To define the effect of various drugs for total intravenous anesthesia (TIVA) on cognitive function (CF) in older patients

Omelchenko-Seliukova, A.V.

SocioEconomic Challenges Journal (Sumy State University)

 
1  
Міністерство освіти та науки, молоді та спорту України 
Міністерство охорони здоров’я 
Сумський державний університет 
Медичний інституту 
 
 
 
 
 
 
 
 
АКТУАЛЬНІ ПИТАННЯ ТЕРЕТИЧНОЇ ТА 
ПРАКТИЧНОЇ МЕДИЦИНИ 
 
Topical Issues of Clinical and Theoretical 
Medicine 
 
 
 
 
 
 
 
Збірник тез доповідей  
ІІІ Міжнародної науково-практичної конференції 
Студентів та молодих вчених 
(Суми, 23-24 квітня 2015 року) 
 
 
 
 
 
Суми 
Сумський державний університет 
2015 
  
 
107 ВНУТРІШНЯ МЕДИЦИНА 
ADDITIONAL THERAPY WITH DAPAGLIFLOZIN IN PATIENTS WITH TYPE 2 
DIABETES WHO HAVE INADEQUATE GLYCEMIC CONTROL 
Ejire Jeniffer, the 6th year student 
Science chief — G.A. Fadieieva, MD 
SumySU, Department of Internal Medicine postgraduate education 
Patients with type 2 diabetes often require intensification of treatment to maintain glycemic 
control. Dapagliflozin is a novel glucose-lowering medication that reduces hyperglycemia by 
increasing urinary glucose excretion independent of insulin.  
Study objectives: to assess the efficacy of dapagliflozin in patients with poorly controlled type 
2 diabetes receiving metformin and sulfonylurea.  
Methods: 42 patients with type 2 diabetes, obesity and inadequate glycemic control defined as 
HbA1c ≥7.0% and ≤9.0% took part in this study. Before randomization they were on stable dose of 
metformin (2g/day) and gliclazide (30-60 mg/day) or glimepiride (2-4 mg/day) for 12 weeks. 20 
patients of the 1st group continued treatment by metformin combined with sulfonylurea. 22 patients 
of the 2nd group had used dapagliflozin at 10 mg/day in addition to metformin and 
glimepiride/gliclazide (triple therapy). All patients received dietary and lifestyle advice. 20 healthy 
persons were in control group. 
The levels of glycosylated haemoglobin (HbA1C), fasting plasma glucose (FPG), postprandial 
glucose (PG), triglycerides, low density lipoproteins cholesterol (LDL-C) were explored. Statistical 
processing of results was carried out using licensed Microsoft Office 2000.  
Results: Patients of the both groups were representative of the duration of diabetes, body mass 
index, mean baseline HbA1C.  
In 3 months of treatment reduction in body weight on (1.8+/-0,21) kg/m2 kg  was observed in 
the 2nd group compared with (0.7+/-0,07)  kg in the 1st group (p< 0.05). 
The levels of triglycerides, LDL-C were (2,0±0,79), (3,8 ± 0,54) mmol/l respectively in patients 
from the 1st group, (1,3±0,90), (3,2±0,74) mmol/l in patients from the 2nd group (p>0.05).  
Triple antihyperglycemic therapy with dapagliflozin lead to reductions in levels of HbA1C from 
(8,1±0,12) to (7,1±0,11) % (p< 0.05). 57% of patients from the 2nd group achieved an HbA1C<7%, 
FPG<6 mmol/l, PG<8 mmol/l compared with 36% of patients from the 1st group (p<0.05). Treatment 
with dapagliflozin appeared well tolerated, there was 1 case of non-severe hypoglycaemia.  
Conclusion: Adding a dapagliflozin to background metformin/sulfonylurea therapy in poorly 
controlled patients had led to greater improvements in glycemic control, significant reduction in body 
weight than dual therapy with metformin/sulfonylurea. 
 
