Dysfunction In Patients Research Articles

Assessment of the Role of Oxidative Stress Indicators and Early Markers of Myocardial Injury and Disfunction in Patients with Lymphoproliferative Diseases

to study dynamics of indicators of oxidative stress and their role in development of cardiotoxicity in patients with lympho-proliferative diseases at the background of polychemotherapy. We included into this study 30 patients with newly detected Non-Hodgkin lymphomas. The control group comprised 15 healthy volunteers. For registration of dynamics of formation of oxygen active forms (OAF), we used highly sensitive chemiluminescence assay. The state of initial stage of lipoperoxidation OAF and radicals of organic compounds) was assessed by dynamics of the leukocyte chemiluminescence. The state of final stage of lipoperoxidation (formation of nonmetabolizing lipid hydroperoxides and other compounds) was assessed by the level of malonic dialdehyde. We also determined indicator of leukocyte chemiluminescence intensity (both basal and zymosan-stimulated). For assessment of the cardiovascular system functional state before and after chemotherapy we used electrocardiography (ECG), echocardiography (EchoCG) and 24-hour ECG monitoring. The data obtained were indicative of increased generation of free radicals by leukocytes during polychemotherapy. After chemotherapy course we detected various types of cardiotoxicity. We noted substantial elevation of frequency of supraventricular and ventricular extrasystoles. There was direct correlation between rate of appearance of supraventricular extrasystoles and level of chemiluminescence of leukocytes (r=0.7; p=0.03). According to data of EchoCG although the left ventricular ejection fraction remained within the normal range during chemotherapy, there was a persistent tendency to its decrease (р<0.001). In this study we for the first time in patients with Non-Hodgkin lymphomas detected an elevation of level of free radical reactions and lipid peroxidation with simultaneous lowering of antiperoxidative activity of blood plasma and their relation to development of cardiotoxic effects. The results obtained indicate to necessity of search for novel early markers of oxidative stress activation, myocardial injury and disfunction able to help to substantially decrease risk of development of cardiovascular complications during and after chemotherapy.

SUN-284 STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE

STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE Unrecognized renal insufficiency, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the presence of normal serum creatinine levels, is a common co morbid condition among patients with various cardiovascular conditions. Epidemiological study demonstrated that renal insufficiency forecast long-term mortality and hence can be used to stratify risk for stroke patients. Our purpose of study is to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients admitted with acute stroke. STUDY DESIGN: Cross sectional prospective study. STUDY DURATION: March 2017 to August 2017. INCLUSION CRITERIA: All patients admitted with acute stroke . EXCLUSION CRITERIA: Acute stroke in < 18 years ,Head injury. MATERIAL & METHODS: Our study group consisted of 100 patients with acute stroke admitted in Stanley Medical College. The detailed history of the patients has been recorded and patients underwent a detailed clinical examination. Appropiate investigations were done. The estimated glomerular filtration rate is calculated using the MDRD and CKD-EPI equation. The study groups are stratified into 3 groups according to the renal function assessment (normal renal Function, unrecognized renal insufficiency and recognized renal insufficiency). Out of the 100 patients with acute stroke included in the study, 62 have normal renal function, 31 have recognized renal insufficiency, and 7 have unrecognized renal insufficiency. Majority of the study subjects in normal renal function group were males (n=48), females in unrecognized renal insufficiency group (n=7) and males in recognized renal insufficiency group (n=24). Using single factor ANOVA test, age distribution,the mean difference of blood urea values and serum creatinine values, the mean difference of MDRD values and CKD-EPI values, the mean difference of systolic blood pressure and diastolic blood pressure ,the mean difference of hemoglobin, the mean difference of random blood sugar values were found to be statistically significant (p <0.05). Using fishers exact test,the difference in percentage of females, the difference in percentage of diabetics, the difference in percentage of subjects with dyslipidemia were found to be statistically significant (p < 0.05) In our study, modified Rankin score(MRS) was significantly higher in patients with recognized renal insufficiency compared to unrecognized renal insufficiency patients. Mortality rates are higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (29%, 28.5% and 9.6% respectively, p< 0.05). Severe disability rates at discharge are also higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (72.27%, 80 %, and 32.14%) respectively, p<0.05. 1. Unrecognized renal insufficiency is found to be a common co morbidity among patients with acute stroke in our study.2. Unrecognized renal insufficiency is significantly common among older age group and more frequently in females compared to male in our study group. 3. Mortality rate and severe disability rate are higher in patients with recognized and unrecognized renal insufficiency compared to patients with normal renal function.

