Risk factors for unfavorable clinical course of the early recovery period of ischemic stroke in young and middle-aged patients

Background. This study was carried out due to persistent increase in the incidence of ischemic stroke in people of working age and insufficient knowledge of risk factors affecting its clinical course in the early recovery period in young and middle-aged patients.The aim. To identify and to study variants of the clinical course of the early recovery period of ischemic stroke in young and middle-aged patients; to determine the risk factors for its unfavorable course.Materials and methods. We carried out a longitudinal prospective study, which involved 145 patients with ischemic stroke in its early recovery period. The main risk factors for cardiovascular diseases were analyzed. Dynamic observation of these patients allowed us to determine five variants of the clinical course of the ischemic stroke early recovery period – regressive, regressive with residual mild focal neurological symptoms, stable, slowly progressive and rapidly progressive.Results. Regressive course was observed in 58 (40 %) patients; regressive course with residual mild focal neurological symptoms – in 66 (45.5 %) patients; stable course – in 9 (6.2 %) patients; slowly progressive course – in 8 (5.5 %) patients, rapidly progressive course – in 4 (2.8 %) patients. The following risk factors had statistically significant affect on the unfavorable course of the disease: more pronounced motor, sensory and speech disorders at the time of patient’s admission to the hospital and at the end of the ischemic stroke early recovery period; severity of ischemic stroke according to the National Institutes of Health Stroke Scale (NIHSS); damage to the carotid basin of the brain; ischemic heart disease; irregular intake or patient’s refuse of taking prescribed antiplatelet, lipid-lowering, antihypertensive therapy (p < 0.05).Conclusions. Defining the variant of the clinical course of the ischemic stroke early recovery period in young and middle-aged patients and risk factors for its unfavorable course is important in determining tactics and further neurorehabilitation measures

ДИФФЕРЕНЦИРОВАННОЕ КОМПЛЕКСНОЕ ЛЕЧЕНИЕ ПАЦИЕНТОВ, СТРАДАЮЩИХ БОЛЕЗНЬЮ ПАРКИНСОНА, С УЧЁТОМ СТЕПЕНИ АТРОФИЧЕСКИХ ИЗМЕНЕНИЙ ВЕЩЕСТВА ГОЛОВНОГО МОЗГА

The objective of this study was to compare the results of complex (medicinal and surgical), and only medicinal treatment of patients with rapidly progressive and dyskinesia associated forms of Parkinson's disease. Three atrophy indices (IA) of the brain matter were proposed to justify a differentiated approach to the treatment of each form. Multivariable regression analysis showed, that patients, who were treated with complex method and had IA-1 less than 0.16, IA-2 - less than 0.115, IA-3 - less than 0.06, had the best improvement of the clinical status during the follow-up period. There were also multiple correlation coefficients obtained in the range 0.911-0.943, which indicates a significant linear relationship between the factors of influence (IA) and response (clinical presentation). In groups with only conservative treatment, the coefficients were in the range of 0.331-0, 423, indicating low and medium dependence on clinical manifestations of atrophy indexes. The status of all patients was assessed after 3, 6, 12 and 18 months. It turned out that in case of the earlier mentioned indices values the result of the treatment was constant during the entire period of observation. It was statistically confirmed by the assessment of the squares of the Mahalanobis distance

Reactivity of an organism at hypertrophic skin scars

The aim of the research was to assess the reactivity of female organism with hypertrophic scars. 42 women of 16-35years were examined on the 5-7th day of the menstrual cycle, 17 of them had normotrophic and 25 - hypertrophic scars. The quality of scars (according to the clinical and morphological characteristics), white blood cells, blood lipids, hormonal and immune status were assessed. Non-parametric Mann - Whitney U-test and discriminant analysis were used at statistical processing of the results. Average values and standard deviations were also calculated for interpreting the results of quantitative indications. As the result of discriminant analysis the most informative indicators of reactivity of an organism that allow to differentiate patients of the studied groups were defined for patients with normotrophic and hypertrophic scars. It was concluded that the imbalance of steroid hormones (progesterone, cortisol, testosterone, estrogen) was important in the etiopathogenesis of hypertrophic scars

Performance of Metabolic Parameters in Formation of Sleep Disorders in Menopausal Women

