Mobile Medicine and General Trends in Medical Informatics

New challenges in medicine gained systemic character along with the accumulation of new data on links between functional units in human body; most of them, starting from the genetic level, are able to impact different disciplines at some earlier unimaginable stages of their development. That is why a counterpart activity, which is purposed to vanquish them, must also have a systemic character. With this respect, medical informatics (MI) is the first line reserve among others. From MI we get the most explicit response to urgent demands in health care via constructive multidisciplinary dialogue]. MI contributes to all medical disciplines; its development led to newest concepts such as personalized medicine, m-health, evidence-based medicine, etc

Эффекты ниацин-оксиэтилидендифософнат германата и альфа-липоевой кислоты на диабет-индуцированный оксидантный стресс в ткани сетчатки

Odessa National Medical University, Odessa, Ukraine, Conferinţa știinţifică cu participare internaţională ”Actualităţi în farmacologie și în farmacologia clinică” întru comemorarea celor 100 de ani de la nașterea ilustrului savant, profesor universitar, laureat al Premiului de Stat al Republicii Moldova Efim Muhin 29 noiembrie – 1 decembrie 2018 Chișinău, Republica MoldovaEffects of two weeks treatment with niacin-oxyethylidendiphosphonatogermanate (MIGU-4, 2,5; 25,0 mg/kg, i.p.) and alpha-lipoic acid (LA, 5,0 and 50,0 mg/kg, i.p.) as well as their combined usage (MIGU-4 – 2,5, and LA – 5,0 mg/kg) upon antioxidative enzymes and level of malon dialdehyde (MDA) in retina tissue of rats with streptozotocin (STZ)induced diabetes was determined. It was established that in six weeks after STZ administration superoxiddismutase (SOD) activity decreased by 33,4% (P<0,05), catalase (CAT) – by 28,2% (P<0,05), glutathione peroxidase (GPx) – by 39,8%, glutathione reductase (GR) – by 48,3%, and MDA level raised by 2,65 times when compared with intact rats (P<0,05). MIGU-4 treatment (25,0 mg/kg, i.p.) increased SOD activity by 38,1% (P<0,05), GPx and GR – by 62,9% (P<0,05) and by 35,2% (P<0,05), when compared with diabetes rats. MDA level was reduced by 30,2% (P<0,05) correspondently. The SOD activity under condition of combined MIGU-4 (2,5 mg/ kg) and LA (5,0 mg/kg) administration exceeded its level in rats with diabetes by 41,3% (P<0,05), while activity of GPx and GR also was higher by 52,4% and by 47,8% (P<0,05) correspondently. MDA level reduction was higher than in groups which were given MIGU-4 or LA alone (P<0,05). Thus, niacin-oxyethylidendiphosphonato-germanate caused prevention on diabetes-induced deterioration of antioxidant enzymes activity and level of MDA in retina tissue. Combined usage of MIGU-4 and LA was resulted in heightened preventive effects upon manifestations of oxidative stress.Au fost investigate efectele administrării de două săptămani a hidroxietilidendifosfonat germanatului (MIGU-4, 2,5; 25,0 mg/kg, i.p.) şi a acidului alfa-lipoic (LC, 5,0 şi 50,0 mg/kg, i.p.) şi efectul utilizării lor combinate (MIGU-4 – 2,5 şi LC – 5,0 mg/kg) asupra activităţii enzimelor antioxidante şi nivelului de malondialdehidă (MDA) in ţesutul retinei şobolanilor cu diabet indus de streptozotocină (STZ). S-a constatat că după 6 săptămani de la momentul aplicării STZ, activitatea superoxid dismutazei (SOD) a scăzut cu 33,4% (P <0,05), a catalazei (CAT) – cu 28,2% (P <0,05), a glutationperoxidazei – cu 39,8%, a glutationreductazei (GR) – cu 48,3%, cu o creştere a conţinutului de MDA de 2,65 ori, comparativ cu şobolanii intacţi (P <0,05). Odată cu introducerea MIGU-4 (25,0 mg/kg, i.p.), activitatea SOD a fost mai mare cu 38,1% (P <0,05), a HP şi GR – cu 62,9% (P <0,05 ) şi, respectiv, 35,2% (P <0,05), in comparaţie cu animalele cu diabet zaharat. Nivelul MDA a scăzut cu 30,2% (P <0,05). Eficacitatea MIGU-4 (25,0 mg/ kg) a fost comparabilă cu cea a LK utilizată in doză de 50,0 mg/kg. In cazul folosirii combinate a MIGU-4 (2,5 mg/kg) şi a LC (5,0 mg/kg), activitatea SOD a depăşit-o pe cea a şobolanilor cu diabet zaharat cu 41,3% (P <0,05), GP şi GR fiind mai mari cu 52,4% şi, respectiv, cu 47,8% (P <0,05). Scăderea nivelului MDA a fost mai mare decat in cazul grupurilor care utilizează MIGU-4 sau LC (P <0,05). Astfel, administrarea hidroxietildidenfosfonat germanatului previne dereglările activităţii enzimelor antioxidante şi nivelului MDA induse de diabet in ţesutul retinian. Administrarea asociată a MIGU-4 şi a LC este insoţită de o acţiune preventivă sporită impotriva manifestărilor stresului oxidativ.Исследовали влияние двухнедельного введения ниациноксиэтилидендифосфонат германата (МИГУ-4, 2,5; 25,0 мг/кг, в/бр) и альфа-липоевой кислоты (ЛК, 5,0 и 50,0 мг/кг, в/бр), а также влияние их совместного применения (МИГУ-4 – 2,5, и ЛК – 5,0 мг/кг) на активность антиоксидантних ферментов и уровень малонового диальдегида (МДА) в ткани сетчатки крыс со стрептозотоцин (СТЗ)-индуцированным диабетом. Установлено, что через 6 недель с момента применения СТЗ активность супероксидисмутазы (СОД) уменьшилась на 33,4% (P<0,05), каталазы (КАТ) – на 28,2% (P<0,05), глутатионпероксидазы (ГП) – на 39,8%, глутатионредуктазы (ГР) – на 48,3% при увеличении содержания МДА в 2,65 раза в сравнении с интактными крысами (P<0,05). На фоне введения МИГУ-4 (25,0 мг/кг, в/бр) активность СОД была выше на 38,1% (P<0,05), ГП и ГР – на 62,9% (P<0,05) и соответственно 35,2% (P<0,05) при сравнении с животными с диабетом. При этом уровень МДА уменьшался на 30,2% (P<0,05). При комбинированном применении МИГУ-4 (2,5 мг/кг) и ЛК (5,0 мг/кг) активность СОД превышала таковую у крыс с диабетом на 41,3% (P<0,05), в то время как активность ГП и ГР была выше на 52,4% и соответственно 47,8% (P<0,05) соответственно. Величина снижения уровня МДА была выше, чем в группах с применением одного МИГУ-4 или ЛК (P<0,05). Таким образом, применение ниацин-оксиэтилидендифосфонат германата предотвращает диабет-вызванные нарушения активности антиоксидантных ферментов и уровня МДА в ткани сетчатки. Совместное введение МИГУ-4 и ЛК сопровождается потенцированным превентивным действием в отношении проявлений оксидативного стресса

