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CLINICAL FEATURES OF patients with posterior wall myocardial infarction, COMPLICATED by the right ventricule INJURY
Brezme О., 3rd year student
Scentific supervisor - assist. Y. Ataman
Sumy State University, department of the internal medicine
According to the literature the frequency of expansion of posterior wall myocardial infarction (MI) to the right ventricle reaches 25%. At the same, the relevance of timely diagnosis of this clinical condition is due to the complexity of its implementation and the fact that treatment of right ventricle MI has a number of significant features (significantly limiting the indications of nitropreparates, ACE inhibitors and other vasodilatators, particularly relevant reperfusion therapy and efforts to reduce complications). The object of our research was to study clinical and functional characteristics of patients with posterior wall MI complicated by the right ventricle injury.
The case histories of 83 patients who were admitted to the intensive therapy wards of the Sumy city hospital №1 in the 2007-2009 years were analyzed. Refining the localization, the process was established on the basis of an electrocardiography (using additional rights leads), echocardiography and autopsy of the deceased. All the patients were divided into two groups: main - patients with MI and spread of the process involving the right ventricle (42 persons), and control - patients with only (true) posterior wall MI (41 persons). Patients of both groups were representative for age, sex, period of previous unstable angina and the presence of concomitant diseases.
The study showed that patients in the main group were characterized by increasingly atypical (nonanginal) variant manifestation of the disease, 26% in the main group (MG), against 17% in the control group (CG)). The course of the disease in some patients was accompanied by the development of early and late complications, including acute cardiovascular failure (Killip III-IV) in the MG in 14 (33%) patients and in 9 (22%) patients of the CG, paroxysmal tachycardias and AV-blocks in 6 (14%) patients of MG against 4 (9%) patients of the CG, pulmonary artery thromboembolism in 6 (14%) patients of the MG and in 2 (5%) patients of the CG. In 8 (19%) patients of the MG and in 5 (12%) patients of the CG fatal were registered.
Thus, extending necrosis in the right ventricle is accompanied by increased probability of atypical manifestation of the disease, increasing the frequency of common complications and higher CFR. Revealed facts make it necessary for an adequate therapeutic treatment.
BRONCHIAL ASTHMA AND OBESITY ASSOCIATION: PATHOGENETIC MECHANISM OF HARMFUL INFLUENCE REALIZATION AND QUALITY OF LIFE
Dytko Vladyslava
Science chief - M.D., L.N. Prystupa
Sumy State University, department of the internal medicine
The goal of the research was the comparative study of the level of inflammation markers during the isolated cases of bronchial asthma (BA) and when it was accompanied with visceral obesity (VO) and quality of life (LQ)
Materials and methods of investigation. The diagnostics of VO was conducted according to the recommendations of WHO. The investigation of inflammation markers was conducted for 71 patients with BA, among which: Group 1 included 35 BA patients with normal body weight, and Group2 had 36 VO patients. The Control Group consisted of 22 practically healthy people. The level of interleikins (IL) IL-6, IL-8 and the tumor necrosis factors- (TNF-) in blood serum was determined using immunofermented tverdofaznym method, the antigenic composition of the membrane of mononuclears in peripheral blood was determined using indirect immunoflorescent method, the level of 1-inhibitor proteinase (1-IP) and 2-macroglobullin (2-MG) was determined using spectrofotometric method. Quality of life were measured with the help of Asthma Quality of Life Questionnaire (AQLQ). The achieved results were analyzed using the methods of variance statistics. The correctness of the difference in the average measurements was evaluated using Student’s t-criterion.
Results of investigation. Group 1 patients had 3x and Group 2 patients 8x the level of FNP-, and IL-6 level was elevated by 2,5 and 5,6, respectively. The level of IL-6 in blood serum was abnormal for both patient groups compared to the Controls, while its level for VO patients was evidently higher compared to Group 1 patients (p<0,05).
Group 2 patients had levels of CD3, CD4, CD8 and CD16 evidently lower compared to Group 1 patients (p<0,05). The levels of adhesive molecules (CD11b, CD54), expression of receptor to IgE (CD23), activation markers of lymphocytes (receptors to IL-2, HLA-DR) were evidently higher for patients of both groups compared to the Control, and higher for Group 2 patients compared to Group 1. It was observed that 1-IP and 2-MG were elevated by 2x and 2,6x respectively compared to healthy individuals.
Results of investigation convey that the presence of VO in BA patients leads to: hyperproduction of proinflammation cytokines (IL-6, IL-8, TNF-); increase of T-lymphopenia, deficiency of cytotoxic cells, increased expression of activation markers, adhesive molecules, receptors to IgE, HLA-DR; increased level of 1-IP and 2-MG proteins.
