Alimentary-constitutional Obesity Research Articles

The effectiveness of the physical therapy program for patients with metabolic syndrome based on the study of the dynamics of the functional state of the autonomic nervous system and hemodynamic parameters

Purpose: determination of the influence of the physical therapy program on the dynamics of blood pressure, heart rate and vegetative Kerdo index in patients with metabolic syndrome. Material & Methods: the study was conducted on the basis of the Municipal institution of health care "Kharkiv City Hospital No. 3". 28 young women were under observation, randomly divided into two groups: the main group (MG) – 14 patients and the control group (CG) – 14 patients. The mean age of patients in the MG was 31,49±0,71 years, in the CG – 31,06±0,57 years. The patients of the main group underwent rehabilitation measures according to the author's program of physical therapy, which included a hypocaloric diet with a lipid-lowering orientation (lipid-lowering diet No. 1), the basic principles of which are developed by the American Heart Association, therapeutic massage for patients with alimentary-constitutional obesity; kinesitherapy using elements of sports-oriented aerobics and special physical exercises based on Pilates gymnastics using fitballs and expanders; dosed walking in combination with breathing exercises, taking into account the activity of the autonomic nervous system, for patients in the control group – according to the program used for metabolic syndrome in the indicated medical institution. To identify the effectiveness of the author's program, a comparison was made of heart rate, arterial tonometry, vegetative Kerdo index (V.I.) at the beginning and end of the study. Results: in the determination and analysis of blood pressure, heart rate and vegetative Kerdo index during the second study, we noted the normalization of heart rate, SBP, DBP in women of the main group (р>0,05), in the control group, the dynamics of DBP was statistically insignificant (р>0,05). In women of the main group, the heart rate during the second examination compared with the primary one decreased by 19,8%, the SBP level decreased by 9,1%, the DBP level decreased by 11,0%. In CG patients, the heart rate during the second study decreased by 8.8% compared to the primary one, the SBP level decreased by 5,2%, the DBP level decreased by 3,9% (р>0,05). Conclusions: comparison of the obtained results of the study showed the normalization of hemodynamic parameters and the tone of the autonomic nervous system, there was also a tendency towards balance of the sympathetic and parasympathetic divisions of the ANS in patients of the main group, in the physical rehabilitation of which therapeutic exercises were applied with the use of regulated breathing exercises, taking into account the tone of the sympathetic or parasympathetic divisions of the autonomic nervous system, which helps to improve the quality of life of patients with metabolic syndrome.

Predictors of lethal outcomes in severe cases of a new coronavirus infection COVID-19

Background. The spread of the new coronavirus infection COVID-19 has already become one of the main problems of national healthcare systems around the world. Until now, it has not been possible to find drugs with sufficient etiotropic activity for COVID-19, and therefore, it is important to determine new points of application for pathogenetic therapy in relation to this pathology.
 Aim. To identify the predictors of an unfavorable outcome of a severe course of COVID-19 infection to determine the prognosis of the clinical course and optimize treatment tactics using succinates.
 Material and methods. A retrospective observational study of 46 cases of treatment with a severe form of the disease on the basis of a monohospital for the treatment of patients with a new coronavirus infection was conducted. All patients had comobrid pathology (median Charlson index 3 points). The most common ones were: encephalopathy of mixed genesis, diabetes mellitus, coronary heart disease, arterial hypertension, alimentary-constitutional obesity. We assessed the relationship between indicators of initial status and mortality in patients, and indicators with a statistically significant relationship were selected as predictors. Statistical processing of the results was carried out in the IBM SPSS v. 23.0, ROC analysis was used to find the relationship between quantitative predictors and lethal outcome.
 Results. Among the treated parameters, the most significant influence on the risk of death was found in arterial anion gap (odds ratio 28.78; p 0.017) and fibrinogen level (odds ratio 22.20; p 0.01). To a lesser extent, the level of urea, aspartate aminotransferase, and the Charlson comorbidity index had an effect on the prognosis of a lethal outcome. The identified predictors of an unfavorable outcome of a severe course of COVID-19 infection can be used to predict the clinical course and build treatment tactics based on the received information.
 Conclusion. Predictors of poor outcomes in severe COVID-19 infections include arterial anion gap and fibrinogen levels, and to a lesser extent, urea levels, aspartate aminotransferase levels, and the Charlson comorbidity index.