Background. It is known that menopausal women suffer from sleep disorders. As additional diagnostic methods, it is possible to use the equations of linear classification functions.Aim: to determine the most informative parameters among the lipid profile, the “lipid peroxidation – antioxidant protection” system parameters and the melatonin secretion chronobiological rhythms in menopausal women with sleep disorders.Materials and methods. 56 perimenopausal women and 70 postmenopausal ones in accordance with the inclusion criteria participated in this study. Diagnoses of insomnia and obstructive sleep apnea syndrome were made according to the results of specialized somnological questionnaires and polysomnographic monitoring. Spectrophotometric methods for studying of lipid metabolism and the “lipid peroxidation – antioxidant protection” system parameters, an enzyme immunoassay method for determining melatonin were also used. A multidimensional discriminant analysis to reveal the most informative parameters among the parameters studied was used.Results. The most informative indicators of the metabolic system for sleep disorders in perimenopausal women with insomnia are melatonin 06.00–07.00 h, melatonin 18.00–19.00 h, melatonin 23.00–00.00 h, ketodienes and conjugated trienes, oxidized glutathione; with insomnia and OSAS – melatonin 06.00–07.00 h, melatonin 12.00–13.00 h, melatonin 23.00–00.00 h, substrates with conjugated double bonds, total cholesterol; in postmenopausal women with insomnia – diene conjugates, α-tocopherol, total antioxidant capacity, active products of thiobarbituric acid, reduced glutathione; with insomnia and OSAS – total antioxidant capacity, α-tocopherol, substrates with conjugated double bonds.Conclusions. The results obtained indicate a great strain in the antioxidant protection system in menopausal women with sleep disorders in response to changes in free radical homeostasis

Prediction of outcomes of cytomegalovirus infection of the initial few months of life

The research was based on the data of 155 newborns with manifestations of cytomegalovirus infection (CMV) appeared in the initial few months of life and on the results of the 7-years follow-up of this group of patients. While studying the courses and outcomes of CMV appeared in the initial few months of life in 155 patients of the tender age the disability is set for 22 (14,2 %) children. On the basis of discriminant analysis with the use of the most significant factors the model of prognosis of the outcomes of the carried infection was created in severe residual-organic disorders, dictating the necessity of determination of disability for children. This model can predict development of severe organ pathology in children of tender age after citomegalovirus infection appeared in the initial few months that will allow to select patients with high probability of disability and to realize for them individual rehabilitation measures to save their health in proper time

State of lipid peroxidation - antioxidant system in men with diabetes mellitus type 1

The aim of study is to assess lipid peroxidation and antioxidant system in men with diabetes mellitus type 1. The objective of this study was to identify features of the lipid peroxidation-antioxidant defense system in men of reproductive age with diabetes mellitus type 1. 22 men with diabetes mellitus type 1 (the average age of 27.1 ± 7.38years) and30 healthy men of the same age (control group) (the average age of 28.0 ± 4.3 years) were involved in the study. The main and control groups were formed on the principle of "copy - pair". Standard clinical examination methods were used: history taking, physical examination and consultation of specialists to identify complications of diabetes. To determine the indicators of the system of free-radical lipid oxidation and activity of antioxidant protection, the spectrophotometric and fluorometric methods were used. In men with diabetes mellitus 1 type, there is increase in the level of active products reacting with thiobarbituric acid compared to the same indicator in the control group. The level of antioxidant protection in men with diabetes mellitus 1 type unlike the control was characterized by decrease in total antioxidant activity. However, stability of processes of superoxide dismutase activity and the glutathione system in comparison with control is observed against the backdrop of intensity increase of oxidative processes. Activation of lipid peroxidation is observed in men with diabetes mellitus type 1

Biomarkers of Myopic Choroidal Neovascularization in Women, Determining the Clinical Course and Response to Anti-VEGF Therapy

Aim: to identify clinical and laboratory biomarkers that determine the nature of the course of myopic choroidal neovascularization (mCNV) and the response to anti-VEGF therapy in women.Material and methods. A prospective non-randomized study was conducted in 52 patients (52 eyes) with active mCNV, treated with ranibizumab intravitreally, 0.5mg. After 12months, the suppression of CNV activity, the number of injections and the fellow eye inclusion in the pathological process were taken into account. There were 2 groups: with a favorable clinical course (n = 31, age – 33,0 ± 5,1 years, anterior-posterior axis (APA) 28,5 ± 0,3 mm) and an unfavorable clinical course (n = 21, age – 34,0 ± 4,1 years, APA – 29,01 ± 0,1 mm). Structural retinal changes, choroid thickness, retinal blood flow, and heart rate were evaluated using OCT and OCTA protocols (Optovue XR Avanti, USA). Studies were conducted before the start of therapy and then one time per month. The concentration of sex and pituitary hormones (ELISA analyzer “Immunohem-2100”), lipoprotein A, Apo B/Apo A (Accent 200 Cormay, Poland), coagulogram data (Helena C-2, UK), and the concentration of highly sensitive C-reactive protein in blood serum before the start of antiangiogenic therapy were studied once.Results. In the first group, 1.4 ± 0.7 ranibizumab injections were administered to suppress the CNV activity. In the opposite group – 3.5 ± 2.1 injections, in 73.7 % of cases, relapses were diagnosed, in 3 cases – primary CNV in the fellow eye. Clinical and laboratory biomarkers of the unfavorable clinical course of mCNV were identified: extreme choroidal thinning, highly organized membranes of a large area, dome-shaped deformation of the posterior pole, excess of the reference values of lipoprotein A, fibrinogen and highly sensitive C-reactive protein by two or more times, an imbalance of sex and pituitary hormones (excess of the reference values of prolactin, follicle stimulating hormone, cortisol, progesterone concentration decrease), a predominant change in the menstrual-ovarian cycle according to the type of amenorrhea and opsomenorrhea.Conclusion. Myopic CNV biomarkers in women allow predicting the response to anti-VEGF therapy, the formation of relapses and the inclusion of the fellow eye in the pathological process

