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"vestnik vsmu" 2010  vol. 9 №4

Microbiology

Zhiltsov I.V., Veremey I.S., Semenov V.M., Generalov I.I.
Comparative assessment of two techniques of evaluation of beta-lactamase activity in biological fluids

Abstract. The goal of the present research was the selection of the most sensitive, specific and reproducible technique of evaluation of beta-lactamase activity of biological substrates with the intention of further adaptation of it for the realization in microvariant with the use of plotting reader. We have compared two widespread techniques – neocuproine and nitrocefin ones. Nitrocefin technique was shown to be 20-fold more sensitive than neocuproine one, its reproducibility is 3,7-fold higher, and the cost of one determination in both techniques is virtually equal (about 0,1 €). The only significant disadvantage of nitrocefin technique if compared to neocuproine one is the impossibility to use any beta-lactam antibiotic as a substrate. Thus, nitrocefin technique seems to be the most promising for the possible use as the basis for the development of simple in use but sensitive and reliable test system for the detection and quantitative evaluation of beta-lactamase activity in different biological objects (such as saliva, blood, sputum or cerebrospinal fluid) for the purpose of antibacterial therapy correction.

Frolova A.V., Okulich V.K., Bulavkin V.P.
Time- and dosedependent killing of causative agents of wound infection with herbal remedy “PhytoMP”

Abstract. Antimicrobic and antimycotic activity of the remedy «PhytоMP» against causative agents of surgical infection was studied. For this purpose the developed method of quantitative determination of time- and dosedepent killing of microorganisms was used. It has been shown, that the remedy «PhytоMP» possesses the marked antimicrobic / antimycotic activity with regard to causative agents of surgical infection, S. aureus, C. albicans in particular. Thus minimal inhibiting concentrations of the remedy and the effective time of its use at local treatment of pyo-inflammatory diseases and complications were determined. Laboratory examinations and clinical studies confirmed, that the used method allows not only to determine in short terms the degree of sensitivity of the isolated strain to the remedy, but also to predict precisely enough the frequency of bandaging with it for every concrete patient.

Physiology

Sheybak V.M., Goretskaya M.V., Pavlyukovets A.Y., Doroshenko E.M.
The dynamics of amino acids concentrations changes in blood lymphocytes after single intragastric administration of tauzinc

Abstract. The determination of the concentrations of free amino acids and their derivatives in serum and in blood lymphocytes of rats was performed in 3 h and 24 h after  single intragastric administration of tauzinc in the dose of 400 mg / kg. We found the reduction in the total number of amino acids in blood serum, the number of branched chain amino acids (BCAA), as well as the reduction of the proportion of BCAA in the total pool of essential amino acids. The amount of proteinogenic amino acids in the serum reduced as well. In blood lymphocytes, on the contrary, the amount of proteinogenic amino acids in 3 h after the injection of the drug reliably increased, however, in 24 h the total number of free amino acids in blood lymphocytes did not differ from the control values. Mainly, the levels of nonessential amino acids increased, and in 24 h reliable decrease in the concentrations of essential amino acids was observed, which manifested itself in the increased ratio of the sum of proteinogenic amino acids to nonproteinogenic derivative amino acids. In animals treated with tauzinc marked change in the concentrations of methionine, cystathionine and taurine was noted.
Thus, single intragastric administration of tauzinc impoverishes the pool of free amino acids and their derivatives in blood serum, increasing at the same time their content in blood lymphocytes.

Gorodetskaya I.V., Korenevskaya N.A.
The influence of thyroid status on the intensity of  stress reaction under chronic stress

Abstract. In experiments on 648 male Wistar rats with the mass of 220-250 g it has been determined, that chronic stress (keeping 18 animals in every cage of the size 20х30х40 cm during 1, 2 and 3 months) causes a variety of changes (hypertrophy of adrenal glands, involution of the spleen and thymus, ulceration of the mucous membrane of the stomach, changes in the concentration of glucose, total protein and lipids, cortisol and insulin in blood, decrease in exercise tolerance), the expressiveness of which increases in proportion to stress influence, that results in the death of rats. Mercazolil (1,2 mg per 100 g body weight during 14 days, then in half dose) reduces the degree of compensatory mechanisms mobilization that causes more significant damages to the ulcerated gastric mucosa, decrease in exercise tolerance and animal mortality. Thyroxin (3,0-5,0 mg per kg body weight during 28 days, then in half dose) causes opposite changes. Consequently, the intensity of stress reaction under chronic stress influence depends on thyroid status of the organism.