Risk of Developing Severe Alimentary-Constitutional Obesity and Metabolic Disorders: Interventional Comparative Study

Background. The relevance of alimentary-constitutional obesity, especially its severe forms, is associated with a number of metabolic disorders, subsequently leading to serious chronic noncommunicable diseases.Objective. To identify factors that increase the risk of severe alimentary-constitutional obesity and metabolic disorders.Methods. A follow-up group of 426 patients aged 18 to 65 years was formed among those seeking help from an endocrinologist for overweight or obesity. The diagnosis of alimentary-constitutional obesity was confirmed at the initial examination in the outpatient clinic setting. Depending on the severity of obesity and the type of fat deposition according to anthropometric data (body mass index, waist circumference), the study participants were ratified into two study groups. The research was conducted between 2010 and 2017 in outpatient settings and was based on a cross-sectional comparative study. In order to assess the risk of severe obesity and factors associated with it, the authors studied medical history data, results of physical examination, including blood pressure level, laboratory examination with analysis of carbohydrate, fat metabolism and liver function, assessed eating behaviour, and performed diagnosis of anxiety-depressive disorder. Statistical analysis of the results was carried out using Statistica 10 (StatSoft, USA).Results. Women are more likely to see an endocrinologist with less severe obesity than men. Severe obesity risk is higher in middle-aged and elderly people, as well as in hereditary tainted patients and those having a history of obesity for more than 10 years. Severe obesity itself is a significant risk for metabolic events, with a 4-fold higher risk of hyperglycaemia and hypercholesterolaemia (due to very low density lipoproteins) and a 5-fold higher risk of hyperinsulinaemia and insulin resistance.Conclusion. Analysis of severe obesity risks has shown that earlier personal commitment to a healthy lifestyle is essential for weight loss and subsequent improvement of metabolic parameters, particularly in men and those aged 45 years or older.

Risks for obesity-associated diseases and conditions

Alimentary-constitutional obesity is a chronic heterogeneous multifactorial disorder, the relevance of which can hardly be overestimated. The severe forms of this disorder are accompanied by specific complications, a high cardiometabolic risk, and obesity-related comorbidities. Objective. To study obesity-associated diseases and conditions. Subjects and methods. The investigation involved 426 overweight and obese patients. They underwent an examination that included historical data collection; physical examination for estimation of the severity of obesity and the grade of hypertension; abdominal ultrasound for diagnosis of hepatic steatosis or non-alcoholic fatty liver disease (NAFLD), and laboratory testing for a study of the parameters of carbohydrate and fat metabolisms and liver function. Results. Patients with severe alimentary-constitutional obesity had a higher risk of comorbidity: the risk of hypertension was elevated by 3.5-fold, type 2 diabetes mellitus and impaired glucose tolerance by 5-fold, metabolic syndrome by 4-fold, and NAFLD by 5.5-fold. Conclusion. Severe alimentary-constitutional obesity is a risk factor for comorbidity. At the same time, the solution of losing weight is a complex task to physicians of various specialties and consists of measures in both public health and patient commitment to a healthy lifestyle.

Variability of the level of the N-terminal fragment of brain natriuretic propeptide in plasma in hypertensive patients with/and without chronic coronary disease

Annotation. The article presents the results of studying the variability of the level of the N-terminal fragment of brain natriuretic propeptide (NT-proBNP) in plasma in patients with hypertension with/and without chronic coronary disease. An open observational one-point randomized comparative study included 118 patients with stage II hypertension with/and without chronic coronary disease (stable angina pectoris I-III functional class). An additional criterion for inclusion in the main group was the presence of atrial fibrillation. All patients, in addition to general clinical examination, additionally determined the levels of NT-proBNP in the blood plasma. Statistical processing of the obtained data was carried out using Microsoft Excel (2016) and Statistica 12.0 (Statsoft, USA). Absolute values were presented as the average value of the indicator (Mean) ± standard deviation for the sample (SD, standard deviation). Comparison of mean values in groups was performed using one-way ANOVA & LSD test. The dependence of the NT-proBNP level on the duration of the hypertensive history, the value of the functional classes of angina pectoris of chronic heart failure was proven. At the same time, it was demonstrated the lack of interdependence of the level of this biomarker with the clinical variant of atrial fibrillation and its characteristics, such as the duration of the history, ENRA class and frequency of attacks. The fact of a decrease in the level of NT-proBNP in the plasma in the case of alimentary-constitutional obesity and an increase in the body mass index was confirmed. In addition, an increase in the level of this biomarker was observed in the case of presence of hypertrophy of the left ventricle according to the ECG data, as well as in the case of a decrease in the value of the glomerular filtration rate, calculated according to the CKD-EPI formula.

