactive pancreatitis (RP). The association between AD and food allergy (FA) in children has been determined, which is recorded as a direct association. A direct association was established between chronic infectious diseases of the upper respiratory tract and the PAR as well as BA. The lack of association between atopic and non-atopic allergic diseases had been confirmed. The association between FDBS and RP and non-atopic allergic diseases in children had been determined – AcU/RecU, QE.