LEFT VENTRICULAR DIASTOLIC FUNCTION IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS AND ITS ALTERATIONS DURING COURSE OF TREATMENT

Objective:Left ventricular diastolic dysfunction is characterized by alterations in LV diastolic filling, and is considered a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for Diastolic Disfunction in patients without heart failure. Doppl

The role of plasminogen activator ingibitor type 1 in the development of endothelial disfunction in patients with acute myocardial infarction and type 2 diabetes mellitus

Acute myocardial infarction continues to occupy one of the leading places among the causes of mortality. Some indicators of endothelial dysfunction are also associated with a high risk of cardiovascular complications, which play a key role in the pathogenesis of cardiovascular complications, which makes it relevant to study the relationship between endothelial dysfunction markers and the development and progression of atherosclerotic vascular lesions. Dysfunction of the endothelial vasodilator system is accompanied by a decrease in the level of nitric oxide (NO), which is a characteristic feature of patients who are at risk of coronary artery disease, so coronary vasodilator dysfunction may involve prolonged progression of atherosclerosis and the frequency of cardiovascular events. The high risk of vascular accidents is an incentive to study the pathogenetic mechanisms of thrombotic formation in type 2 diabetes. Plasminogen activator inhibitor type 1, which is a member of the superfamily of serine protease inhibitors and the main inhibitor of fibrinolysis in the plasminogen activator system, plays a key role in the pathogenesis of arterial and venous thrombosis and, therefore, contributes to the occurrence of thrombotic events. The combination of acute myocardial infarction with type 2 diabetes mellitus is characterized by a significant increase in the content of the plasminogen activator inhibitor type 1 in serum compared with those without diabetes. As a result of the study, a close direct correlation between the increase of lipid, carbohydrate metabolism, hemostasis parameters proportional to the high content of the plasminogen activator inhibitor type 1 in serum of patients with acute myocardial infarction with concomitant type 2 diabetes mellitus was proved. The inverse correlation between the level of type 1 plasminogen activator inhibitor and the reduced content of nitric oxide synthase, which increases endothelial dysfunction and atherothrombosis in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus, is proved.

Prevalence and short-term changes of cognitive dysfunction in young ischaemic stroke patients.

Background and purposeInformation on the prevalence and course of post‐stroke cognitive impairment in young stroke patients is limited. The aim was to assess a consecutive sample of acute young ischaemic stroke patients (18–55 years) for the presence and development of neuropsychological deficits.MethodsPatients prospectively underwent a comprehensive clinical and cognitive assessment, examining general cognitive function, processing speed, attention, flexibility/executive function and word fluency within the first 3 weeks after hospital admission (median assessment at day 6) and at a 3 months’ follow‐up (FU). Cognitive dysfunction was defined in comparison to age‐standardized published norms.ResultsAt baseline (N = 114), deficits were highly prevalent in processing speed (56.0%), flexibility/executive function (49.5%), attention (46.4%) and general cognitive function (42.1%). These frequencies were comparable for those with FU assessment (N = 87). In most domains, cognitive performance improved within 3 months, except for word fluency. However, in about one‐third of patients, cognitive deficits (as defined by 1.5 standard deviations below the standardized mean) were still present 3 months after stroke. At FU, 44.0% were impaired in the domain flexibility/executive function, 35.0% in processing speed and 30.0% in attention.ConclusionsThe high prevalence of cognitive deficits in acute young patients with ischaemic stroke highlights the importance of early post‐stroke cognitive assessment to capture a patient's dysfunction in a comprehensive manner and to offer adequate rehabilitation. The role of factors which promote neuropsychological deficits needs further exploration.