The value of laboratory indicators estimation in patients with metabolically healthy obesity: analysis of a clinical case with literature review

Introduction. Obesity currently is a relevant issue of modern medicine due to its global prevalence, heterogeneity of clinical and laboratory manifestations, as well as the association with various comorbid conditions. Depending on the metabolic status, metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) are distinguished. MUO is defined with the presence of criteria for metabolic syndrome (MS) and is associated with an increased risk of cardiovascular and metabolic complications. MHO is characterized by a «metabolically healthy» profile, but the probability of a favorable course of the disease is controversial; many studies indicate the instability of the MHO phenotype and the possibility of further development of MUO. The aim of study: to analyze the features of laboratory indicators associated with MHO and determine the risk factors for the MUO development on the example of a clinical case. Materials and methods. A clinical case of 24 year old female patient diagnosed with alimentary-constitutional obesity class III. Objectively: height – 174 cm, weight – 124.7 kg, body mass index (BMI) – 41.21 kg/m2, waist circumference – 107 cm, hips circumference – 144 cm; white striae on the abdomen; excessive subcutaneous fat stores, mostly distributed in the abdomen, thighs; blood pressure (BP) – 125/80 mm Hg. Investigation data: hyperleptinemia – 86.82 ng/ml, increased level of HOMA index – 4.6, hyperuricemia – 6.8 mg/dl, vitamin D deficiency – 9.19 ng/ml; lipid profile, fasting plasma glucose, glycated haemoglobin (HbA1c), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-thyroid peroxidase (anti-TPO) antibodies, cortisol, blood electrolytes, liver function tests – within normal limits. Electrocardiography (ECG), ultrasound of the heart and abdominal organs – without pathology. Results. Normal indicators of lipid metabolism, blood glucose and BP measurement in our patient are characteristic for MHO. However, the combination of hyperleptinemia with insulin resistance, hyperuricemia and vitamin D3 deficiency indicate metabolic and hormonal imbalance and are considered as a risk factors for the development of MS and the further transition of MHO to MUO. Conclusion. MHO should be considered as a transient state, the management of such patients requires careful laboratory monitoring with early detection of metabolic disorders and its adequate and timely correction.

Risks for development of metabolic disorders in alimentary constitutional obesity

BACKGROUND: alimentary-constitutional obesity due to it’s high prevalence, is the key problem of modern healthcare system. However, obesity is not always accompanied with metabolic disorders, leading to early invalidization and mortality. That’s why it is important to study risks of metabolical nonhealth in obesity.AIM: to detect factors, increasing risks of development of metabolic disbalance in alimentary-constitutional obesity.MATERIALS AND METHODS: In patients with alimentary-constitutional obesity there was performed an examination including anthropometry (body mass index, Waist Circumference, Hip Circumference,waist to hip ratio), blood pressure measurement, laboratory tests – metabolic indexes: glucose, insulin, insulin resistance indexes, leptin, cholesterol, cholesterol of lipoproteins, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamiltransferase), body composition measurement by bioelectrical impedance analysis; patients were also interviewed on their behavior (food habits) and physical activity.RESULTS: There were formed two groups depending on metabolic health indexes: main group – metabolically non-healthy obesity (MNHO) - 241 persons (aged 41±12,09, duration of obesity 12,5±9,51 years) with alimentary-constitutional obesity and two or more signs of MS, a comparison group – of metabolically healthy obesity (MHO) – 120 persons (aged 35,5±10,03; p<0,05, duration of obesity 8,0±7,39 years; p<0,05) with alimentary-constitutional obesity and one sign of MS or without it. Data analysis of studied risk factors for development of metabolically non-healthy alimentary-constitutional obesity confirmed that most relevant factor in development of MNHO is abdominal fat mass distribution (increasing of Waist Circumference over 88 sm in females and over 102 sm in mails). At the same time MNHO had correlation not only with classical signs of MS, but also with blood insulin level, insulin resistance indexes, fat metabolism disbalance and liver disfunction. More severed risk for appearance of metabolic disorders have patients over 45 years old with decreased active cell mass (less than 45%), duration of obesity above 10 years and obesity-burdened heredity. In food habits risk of development of metabolically non-healthy obesity was increased in taking of fat milk food, and, on the contrary, - frequent snacks, alcohol free sweet drinks didn’t affect it.CONCLUSION: Development of MNHO is associated not only with the age of patient, duration of obesity, carbohydrate and fat metabolism indexes, but also with decreased percentage of metabolically active tissues and some food habits.