Застосування реінфузії асцитичної рідини для лікування хворих із цирозом печінки

Мета. Визначення ефективності реінфузії асцитичної рідини як складової лікування хворих із цирозом печінки (ЦП) за наявності сформованого набрякового синдрому. Матеріали і методи. Проліковано 262 хворих із ЦП. Ретроспективно проаналізовано історії хвороб 48 пацієнтів із ЦП, ускладненим асцитом, які були розподілені на дві групи. До 1-ї групи віднесено 21 (43,8%) хворого, якому було виконано пункцію черевної порожнини та в подальшому проведено доопераційне лікування ЦП. До 2-ї групи віднесено 27 (56,3%) пацієнтів із ЦП та асцитом, яким також виконували пункцію черевної порожнини, але в подальшому застосовували реінфузію асцитичної рідини після її очищення. Результати. Із 21 хворого 1-ї групи протягом трирічного спостереження гарний результат констатовано у 3 (14,3%), задовільний - у 4 (19,0%), незадовільний – у 2 (9,5%). Померли 7 (33,3%) хворих. Із 27 хворих 2-ї групи гарний результат зафіксовано у 12 (44,4%), задовільний - у 7 (25,9%), незадовільний – у 3 (11,1%). Померли 3 (11,1%) хворих. Висновки. Ефективним способом лікування ЦП із сформованим асцитом є реінфузія очищеної асцитичної рідини, що відновлює динаміку лабораторних показників у пацієнтів та покращує перебіг захворювання

Efficiency of treatment of children suffering from neurogenic dysfunctions of bladder with taking into account urodynamic features

Обследованы 127 детей в возрасте от 4 до 11 лет, у которых была диагностирована нейрогенная дисфункция мочевого пузыря по гиперактивному типу. Всем пациентам было проведено уродинамическое обследование с помощью урофлоуметрии; в группе больных с тяжелой степенью уродинамических нарушений также проводили цистометрию. С учетом полученных результатов осуществляли дифференцированную терапию, предполагающую применение медикаментозной и физиотерапевтической коррекции. Оценка результатов лечения показала, что у пациентов с легкой степенью уродинамических нарушений эффективно применение динамической электронейростимуляции (ДЭНС), при выраженных нарушениях уродинамики необходимо применение ДЭНС на фоне приема М-холинолитика, что обусловливает потенцирование корригирующего эффекта.Obtained data confirm potentiation of effectiveness of combined usage of Mcholynolytic and DNES in patients suffered from hyperactive urinary bladder. Such combination was effective in patients suffered from severe form of disease while separate usage of M-cholynolytic and DNES were much less effective

Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Modern peculiarities of eating behavior in children

Relevance. The role of eating behavior (EB) in neurophysiological processes of central nervous structure ripening, the formation of intestinal microbiome, occurrence of orthodontic pathology have been explored, relationship with psychobehavioral disorders, autistic frustration have been proofed. The problem of the formation of EB under conditions of chronic stress, during wartime and during epidemics deserves special attention

FIBROTIC CHANGES IN PATIENTS WITH CHRONIC HEART FAILURE WITH CARDIAC DYSSYNCHRONY AND ASSOCIATED TYPE 2 DIABETES MELLITUS

The study of fibrosis markers was carried out on 72 observed patients (mean age (69 ± 10.37) years) with chronic heart failure (CHF) of ischemic genesis with manifestations of cardiac dyssynchrony (CD) and concomitant type 2 diabetes mellitus – Galectin 3 and matrix metalloproteinase 1. All patients were divided into 2 groups, depending on the presence of CD. The CD was evaluated according to a conventional technique, the volume fraction of interstitial collagen was measured using the formula of J. Shirani and co-authors, the levels of Galectin-3 and matrix metalloproteinase 1 – by the enzyme-linked immunoassay according to the manufacturer's instructions. The data were processed using parametric and nonparametric statistics. It was revealed that the level of fibrosis development was higher in the group of patients with CD than in the group without CD. This indicates the dependence of the development of myocardial sites asynchronous reduction with the presence of interstitial collagen development. That further requires the study of the effect of anti-fibrotic, anti-ischemic and hypoglycemic agents on the progression of CD to prevent subsequent myocardial remodeling