ISSN / EISSN : 2306-8027 / 2310-1237
Published by: Zaporozhye State Medical University (10.14739)
Total articles ≅ 457
Latest articles in this journal
Pathologia, Volume 18, pp 152-158; https://doi.org/10.14739/2310-1237.2021.2.230342
Exploring new possibilities for the use of methylxanthines to prevent the development of acute kidney injury (AKI) in full-term infants with perinatal asphyxia. Aim: to evaluate the efficacy and safety of methylxanthines in full-term infants for the prevention and conservative treatment of acute kidney injury. Materials and methods. To test the effectiveness of the proposed method of AKI treatment, 38 infants were chosen and divided into 2 groups by random selection. Nursing and intensive care were according to current legislation (Order of the Ministry of Health of Ukraine No. 225 of March 28, 2014). The main group (n = 20) received therapy with caffeine citrate, the comparison group (n = 18) – theophylline. Both of these drugs were used to prevent the development of acute kidney injury – stage II and III according to KDIGO. Results. A significant difference in serum creatinine was found in the main group - the level of serum creatinine was higher than in the comparison group, but did not exceed the physiological norm. GFR on the 3rd day of life was higher with administration of theophylline, but in the group of caffeine did not exceed the reference values of the norm. No differences between urea levels and diuresis rates were found in the groups. The initial results indicate the lack of statistical significance when using various drugs of the methylxanthine group, namely theophylline and caffeine citrate. This is explained by the fact that in the main group 65.00 % (n = 13) of patients had AKI stage 0 according to KDIGO, and 35.00 % (n = 7) had stage I. In the comparison group, 55.56 % (n = 10) and 44.44 % (n = 8), respectively. Stages II and III in both groups of the study did not develop, the obtained data are equivalent – U = 163,00; P = 0,6296. However, the use of caffeine citrate may become a priority due to a better safety profile compared to theophylline. Caffeine is less likely to cause adverse effects in the form of non-pathological bile vomiting and has significantly lower relative risk of non-pathological bile vomiting in infants (RR 0.26 (95 % CI 0.10; 0.66)). Conclusions. Conservative methylxanthine therapy in full-term infants with perinatal asphyxia prevents the development of stages II and III of AKI according to KDIGO. However, it is necessary to continue the collection of material to increase the statistical significance, as well as to study the early and long-term consequences of this therapy.
Pathologia, Volume 18, pp 189-195; https://doi.org/10.14739/2310-1237.2021.2.225193
The aim is to study the relationship between the level of exhaled nitric oxide (FeNO) and the activity of the fibrogenic cytokine TGF-β1 in blood serum and brush biopsy samples of bronchial mucosa in order to determine their role in the development of irreversible morphological and functional changes in smoking adolescents. Materials and methods. 20 adolescent smokers with chronic bronchitis (CB) (average age – 17.5 ± 0.2 years) were examined. The comparison group consisted of 37 adolescent smokers without respiratory symptoms (average age – 15.9 ± 0.2 years) and 15 healthy adolescents, who never smoked (average age – 15.9 ± 0.4 years). In adolescent smokers the tobacco smoking status was assessed. To confirm active smoking, the nicotine metabolite cotinine was determined in urine. Instrumental methods included spirometry, chest X-ray, tracheobronchoscopy. The FeNO level was measured using a Niox Mino. TGF-β1 level was determined in the blood serum and brush biopsy samples of the bronchial mucosa. Results. The FeNO levels were significantly lower in adolescent smokers with CB in comparison with adolescent smokers without respiratory symptoms (6.1 ± 0.3 ppb versus 8.8 ± 0.6 ppb, P < 0.05). The relationship between the FeNO levels and indicators of the tobacco smoking status has been established in patients with CB and in asymptomatic smokers. There was a significant increase in the TGF-β1 levels in the blood serum in patients with CB compared with asymptomatic smokers (478.7 ± 57.9 pg/ml versus 231.5 ± 23.5 pg/ml, P < 0.05). In smoking adolescents a relationship between a FeNO level and an increased activity of the fibrogenic cytokine TGF-β (r = -0.63; P < 0.05) has been established. In one third of patients the TGF-β1 factor was identified in the bronchial endothelium. The presence of this factor in the bronchial endothelium is a serious prognostic criterion for the risk of developing “inadequate” pneumofibrosis, which can lead to irreversible remodeling processes in the bronchi. Conclusions. Determination of FeNO levels and TGF-β1 in the blood serum in smoking adolescents has a reliable diagnostic value for determining the risk group for the development of irreversible morphological and functional changes in the bronchi and can improve the efficiency of early diagnosis of chronic respiratory pathology.