Internal medicine

Korneyeva V.A., Velichinskaya O.G., Kunder E.V.
The predominant type of attitude towards the disease in patients with rheumatoid arthritis and osteoarthritis

Abstract. Rheumatoid arthritis and osteoarthritis are severe chronic diseases, which decrease the quality of life, disturb the physiologic and social status of the patients. Thus the including of psychotherapy in complex system of rehabilitation measures of the patients with rheumatic diseases is a very urgent problem. The aim of the study was to assess the types of attitude towards the disease in patients with rheumatoid arthritis and osteoarthritis. The specific personal features of these patients were described. In patients with rheumatoid arthritis the disturbance of social adaptation is marked to a greater extent than that in patients with osteoarthritis. The predominant type of attitude towards the disease in patients with rheumatoid arthritis is ergopathic. In patients with osteoarthritis the harmonic type prevails. The results obtained enable us to conclude that the majority of patients with rheumatoid arthritis and osteoarthritis need qualified psychological aid for more successful treatment.

Poplavets E.V., Denisenko V. L, Nemtsov L.M.
Clinical importance of somatotype and trophological status features in adolescents  with gastroduodenal pathology

Abstract. 239 military age adolescents (16-27 years) were examined. 74 out of them were with functional dyspepsia syndrome, 52 had erosive-ulcerative pathology of the stomach and duodenum, the control group consisted of 113 persons. In military age adolescents macrotrophic and microtrophic somatotypes are the factors which raise the chances of gastroduodenal pathology development (р<0,05) and are associated (rs>0,3; р<0,05) with the estimation of pain syndrome and immunity parameters.

Lemeshevskaya Z.P., Vodoyevich V.P.
Correlation between biogenic amines metabolism and psychovegetative and somatic disturbances in patients with bronchial asthma

Abstract. Out of 101 examined patients with asthma 47 (46%) had sympathetic activity increase (the first group); 35 (35%) had parasympathetic activity increase (the second group); 19 (19%) had the increase neither in parasympathetic nor in sympathetic activity (the third group).
We revealed several links between biogenic amines and psychovegetative state, and the reduction in the concentration of free serotonin in blood plasma correlates with the improvement in pulmonary function and clinical status.
Complex treatment for the first group of patients included anxiolytics and decreased doses of beta-2-agonists, the patients of the second group received antidepressants, anticholinergic and mycolytic drugs.
The differentiated approach to bronchial asthma treatment depending on the state of vegetative nervous system and on the psychic state of the patients allows to achieve positive clinical effect in shorter terms, to shorten the period of patients’ hospital stay, to improve the life quality of the patients.

Mastykova E.K., Konorev M.R., Matveyenko M.E.
Barrett’s esophagus in the structure of gastroesophageal reflux disease - modern conceptions

Abstract. Literature review demonstrates that Barrett’s esophagus (BE) is a serious complication of gastroesophageal reflux disease (GERD) and the World Gastroenterologists Society views it as a precancerous condition. This problem is important today because BE is associated with an increased risk of the development of esophagus adenocarcinoma. Patients with BE have 30-40 fold increased risk of esophageal adenocarcinoma (EAC) development as compared to the whole population. Risk factors (such as male sex, white race, age more than 60 years, hiatal hernia, obesity, etc.) have a stronger impact in genetically predisposed individuals. Due to asymptomatic disease course, uncontrolled intake of antacid medicines, BE can’t be diagnosed in time in many cases. Modern diagnosing of esophageal metaplasia is performed endoscopically with morphologic verification of the diagnosis made. It is important to size up the length of BE. Long-segment of BE (more than 3 cm) is associated with a greater risk of EAC development. Nowadays, treatment of BE is the same as that of GERD. Proton pump inhibitors (PPI) are the drugs of choice. However, further studies are needed to investigate the possibility to use non-steroid anti-inflammatory drugs (NSAID) and PPI for prevention of EAC development.

Sirotko O.V.
Pressing questions of differential diagnosing of rheumatoid and reactive arthritis

Abstract. In this review the data about the urgency of the problem of early diagnosing of rheumatoid and reactive arthritis are given, considering the increase of primary morbidity rate, affection of persons of able-bodied age, high level of invalidism of patients in the absence of adequate therapy (about 50% of patients become disabled during the first 2 years). In the review discussion of a number of questions concerning the problem of clinicoinstrumental diagnosing of the lesions of joints in rheumatoid and reactive arthritis is presented. However the clinical picture is not always typical at the early stages, and the existing instrumental methods of diagnosing are informative in the detection of erosions only at the late stages of the disease when the treatment is already less effective. Of existing modern methods the ultrasound method of investigation which is widely applied in diagnosing of the lesions of both articular and extra-articular structures is promising and less expensive. However ultrasonic criteria of differential diagnosing of erosive lesions of the joints in arthritis haven’t been developed yet.