INTERACTION OF INDICATORS OF STAT SIGNALING AND WNT SIGNALING IN THE PROCESS OF ADIPOGENESIS

An increase in the consumption of high-calorie foods combined with the spread of a sedentary lifestyle are the main factors contributing to the growth of obesity in modern society. Due to excess body weight, the course of many chronic diseases is aggravated, including diabetes mellitus, cardiovascular diseases, non-alcoholic fatty liver disease, etc. In recent years, many researchers have paid close attention to the involvement of transcription factors of signal transducers and STAT transcription activators in the pathogenesis of metabolic diseases. It has been established that STAT signaling is involved in the most important functions of metabolically active tissues, including fat cells, liver, skeletal muscles and pancreatic B cells, as well as in immune cells, including macrophages, natural killers and T cells. The WNT signaling pathway is an important regulator of the development and progression of organ and cell growth. In vivo and in vitro studies have shown that components of the WNT pathway are involved in pancreatic β-cell proliferation, lipid metabolism, and glucose-induced insulin secretion. The interaction of STAT and WNT signaling systems in the process of adipogenesis is poorly studied. The purpose of this study was to study the interaction of these signaling systems. The study included 39 people aged 40 ± 10 years, of which 15 people with normal body weight, they made up the control group. The study group was represented by 24 patients with alimentary-constitutional obesity of I - III degree in the absence of diabetes mellitus. A complex of immunological and general clinical research methods was used in the work. The study revealed a correlation of STAT and WNT indicators of signaling systems, which suggests that a change in the concentration of proteins representing these signaling systems has a multidirectional regulatory effect on adipogenesis. Determination of the level of correlating proteins in blood serum may be promising for the diagnosis and new therapeutic approaches to the treatment of obesity, liver steatosis and other diseases.

Correction of carbohydrate metabolism by means of physical therapy of patients with metabolic syndrome

Purpose: to investigate the characteristics of carbohydrate metabolism indicators in patients with metabolic syndrome before the beginning of rehabilitation effects as well as to trace the dynamics of indicators in the process of application of our physical therapy comprehensive program. Material and methods. The survey involved 70 women with metabolic syndrome, who were divided into the main (MG) (35 women) and control (CG) (35 women) groups with the average age in the MG 31.49±0.71-year-olds, in the CG – 31,06±0,57 -year-old. In the main group, a physical therapy program was applied for patients with metabolic syndrome, which includes a hypo caloric diet with a hypolipidemic focus; therapeutic massage according to the method of P.B. Efimenko for patients alimentary-constitutional obesity; medical gymnastics using elements of sports-oriented aerobics and special physical exercises based on Pilates gymnastics using fitballs and expanders; morning hygienic gymnastics; limited walking in combination with breathing exercises, taking into account the activity of the autonomic nervous system. Result. As a result of a comprehensive and developed physical therapy program that was justified and applied for 4 months for patients with metabolic syndrome, the studied carbohydrate metabolism parameters changed significantly. Main group women showed significantly improved indicators of glycemia on empty stomach: from 8,85±1,54 to 5,98±0,81mmol / l, glycemia after eating: from 11,47±1,85 to 7,68±0,86mmol / l and reached the target levels of diabetes compensation and diagnostic criteria for the metabolic syndrome. Conclusions: physical exercises contribute to the improvement and normalization of carbohydrate metabolism. They restore adaptation to physical exertion and normalize the function of the cardiovascular system, motor activity and psychoemotional state as well.

Подход к профилактике и лечению неалкогольной жировой болезни печени у детей с ожирением с позиции современных международных рекомендаций

Актуальность. Статья посвящена проблеме профилактики развития и терапии неалкогольной жировой болезни печени (НАЖБП) у детей с ожирением по алиментарно-конституциональному типу. Цель: изучение эффективности и безопасности использования препаратов омега-3 полиненасыщенных жирных кислот (ПНЖК) с витамином Е и мультипробиотического комплекса, обогащенного витаминами, для профилактики развития и прогрессирования стеатогепатоза. Материалы и методы. Под наблюдением находились 55 детей с избыточной массой тела. Всем пациентам была назначена медикаментозная терапия с использованием препарата омега-3 ПНЖК Рейтоил и комплексного пробиотика Бревелак (Lactobacillus helveticus R0052, Lactococcus lactis ssp. Lactis R1058, Bifidobacterium longum R0175, Lactobacillus rhamnosus R0011, Bifidobacterium breve R0070, Streptococcus thermophilus R0083, Bifidobacterium bifidum R0071, Lactobacillus casei R0215, Lactobacillus plantarum R1012) на фоне модификации образа жизни. Результаты. Течение НАЖБП у детей в большинстве случаев не имеет характерной клинической симптоматики и выраженного синдрома цитолиза. Структурно-функциональные изменения в печени при НАЖБП могут вызывать метаболические нарушения с формированием выраженной атерогенной дислипидемии. Трехмесячный курс терапии НАЖБП препаратами омега-3 ПНЖК Рейтоил в сочетании с использованием комплексного пробиотического препарата Бревелак показал достоверное снижение активности печеночных цитолитических ферментов и улучшение показателя липидного спектра крови. Выводы. Назначение препаратов омега-3 ПНЖК в сочетании с комплексом штаммов пробиотических культур с доказанной клинической эффективностью при НАЖБП на фоне модификации образа жизни способствует эффективной профилактике и лечению данной патологии у детей.

