Vol 22, No 2 (2018)

Background. Frailty is a high-priority issue in cardiovascular medicine because of the aging of patients. It reflects the complex functional disorders and is associated with high morbidity and adverse outcomes. The aim of the study was to examination prevalence of frailty, its associations with mortality and hemorrhagic risk in elderly patients with ACS. Materials and methods. In 130 patients ≥ 75 years (82,7 ± 4,7 years, arterial hypertension (AH) 91,5%, previous myocardial infarction (MI) 32,3%, atrial fibrillation 32,3%, diabetes 26,9%, admitted with MI 75,4% or unstable angina 24,6%, frailty (national validated questionnaire), nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination) were assessed. Results. Mean score on a national validated questionnaire was 2,9 ± 1,4 points. Only 8.5% of patients responded negatively to all questionnaire questions. None of the patients had 7 points. 6,2, 19,2, 32,3, 23,8, 6,9 and 3,1% patients had 1, 2, 3, 4, 5 and 6 points. 8,5% of the patients were non-frail, 25,4% pre-frail and 66,1% frail. Patients with frailty were more likely women, had higher incidence of AH, MI in this hospitalization, GFR < 60 ml/min/1,73 m2. Conclusion. Frailty occured in 66,1% of elderly patients with ACS, was associated with increased prevalence of cardiovascular diseases.

Purpose and objectives of the study:evaluate and compare the results of surgical treatment of complex fractures and fractures of the proximal humerus. Materials and methods: an analysis of the results of surgical treatment of 202 patients with 3 and 4 fragmentary fractures and fractures of the proximal humerus was performed. During the period of 2015-2017 in the City Clinical Hospital named after V.P. Demikhov. Results: Based on the analysis of surgical treatment of 202 patients with fractures and complex fractures of proximal metaepiphysis of the humerus within 7 days from the time of injury, we came to the conclusion that the most effective method is endoprosthesis of the shoulder joint by a reversible system. This method allows you to reach the maximum amplitude of movements in the shoulder joint in the early stages of rehabilitation treatment. In the main group, where reversive endoprosthetics were used, excellent and good results on the Constant-Murley and ASES scales were obtained in 46 patients (85.2%). Unsatisfactory outcomes were not encountered. More modest results were obtained in the groups where the osteosynthesis of the fractures with pins and plates was performed, and hemiarthroplasty for the surgical treatment of "fresh" fractures and complex fractures of the proximal metaepiphysis of the humerus was found to be untenable.

The purpose of the study: to research the active changes in several enzymes of the antioxidative protection within the dynamical development of the liver reperfusion in rats. Materials and methods: the study has been performed on 95 white non-lineal male rats with the mass of 240-280 g divided into groups, the biological material of which has been sampled within 5-20 minutes of the ischemic period and 5-20 minutes of the reperfusion period with the interval of 5 minutes. To evaluate the changes of the antioxidative system the activity of the superoxide dismutase, the erythrocyte catalase and the liver homogenate as well as the general antioxidative activity have been determined. Results: the performed study has demonstrated the imbalance development for the relation between the activity of catalase and superoxide dismutase by the development of the ischemic reperfusion syndrome with the change of this relation to the prevalence of the catalase activity on the systemic level and the superoxide dismutase activity on the organic level after the circulatory restoration. Besides the increase in activity of the studied enzymes from the erythrocyte, meal by 2 times in comparison with the control group has been determined especially at the ischemic period as well as the tendencies to the progressive activity decrease of the same enzymes in the liver tissue. The general antioxidative activity in the period of ischemic reperfusion has been decreasing to the fifth minute of ischemia by 2 times and has lasted on the same level (0.04-0.05 mg/l of vitamin C in terms of 1 gram of homogenate protein) during the entire experiment. Conclusion: the received results have demonstrated the possibility for the evaluation of the functional state for the system of oxidative restorative homeostasis in an animal by ischemic reperfusion of the liver against the background of the lowered general antioxidative activity. It was marked also the necessity of the metabolic support of this link within the system of non-specific resistance for the correction of the developing disorders.