Surgery

Yurchenko S.A.
Effect of diazepam application in the preoperative period depending on the initial functional condition of the vegetative nervous system

Abstract. We examined 44 patients who had undergone planned operation. We investigated diazepam influence on the vegetative nervous system in the preoperative period. We divided all patients into two groups: cortisol decrease after premedication (18 persons) and cortisol increase after premedication (26 persons). We studied the dynamics of functional activity indices of the divisions of the vegetative nervous system before and after premedication in both groups using mathematical analysis of heart rate variability.
Diazepam shows tranquilizing action at hyperactivity of sympathetic division and activating action at hyperactivity of parasympathetic division of the vegetative nervous system.
 

Sapego I.A., Lukomsky I.V., Ulashchik V.S., Zenkov A.A., Grummo A.M.
Transcranial electrostimulation in early rehabilitation of patients after reconstructive operations on the main arteries of the head

Abstract. We examined 70 patients after reconstructive operations on the main arteries of the head to study the possibility of transcranial electric stimulation (TES) as a new method of rehabilitation. It has been found that the asthenic symptom complex (ICD: Х F07, F43) of a different degree of manifestation is the most frequent disorder in the postoperative period. The application of transcranial electric stimulation in the early postoperative period in addition to neuroprotective pharmacotherapy resulted in the acceleration of the reduction of neurosis-like symptoms. Clinical findings were confirmed by psychological and neurophysiological testing results, therefore we can recommend transcranial electric stimulation usage in early postoperative period after reconstructive operations on the main arteries of the head.
The material of this publication can be addressed to angiosurgeons, neurologists, general practitioners, physiotherapists, and rehabilitologists.

Obstetrics and gynecology

Lysenko O.V.
Cytokintherapy in complex treatment of endometrial polyps

Abstract. Endometrial polyps are an urgent problem of modern gynecology. We examined a total of 50 cases – women of reproductive and premenopausal age. Two groups of patients were analyzed according to histological data: with endometrial polyps, with normal proliferative endometrium. Tumor necrosis factor alpha (TNF alpha), interleukin 2 (IL-2), interleukin 4 (IL-4), sFas-ligand concentrations were determined by enzyme linked immunosorbent assay in blood serum and in aspirates from the uterus cavity. Statistical analysis included parametric and nonparametric statistical methods.
P<0,05 was considered significant. Differences in cytokines and sFas-ligand levels in serum were not found. In aspirates from the uterus cavity in women with endometrial polyps the concentration of sFas-ligand and IL-2 decreases and the concentration of TNF-d increases.
The treatment of endometrial polyps with the addition of Ronkoleukin to the traditional hormone therapy leads to the normalization of initial local cytokine disbalance, and the increase of sFas-ligand local level.
Адрес для корреспонденции: г.Витебск, пр. Строи-телей, д.12, кв. 41, тел. 21-70-96. – Лысенко О.В.

Pediatrics

Semenova O.V.
Cytokines and symptoms in the diseases of biliary tract in children

Abstract. The formulas of cytokines IL-1t:IL-2:IL-4:IL-6 may be presented as follows: in case of nausea 5:30:40:10, bitterness 130:20:20:15, vomiting 360:35:65:5, as distinct from adaptive response 5:10:5:5, this characterizes pathology progression and requires treatment correction. To recover the transit of bile and chyme, to reduce the contact of microflora with gastrointestinal tract epithelium in case of all symptoms ursodeoxycholic acid is indicated, in addition prokinetics or spasmolytics may be administered. The course of antibiotic therapy is indicated in case of bitterness or vomiting and considering their association with IL-1i, threshold concentration 28 pg/ml. The profile of cytokines represents the general mechanism of dyspepsia symptoms formation in children with biliary pathology, relapses of infections, under stress of different genesis and is a connecting link of immune, endocrine and nervous systems reactions. The decisive role in the formation of antiperistalsis plays IL-1p, IL-6 prolongs the effects and changes the metabolism, on delay of the transit of bile and chyme IL-4 influence dominates over IL-2 that differs from adaptive immune response and forms chronic process.