Клиническое течение и распространенность ожирения в сочетании с дисфункцией сфинктера Одди по панкреатическому типу у подростков

Актуальность. Гастроэнтерологические проявления ожирения являются актуальной проблемой медицины вследствие взаимоотягощающего характера. Цель работы: изучить распространенность и клинические особенности течения у подростков с алиментарно-конституциональным ожирением и сопутствующей дисфункцией сфинктера Одди по панкреатическому типу и без данного сочетания. Материалы и методы. Обследованы 120 подростков с алиментарно-конституциональным ожирением в сочетании с дисфункцией сфинктера Одди по панкреатическому типу, которые находились на лечении в областной детской клинической больнице г. Ивано-Франковска за период с 2016 по 2019 год включительно. Больные подлежали комплексному обследованию в соответствии с современными протоколами диагностики и лечения. Результаты. Распространенность ожирения по Украине, по данным статистики, составляла 13,4 % на 1000 детского населения. Среди пациентов преобладали мальчики (70,0 и 30,0 %, р < 0,05). Продолжительность болезни у большинства детей с сочетанной патологией составила 6,0 ± 2,1 года, а в случае изолированного течения заболевания — 4,5 ± 3,1 года. К доминирующим факторам риска вовлечения поджелудочной железы в патологический процесс относились: генетическая предрасположенность (наличие ожирения или избыточной массы тела у одного или двух родителей), гиподинамия и нарушение рациона питания (преобладание мучных изделий и сладостей), реже — недостаточный питьевой режим. Среди клинических проявлений сочетанной патологии доминировала спастическая боль с локализацией в левом подреберье и продолжительностью несколько часов, которая плохо снималась спазмолитиками (75,0 и 25,0 %, c2 = 17,69, р < 0,05). Общий диспептический индекс (вздутие живота и понос) у детей с сочетанной патологией был выше, чем у остальных обследованных (5,01 ± 0,06 и 3,02 ± 0,04 балла, р < 0,05). Интоксикационный индекс за счет общей слабости был самым высоким в когорте детей с алиментарно-конституциональным ожирением и функциональным панкреатическим расстройством (7,02 ± 0,06 и 3,50 ± 0,02 балла, р < 0,05). Выводы. Ожирение часто сочетается с функциональной патологией поджелудочной железы, а отдельные клинико-лабораторные маркеры и факторы риска вовлечения поджелудочной железы в патологический процесс должны лечь в основу обновленных протоколов диагностики и лечения.

Exocrine pancreatic dysfunction in children with obesity: characteristics of clinical picture and diagnostics

Introduction. During the last twenty-five years the occurrence of obesity in children and teenagers has increased significantly. Materials and methods. 110 adolescents of 12–17 years old, with alimentary-constitutional obesity and involvement of pancreas and without its injury, as compared to the 30 healthy children of control group, were examined. The research provided determination of the sizes and elasticity of pancreas. The detection of the total cholesterol, high density lipoproteins and leptin level was carried out. Intensity of clinical symptoms (spastic pain in epigastrium and left subcostal arc; abdominal pain without localization, vomit without relief, general weakness) have been made accordingly to sum of points (from 0 to 3 points). If sum of points makes from 0 to 2 – intensive character of abdominal pain is low, from 3 to 5 points – it is high, from 5 to 10 points – it is very high. Normal level of amylase in a blood serum (Karavey’s method) is 12–32 g/(hour l), аnd diastase in urine – 20–160 g/(hour l). We made a screening test for elastase-I level by ELISA test. Normal activity of this enzyme in feces is 200 мkg/g. We have used sonographic method for detection of pancreatic diseases in obese children due to echo-structure of parotid gland. The analysis and statistical data processing were made by computer program "Statistica 7.0" and MS Excel XP. Research data. Physical inspection of our patients confirms prevalence of І degree over II degree obesity (52.7 % and 47.3 %, respectively; Р < 0.05). We have confirmed valid risk factor of pancreatic lesion in obese children – presence of diabetes mellitus type I in close relatives (80 % and 65 %, χ2 = 2,05; Р < 0.05). The changes of exocrine function of the pancreas in children with the stage II obesity were established. Echographic signs of the pancreas lesion in teenagers with obesity indicate the presence of functional changes: edema of head or entire edema, partial increase of parenchymal echogenicity, insufficient enlargement of the duct of Wirsung.

