"vestnik vsmu" 2011 vol. 10 №3
Volkovich T.K., Korolkova N.K., Khoroshenkaya N.V.
Bacterial keratitis: etiology, pathogenesis
Abstract. Bacterial keratitis, being a grave inflammatory disease of the cornea, is a serious problem of modern ophthalmology. Anatomic features of the cornea cause the severity of a pathological process, high level of complications and, as a result, vision disability. The given article is devoted to the peculiarities of etiopathogenesis of bacterial keratitis.
Histology, cytology, embryology
Seasonal dynamics of lipid-containing and lipid-synthesizing structures in different topographic areas of the human skin
Abstract. Man lives in such climatic conditions in which his skin constantly experiences seasonal changes. Lipid-containing and lipid-synthesizing skin structures are involved in the processes of thermoregulation of the skin and also perform the barrier-protective function. 3 types of structures actively producing and secreting fat and fat-like substances are distinguished. Firstly, to them belong adipocytes of fat tissue which is the lipid-skin producer; secondly, keratinocytes, which produce fats in terminal differentiation; and thirdly, sebocytes of oil glands, which produce sebum by means of holocrine secretion.
These three groups of structures synthesize, secrete and accumulate fats, which differ in their chemical structure and to this or that extent, provide for physiological functions and cosmetic properties of the skin. In this paper seasonal dynamics of lipid-containing and lipid-synthesizing structures of different topographic areas of the human skin is shown.
Fedotov D.N., Myadelets O.D.
Comparative histological organization of adrenal glands in newborns, adults and people of extreme old age
Abstract. In this article the material concerning comparative histology of human adrenal glands in various age groups is presented. Ontogenetic regularities of adrenal structures growth, lipid content and functional features have been determined.
It has been established that the thickness of the capsule and the glomerular zone of the adrenal gland increases from birth to 30 years. In the gerontological period the thickness of the fascicle and reticular zones and lipid content in them reduce sharply. The greatest morphometric and morphofunctional values are observed in the adrenal glands of mature people (25-30 years).
Sharyakov D.E., Semenov V.M., Golubtsov V.V.
Clinicopathomorphologic peculiarities of postinfluenzal pneumonia
Abstract. The aim of this study was to make a comparative clinical and laboratory analysis of case histories and autopsy results of the patients who had died of metagrippal and community-acquired pneumonias.
We analyzed case histories and autopsy protocols of 21 patients who had died of acute community-acquired pneumonias. Viral pneumonia as a complication of influenza was detected in 6 patients (28,6%), community-acquired pneumonia of other etiology - in 15 patients (71,4%). Clinical examination data, autopsy results and those of microscopic examination of lungs, heart, kidney and brain preparations were studied.
We established the existence and nature of the key differences in the clinical course, laboratory data, as well as in the nature of pathoanatomical and histochemical changes in patients with community-acquired and metagrippal pneumonias. The factors causing the severity and high mortality risk in patients with metagrippal pneumonias were revealed.
In deceased patients the pattern of shock lungs and kidneys, brain swelling, degenerative changes in neurons and myocardium cells were observed. Having compared the clinical examination data and those of histological studies we can suppose that most of the pathological processes are associated with significant circulatory disorders in these organs.
Sivakov V.P., Podpalov V.P.
«Prehypertension» - the most significant traditional risk factors of arterial hypertension development in the future (the data of ten-year study)
Abstract. The research of 224 persons with normal arterial blood pressure which lasted for ten years has been carried out. Two groups have been composed: the first consisted of 86 persons with the optimal arterial blood pressure; the second group was made up of 138 persons with «prehypertension» (JNC VII).
Traditional risk factors of cardiovascular diseases development have been studied: age, sex, heart rate, threshold of salt sensitivity, body mass index, lipid blood spectrum. Besides, other factors have been studied: education, occupation, smoking, alcohol consumption, physical activity, cardiovascular diseases heredity, marital status.
It has been revealed, that in persons with «prehypertension» during the whole period of research clinical arterial hypertension has developed by 22,1% more often than in persons with optimal arterial blood pressure.