DISCRIMINANT ANALYSIS AS A METHOD OF DETERMINATION OF GESTATIONAL PERIOD IN DRINKING WOMEN AND HEALTH CONDITION OF THEIR NEWBORNS

The article presents the methods of mathematical analysis of the impactof alcohol on pregnancy, childbirth, postpartum and the state of health of newborn state. With the help of this analysis we revealed informative diagnostic features that let determine the effect of alcohol on pregnancy, childbirth, postpartum and newborn state: the use of alcohol before pregnancy once per month; alcohol consumption before pregnancy 2-4 times per month; smoking during pregnancy; abortion history; anemia during pregnancy; congenital heart disease on the third ultrasound screening; abnormal birth activity; subinvolution of uterus in the postpartum period; newborn gender; gestational age; prematurity and generally heavy state of a newborn. Linear classification function can be calculated by the formula 1.2. Canonical linear discriminant function can be calculated from equation [formula 3]. Diagnostic accuracy of decision rules in the middle is quite high - 76,69 %, in the first group - 75,7 %, in the second group - 77,6 %

Features of lipid peroxidation and antioxidant protection in Mongoloid men, carriers of non-functional polymorphisms of GSTT1 and GSTM1 genes, with different status of fertility

Background. Genetic factors cause 30-50 % of cases of male infertility different forms. We have conducted the investigation of the lipid peroxidation and antioxidant protection system components, associated with the biotransformation genes polymorphisms, in men with infertility. Aims: to study parameters of lipid peroxidation and antioxidant defense system associated with polymorphisms of biotransformation genes in infertile Mongoloid men. Materials and methods. The main group included 143 men of reproductive age from Mongoloid population who came to the Public Health Institution "Republican Perinatal Center" in Ulan-Ude with the problem of one year and more infertility after the marriage. Fifty-three almost healthy males with proven fertility were included in the control group. Blood samples of all men were genotyped by glutathione S-transferase (GSTP1, GSTM1, GSTT1) gene family and activity of glutathione system enzymes was determined. Results. In the fertile Mongoloids with non-functional genotype GSTT1(0/0)/GSTM1(0/0) we have established an increase concentration of a-tocopherol in serum, activity of glutathione peroxidase and a decrease in glutathione-S-transferase, as well as a decrease in the concentration of a-tocopherol. In infertile Mongoloids with non-functional GSTT1(0/0)/ GSTM1 (0/0) genotypes, an increase in the tiobarbituric acid reactants, glutathione peroxidase and a decrease in the concentration of a-tocopherol was found in the ejaculate; we also detected a decrease in the concentration of a-tocopherol, the level of oxidized glutathione and glutathione-s-transferase activity. Conclusions. Genetically determined peculiarities of functioning of the xenobiotic biotransformation system make each individual unique with regard to their adaptive capacity - resistance or sensibility to the damaging exo- and endogenous factors

PREDICTING THE RISK OF PROTHROMBOTIC CHANGES IN ADOLESCENTS WITH ESSENTIAL HYPERTENSION

Today, the problem of early diagnosis of hematological changes predisposing to the development of thrombotic complications in patients with essential hypertension (EH) is an urgent problem that requires close attention not only of physicians, but also of pediatricians. The aim of the study was the development of prognostic criteria for risk of prothrombotic changes (PC) in adolescents with EH, timely preventive measures and prevention of thrombotic complications. Sixty adolescents with EH without PC and 37 adolescents with EH and PC were examined. We used the following methods: clinical anamnestic (including genealogy), functional and ultrasound, laboratory, mathematical and statistical. To create a mathematical model of forecasting, discriminant analysis was used, with the help of which from the 59 proposed predictors the algorithm selected 8 most informative features: the C777T polymorphism of the 5,10-methylenetetrahydrofolate reductase gene, the A66G gene of the methionine synthase reductase gene, the daily diastolic blood pressure level, the level of the nocturnal systolic arterial pressure-time index of hypertension, systolic blood pressure during the day, weighed down by thrombotic genealogically history, early onset of thrombosis, burdened thrombotic genealogical history. Our method for predicting the risk of developing PC allows to place adolescents with EH having an increased risk of developing these coagulation shifts in a separate group, to identify thrombogenic risk in adolescence and, if necessary, to initiate preventive measures in time to reduce the incidence of thrombotic complications of EH and mortality of patients