Matyushchenko O.V.
The state of the functional activity of B-cell immunity in children with bronchial asthma

Abstract. This article deals with the results of the analysis of the functional activity of B - cell immunity in children with bronchial asthma. Concentrations of IgA, IgM, IgG, IgE in blood serum were determined using the enzyme-linked immunosorbent assay (ELISA). 44% of children with allergic bronchial asthma have  local immunity failure due to low concentration of total IgA in blood serum, and 62% of the examined children have low level of total IgG, that can be regarded as a transient immunodeficiency state. Serious defects in the functional activity of B-cell immunity considering these immunoglobulins were not detected. 85% of children have total IgE concentration above the level of 100 IU / ml.

Allergology and immunology

Titova N.D.
Sensitization of granulocytes to food dyes in patients with allergic diseases

Abstract.  Diagnosing of adverse reactions to food additives is difficult due to a wide variety of mechanisms involved in their implementation and lack of sufficiently reliable methods for their determination. We examined 114 patients with allergic diseases, аll of them were examined clinically and laboratorially using the reaction of antigen induced damage of leukocytes (ADL) and the test of the release of myeloperoxidase (TRM) from granulocytes for the diagnosis of intolerance towards food dyes. Increased sensitivity of leukocytes to red dye azorubine was detected most frequently – in 11 out of 114 patients according to ADL and in 9 out of 83 patients according to TRM. Positive test results for yellow dyes – tartrazine and sunset yellow according to ADL were obtained in 7 and 9 out of 114 patients, respectively, and 7 and 4 out of 83 patients according to TRM. Practical application of the proposed methods will improve the accuracy of the diagnosis of allergy to food dyes.

Oncology

Medvedev M.N., Lyubenkova V.S., Malashenko S.V., Medvedeva L.Z.
Morphologic aspects of endoscopy diagnosing of gastric cancer

Abstract. The data about patients’ age and sex structure, the histological forms ratio of gastric cancer revealed in 2006-2007 while conducting fibrogastroscopy in Vitebsk regional clinical hospital are presented in this article. It has been determined, that gastric cancer occurs more often in the age groups over 50 years both in men and in women. Diffuse type cancer prevails among the histological forms of cancer of the stomach.

Aleksinsky V.S., Basinsky V.A.
Morphologic assessment of M-catenin expression in skin melanoma

Abstract. On the basis оf the immunohistochemical research data the adhesive properties of skin melanoma cells were analyzed. The influence of this prognostic marker on the clinical prognosis of the tumor, as well as its dependence on the stage of invasive growth by Clark, the thickness of the tumor by Breslow, the prevalence of primary tumor (pT) were shown.

Infectious and parasitic diseases

Logishinets I.A.
Morphofunctional aspects of homeostasis of hypophysis-thyroid system in experimental ascariasis

Abstract. The state of the histological structure, morphometrical parameters of the thyroid gland as well as the secretion of hypophysial-thyroid system hormones in experimental ascariasis depending on the stage and intensity of infection were studied.
It has been established, that migration of Ascaris suum larvae is accompanied by the changes of thyroid gland histological structure which are characterized by the enlargement of follicles, accumulation of colloid substance in them, reduction of follicular epithelium height and the size of its nuclei. In blood serum of the animals during the migration of Ascarides larvae the decrease in the concentration of thyreotropic hormone, triiodothyronine and thyroxin is observed. These changes are most expressed on the 7-th and 10-th days of the experiment. The degree of thyroid structural changes expressiveness and hormonal transformations in an organism of the host depend on the stage of the invasive process and the number of the ingested eggs.

Phthisiopulmonology

Seregina V.A., Budritsky A.M., Gapanovich S.E., Kuchko I.V., Romanovsky R.V., Pravada N.S., Zagorets T.M.
The epidemiological and clinical characteristic of relapses of respiratory organs tuberculosis in Vitebsk region

Abstract. In this paper we investigated the frequency of pulmonary tuberculosis (PTB), the causes of its development and peculiarities of its relapses course in Vitebsk region. We found significant negative impact of PTB relapses on the epidemiological situation in Vitebsk region due to high prevalence of patients with multiple drug resistance among them. The main causes of PTB relapses in this group of patients are social (absence of family, smoking and alcohol abuse, being imprisoned in their past history, unemployment) and medical (being ill with concomitant pathology of the respiratory tract, digestive system, diabetes mellitus, psychiatric disorders) risk factors. The prophylaxis of PTB relapses requires the formation of high risk groups out of persons having PTB in their past history taking into account social and medical factors.