On the basis of the data of nonlinear binary logistical regression the most significant risk factors have been determined: heart rate, body mass index, total cholesterol.
Kozlovsky V.I., Dubas I.O.
Pathological orthostatic reactions in patients with arterial hypertension and community-acquired pneumonia
Abstract. This article is devoted to the correlation estimation of pathological orthostatic reactions (POR) with an increased aggregation of the suspension of leukocytes and platelets (SLP), low erythrocyte deformability (ED) and the development of unfavourable cardiovascular events (CVE) in patients with arterial hypertension (AH) of the 2nd degree and community-acquired pneumonia (CAP). It has been determined that the patients with AH of the 2nd degree and CAP had reliably higher frequency of POR compared with the data of the patients with AH of the 2nd degree without CAP, the presence of which was associated with higher aggregation of the SLP and low ED, that subsequently resulted in more frequent damage of vitally important organs. Thus, revealing POR in patients with AH of the 2nd degree and CAP, the authors proved that it was necessary to study the aggregation of the SLP and ED. Furthermore, it is rational to include in the complex of treatment medicines reducing the aggregation of the SLP and improving ED in order to prevent the development of unfavourable cardiovascular events in patients with POR.
Mastykova E.K., Konorev M.R., Matveyenko M.E.
Complications occurrence frequency of gastroesophageal reflux disease
Abstract. Frequency of gastric and intestinal metaplasia of the mucous membrane of the esophagus in patients with gastroesophageal reflux disease (GERD) has been determined. Occurrence frequency of erosions and ulcers of the mucous membrane and strictures of the esophagus in this category of patients has also been studied depending on the presence or absence of metaplasia.
The present study has determined that both erosions and ulcers of the mucous membrane of the esophagus are found reliably more often in the group of patients with GERD without metaplasia (42,%) than in the group of patients with GERD and gastric type of metaplasia (21,9%). Moreover, it has been found that ulcers of the esophagus are revealed reliably more frequently in the group of patients with GERD without metaplasia of the mucous membrane (19,0%) and the in group with intestinal type of metaplasia (29,6%) than in the group of patients with GERD and gastric type of metaplasia (3,1%).
There were no reliable differences in occurrence frequency of strictures in patients with GERD with and without metaplasia (gastric or intestinal type) of the mucous membrane of the distal part of the esophagus.
Obstetrics and gynecology
Petukhov V.S., Zanko S.N.
Iron deficiency and endothelium dysfunction as risk factors and diagnostic markers of placental insufficiency
Abstract. This article discusses the current pathophysiological mechanisms of placental insufficiency development in women with iron deficiency and anemia. The study included 116 pregnant women in the I trimester and 23 females of the control group. We evaluated endothelial function, the deformability of red blood cells, antioxidant activity of blood plasma and the intensity of lipid peroxidation depending on the degree of iron deficiency due to the level of C-reactive protein as a marker of inflammation. Pregnant women in the I trimester showed signs of endothelial dysfunction and decreased erythrocyte deformability. Iron deficiency was found in 84.4% of pregnant women by the 11th week of their pregnancy. High frequency of iron deficiency in pregnant women is a consequence of changes in reference standards, but despite this, determination of the concentration of serum ferritin is likely to be of great functional importance not limited by the diagnosing of iron deficiency. The obtained results allow us to revalue the role of iron deficiency diagnosing in the I trimester of pregnancy and provide additional opportunities for prevention of placental insufficiency.
Effectiveness of specific immunotherapy and interrupted hypobaric adaptation in the treatment of children with allergic diseases
Abstract. This article presents the results of effectiveness of specific immunotherapy (SIT) and hypobaric adaptation in the treatment of children with allergic diseases.
We have revealed the decrease of IL-4 and IL-6 (p<0,05), IgE total and TNF-< (p<0,1) in 70% of children after SIT course in the hospital, that testifies to the switch of immune response from Th2-type to Th1-type after 2 weeks of appropriate treatment. However, 30% of patients after SIT had increased concentrations of IL-6 and TNF-a (p<0,05), IgE total (p<0,1), that suggests the necessity to select such patients for possible further immunomodulating therapy.