Study of LQshowed that in patients with obesity the level of physical activity (p <0.05) and emotional status (p <0.05)were lower along with a more pronounced influence of the environment (p <0.05). Overall rating of LQ were in patients of I group (4,5 ± 0,4) points against (3,4 ± 0,3) points in II group (p <0.05).
Conclusions
These changes, along with known negative impacts of obesity on the process of BA (bronchial hyperactivity, increased frequency of hastroesophageal reflux, aggravation of pulmonary deficiency), represent one more pathogenetic mechanism – the exacerbation of inflammatory process. Presence of obesity complicated BA duration, entailing a more pronounced reduction LQ that dictates new conditions of including in their
Estimate of Lovastatin Efficiency at Old Patients with Chronic Cardiac Failure and Type 2 Diabetes
H-jeva Deogratras, Allabaid Bassam, the student of the 3nd course
Sumy State University, Department of internal medicine
Scientific supervisor - Candidate of medical science N.V Demikhova
Dislipoproteinemia is the risk factor of coronary heart disease and other diseases, conditioned by atherosclerosis. That`s why medicinal correction is important for practical cardiology. Due to present conception, inhibitors of GOMK-reductase (statines) are the necessary chain in coronary heart disease, complicated by chronic cardiac failure.
Results of great number of multicenter researches during the last 15 years are evidence of statines efficiency (WOSCOP, MAAS, MARS, AFCAPS, 4S researches). It was proved that regular usage of statines leads to decrease of frequency of myocardium infarction development and death caused by coronary vessels pathology on 40%.
The object of our research was to study lovastatin influence on indexes of lipid metabolism and clinical course of concomitant chronic cardiac failure and type II diabetes patients.
Materials and Methods. We observed 47 patients with type II diabetes, cardiac heart (CHD) complicated by chronic cardiac failure in age from 67 to 87 years (27 men and 20 women). Lovastatin was prescribed side by side with basic therapy in dose 20 mg one time a day in the evening white eating. Each patient was examined before treatment and in three weeks of lovastatin intake 38 patients were examined for the second time in 6 months after discharge from the hospital. Each of them confirmed that they had taken lovastatin regularly. Control group included 15 patients with CHD complicated by chronic cardiac failure without type II diabetes.
Side-effects development, lovastatin influence on biochemical indexes and blood cells were estimated in our research. Side-effects were noted at 4 patients of 47: abdominal pain and dry mouth. Lovastatin influence on bilirubin, creatinin, urea haemoglobin levels, ESR, content of leucocytes and erythrocytes in blood. Clinical tolerance to lovastatin was satisfactory.
Conclusion. Conducted research showed that prolonged course of treatment by lovastatin during 6 months at patients with CHD, complicated by CF at type 2 diabetes was accompanied by reliable decrease of level of general cholesterol (on 15,74%) and triglycerides (on 17,92%). Lovastatin shows antiishemic effect at patients with CHD and diabetes mellitus of the II type, which is conditioned by direct influence on lipid exchange and also by endothelium protector effect. Even after therapy by lovastatin in dose 20 mg a day during 3 weeks tendency to decrease of number or CHD attacks and to increase of tolerance to physical loading at patients with chronic cardiac failure and type 2 diabetes was noted, at conducting of 6-minutes walk test prevalence of normotonic reaction after treatment in comparison with results before treatment. Lovastatin is characterized by high tolerance by the patients with chronic cardiac failure and type 2 diabetes, it almost doesn’t cause side effects and complications.
НАУКОВЕ ВИДАННЯ
МАТЕРІАЛИ
НАУКОВО-ПРАКТИЧНИХ КОНФЕРЕНЦІЙ
СТУДЕНТІВ, МОЛОДИХ ВЧЕНИХ, ЛІКАРІВ ТА ВИКЛАДАЧІВ
«АКТУАЛЬНІ ПИТАННЯ ТЕОРЕТИЧНОЇ МЕДИЦИНИ»,
«АКТУАЛЬНІ ПИТАННЯ КЛІНІЧНОЇ МЕДИЦИНИ»,
«МІКРОЕЛЕМЕНТОЗИ В КЛІНІЧНІЙ МЕДИЦИНІ»
(Суми, 21-23 квітня 2010 року),
«ACTUAL PROBLEMS OF FUNDAMENTAL AND CLINICAL MEDICINE
(IN ENGLISH)»
(Суми, 22-23 квітня 2010 року)
Відповідальний за випуск Л.Н. Приступа
Комп’ютерне верстання І.М. Колесник
Стиль та орфографія авторів збережені.
Формат 60×84/8. Ум. друк. арк. 30,23 Обл.-вид. арк. 35,45. Тираж 100 пр. Зам. №
Видавець і виготовлювач
Сумський державний університет,
вул. Римського-Корсакова, 2, м. Суми, 40007
Свідоцтво суб’єкта видавничої справи ДК № 3062 від 17.12.2007.