ЭНДОТЕЛИАЛЬНАЯ ДИСФУНКЦИЯ У ПАЦИЕНТОВ С ВТОРИЧНОЙ ЛИМФЕДЕМОЙ И СПОСОБЫ ЕЕ КОРРЕКЦИИ (ОБЗОР ЛИТЕРАТУРЫ)

ЭНДОТЕЛИАЛЬНАЯ ДИСФУНКЦИЯ У ПАЦИЕНТОВ С ВТОРИЧНОЙ ЛИМФЕДЕМОЙ И СПОСОБЫ ЕЕ КОРРЕКЦИИ (ОБЗОР ЛИТЕРАТУРЫ)

Factors Associated Sexual Dysfunction in Patients Pelvic Organ Prolapse at Dr. Cipto Mangunkusumo and Fatmawati Hospital Jakarta in 2016

Pelvic Organ Prolapse (POP) is a bulge or protrusion of pelvic organs and related segments into or through the vagina. Disturbances in sexual function rarely complained, but from the literature it is known that patients with stage 3–4 prolapse associated with difficulty in achieving an orgasm. This study aims to determine the prevalence of sexual dysfunction in patients with POP and factors associated with sexual dysfunction among them. A cross-sectional design was conducted in Dr. Cipto Mangunkusumo and Fatmawati Hospital Jakarta. All patients who met the inclusion criteria of POP filled out a questionnaire of sexual function index (FSFI-19), then performed univariate analysis of data on the characteristics of the data subject, and bivariate and multivariate analysis to know the relationship between the dependent and independent variables. Of the 82 data, the prevalence of sexual dysfunction in patients with POP reached 57.3%. While most of the patients had experienced menopause POP also with a prevalence of 76.8%. The prevalence of sexual dysfunction in patients who were menopausal POP by 66.7%. From the results of the bivariate analysis, age, menopause, obesity and stage of prolapse were a significant risk factor on the incidence of sexual dysfunction in patients with POP. The variables of age, smoking, menopause, obesity and stage of prolapse, p &lt; 0.25 to be included in the multivariate analysis. From the multivariate analysis, the variables associated with the incidence of sexual dysfunction in patients with POP were age &gt;60 by OR 8 (IK95 2,45–26.12), and obesity (BMI 30 kg/m2) with an OR of 0.30 (CI 95 0.09 to 0.98). Advanced age and obesity are associated with the incidence of sexual dysfunction in patients with POP.

The Significance of New Left Bundle Branch Block Complicating Acute Myocardial Infarction

The aim of our study was to evaluate the impact of new LBBB on left ventricular systolic function and arrhythmic risk in patients with acute myocardial infarction and unicoronarian lesion. We prospectively studied the patients with acute myocardial infarction with and without LBBB and unicoronarian lesion after a mean of 16.51 � 2.41 months from the onset of acute coronary event. We observed a higher risk of ventricular premature beats and left ventricular systolic disfunction in patients with left bundle branch block. Also, the presence of left bundle branch block (F = 3.64; p [ 0.005; partly h2= 0.33) and the duration of the QRS complex (F = 4.17; p [ 0.005; partly h2= 0.36) was statistically significantly correlated with the value of left ventricular ejection fraction. Almost a double number of patients with left bundle branch block had an ejection fraction below 30%, despite an early revascularization. Patients with acute myocardial infarction and left bundle branch block represent a relatively small group but with an increased risk of malignant ventricular arrhythmias and left ventricular systolic dysfunction, and they should therefore benefit from a promptly and appropriately treatment in order to improve long term outcome.

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Load distribution of the hand during cylinder grip analyzed by Manugraphy

Study DesignClinical measurement and basic research. IntroductionManugraphy allows assessing dynamically all forces applied perpendicular to a cylinder surface by the whole contact area of the hand with a high spatial resolution. Purpose of the StudyTo identify the physiological load distribution of the whole contact area of the hand during cylinder grip. MethodsA sample of 152 healthy volunteers performed grip force tests with 3 cylinder sizes of the Manugraphy system (novel, Munich, Germany) on 3 different days. The whole contact area of the hand was sectioned into 7 anatomic areas, and the percent contribution of each area in relation to the total load applied was calculated. The load distribution of the dominant and nondominant hands and with different cylinder sizes was compared. Furthermore, the load distribution between the finger phalanges of each finger was analyzed. ResultsThe results for the dominant and nondominant hands were in all 7 areas of the hand similar with the percent contribution differing within a range of 1%-4% (P > .138). Load distribution changed significantly with different cylinder sizes: all 7 areas differed between 1% and 7% with P < .001, most pronounced for the thumb. The load distribution of the phalanges showed that the contribution of the distal phalanges increased with ascending cylinder size, whereas the contribution of the proximal phalanges decreased. The interindividual variability of the load distribution pattern was noticeable. DiscussionFor the clinical practice, Manugraphy might be a useful supplement to traditional grip force measurement for identifying the individual characteristics of a patient's dysfunction and monitoring the progress of hand rehabilitation. ConclusionsThere is no universal or typical load distribution pattern of the hand but only an individual pattern. To evaluate a compromised hand, it is permissible to compare it with the healthy opposite hand as a reference. Several cylinder sizes should be used for load distribution testing. Using smaller handles in the daily life can help to compensate impairment of the thumb and fingertips. Level of Evidence2.