We have also found out reliable reduction of the concentration of IL-4 (p=0,048) in children with allergic diseases after undergoing the course of hypobaric adaptation (n=15). The increase of blood serum levels of IL-6 and TNF--a hasn’t been observed after treatment.
Clinical-anamnestic and medicogenetic risk factors of cardiovascular pathology in young sportsmen having often been ill with acute respiratory infections earlier
Abstract. The results of researches aimed at determining the risk factors of cardiovascular pathology in young sportsmen having often been ill with acute respiratory infections earlier, engaged in kayaks and canoe rowing have been presented. The role of hereditary component (genetic polymorphisms GSTT1 (del), GSTM1 (del), GPX1 (Pro198Leu), MTHFR (C677T)), the results of clinical investigations, the influence of prooxidant environmental factor - tobacco smoking in the realization of risk of pre- and pathological conditions of cardiovascular system in young sportsmen have been considered.
Pathologic labor in mothers, the presence of cardiovascular pathology in the genealogical anamnesis, the presence of cyclic vomiting episodes in the anamnesis, the prevalence of saturated fats and simple carbohydrates in the diet, the inheritance of zero polymorphisms of genes GSTT1 (00), GSTМ1 (00), low active genotypes 198LeuLeu of gene GPX1, 677TT of gene MTHFR associated with increased levels of general creatine phosphokinase and aspartate aminotransferase in blood serum, decreased level of hemoglobin in peripheric blood have been determined to be the risk factors.
Clinical and laboratory criteria of selecting children for going in for sport
Abstract. On the basis of the results of clinical, hematologic, biochemical, molecular and genetic researches the criteria of selecting those children for going in for sport who earlier were often ill with acute respiratory infections have been elaborated. The role of genetic polymorphisms GSTT1 (del), GSTM1 (del), GPX1 (Pro198Leu), MTHFR (C677T) in the risk realization of pre- and pathological conditions of cardiovascular system in young sportsmen has been determined. The importance of clinical and anamnestic indices, alteration in the level of hematologic and biochemical indices in the early diagnosing of cardiovascular system disturbances in young kayaks and canoe oarsmen has been studied.
Neurology and neurosurgery
Sidorovich R.R., Smeyanovich A.F.
The use of combinations of surgical intervention methods on the brachial plexus structures in case of its extensive damage
Abstract. The aim of the present investigation was to study the effectiveness and productivity of combining surgical intervention methods on the brachial plexus structures depending on the methods used, the level of the damage and trauma period.
Surgical interventions on the brachial plexus structures with the use of different methods combinations (neurolysis, suture, autoneuroplasty, neurotization) were performed in 23 patients. The indication for the use of different methods combinations is polymorphism of the lesion of brachial plexus structures with different character and the level of the damage, which determine the choice of one or another surgical intervention combination in every concrete case.
The effectiveness of the combination of methods made up 78,3%, the productivity of power restoration of separate muscles of the upper extremity was 61,3%. There were no reliable differences in the effectiveness of surgical intervention combinations depending on the level of the damage and trauma period.
The conclusion is drawn that the combination of various methods of surgical intervention on the brachial plexus structures is an effective way to treat their traumatic damages at different levels.
Kulesh S.D., Filina N.A., Kostinevich T.M., Kletskova L.A., Savchenko M.E.
Long-term outcomes of cerebral insult in the large urban population of Belarus
Abstract. The regularities of five-year survival among the residents of Grodno having survived cerebral insult in 2001 were studied. The five-year risk of death due to survived cerebral insult made up 63,0% and was 2,9 times greater in comparison to people of similar age and sex in the general population of Grodno. Fatal outcomes during the 1st year of the follow-up were caused mainly by survived or repeated insult (67% of all deaths) in those patients who had survived the acute stage of the disease whereas other cardiovascular diseases were the prevalent causes of death (62%) during the subsequent period (2-5 years). The significant prognostic factors of five-year risk of death after cerebral insult have been determined such as age (hazard ratio (HR) 1,04), stroke in the anamnesis (HR 1,48), arterial hypertension (HR 0,76), and diabetes mellitus (HR 1,26). In the subgroup of patients having survived the acute stage of cerebral insult the reliable prognostic factors of five-year risk of death were age (HR 1,05), stroke in the anamnesis (HR 1,62), diabetes mellitus (HR 1,46), atrial fibrillation (HR 1,34), and myocardial infarction in the anamnesis (HR 1,43).