Syndrome of bronchial obstruction is a symptomatic complex arising on the background of constriction or occlusion of bronchial tubes of different caliber due to bronchospasm, edema and inflammation of the bronchial mucosa, hypersecretion of mucus or compression by surrounding structures. Bronchoobstructive syndrome (BOS) is one of the most common pathological conditions in pediatric practice. The outcome of BOS can be different: from the complete disappearance of clinical manifestations to the process, disability or even death. Accordingly, the study of this problem and the search for methods for early diagnosis and prediction of the outcome of BOS is a very urgent problem. In order to identify risk factors for BOS and to clarify the association with polymorphism of the CC16 gene, 126 children belonging to the main group and 58 from the comparison group were examined. In the course of the study, the triggers influence on the formation of the BOS of concomitant ENT pathology, burdened personal and family allergic anamnesis, and also the recurrent nature of respiratory infections in the first year of life was proved. The association of polymorphism of AA gene of CC16 with the presence of weighed allergic anamnesis and frequent episodes of ARVI, as well as the influence of this genotype on the early debut of respiratory diseases in children, has been revealed. The relationship of the GG genotype with the concomitant ENT pathology among patients with recurrent BOS has been proved.

Β-defensins play an important role in protecting the fetus from infection, so the expression of these antimicrobial peptides in the respiratory tract in newborns is really important. In this regard, we set a task of studying the expression of the HBD-1 and HBD-2 genes in the epithelial cells of the mucous of the upper airway in newborns with pneumonia and in healthy newborns, depending on the causative agent. Also, the polymorphic marker G(-20) A in the DEFB1 gene was associated with infectious pathology of newborns (in particular pneumonia). Methods: The microflora and the factors of congenital immunity on the mucous membranes of the upper airway have been studied in two groups: newborns with ventilator-associated and congenital pneumonia. The biological material was scrapings of epithelial cells of the mucous membrane of the upper airway of newborns and puerperas and blood. Results: It was found that the expression of the HBD-2 gene increases 2.3-fold in children who have an infectious agent, but there are no clinical manifestations of pneumonia. A significant decrease in HBD-2 (3.2 times) in patients with pneumonia caused by K. pneumonia was shown. The frequencies of alleles of the DEFB1 gene in the fetal infection group and in the comparison group: allele G - 0.66, 0.79, allele A - 0.34, 0.21, respectively. The frequencies of the genotypes of the test marker in mothers in the ventilator-associated, congenital pneumonia and the comparison group were as follows: GG - 0.78, 0.58, 0.58; AA is 0, 0.25, 0; AG - 0.22, 0.17, 0.42, respectively. In newborns allele G dominated among alleles (frequency was higher than 0.73 in all groups) and genotype GG (frequency exceeded 0.52). Conclusion: In the course of the study, it was confirmed that β-defensins protect the mucous from infectious agents. The results indicate that the genetic marker G (-20) A of the DEFB1 gene is associated with the risk of developing the child's UTI.

In recent years, the number of hard diagnosed, polysymptomatic and polysyndrome conditions and diseases caused by mono- and mixed-herpes infections has sharply increased in the practice of physicians of all specialties. The clinical aspects of the close attention of physicians, virologists and epidemiologists to this viral family are due not only to the onset of atypical forms of these infections, but also to the emergence of the relative new concept of “active chronic atypical infection” caused by herpesviruses and in particular the Epstein-Barr virus. We observed 198 people of both sexes aged between 23 and 60 years, suffering from mono- and mixed herpetic infections (EBV, CMV, HSV 1/2, and HSV type 6). 36% of these, suffered from mono-herpesvirus infections, mixed-herpesvirus infections were diagnosed in 63.7% of cases. A study of functioning characteristics of antiviral protection system as well as defects and disorders in the system of interferons was carried out in patients suffering from various mono-, mixed herpes virus infections and bacterial co-infections. The main clinical syndromes associated with these herpetic infections, as well as prevailing nosological forms of concomitant diseases were revealed. The revealed clinical syndromes and functioning characteristics of an antiviral protection will allow developing of a conceptual, individualized, etio- and immunopathogenetic therapy.