 
DYNAMICS OF COGNITIVE FUNCTION IN OLDER PATIENTS AFTER 
INTRAVENOUS ANESTHESIA 
Omelchenko-Seliukova A.V. 
Kharkiv National Medical University, Department of Critical Care Medicine, 
Anesthesiology and Intensive Care 
It is projected that patients older than 60 years will become the largest segment of the surgical 
population by 2020. Postoperative cognitive dysfunction (POCD) is increasingly recognized as an 
appearance after surgery. Older age is a strong preoperative risk factor of POCD.  
Aim. To define the effect of various drugs for total intravenous anesthesia (TIVA) on 
cognitive function (CF) in older patients.  
Materials and methods. Were examined 25 patients aged from 60 to 74 years, mean age 66,9 
± 4,3 years. Among them were 15 men and 8 women, who met the standard of the ASA I-II. All 
patients had routine abdominal operations. Cognitive function was assessed on day before operation, 
day 3 and 7 after operation using the Montreal Cognitive Assessment (MoCA). A score of ≤24 was 
indicative of cognitive dysfunction. Patients were divided into 3 groups depending of the method of 
anesthesia. In 1st group (7 patients) anesthesia was introduced by TIA based on ketamine, in 2nd (8 
patients) - based on propofol, in 3rd (8 patients) – on thiopental sodium. Analgesia was provided in 
 
108 ВНУТРІШНЯ МЕДИЦИНА 
all groups by fentanyl. There was’t significant difference in character and time for surgery, the age, 
the mean arterial pressure, heart rate and oxygen saturation into groups. 
MoCA test results before surgery were insignificantly different in all groups. CF became 
worse significantly on 3rd day after sergery in 5 patients of group 1 (70%), 4 patients in 3rd (50%) 
and 1 patient in group 2 (12.5%). In the 1st group mainly suffered indicators of concentration and 
stability of attention and short-term and long-term memory. Whereas, in the other groups were 
registered violation of long-term memory. In 7 days after surgery state of CF in 83% of patients 
improved, but 3 patients in1 and 1 patient of 3rd group received ≤24 in MoCA test. 
 Conclusions. In 43% of elderly patients after  routine surgical treatment in under total 
intravenous anesthesia there was a decrease CF. The use of TIVA based on propofol has less impact 
in the development of POCD. 
 
 
        IDENTIFICATION OF ANTI-MOESIN ANTIBODIES IN THE SERUMS OF PATIENTS  
WITH ANTIPHOSPHOLIPID SYNDROME 
Popovytch L.O., Doskaliuk B.V. 
Scientific director: Savtchuk L.D. 
Ivano-Frankivsk medical university 
Department of endocrinology 
Introduction: The antiphospholipid syndrome (APS) is an acquired autoimmune disease 
characterized by recurrent vascular thrombosis and obstetric complications. However, the precise 
mechanisms by which the autoantibodies mediate disease remain to be elucidated. Moesin is an 
intracellular protein that links the cell membrane and cytoskeleton, mediating the formation of 
microtubules and cell adhesion sites as well as ruffling of the cell membrane, which is crucial for 
platelet activation. 
Materials and methods: We screened the serums from patients with APS for the presence of 
anti-moesin antibodies (anti-moesin Abs) recognizing antigens derived from prokaryotic expression 
system, and investigated the effect of murine monoclonal anti-moesin Abs (anti-moesin mAbs) on 
platelet activation and aggregation by flow cytometry and platelet aggregation assay in vitro to study 
their potential pathogenic role in APS. 
Rеsults: The presence of anti-amino (N)-terminal portion of moesin antibodies (anti-moesin-N 
Abs) was observed in 63% (63/100) patients with APS, which was significantly higher than anti-
cardiolipin antibodies (aCL, 39%) and anti-β2 glycoprotein I antibodies (anti-β2GPI, 53%). 
Moreover, the elevated anti-moesin-N Abs levels significantly correlated with plasma levels of anti-
β2GPI (rs=0.574, P<0.002) rather than aCL (P=0.303). The murine anti-moesin mAbs promote 
platelet activation and aggregation in vitro, which could be effectively neutralized by moesin-N. 
Summary: In combination of the detection of aCL and anti-β2GPI, screening for the presence 
of anti-moesin-N Abs might has its value in facilitating the laboratory diagnosis of APS. The 
pathogenic role of anti-moesin-N Abs in the serums of APS patients needs to be further studied. 
 
 
CHOOSING THE NUTRITIONAL INTERVENTION TO OVERWEIGHT AND OBESE 
PATIENTS 
Posea M1,2, Dragomir A2, Rusu E1,2, Nan R¹,², Draguţ R1,2, Popescu H1,2, Radu F1,2,  Teodoru I1,2, 
Hâncu A2, Radulian G1,2 
1. National Institute of Diabetes, Nutrition and Metabolic Diseases “N. C. Paulescu”, Bucharest 
2. University of Medicine and Pharmacy “Carol Davila”, Bucharest 
Background and Aims. Weight problems occur in 1.5 billion people and these are a risk 
factor for type 2 diabetes, cardiovascular, pulmonary and periodontal diseases, cancer and 
osteoporosis. Our study aimed to evaluate the caloric intake, vitamins and minerals from food before 
a nutritional intervention to overweight and obese patients. 