Pathologia, Volume 18, pp 243-250; https://doi.org/10.14739/2310-1237.2021.2.225044
The article describes a rare clinical case of hyperkalemia backgrounded by type 1 diabetes mellitus with signs of acute cardiovascular insufficiency, arrhythmia and QRST disturbances which was primarily diagnosed as acute coronary syndrome with ST elevation. Coronary angiography excluded pathology of the coronary arteries. Hyperkalemia, as the cause of ECG changes, was suspected in the hospital treatment. Stabilization of the patient’s condition, renewal of heart rhythm and conduction was obtained against the background of infusion support and insulin therapy. The pathogenesis of arrhythmia and QRST complex had a secondary genesis in relation to fluid and electrolyte metabolism disorders, so the restoration of sinus rhythm occurred without usage of antiarrhythmics. The usage of antiarrhythmic drugs according to the guideline of management of patients with ACS can deepen electrolyte shifts and lead to fatal arrhythmias in conditions of insulin deficiency and hyperkalemia. This example illustrates the urgent need to diagnose life-threatening electrolyte changes, namely hyperkalemia, under the guise of acute coronary syndrome, as well as signs of ACS, along with ECG, to pay special attention to the assessment of medical history and clinical data for the correct choice of emergency care and further treatment tactics.
Pathologia, Volume 18, pp 136-141; https://doi.org/10.14739/2310-1237.2021.2.233425
Aim: to clarify the prognostic value of cytoplasmic p16ink4A, VEGF, MMP-9 and Ki-67 expressions in gastrointestinal stromal tumors (GISTs) and connection of different levels of these markers expression with aggressive transformation of GISTs. Materials and methods. Our study included 36 samples of primary tumors and 10 relapses of GIST and metastases in liver after primary combined treatment (surgery and chemotherapy with imatinib). The immunohistochemical study was performed with 4 primary antibodies: Ki-67, p16ink4A, VEGF and MMP-9. We used formalin fixed and paraffin embedded (FFPE) tissue samples for immunohistochemical study. Results. In our study we showed significant connection between levels of cytoplasmic expression of p16ink4A in primary GISTs and such markers of tumor aggressive behaviour as Ki-67, MMP-9 and VEGF (Fisher’s exact P-value = 0.000753; 0.000101 and 0.000048 respectively). Between cytoplasmic expression of p16ink4A and VEGF and also between p16ink4A and MMP-9 strong direct correlation was found (γ = 0.829, P < 0.05 and rs = 0.961, P < 0.05 respectively). The correlation between expression of Ki-67 and p16ink4A was also direct and strong (rs = 0.754, P < 0.05), but with some exclusions, that’s why this correlation needs further investigation in larger groups with preciser molecular analysis. Analysis of metastatic GISTs samples showed prominent levels of MMP-9 and VEGF expression. Conclusions. Our study has shown very important role of cytoplasmic expression of p16ink4A in GIST as one of the markers of aggressive behavior, which can be used in complex with other markers for more accurate prognosis of GISTs progression. Prominent levels of MMP-9 and VEGF expression in metastatic GISTs can be a marker of resistance to imatinib. So probably evaluation of MMP-9 and VEGF expression can be used as a tool for correct choice of chemotherapy for patients with GISTs.