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Management of erectile dysfunction in patients who failed prior vascular intervention

Management of erectile dysfunction in patients who failed prior vascular intervention

MP31-05 UROTHELIAL DYSFUNCTION AND CHRONIC INFLAMMATION IN PATIENTS WITH BLADDER OUTLET OBSTRUCTION AND DIFFERENT BLADDER DYSFUNCTION AND DIFFERENT BLADDER OUTLET OBSTRUCTION DEGREE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research1 Apr 2015MP31-05 UROTHELIAL DYSFUNCTION AND CHRONIC INFLAMMATION IN PATIENTS WITH BLADDER OUTLET OBSTRUCTION AND DIFFERENT BLADDER DYSFUNCTION AND DIFFERENT BLADDER OUTLET OBSTRUCTION DEGREE Chung-Cheng Wang, Jia-Hui Chang, and Hann-Chorng Kuo Chung-Cheng WangChung-Cheng Wang More articles by this author , Jia-Hui ChangJia-Hui Chang More articles by this author , and Hann-Chorng KuoHann-Chorng Kuo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1360AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The underlying mechanisms responsible for the bladder dysfunction in bladder outlet obstruction (BOO) remain poorly understood. The purpose of this study is to investigate the urothelial dysfunction and chronic inflammation in patients with BOO. METHODS In this prospective study, we enrolled those patients with LUTS. Based on their VUDS performances, it was categorized into 4 sub-groups: control, BOO with detrusor overactivity (DO), BOO with Detrusor underactivity (DU) and BOO with hypersenstivity bladder (HSB). Bladder tissues taken from these patients were analyzed. Immunofluorescence (IF) staining of junction protein E-cadherin, mast cell, TUNEL and zonula occludens 1(ZO-1) were performed. RESULTS A total of 44 men were enrolled in this study. There were 34 patients presented with BOO (DO: 12, DU: 11 and HSB: 11). The expression and cellular location of E-cadherin, mast cell, TUNEL and ZO-1 were illustrated in Fig. 1. The distribution of E-cadherin is significantly reduced in BOO with DU (8.37±9.50) (p<0.000), whereas exhibit highest number of TUNEL (3.60±3.43) (p<0.021). The tryptase signal in BOO with DO is significantly increased (19.05±6.14) (p<0.000)(Table 1). All these parameters do not show positive correlation with Abrams-Griffiths (AG) number. Increasing number of E-cadherin is associated with Pdet and Qmax. Tryptase/ mast cell is positively associated with FSF. CONCLUSIONS In this study, we have shown that LUTS secondary to BOO are associated with chronic urothelial inflammation and urothelial dysfunction. DU induced by BOO is associated with significant urothelial defection. This may imply that the loss of functional protein and urothelial cell apoptosis might contribute to the pathophysiology of bladder dysfunction in BOO. Table 1. The numbers of E-cadherin, tryptase, TUNEL and ZO-1 in different sub-groups Normal (N=10) BOO+DO (N=12) BOO+DU (N=11) BOO+HSB (N=11) P value E-cadherin 27.70±10.42 11.16±7.65 8.37±9.50 27.23±13.94 0.000 Tryptase (mast cell) 4.16±2.68 19.05±6.14 11.67±11.10 12.91±4.51 0.000 TUNEL 0.85±1.31 3.45±2.55 3.60±3.43 1.39±1.79 0.021 ZO-1 6.90±1.82 7.43±1.65 9.08±5.82 7.14±3.40 0.490 BOO: bladder outlet obstruction; DO: detrusor overactivity; DU: detrusor underactivity; HSB: hypersenstivity bladder; ZO-1: zonula occludens 1 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e357 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chung-Cheng Wang More articles by this author Jia-Hui Chang More articles by this author Hann-Chorng Kuo More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP43-20 ENDOTHELIAL DYSFUNCTION IN PATIENTS OF ERECTILE DYSFUNCTION USING SHORT-TERM LOW DOSE TADALAFIL : A DOUBLE BLIND RANDOMIZED CONTROL TRIAL