Dynamics of cognitive function in older patients after intravenous anestesia

Electronic Sumy State University Institutional Repository

 1  Міністерство освіти та науки, молоді та спорту України Міністерство охорони здоров’я Сумський державний університет Медичний інституту         АКТУАЛЬНІ ПИТАННЯ ТЕРЕТИЧНОЇ ТА ПРАКТИЧНОЇ МЕДИЦИНИ  Topical Issues of Clinical and Theoretical Medicine        Збірник тез доповідей  ІІІ Міжнародної науково-практичної конференції Студентів та молодих вчених (Суми, 23-24 квітня 2015 року)      Суми Сумський державний університет 2015    107 ВНУТРІШНЯ МЕДИЦИНА ADDITIONAL THERAPY WITH DAPAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES WHO HAVE INADEQUATE GLYCEMIC CONTROL Ejire Jeniffer, the 6th year student Science chief — G.A. Fadieieva, MD SumySU, Department of Internal Medicine postgraduate education Patients with type 2 diabetes often require intensification of treatment to maintain glycemic control. Dapagliflozin is a novel glucose-lowering medication that reduces hyperglycemia by increasing urinary glucose excretion independent of insulin.  Study objectives: to assess the efficacy of dapagliflozin in patients with poorly controlled type 2 diabetes receiving metformin and sulfonylurea.  Methods: 42 patients with type 2 diabetes, obesity and inadequate glycemic control defined as HbA1c ≥7.0% and ≤9.0% took part in this study. Before randomization they were on stable dose of metformin (2g/day) and gliclazide (30-60 mg/day) or glimepiride (2-4 mg/day) for 12 weeks. 20 patients of the 1st group continued treatment by metformin combined with sulfonylurea. 22 patients of the 2nd group had used dapagliflozin at 10 mg/day in addition to metformin and glimepiride/gliclazide (triple therapy). All patients received dietary and lifestyle advice. 20 healthy persons were in control group. The levels of glycosylated haemoglobin (HbA1C), fasting plasma glucose (FPG), postprandial glucose (PG), triglycerides, low density lipoproteins cholesterol (LDL-C) were explored. Statistical processing of results was carried out using licensed Microsoft Office 2000.  Results: Patients of the both groups were representative of the duration of diabetes, body mass index, mean baseline HbA1C.  In 3 months of treatment reduction in body weight on (1.8+/-0,21) kg/m2 kg  was observed in the 2nd group compared with (0.7+/-0,07)  kg in the 1st group (p< 0.05). The levels of triglycerides, LDL-C were (2,0±0,79), (3,8 ± 0,54) mmol/l respectively in patients from the 1st group, (1,3±0,90), (3,2±0,74) mmol/l in patients from the 2nd group (p>0.05).  Triple antihyperglycemic therapy with dapagliflozin lead to reductions in levels of HbA1C from (8,1±0,12) to (7,1±0,11) % (p< 0.05). 57% of patients from the 2nd group achieved an HbA1C<7%, FPG<6 mmol/l, PG<8 mmol/l compared with 36% of patients from the 1st group (p<0.05). Treatment with dapagliflozin appeared well tolerated, there was 1 case of non-severe hypoglycaemia.  Conclusion: Adding a dapagliflozin to background metformin/sulfonylurea therapy in poorly controlled patients had led to greater improvements in glycemic control, significant reduction in body weight than dual therapy with metformin/sulfonylurea.   DYNAMICS OF COGNITIVE FUNCTION IN OLDER PATIENTS AFTER INTRAVENOUS ANESTHESIA Omelchenko-Seliukova A.V. Kharkiv National Medical University, Department of Critical Care Medicine, Anesthesiology and Intensive Care It is projected that patients older than 60 years will become the largest segment of the surgical population by 2020. Postoperative cognitive dysfunction (POCD) is increasingly recognized as an appearance after surgery. Older age is a strong preoperative risk factor of POCD.  Aim. To define the effect of various drugs for total intravenous anesthesia (TIVA) on cognitive function (CF) in older patients.  