Pathologia, Volume 18, pp 174-182; https://doi.org/10.14739/2310-1237.2021.2.229454
The aim was to study the mechanisms of immunological dysregulation of cytokine and immunoglobulin production, changes in the CD expression of T and B lymphocyte subpopulations in patients with hepatosplenomegaly of different etiology. Materials and methods. We examined 73 patients with liver cirrhosis complicated by portal hypertension, hepatosplenomegaly, and bleeding from phlebectasia. We identified three groups of patients depending on the triggering factors of cirrhosis: the first (I) group – HBV/HCV; the second (II) group – CMV/VEB; the third (III) group – hereditary enzymopathies. The study material was lymphocytes and blood serum. We used the methods of ELISA, immunofluorescence and flow cytometry. Results. An increase in the concentration of IgA and IgM was revealed against the background of normal number of CD22+ B lymphocytes with HBV/HCV (I group), high level of IgM and their producers, B lymphocytes, with CMV/VEB (II group), in group III with hereditary enzymopathies, the concentration of all immunoglobulins was normal with an increased content of B lymphocytes. Multidirectional changes in the content of cytokines were revealed: in group I the synthesis of anti-inflammatory cytokines IL-4, IL-10 and in group II – pro-inflammatory IL-1β, INF-γ, TNF-α dominated; in group III the concentration of IL-6 and vascular growth factor (VEGF) was maximally increased. The number of activated CD3+CD4+CD25+ T cells was reduced in groups I and II – by 2.3 and 2.0 times respectively, in group III – increased by 1.2 times. The number of regulatory T lymphocytes CD3+CD4+CD25+CD127neg was reduced by half in I and II groups. Expression of co-stimulatory molecules CD3+CD4+CD28+ was low in all groups and the maximum decrease was in group III. In patients with HCV/HBV, an increase in the expression of the late activation marker of lymphocytes CD3+HLA-DR+ by an average of 63 % was noted. Conclusions. The revealed immune disorders in hepatosplenomegaly of different etiology are characterized by multidirectional changes. Approaches to the treatment of these patients should be complex, taking into account the trigger factors that cause dysregulation of immune responses, which leads to further destruction, and focuses at remodeling target organs.
Pathologia, Volume 18, pp 196-202; https://doi.org/10.14739/2310-1237.2021.2.229500
Aim. To use the cluster analysis of clinical and laboratory data, characteristic to children aged 6 to 24 months with acute diarrhea, in demonstrating the signs of infectious or functional intestinal disorders. Materials and methods. 56 children admitted to the children’s infectious unit with diarrhea and 31 healthy toddlers of the control group were observed. Anamnesis, laboratory blood and urine tests, microscopy and bacteriological cultures of feces on selective media and tests to identify adeno- and rotaviruses were performed. The presence of Clostridium difficile A/B toxins in the stool, hemoglobin, fecal calprotectin (FC) and the content of undigested fecal carbohydrates also were studied. Results. Children who in their majority have received antibiotics only in 58.9 % of cases were corresponding to the bacterial or viral nature of the disease or the infection was clinically highly probable. Another 41.1 % of patients has experienced non-infectious diarrhea. In 7.1 % of all cases the diarrhea was triggered by an increase of the carbohydrate content in the stool. Diarrhea had the same mechanism in 3.4 % of patients with Giardia lamblia. In 17.9 % of patients the frequent bowel movements were the manifestation of symptomatic (parenteral) diarrhea caused by extraintestinal diseases, and in another 7.1 % the intestinal hypermotility was not explained but resembled irritable bowel syndrome in adults. Additionally, cluster analysis identified 5.4 % of patients with non-infectious diarrhea who had only significantly increased FC corresponding to allergic or immune inflammation in the gut. Conclusions. The classification of patients for the causes of diarrhea became possible due to the microbiological tests and highly informative markers of intestinal health – fecal calprotectin and reducing substances (carbohydrates) in the stool.