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 2015MP43-20 ENDOTHELIAL DYSFUNCTION IN PATIENTS OF ERECTILE DYSFUNCTION USING SHORT-TERM LOW DOSE TADALAFIL : A DOUBLE BLIND RANDOMIZED CONTROL TRIAL Ravimohan Mavuduru, Pawan Kundal, Smita Pattanaik, Shrawan Singh, and Arup Mandal Ravimohan MavuduruRavimohan Mavuduru More articles by this author , Pawan KundalPawan Kundal More articles by this author , Smita PattanaikSmita Pattanaik More articles by this author , Shrawan SinghShrawan Singh More articles by this author , and Arup MandalArup Mandal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1627AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flow mediated dilatation (FMD) of brachial artery is a noninvasive measurement of Endothelial dysfunction EnD. Studies have shown low dose Tadalafil improves (EnD), however placebo controlled RCTs are lacking. METHODS This DB-RCT was conducted in accordance with the principles of Declaration of Helsinki and was approved by Institutional Ethics Committee. ED and EnD were assessed by self-administered IIEF-5 questionnaire and FMD respectively at baseline and 4 weeks by the same observer. Patients with FMD of < 15% were included. patients with history of PDEI intake in the past were excluded. Patients were randomized in 1:1 ratio to receive either placebo or tadalafil by a computer generated randomization list. Both placebo and tadalafil in tablet form were dispensed in bottles with dosage for 4weeks by a co-investigator who was not involved in the process of selection or evaluation of the end points to ensure complete blinding. Compliance was assessed by checking the empty drug bottles. Any drug related events during the study were recorded. The randomization codes were decoded at study completion. Appropriate statistical tests were applied. RESULTS Of 96 patients, 89 were randomized, and 82 completed the study, 41 in each group. Demographic profile, baseline IIEF-5 score and FMD % were comparable. Post-treatment there were significant improvements in IIEF-5 score (Pre vs Post treatment; Tadalafil: - 11.4±3.2vs 15.9±3.7, p <0.001 and placebo: 11.2±3.2 vs 14.9±3.5, p <0.001, respectively ) and FMD % (Pre vs Post treatment; Tadalafil: 11.2±2.2 vs 13.8±2.7, p <0.001 and placebo: 11.6±1.7vs 14.0±2.7, p <0.001, respectively) and this change was significant in all the sub-groups (based on IIEF-5 severity categorization). Inter-group comparison did not show any significant difference in IIEF scores (Mean change in IIEF-5 scores, Tadalafil vs Placebo: 3.7±1.9 vs 4.4 ± 3.3, p=0.223) and FMD % (Mean change in FMD%, Tadalafil vs Placebo: 2.4 ± 2.6 and 2.8 ± 2.9, p=0.528) This was true across all the subgroups except in patients with severe ED, where tadalafil group showed a significant improvement in FMD %.( Mean change in FMD%, Tadalafil vs Placebo: 4.6 ± 1.9 vs 1.6 ± 1.4, p=0.020 ). The adverse events were significantly more in Tadalafil group (Tadalafil vs placebo 14 ADR vs 5 ADR, p<0.001) CONCLUSIONS The response of low dose tadalafil (10mg per day) on IIEF and FMD is largely similar to placebo especially in young patients, however to draw meaningful conclusions, utility of FMD % in young patients and placebo effect a longer study need to be seen. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e525-e526 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravimohan Mavuduru More articles by this author Pawan Kundal More articles by this author Smita Pattanaik More articles by this author Shrawan Singh More articles by this author Arup Mandal More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

REPLACEMENT AND INTERSTITIAL FIBROSIS BY CARDIAC MR AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH DILATED CARDIOMYOPATHY

Cardiac MR can be used to determine the extent of both replacement and interstitial fibrosis in patients with cardiomyopathies. We hypothesized that myocardial extracellular volume fraction (ECV) and scar burden by CMR are related to LV diastolic function in patients with dilated cardiomyopathy (DCM