HORMONAL CHANGES IN THE HYPOTHALAMUS-PITUITARY-ADRENAL- GONADS SYSTEM IN YOUNG MEN WITH HYPOTHALAMIC OBESITY

Purpose of the study - to analyze the frequency and severity of hormonal changes in the hypothalamus-pituitary-adrenal-gonads system in young men with hypothalamic syndrome and alimentary-constitutional obesity. Materials and methods. We examined 340 males (mean age 21.27±2.44 years). Examined patients were divided into the following groups: Group I ‒ hypothalamic syndrome of the late puberty (n=84); Group II ‒ constitutional-exogenous obesity of the late puberty (n=20); Group III ‒ hypothalamic syndrome of mature age (n=158); Group IV ‒ constitutional-exogenous obesity of mature age (n=78). Results. In groups of patients with hypothalamic syndrome, a higher level of morning cortisol (р

Changes in the mobility of obese people under the influence of a physical therapy program

Objective: to determine the effectiveness of a physical therapy program for patients with obesity by the indicators of Functional Movement Screen test exercises.
 Materials and methods. A total of 114 people of the second adulthood with alimentary-constitutional obesity of the I-III degrees were examined. They were divided according to the level of compliance into two groups. The comparison group consisted of individuals with a low level of compliance; they did not go through a rehabilitation program, but were informed about the risks of obesity; acquainted with the basic principles of hypocaloric nutrition and physical activity. The main group consisted of individuals with a high level of compliance; they underwent a developed program for correcting body weight using measures to maintain a high level of compliance, nutrition modification, increased physical activity, lymphatic drainage procedures, and elements of behavioral psychocorrection. The control group consisted of 60 people with no signs of obesity. A survey of the test exercises Functional Movement Screen was conducted in dynamics before and after the one-year period of implementation of the rehabilitation program.
 Results. During the initial examination in obese patients, all the obtained parameters of the Functional Movement Screen exercises were statistically significantly worse than in individuals with normal body weight (p <0.05). Re-examination of patients with low compliance showed that no statistically significant positive changes occurred in any test test (p> 0.05). When analyzing the results of test exercises of patients with a high level of compliance under the influence of a physical therapy program, a statistically significant improvement was achieved in all studied parameters relative to the initial level (p <0.05).
 Conclusions: Diagnostics of mobility based on test exercises Functional Movement Screen in physical therapy programs for obese patients is a modern, simple and affordable method of rehabilitation examination. To achieve the target level of the control group for the studied parameters by patients of II-III degree of obesity, the rehabilitation program should be long for one year.

Development of mathematical methods for calculation of the pubic arch angle

Hypothesis/aims of study. The frequency of adverse intranatal outcomes is significantly increased when the pubic arch angle (PAA) is less than 90°. The accuracy of the manual method for determining PAA depends on a large number of parameters, such as obesity of a woman, as well as stereometric sensation and the experience of a doctor. Determination of PAA using ultrasound and X-ray pelviometry is generally available and reliable; however, it requires special training. The aim of this study was to develop mathematical methods for calculation of PAA.
 Study design, materials and methods. The study included a retrospective and prospective analysis of 120 birth histories based on the Regional Clinical Hospital Perinatal Center (the Chita city, the years 2017/2018), which were divided into three equal groups. Group 1 consisted of patients with body weight deficit, group 2 included patients with normal body mass index, and group 3 comprised patients with alimentary constitutional obesity. On the eve of the birth, external pelviometry, the manual method for determining PAA, and ultrasound pelviometry by translabial access were performed.
 Results. PAA determined by the manual method was 99.6 ± 11.3° in group 1, 100.1 ± 14.2° in group 2, and 98.2 ± 10.7° in group 3. When ultrasound pelviometry was performed, the value of PAA was 97.4 ± 10.7° in group 1, 104.8 ± 13.8° in group 2, and 104.1 ± 12.3° in group 3. The error of the manual method was 2.2% in group 1, 4.5% in group 2, and 7.6% in group 3. On the basis of mathematical modeling of external pelviometry data, a pattern is defined, which is expressed by the formula: PAA = 180° – arccos (0,5 ∙ S1S2/S1P) – arccos (0,5 ∙ B1B2/(B2S1 – S1P), where PAA is the pubic arch angle (°); S1S2, Distantia spinarum; S1P, the distance between the anterior superior spine of the ilium to the lower edge of the symphysis; B2S1, the distance between the anterior superior spine of the ilium to the tuberosity of the opposite ischium; B1B2, the transverse size of the output plane. The coefficient of determination (R-squared) is 0.82. Thus, mathematical modeling allows determining PAA with a high degree of reliability.