Change of cognitive event-related potential in young patients with primary cephalalgias under the influence of hypobaric hypoxic therapy
Abstract. Tension-type headache (TTH) and migraine are the most common forms of cephalalgias all over the world. They are accompanied not only by the aggravation of health and reduction of working capacity, but psychophysiologic disorders as well, which are the basis for the development of chronic disadaptation. The method of cognitive event-related potentials can objectively indicate psychophysiologic disorders, accompanying the pain syndrome development. The article shows the changes of cognitive event-related potential parameters in patients with various forms of primary cephalalgias. The initial disturbance of the process of directed attention in patients with combined headache and chronic TTH (CTTH) was revealed. There was no difference in P300 wave parameters in patients with episodic TTH (ETTH) and migraine and people without headache. Hypobaric hypoxic therapy produced reliably positive effect on the components dynamics of cognitive event-related potential in the subgroups of patients with CTTH and migraine. At the same time in patients with combined headache, significant changes of P300 parameters were not revealed after the course of treatment.
Zhiltsov I.V., Veremey I.S., Semenov V.M., Zenkova S.K., Vasilyeva M.A.
Beta-lactamase activity of CSF is a possible cause of inefficacy of antibiotic treatment of bacterial CNS lesions
Abstract. We have designed the test system «BioLactam» which is capable of registering the level of beta-lactamase activity in biological substrates. In the present study we have evaluated the fundamental possibility of determining beta-lactamase activity of cerebrospinal fluid (CSF) using the test system «BioLactam», and also made an analysis of clinical significance of this parameter. As a result it has been revealed that our test system may be successfully used for qualitative and quantitative evaluation of beta-lactamase activity in CSF. We have demonstrated that up to 97,6% of CSF samples possess beta-lactamase activity which exceeds zero. The highest level of CSF beta-lactamase activity was detected in patients with subarachnoid hemorrhage that may be explained by significant increase of human serum albumin concentration in CSF. This fact makes it possible to use the evaluation of CSF beta-lactamase activity as an additional test for diagnosing subarachnoid hemorrhages. The lowest level of beta-lactamase activity of CSF was revealed in patients without CNS diseases, whereas the mean levels of CSF beta-lactamase activity in patients with viral and bacterial meningitis were comparable and had no reliable differences. Finally, relatively high (above 20%) level of CSF beta-lactamase activity 1,8-2,3 times increases the probability of failure of starting empirical antibacterial treatment given to the patients with bacterial CNS lesions, and this increase is statistically significant.
Zhiltsov I.V., Veremey I.S., Semenov V.M., Shatalov S.Y., Kuryanovich A.V., Malinovsky V.A.
High beta-lactamase activity of sputum as a predictor of failure of antibacterial treatment of bacterial pulmonary lesions
Abstract. We have designed the test system «BioLactam» which is capable of registering the level of beta-lactamase activity in biological substrates. In the present study we have evaluated the fundamental possibility of determining beta-lactamase activity of sputum using the test system «BioLactam», and also made an analysis of clinical significance of this parameter. As a result it has been revealed that our test system may be successfully used for qualitative and quantitative evaluation of beta-lactamase activity in sputum. Up to 89% of sputum samples possess beta-lactamase activity which is above zero; for all this, beta-lactamase activity of sputum in patients having pneumonia, chronic obstructive pulmonary diseases and cancer of the lungs doesn’t differ reliably. At least in some cases human serum albumin contributes to the total level of beta-lactamase activity of sputum; this influence may be eliminated by the treatment of sputum samples with suspension of Blue Sepharose beads (Sigma cat. # R9903). Relatively high (above 20%) beta-lactamase activity of sputum reliably increases 2,0-3,1 times the probability of failure of starting empirical antibacterial treatment of bacterial lesions of bronchi and lungs. Ultimately, test system «BioLactam» enables us to evaluate the presence and the level of sputum beta-lactamase activity avoiding the mandatory step of obtaining pure culture of microbial agent from the sputum.