Pathologia, Volume 18, pp 229-242; https://doi.org/10.14739/2310-1237.2021.2.235805
Myeloperoxidase is one of the key enzymes involved in oxidative stress and inflammation. Its elevated levels are determined in a wide range of both acute and chronic forms of cardiovascular diseases. The inflammation results in the release of the enzyme from the white blood cells to form products such as hypochlorous acid, which in turn can have a negative effect on the target proteins. Inconsistent evidence on the predictive role of this biomarker in diseases of the circulatory system generates scientific interest and provokes further research in this direction. The aim of this review is to analyze the scientific literature data on myeloperoxidase as a possible clinical use for the diagnosis and risk stratification of patients with саrdiovascular diseases. Materials and methods. Searching and generalization of data from leading specialized sources, which are indexed by scientific databases PubMed, SCOPUS, Web of Science. Results. The results of the studies indicate that myeloperoxidase is actively involved in the pathophysiology of cardiovascular diseases through participation in oxidative stress and inflammation, excessive production of proatherogenic lipoproteins, changes in nitric oxide activity, endothelial dysfunction, and due to the effect on the instability of atherosclerotic plaques. In patients with cardiovascular diseases, including ischemic heart disease, the concentration of the indicated protein is increased and is often associated with a poor prognosis, including an increased risk of mortality. Myeloperoxidase metabolites are often the factors that contribute to cell damage under conditions of ischemia. The review also considers the relationship of the enzyme with the development of restenosis and the effectiveness of revascularization after percutaneous coronary intervention. Conclusions. The presented data mainly define myeloperoxidase as a significant marker for predicting long-term follow-up results and the development of serious adverse cardiovascular events, mortality in patients with cardiovascular disease. At the same time, despite the great achievements in disclosing the complex effects of myeloperoxidase, inconsistency in the available results is noteworthy. This controversy necessitates further research to elucidate and reveal the full clinical potential of myeloperoxidase in patients with cardiovascular pathology.
Pathologia, Volume 18, pp 167-173; https://doi.org/10.14739/2310-1237.2021.2.217936
Aim. To stratify hemodynamic phenotypes in children with diabetes mellitus and their frequency, depending on the duration of the disease. Materials and methods. The study involved 72 children suffering from diabetes, aged 10 to 16 years who were divided into 3 groups. The first group – 22 children with diabetes mellitus up to 1 year. The second group – 24 patients with a disease duration of 1 to 5 years. The third group – 26 children with the disease over 5 years. Control group – 20 children, representative by age and sex. All children underwent daily blood pressure monitoring (ABPM) with the ABPM-04 device (Meditech Ltd, Hungary). Diagnosis of latent hemodynamic disorders was performed by the method of quantitative analysis of the relationships of blood pressure parameters, which involved a linear regression of systolic blood pressure by pulse blood pressure. According to the results of regression, 6 hemodynamic phenotypes were determined, which characterized the individual features of the circulatory system: harmonic, myocardial-insufficient subtype of harmonic, borderline diastolic harmonic, borderline systolic harmonic, dysfunctional diastolic and dysfunctional systolic. According to ABPM results, the ambulatory arterial stiffness index (AASI) was calculated using a linear regression equation. The results were statistically processed using statistics software package Statistica 13.0 (StatSoft Inc., No. JPZ8041382130ARCN10-J). Results. It was found that in the dynamics of diabetes the registration of the harmonic hemodynamic phenotype during the day decreased due to an increase in the proportion of patients with dysfunctional diastolic hemodynamic phenotype. At the same time, in children with diabetes, there was a significant increase in AASI from the first year of the disease with a progressive increase with its dynamics. The highest values of AASI were observed in dysfunctional hemodynamic phenotype. Conclusions. In children with diabetes mellitus observed the formation of disharmonious hemodynamic phenotypes in the dynamics of the disease. In combination with increased vascular stiffness these changes realized in systemic circulatory disorders and the development of a diabetic angiopathy. Detected disorders, apparently, became the risk factors of hypertension. Determination of hemodynamic phenotype in children with diabetes mellitus can be used as screening method for preclinical diagnosis of latent disorders of the cardiovascular system, early treatment and prevention.