Forensic medicine

Denisenko A.G.
Some indices of T-cells immunity at different intervals after death

Abstract. To establish the remoteness of death the total level of T-lymphocytes and of the so-called «active» T-lymphocytes was determined by the method of spontaneous rosetting with ram red blood cells (E-RFC), the level of T-lymphocytes expressing molecules-markers CD3, CD4, CD8, CD25 was also determined. Blood levels of T-lymphocytes (general and “active”) were determined using the E-RFC method in 31 deceased including 11 persons who died of coronary heart disease, 7 – poisoning with ethyl alcohol, 13 – other causes. In 10 cases of death from other causes (mechanical traumas and asphyxias) we used additionally the phenotyping method to determine the quantity of T-lymphocytes expressing CD3-, CD4-, CD8-, CD25-receptors. Lymphocytes were phenotyped in leukosuspension using anti-CD sets based on monoclonal antibody technology. The results were recorded using conventional light microscopy. We observed statistically significant changes of T-cellular component of the immune system with the decrease of T-cells (E-RFC) and also of CD3-, CD4-, CD8-lymphocytes quantity and the decrease of expression of receptors to IL-2 on CD25-lymphocytes in the course of time up to three days. These results may be used to establish the remoteness of death.

Dentistry

Sakharuk N.A.
Treatment and prevention of candidiasis of mouth in persons with chronic skin diseases

Abstract. Detection frequency of the genus Candida spp. fungi in persons with chronic skin diseases (psoriasis, eczema) in comparison with the control group as well as prevalence of candidiasis of mouth in the given groups of persons were determined. The evaluation of the oral cavity condition in the investigated groups of patients was made. The correlation between main stomatological indices (OHIS, GI, PI, CFR) and the severity degree of skin diseases, expressed by indices PASI for psoriasis and EASI for eczema, and also between the severity of oral cavity candidiasis and that of skin diseases was found. The scheme of examination, treatment and prevention of oral cavity candidiasis in patients, suffering from chronic skin diseases was proposed. It enables the increase of the efficacy of the provided treatment and the decrease in the number of relapses of oral cavity candidiasis in the given group of persons that was confirmed by observations in 6, 12 months.

Pharmacology

Kosinets A.N., Frolova A.V., Okulich V.K.
Retrospective analysis of S. aureus sensitivity to antiseptics conventionally used in surgical practice

Abstract. The retrospective analysis of sensitivity / resistance to synthetic antiseptics used during the period from 1997 to 2009 at the surgical departments of treatment-and-prophylactic establishments of Vitebsk region was made on the strains of  S. aureus, isolated from wound contents of the patients with pyo-inflammatory diseases and complications. All isolated strains possessed polyresistance to the administered antibiotics. The obtained data have shown the increasing resistance of the representative of Gram-positive causative agents of wound infections S. aureus to synthetic antiseptics and at the same time preservation of high efficacy of dioxidinum, hydrogen peroxide, chlorhexidin bigluconate, iodo-containing antiseptics, that presupposes the necessity of further development of medicinal preparations on their basis and their active use in complex antimicrobial therapy of purulent s urgery patients.

Medical psychology

Tserkovsky A.L.
The peculiarities of the subjective control of medical students

Abstract. This article is devoted to the research of the subjective control of medical students. In 432 students of the medical faculty the following scales of the subjective control have been studied: the general internal control, internal control in the field of achievements and internal control in the field of failures. The level of the subjective control is one of the indices of social maturity of a student. The decrease of the level of the subjective control leads to emotional instability, poor self-control, high tension that may cause socioenvironmental deadaptation of the students. The analysis of the received results allows to use the diagnosing technique of the subjective control level of J. Rotter in the work of psychological service and also to include it in psychodiagnostic techniques complex used at practical classes on the subject «The fundamentals of psychology and pedagogics».

Case from practice

Kuryakova L.Y., Petrova N.N., Klisho V.E.
Case of congenital hyperinsulinism in a child

Abstract. Hyperinsulinism is a condition caused by inadequate secretion of insulin by H-cells of the newborn’s pancreas. The causes of it can be both compensatory hyperplasia of these cells due to mother’s hyperglycemia and insulinoma, nesidioblastosis and some other congenital diseases. Under our observation there was a newborn child in whom steady hypoglycemia, resistant to the employed therapy was noted. During the examination the diagnosis «congenital hyperinsulinism» was made. The diagnosis was proved by means of molecular-genetic method. Thereafter specific therapy was chosen, as a result of which the condition of this child was compensated.

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