Kuchko I.V., Zhiltsov I.V., Veremey I.S., Semenov V.M., Generalov I.I., EgorovS.K.
Beta-lactamase activity of human blood serum and its clinical and pathogenetic significance
Abstract. In the present study we have demonstrated that blood serum of all sick and healthy individuals is characterized by a certain level of beta-lactamase activity. An average level of this activity was 61,2% (95% CI: 60,3…62,1), and values of this factor ranged from 0 to 99,2%. We observed consecutive decrease of average values of blood serum beta-lactamase activity in the following order: practically healthy conscripts > traumatic pathology patients > adenoviral infection patients > acute purulent tonsillitis patients > patients with the pandemic flu (H1N1, or «swine») > bacterial pneumonia patients > patients with pulmonary tuberculosis > patients with viral meningitis > erysipelas patients > patients with bacterial meningitis. Serum beta-lactamase activity in young and healthy persons is considerably higher than that in sick individuals; in turn, this activity decreases in patients alongside with the increase of disease severity and duration; thus, low level of serum beta-lactamase activity may be used as a reliable (p<0,001) independent prognostic factor of severe and/or protracted course of infectious diseases. Beta-lactamase activity of blood serum isn’t a response of an organism to the influence of beta-lactam antibiotics. The use of factor analysis enabled us to reveal the group of patients with severe course of pathologic processes accompanied by significant duration of antibacterial therapy, frequent replacement of antibiotics and frequent administration of the reserve antibacterial preparations of all available groups and high level of beta-lactamase activity of blood serum.
The influence of different morphologic types of diabetic macular edema on the efficacy of antiangiogenic therapy
Abstract. The purpose of this research was to study the efficacy of intravitreal bevacizumab administration in the treatment of various morphological types of refractory diabetic macular edema (DME) according to the data of optical coherence tomography (OCT).
In this retrospective study 58 eyes (48 patients) with refractory DME were included. According to OCT data patients were divided into three groups: with diffuse spongiform retinal swelling, cystoid macular edema and serous neuroepithelial retinal detachment.
It was determined that intravitreal bevacizumab injections were effective in all three types of DME. The final result depended on visual acuity before treatment.
It can be concluded that the efficacy of intravitreal bevacizumab injections in refractory DME treatment doesn’t depend on its morphological type and initial central retinal thickness. Initial visual acuity has a strong positive correlation with final visual acuity and is an important predictor of high visual acuity after treatment.
Hygiene and ecology
Ivanov V.S., Cherkasova O.A.
The role of industrial enterprises in polluting soil with cobalt, copper, lead
Abstract. On researching soil condition of the town great attention is devoted to heavy metals as urban environment pollution indicators. In the article the factual data of monitoring of Vitebsk soil pollution with heavy metals (Co, Cu, Pb) for 2009 are presented. The main sources of city soils pollution - the industrial enterprises: public joint-stock company «Vitebsk radio components plant» Monolit», «Vitebsk pilot-production plant» of industrial association «Soyuz-energoavtomatika», public joint-stock company «Vitebsk electric measuring devices plant», public joint-stock company «Vizas» plant, public joint-stock company «Vityaz», republican unitary industrial enterprise «Megom» plant, public joint-stock company «Ceramics», republican unitary enterprise «Evistor» plant were analyzed. As a result of the conducted studies it has been determined, that cobalt and lead are priority contaminants of Vitebsk soil, copper - to a lesser degree. Dust-gas emissions of the industrial enterprises manufacturing radio components, electric measuring devices and machine- tools, boiler and power installations are the main sources of environmental pollution with heavy metals. It is necessary to realize complex of measures aimed at the decrease of technogenic pollution of soils in the town of Vitebsk.
Chernyavsky Y.P., Dolin V.I., Stepanov V.N.