Gas chromatography-mass spectrometry based metabolomics of urine steroids in women with different phenotypes of polycystic ovary syndrome

This article presents an analysis of the metabolism of androgens, glucocorticoid hormones, and progestins obtained by gas chromatography-mass spectrometry in 56 women with obesity and hyperandrogenia in comparison with 23 women with alimentary-constitutional obesity and 25 healthy women. An increase in urinary excretion of androsterone, 16-oxo-androstenediol (16-oxo-dA2), and α-tetrahydrometabolites of cortisone and corticosterone has been established in 25 women with polycystic-altered ovaries according to ultrasound, with urinary excretion of dehydroepiandrosterone (DHEA) and its metabolites (dA2-17β, 16β-DHEA, 16-oxo-dA2, and androstentriol), α- and β-metabolites of glucocorticoids and androstenedione, and 5-en-pregnans increased in 31 women without signs of polycystic ovaries according to ultrasound. A decrease in the tetrahydrocortisol/tetrahydrocortisone ratio was found in women with polycystic ovaries, indicating a decrease in the activity of 11β-hydroxysteroid dehydrogenase type 1. Evidence for the increased 5α-reductase activity was obtained in women with different phenotypes of polycystic ovary syndrome.

Early functional results of total knee arthroplasty in patients with alimentary obesity

Introduction. Total knee replacement has become a standard planned intervention at specialized clinics. The study of surgical results is not as urgent as the follow up of the patients with concomitant pathology because various complications are most often registered in this group. Purpose: to evaluate the efficacy of total knee arthroplasty in patients with increased body mass index at early rehabilitation steps. Patients and methods. Open prospective comparative study included 75 patients with III-IV stages of gonarthrosis by Kellgren-Lawrence. Mean age of the patients made up 63.8±6.87 years. Main group included 48 patients with excessive body mass and alimentary-constitutional obesity of different degree, the control group - 27 patients with normal body mass index. The duration of intervention, volume of blood loss intraoperatively and drainages was assessed. Evaluation of clinical functional results was performed OKS, KSS and visual analog scale (VAS) before surgery, at discharge, 3 months and 1 year after surgical intervention. Results. In comparison to the patients with normal body mass index the patients from the main group showed slightly higher duration of the intervention and intraoperative blood loss - by 13.05% (p=0.027) and 12.8% (p=0.003), respectively. In the main group the severity of pain syndrome by VAS decreased from 90.4±14.4 to 9.6±0.4 mm (p=0.0001), evaluation of clinical functional results by KSS increased from 47.39±1.63 to 88.02±2.01 points, by OKS - from27.3±4.3 to 43.2±6.5 points (p=0.001). In the control group the severity of pain syndrome by VAS within 1 year follow up decreased from 86.2±2.4 to 3.8±0.7 mm (p=0.002) and clinical functional indices by KSS increased from 52.2±10.1 to 93.8±1.3 points (p=0.001), by OKS - from28.4±1.6 to 44.7±1.9 points (p=0,001). Conclusion. The study results demonstrate the high potentialities of arthroplasty in patients with alimentary obesity and confirm the necessity of its performance for the improvement of the patients’ future quality of life.

Vascular Endothelial Growth Factor and its Receptors in the Placenta of Gravidas with Obesity

The paper describes a comparative morphological study of placentas obtained from women with obesity and normal body weight. The purpose of this research was to carry out immunohistochemical study VEGF and its receptors (VEGFR-1, VEGFR-2 and VEGFR-3) in the placenta of gravidas with obesity. The study is based on the morphological analysis of 20 secundines after the timely delivery (39-40 weeks). The main group consisted of 14 women (aged 29-40), suffering from alimentary-constitutional obesity. The control group consisted of 6 patients (aged 23-37) with normal body weight and physiological pregnancy. In the main group, histological study of the placenta preparations, stained with hematoxylin and eosin, revealed that maturation degree of the villous tree corresponded to gestational age, along with moderately expressed compensatory-adaptive and involution-degenerative processes. The identified features of immunohistochemical distribution of VEGF expression and its receptor in placental tissue of women suffering from obesity, to a certain extent, reflect the processes related to compensation and abnormal functioning of the mother-placenta-fetus system in the presence of hypoxia and hyperlipidemia. Research results indicate unavoidable development of morphological changes in the placenta during pregnancy against the background of obesity. Decrease in body weight before pregnancy can reduce the risk of placental disorders and improve perinatal outcomes.