Efficiency assessment for antihypertensive, hemodynamic, renal effects of adenosine-converting enzyme (ACE) inhibitors and irbesartan and impact on endothelial disfunction in patients with stage II hypertension

Aim. To provide a comparative assessment of the impact of enalapril maleate and Irbesartanum on renal function, endothelium, hemodynamic and blood pressure in patients with essential hypertension stage II. Methods and results. The results of the most part of meta-analyses demonstrate absolutely comparable efficiency of iACE [inhibitors of adenosine-converting enzyme] and angiotensin II-renin-blockers (ARBs) in respect of reduction in frequency of different cardiovascular diseases. However, attention should be drawn towards the fact that ARBs show substantially higher efficiency as compared to other classes of antihypertensive drugs by strength of nephroprotective effects. Especially when diabetic or hypertensive neuropathy progression is inhibited. The objective of this study was to investigate the microalbuminuria level and the endothelial function in patients with stage II hypertension and to compare the impact of ACE inhibitors and Irbesartan. 60 patients with stage II hypertension (HTN) before treatment and after 12 weeks therapy were examined. The key factor for selection was the presence of microalbuminuria (MAU). The group of patients with stage II HTN with MAU was divided into two groups: 30 patients were treated with ACE inhibitor, namely Enalaprili maleates “Enalapril” (I group) and 30 patients were treated with Irbesartan, namely “Aprovel” (II group) accordingly. It was established that the Irbesartan group showed significant reduction in albuminuria level from 127.1±26.3 μg/mL to 56.2±21.8 μg/mL (by 44%, Р<0.05), while the ACE-inhibitor group showed reduction from 125.3±21.5 μg/mL to 101.3±19.6 (Р<0.05). Thus, at the end of the treatment period the albuminuria level in the Irbesartan group was 44.8% lower than in the other group (Р<0.05). 60% of patients of this group and only about 30% of patients of the ACE-inhibitor group reached normal level of albuminuria. On comparing Е-1 level between the patients with stage II HTN of both groups it was revealed that reduction level of endothelin-I in the group treated with Irbesartan was 12% lower than in the group of patients treated with Enalapril. NО2 level as compared with the data before treatment and after administered therapy increased by 35% in case of treatment with Enalapril and by 42.5% in case of treatment with Aprovel. NО3 level increased by 21% and accordingly 29%, and NОх level – by 28% and 33% accordingly.This fact indicates that Irbesartan treatment results in improvement in renal functional state in patients with HTN what is revealed by highly significant reduction in albumin excretion in urine and is due to increase of functional renal reserve and so positively effects endothelial function. Conclusion. This suggests that treatment with Irbesartanum increases renal functional reserve and has a positive effect on endothelial function.

Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke

Acute cerebrovascular disease is a global medical and social problem of the modern angioneurology, occupying leading positions in the structure of morbidity and mortality among adult population of the world. Ischemic stroke – is one of the most common pathology. Today this disease took out the world pandemic. More than 16 million new cases of cerebral infarction recorded in the world each year and it “kills” about 7 million of people.About 111,953 cases of cerebral stroke were registered in 2013 in Ukraine. Cognitive impairment, t hat significantly disrupt daily activities and life of the patient, is one of the most significant post-stroke complications that have social, medical and biological significance.Aim. The purpose of this investigation was to study features and dynamics of cognitive impairments in patients with primary and recurrent cerebral hemispheric ischemic stroke (CHIS ) in the acute stage of the disease.Materials and methods. To achieve the aim, and the decision of tasks in the clinic of nervous diseases Zaporozhye State Medical University (supervisor - Doctor of Medicine, Professor Kozelkin A.) based on the department of acute cerebrovascular disease were performed comparative, prospective cohort study, which included comprehensive clinical and paraclinical examinations of 41 patients (26 men and 15 women) aged 45 to 85 years (mean age 66,4 ± 1,4 years) with acute left-hemispheric (2 patients) and right - hemispheric (39 patients) CHIS . First up was a group of 28 patients (19 men and 9 women, mean age 65,6 ± 1,6 years), who suffered from primary CHIS. The second group consisted of 13 patients (7 men and 6 women, mean age 68,1 ± 2,5 years) with recurrent CHIS. The groups were matched by age, sex, localization of the lesion and the initial level of neurological deficit.All patients underwent physical examination, neurological examination. Dynamic clinical neurological examination assessing the severity of stroke was conducted using a NIHS scale. Neuropsychological examination included verification of the existence and structure of the cognitive impairments using scales Montreal Cognitive Assessment (MoCA), Mini-Menthal State Examination (MMSE), Frontal Assessment Battery (FAB) on the 1st -3rd and 10 - 13th day of the acute period of the disease. Outcome of the acute period of the disease was assessed by the modified Rankin scale .All patients underwent a CT scan (Siemens Somatom Spirit, Germany) of the brain and laboratory investigations. The obtained data were processed using the program Statistica 6.0 (StatSoft., USA ) and software package Microsoft Excel.It was detected that patients with recurrent ischemic supratentorial stroke are characterized with lower summary score by Mini-Menthal State Examination, Montreal Cognitive Assessment and Frontal Assessment Battery scales than those with first stroke episode. It was revealed that moderate cognitive disturbances are prevailed in the structure of cognitive disorders in primary stroke, while in recurrent brain ischemia mild and moderate dementia is dominated. Transitory type of perception-gnostic field violations in primary ischemic supratentorial stroke was established. The leading cognitive domains which are associated with expressed cognitive disfunction in patients with recurrent brain ischemia were detected.Conclusions. The patients with recurrent CHIS were characterized by more severe cognitive impairment in the acute period of the disease, so a primary CHIS we can considered as a main risk factor for the progression of cognitive disorders in a specified group of patients.

CORRECTION OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH TERMINAL RENAL INSUFFICIENCY

The problem of development of endothelial disfunction in patients with end-stage renal failure and possibilities of its correction in extracorporal and medical methods is discussed.In research took part 60 patients with chronic kidney disease stage V by K/DOQI, which was evaluated vasomotor endothelial function in samples with reactive hyperemia and nitroglycerin, with simultaneous detection of the concentration of endothelin-1. The study confirmed the expressed changes of indicators vasodilating activity of the vascular wall and raising of endothelin-1 level in patients of this group. Effective method of correction of endothelial disfunction in patients with terminal renal insufficiency was early initiation of haemodyalisis therapy in combination with ACE inhibitors pharmacotherapy.

Do neutrophil gelatinase-associated lipocalin and interleukin-18 predict renal dysfunction in patients with familial Mediterranean fever and amyloidosis?

Background: The aim of this study was to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) predict renal disfunction in patients with familial Mediterranean fever (FMF). Methods: This prospective study consisted of 102 patients with FMF in attack-free period, and 40 matched healthy controls. Of the patients, nine were diagnosed as amyloidosis. The patients were divided into two groups according to eGFR as below 120 mL per minute and above 120 mL per minute. Also, patients were divided into three groups according to the degree of urinary albumin excretion as normoalbuminuric, microalbuminuric, and macroalbuminuric. The serum levels of IL-18 (sIL-18) and NGAL (sNGAL), and urinary levels of IL-18 (uIL-18) and NGAL (uNGAL) were measured by using ELISA kits. Results: The levels of sIL-18, sNGAL, uIL-18, and uNGAL were detected significantly higher in FMF patients, particularly in patients with amyloidosis, when compared to controls. sNGAL, uIL-18, and uNGAL were significantly higher in patients with eGFR < 120 mL per minute than in patients with eGFR ≥ 120 mL per minute. sNGAL, uIL-18, and uNGAL were correlated significantly with urinary albumin excretion, additionally, were inverse correlated with eGFR. The most remarkable findings of this study are of the higher values of sIL-18, sNGAL, uIL-18, and uNGAL in both normoalbuminuric FMF patients and patients with eGFR ≥ 120 mL per minute. Conclusions: The results of this study suggest that sIL-18, uIL-18, sNGAL, and uNGAL are reliable markers of early renal disfunction in FMF patients, and may let us take measures from the early stage of renal involvement.

MENTAL STRESS IS ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

Mental stress (MS) provokes myocardial ischemia in many patients with coronary artery disease (CAD). Arterial stiffness and endothelial dysfunction are important determinants of cardiovascular risk. We investigated the effect of MS on endothelial function and arterial stiffness, with the hypothesis