Pharmacologic correction of patients stress state at the prosthetic dentist`s
Abstract. This paper presents the results of the comparative characteristic of the efficacy of drugs with anxiolytic and analgesic effects. The aim of the study was to determine the most appropriate drugs for correction of dental stress in orthopedic dental patients. We examined 84 patients during the first and repeated visit to a prosthetic dentist. The age of the patients ranged from 25 to 72 years. Successively, we investigated the efficacy of drugs with anxiolytic effects, such as novo-passit and tenoten, and with analgesic effect: metamizol sodium (analginum) and diclofenac sodium. For each drug sample size was 21 people. We evaluated changes in autonomic and hemodynamic indices to determine the efficacy of different drugs. As a result of this study we have found that tenoten has marked stress-protective effect and excels novo-passit. In its turn metamizol sodium has a greater analgesic effect than diclofenac sodium.
Khodos O.A., Samsonova I.V., Gidranovich L.G., Sachek M.M.
Ethylmethylhydroxypyridine succinate and thiotriazolin influence on the histological structure of brain in rats after chronic alcohol intoxication
Abstract. Histological structure of brain after chronic alcohol intoxication and ethylmethylhydroxypyridine succinate and thiotriazolin influence was investigated in experiments on Wistar line male-rats.
It has been shown that abstinence syndrome is accompanied by severe hemodynamic disorders in the brain microcirculatory bed, increase of metabolic and irreversible dystrophic disturbances of atrophic (kario- and cytopyknosis) and necrotic (kario- and cytolysis, karyorrhexis) character. These changes provide for the brain functional activity lesions.
The administration of Ethylmethylhydroxypyridine succinate and Thiotriazolin leads to decrease of destructive changes due to their vaso- and neuroprotective influence resulting from their positive effect on brain tissue metabolism and microcirculation.
Khodos O.A., Gidranovich L.G., Sachek M.M.
Thiotriazolin influence on proteinases and their inhibitors activity in brain tissue in chronically ethanol intoxicated rats
Abstract. The influence of thiotriazolin on proteolysis intensity in brain tissue extract, cerebellum and blood serum in rats at withdrawal after chronic alcohol intoxication was studied. Thiotriazolin was shown to normalize the activity of trypsin-like proteinases and their endogenous inhibitors in cerebral hemispheres tissue of rats up to the normal levels in 7 days and in cerebellum tissue in 1 day after alcohol withdrawal. Thiotriazolin stabilizes the activity of cysteine proteinases and their endogenous inhibitors in cerebral hemispheres in 3 days and in cerebellum tissue in 1 day after alcohol withdrawal. Thiotriazolin doesn`t normalize the balance of activity of proteinases and their inhibitors in blood serum because the activity of 1-proteinase inhibitor remains reliably less than the normal levels even in 7 days after alcohol withdrawal.
Chaly G.Y., Titorovich O.V., Kheydorov V.P.
The unique chemical and biological properties of hypochlorite ions and their application
Abstract. The studying of the reactions of oxidative transformation of biologically active substances affected by hypochlorite ions (OCl–) is of interest for applied medicine and pharmacy. Recently it has been established, that hypochlorous acid (HOCl), containing highly active oxidizing group - hypochlorite ion, is formed in the human organism and is the basic protective component of the immune system against bacteria and viruses. In the human body hypochlorite ions are capable of modelling oxidizing function of liver cytochrome P-450, thanks to this fact hypochlorite ions solutions are used as drugs even intravenously.
In the present work the kinetic study of oxidation reaction of pentoxifylline by means of hypochlorite ions at various temperatures and concentrations of both reagents in water solutions with physiologic value of рН was conducted for the first time. The rate law which describes the kinetics of the process was offered. The reaction was determined to have the first order both according to the oxidizer, and the substrate. It was experimentally shown, that the change of ionic force of the medium did not exert any marked influence on the rate of oxidation. The reaction mechanism was proposed.
The conducted experimental studies and the obtained kinetic results can serve as a basis for further investigation of oxidative transformation of medicinal substances with hypochlorite ions, and also for the use of hypochlorite ions in clinical toxicology in case of overdosage or pentoxifylline and other substances poisoning.