Особливості клінічних проявів ураження тканин пародонта у підлітків на тлі аліментарно-конституціонального ожиріння

The article presents the results of clinical examination of periodontal tissues in adolescents against the background of alimentary-constitutional obesity.The aim of the study – to investigate the features of the course of diseases of the periodontal tissue according to clinical indices in persons with alimentary-constitutional obesity.Materials and Methods. As a result of the survey, 95 adolescents aged 16–18 years old were included to study the features of the course of infl ammatory diseases of periodontal tissues in adolescents with alimentary-constitutional obesity 76 adolescents and 19 adolescents with harmonious physical development. To clarify the diagnosis, «excessive body weight» was determined by weight and height of the patient, and measured the circumference of the waist and hips. In the future, the body mass index (BMI) was calculated as the ratio of body weight in kg to square of growth in m2. Diagnosis of excess body weight was confi rmed with BMI less than 30kg/m2. The evaluation of the condition of periodontal tissues was carried out according to subjective and objective criteria (clinical parameters, index score). For the verifi cation of the pathological process in the periodontium, the classifi cation of M. F. Danilevskyi (1994) was used. The state of periodontal tissues was described using a traditional index score. Statistical processing of the results was carried out using commonly used methods of variation statistics with a help of personal computer using a statistical software package «Statistica 8.0» («Statsoft», USA). The probability level was estimated at 95 % (p<0.05) using Student’s t criterion.Conclusions. Consequently, the clinical indicators of the state of periodontal tissues in the context of alimentaryconstitutional obesity (Fedorov-Volodkin’s index, Green-Vermillion index, Sillness-Loe index, CPITN index) signifi cantly deteriorate compared with the corresponding indicators in the control group of adolescents without AKO, indicating the effect of alimentary-constitutional obesity on the clinical course, the severity and severity of theinfl ammatory process and the feasibility of timely and effective pharmacotherapy.

Cytogenetic effects of tick-borne encephalitis in residents of the north of Western Siberia with alimentary-constitutional obesity depending on the polymorphism of the genes of glutathione-S-transferase

Backgraund. Tick-borne encephalitis (TBE), one of the large-scale public health problems of the Siberian region, can cause significant cytogenetic damage in humans by stimulating oxidative stress. Active functioning of the detoxification system including enzymes of glutathione-S-transferase is intended to protect the genetic structure of cells in the body, while at the same time, there are studies showing the defective functioning of this system in individuals with obesity.
 Aims. Aim of this work is to study the longevity of term of TBE-induced cytogenetic damage in patients with different alleles of genes of glutathione-S-transferase, suffering from alimentary-constitutional obesity compared with the control.
 Materials and methods. We were examined 133 female residents of the northern areas of Tomsk region from 35 to 44 years old who were hospitalized for infection TBE at local medical clinics. All individials were divided into two subgroups. Patients of the 1st subgroup (control) had a body mass index (BMI) within 2126, the 2nd subgroup had BMI showing severe obesity (BMI 3545). Buccal cells for cytogenetic and molecular analysis were taken several times: 12 days after hospitalization, 1 week, 1 month, 3 months, and 6 months after beginning of the disease. Methods of immunoassay and polymerase chain reaction (PCR) was used to confirm the diagnosis of TBE. As an untreated control were examined 126 healthy female residents of the same age groups. All individuals signed informed consent. In the analysis of deletions in the genes GSTM1 and GSTT1 was used multiplex PCR. We studied at least 1000 epithelial buccal cells from each individual.
 Results. In patients with high BMI rates revealed a significant increase in the frequency of the buccal cells with cytogenetic damage, compared to the control group. TBE disease was significantly increased the frequency of the cytogenetically damaged cells in this group of patients. The cytogenetic aberrations persisted in their body for six months after hospitalization. In patients with normal BMI rates TBE induced significantly less changes. The recovery of normal cytogenetic status was observed in this group 3 months after hospitalization. Analysis of the glutathione-S-transferase gene variants showed that in TBE patients with normal BMI and non-active alleles of these genesthe frequency of micronucleated epithelial cellswere significantly increased compared to the patients with the activeGSTM1 (+) / GSTT1 (+)genes. In the patients with alimentary obesity such patterns were not observed.
 Conclusions. Thus,infection with TBE in patients with obesity induced significant increase in both the frequency of cytogenetically damaged cells and the longevity of their persistency in the body compared to these in control group. Polymorphisms in genes of glutathione-S-transferase had no significant effect on the indices.