Materials and methods. Were examined 25 patients aged from 60 to 74 years, mean age 66,9 ± 4,3 years. Among them were 15 men and 8 women, who met the standard of the ASA I-II. All patients had routine abdominal operations. Cognitive function was assessed on day before operation, day 3 and 7 after operation using the Montreal Cognitive Assessment (MoCA). A score of ≤24 was indicative of cognitive dysfunction. Patients were divided into 3 groups depending of the method of anesthesia. In 1st group (7 patients) anesthesia was introduced by TIA based on ketamine, in 2nd (8 patients) - based on propofol, in 3rd (8 patients) – on thiopental sodium. Analgesia was provided in  108 ВНУТРІШНЯ МЕДИЦИНА all groups by fentanyl. There was’t significant difference in character and time for surgery, the age, the mean arterial pressure, heart rate and oxygen saturation into groups. MoCA test results before surgery were insignificantly different in all groups. CF became worse significantly on 3rd day after sergery in 5 patients of group 1 (70%), 4 patients in 3rd (50%) and 1 patient in group 2 (12.5%). In the 1st group mainly suffered indicators of concentration and stability of attention and short-term and long-term memory. Whereas, in the other groups were registered violation of long-term memory. In 7 days after surgery state of CF in 83% of patients improved, but 3 patients in1 and 1 patient of 3rd group received ≤24 in MoCA test.  Conclusions. In 43% of elderly patients after  routine surgical treatment in under total intravenous anesthesia there was a decrease CF. The use of TIVA based on propofol has less impact in the development of POCD.           IDENTIFICATION OF ANTI-MOESIN ANTIBODIES IN THE SERUMS OF PATIENTS  WITH ANTIPHOSPHOLIPID SYNDROME Popovytch L.O., Doskaliuk B.V. Scientific director: Savtchuk L.D. Ivano-Frankivsk medical university Department of endocrinology Introduction: The antiphospholipid syndrome (APS) is an acquired autoimmune disease characterized by recurrent vascular thrombosis and obstetric complications. However, the precise mechanisms by which the autoantibodies mediate disease remain to be elucidated. Moesin is an intracellular protein that links the cell membrane and cytoskeleton, mediating the formation of microtubules and cell adhesion sites as well as ruffling of the cell membrane, which is crucial for platelet activation. Materials and methods: We screened the serums from patients with APS for the presence of anti-moesin antibodies (anti-moesin Abs) recognizing antigens derived from prokaryotic expression system, and investigated the effect of murine monoclonal anti-moesin Abs (anti-moesin mAbs) on platelet activation and aggregation by flow cytometry and platelet aggregation assay in vitro to study their potential pathogenic role in APS. Rеsults: The presence of anti-amino (N)-terminal portion of moesin antibodies (anti-moesin-N Abs) was observed in 63% (63/100) patients with APS, which was significantly higher than anti-cardiolipin antibodies (aCL, 39%) and anti-β2 glycoprotein I antibodies (anti-β2GPI, 53%). Moreover, the elevated anti-moesin-N Abs levels significantly correlated with plasma levels of anti-β2GPI (rs=0.574, P<0.002) rather than aCL (P=0.303). The murine anti-moesin mAbs promote platelet activation and aggregation in vitro, which could be effectively neutralized by moesin-N. Summary: In combination of the detection of aCL and anti-β2GPI, screening for the presence of anti-moesin-N Abs might has its value in facilitating the laboratory diagnosis of APS. The pathogenic role of anti-moesin-N Abs in the serums of APS patients needs to be further studied.   CHOOSING THE NUTRITIONAL INTERVENTION TO OVERWEIGHT AND OBESE PATIENTS Posea M1,2, Dragomir A2, Rusu E1,2, Nan R¹,², Draguţ R1,2, Popescu H1,2, Radu F1,2,  Teodoru I1,2, Hâncu A2, Radulian G1,2 1. National Institute of Diabetes, Nutrition and Metabolic Diseases “N. C. Paulescu”, Bucharest 2. University of Medicine and Pharmacy “Carol Davila”, Bucharest Background and Aims. Weight problems occur in 1.5 billion people and these are a risk factor for type 2 diabetes, cardiovascular, pulmonary and periodontal diseases, cancer and osteoporosis. Our study aimed to evaluate the caloric intake, vitamins and minerals from food before a nutritional intervention to overweight and obese patients. 

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Dynamics of cognitive function in older patients after intravenous anestesia

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SocioEconomic Challenges Journal (Sumy State University)

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