Pathologia, Volume 18, pp 183-188; https://doi.org/10.14739/2310-1237.2021.2.233431
The aim of the study is to investigate activity of markers of oxidative and nitrosative stresses in blood plasma of patients in the I–II stages of Parkinson’s disease (PD) and to determine correlations between their concentrations and severity of non-motor PD symptoms. Materials and methods. 67 patients at I–II PD stages and 20 healthy controls took part in the research. Cognitive functions were examined due to the Montreal Cognitive Assessment test – MoCA test. For the severity of psycho-emotional disorders evaluation the following scales and questionnaires were used: Night Sleep Assessment Questionnaire by A. M. Vein, Zung test for anxiety, apathy Starkstein scale, Boston stress-resistance test, Beck Depression Inventory (BDI-II). We performed ELISA test for determination of glutathione peroxidase (GPx) and glutathione-S-transferase (GST) activities and 3-nitrotyrosine (3-NT) level in blood plasma of participants (Elabscience® kit). Results. The middle age of PD patients and healthy controls was 64.35 ± 1.22 and 66.40 ± 0.70 years, respectively. GPx activity in plasma of patients at І–ІІ PD stages was significantly lower than in healthy controls (P < 0.001) and was higher at the I stage compared to the II PD stage (P = 0.003). Also GPx activity in PD patients with normal cognition was higher than in PD patients with cognitive impairment (P = 0.042). The GST activity in plasma of PD patients with anxiety was significantly lower (P = 0.002) compared to those without anxiety, and 3-NT blood plasma level in PD patients with moderate anxiety was higher than in those without one (P = 0.029). Conclusions. The activity of antioxidant GPx was significantly lower in PD patients at early stages compared to healthy controls, and in PD patients in the II stage of the disease compared to the I stage, and it was significantly lower in PD patients with cognitive impairment. PD patients with moderate anxiety had lower 3-NT levels and GST activity in blood plasma.
Pathologia, Volume 18, pp 203-210; https://doi.org/10.14739/2310-1237.2021.2.214397
Aim. Evaluation of ultrasound diagnostics of paraurethral glands considering their types of location in women of fertile age. Materials and methods. A gynaecological, sexological and ultrasound study of 94 women in the age from 24 to 42 (average age 31.01 ± 6.60) was carried out. Determination of paraurethral glands during ultrasound study was conducted in the format of grey scale (B-mode) using the Doppler colour flow mapping and evaluation of Doppler indices of paraurethral glands both before and after sexual stimulation. To optimize the paraurethral glands visual view at the beginning of examination urinary bladder was catheterized and a balloon, filled with gel, was inserted into vagina. Results. The front type of paraurethral glands location was found in the accumulation of glandular tissues in regard to the distal part of urethra in 67 (71.2 %) of the examined, back type – in the area of back urethra in 19 (20.2 %), diffuse type – along urethra in 7 (7.5 %) and absence – in 1 (1.1 %). Paraurethral glands were visualized in the form of clear isoechogenic oval formation with the following dimensions: length – 2.20 ± 0.60 cm, width – 1.52 ± 0.40 cm, thickness – 1.30 ± 0.30 cm, and volume – 4.75 ± 0.50 cm3. The diameter of vessels in the paraurethral glands area was between 0.17 cm and 0.21 cm in calm state and 0.39–0.41 cm – during stimulation. Maximum systolic speed of blood flow (Vps) in calm was 8.9–11.1 cm/sec, while in sexual stimulation it was 13.9–14.1 cm/sec, resistance index (IR) – 0.60–0.62 and 0.63–0.68, respectively, pulsation index (IP) – 1.22–1.44 and 1.61–1.72, respectively. Conclusions. The ultrasound study of vessels of paraurethral glands, when Doppler method is used according to the suggested methodology, gives the opportunity not only to identify its anatomical structure, but also to determine its types. In CDC the increase of diameter of vessels and the optimization of vessels image in the area of paraurethral glands in case of sexual stimulation were marked.