Presence Of Comorbid Pathology Research Articles

Recurrent respiratory diseases in practice of family physician and pediatrician: main issues (a literature review)

The aim of the study – to analyze the professional literature and evaluate modern scientific trends concerning definition, peculiarities of etiopathogenesis, differential diagnosis and prevention of recurrent respiratory diseases (RRD) in the practice of family doctors and pediatricians. Conclusions. Respiratory diseases in children can play an ambiguous role, because on the one hand, they are an inducement for the host defenses, while they can cause secondary immune dysfunction in a significant increase in their incidence and severity, on the other. However, there are no specific criteria for RRD diagnosis. Contributing factors include harmful ecological conditions, unfavorable family history, absence of breastfeeding, presence of comorbid pathology and many other factors. Some children with RRD have immune dysfunctions, including changes in nonspecific protection and cellular immunity. Even if there are no changes in the main immunological indices, RRD can occur. Children with RRD require special attention, because severe, sometimes incurable diseases can be under the mask of frequent RRD. For such children family doctor and pediatrician should conduct a differential diagnosis with atopy, primary immune deficiency, gastroesophageal reflux, bronchial foreign body, cystic fibrosis, psychogenic cough and other diseases. Children with chronic infection should also be separated. In order to adequately assess the situation and develop a well-grounded treatment tactics for such patients, it is necessary to work out domestic criteria for assigning children to the RRD group. A physician should provide an individual approach to such a patient with optimal diagnostic methods and the development of management tactics both in acute episodes of respiratory diseases and during non-acute periods with the maximum involvement of drug-free modalities and for prevention of the pathological process progression.

Correlation between Cone Beam CT Data and the Levels of Inflammatory Markers in Odontogenic Respiratory Comorbidity

Aim. In this study, the authors set out to find the correlation between the data of cone beam computed tomography (CBCT) and the levels of inflammatory markers in patients with chronic generalised periodontitis (CGP), both without somatic pathology and with bronchiectasis.Materials and methods. The study included 90 CGP patients and 40 somatically healthy individuals with intact periodontium. CGP patients were divided into two groups: CGP patients without somatic pathology (n = 40) and CGP patients with bronchiectasis (n = 50). Using ELISA, the authors determined the level of the following inflammatory markers in oral fluid: transforming growth factor beta 1 (Tgfß-1), interleukin -8 (IL-8), lactoferrin (LF) and C-reactive protein (CRP).Results. The analysis of CBCT data and the levels of inflammatory markers (Tgfß-1, LF, IL-8 and CRP) revealed that more pronounced changes in their values were observed in CGP patients with bronchiectasis. In addition, the revealed correlations between CBCT data and the levels of inflammatory markers in CGP patients without somatic pathology and CGP patients with bronchiectasis indicate a relation between the severity of inflammatory reaction and the clinical manifestations of CGP. Furthermore, this correlation is stronger in CGP patients with comorbid pathology than in CGP patients without somatic pathology.Conclusion. The presence of comorbid pathology in the form of bronchiectasis in CGP patients has a negative impact on the periodontium, which should be considered when managing patients.

ОЦЕНКА УРОВНЯ МАРКЕРА АПОПТОЗА АННЕКСИНА А5 И ЗНАЧЕНИЙ СТОМАТОЛОГИЧЕСКИХ ИНДЕКСОВ ПРИ ХРОНИЧЕСКОМ ГЕНЕРАЛИЗОВАННОМ ПАРОДОНТИТЕ РАЗЛИЧНОЙ СТЕПЕНИ ТЯЖЕСТИ БЕЗ ОБЩЕСОМАТИЧЕСКОЙ ПАТОЛОГИИ И НА ФОНЕ БРОНХОЭКТАТИЧЕСКОЙ БОЛЕЗНИ

Background. The study of the features of the course and the general links of pathogenesis in patients with chronic generalized periodontitis (CGP) with comorbid pathology is one of the priorities of modern medicine.
 Objectives ― to assess and analyze the level of apoptosis marker annexin A5 and the value of dental indices in patients with CGP of varying severity without General somatic pathology and against the background of bronchiectatic disease
 Methods. The study involved 90 patients with present study included varying degrees (light, medium, heavy), which were divided into two groups: patients with no somatic pathology (n=40) and patients with comorbid pathology in the form of bronchoectatic disease (n=50). Somatically healthy individuals with intact periodontal disease (n=40) were examined as a control group. The values of dental indices – PMA, PI, Muhlemann and OHI-s. The level of annexin A5 was determined in the oral fluid by enzyme immunoassay.
 Results. In patients with CGP revealed a statistically significant higher value of the level of annexin A5 compared with somatically healthy individuals with intact periodontal and statistically significantly higher in patients with more severe periodontitis. At the same time, in patients with comorbid pathology, the level of annexin A5 in patients with CGP with bronchoectatic disease with mild, average and heavy degree of periodontitis is statistically significantly higher than in patients with CGP without somatic pathology. The revealed relationships between the value of dental indices and the level of annexin A5 indicate the influence of the studied marker of apoptosis on the state of periodontal tissues. Moreover, the patients with comorbidity the power value of the identified links more than the present study included patients with no somatic pathology.
 Conclusion. The obtained data show the influence on the currents present study included the presence of comorbid pathology in the form of bronchoectatic disease and presence of common mutually aggravating link of pathogenesis of apoptosis and the opportunity to use annexin A5 as predictive marker of progression, as the present study included patients with no somatic pathology and in the background bronchoectatic disease.

Adaptive capacity of the cardiovascular system in children with rheumatic diseases and comorbid conditions

Purpose: to study the functional state of the cardiovascular system and its adaptive reactions in children with rheumatic diseases, taking into account the development of comorbid conditions. Materials and methods. 44 patients with RD were examined, 8 of them with systemic lupus erythematosus, 36 with juvenile idiopathic arthritis. The average age of the children was 13.39 ± 0.82 years. To study tolerance to the minimum physical activity and its influence on the state of the CVS in children, a six-minute walk test (SMWT) was conducted. To assess the functional intensity of the CVS, the following indices were calculated before and after the SMWT: Allgower index, endurance coefficient according to Kvas formula, Robinson index, coefficient of circulatory efficiency. To assess the influence of the vegetative nervous system (VNS) on the CVS activity, Kerdo vegetative index (KVI) was determined. At rest, the functional changes index (FCI) of the circulatory system, or the adaptation potential (AP), was also determined. Results. In patients with RD, there is a reduced tolerance to minimal physical activity with an increase in the functional tension of the cardiovascular system and activation of the sympathetic division of the autonomic nervous system. When analyzing the functional stress of the cardiovascular system in children with RD and the presence of comorbid pathology, significantly higher values of the adaptation potential and Allgower index were revealed, which indicates the formation of disturbances in the circulatory system against the background of the breakdown of the adaptation mechanisms of the cardiovascular system. The KVI indicates activation of the sympathetic part of the autonomic nervous system in them and an increase in the catabolism processes characteristic for intense functioning with the expenditure of the body's energy reserves. When evaluating these indicators in children without comorbid conditions, the negative KVI value indicates activation of the parasympathetic division of the VNS, which indicates a more favorable, anabolic variant of the shift and more economical mode of functioning of the body systems. Conclusions. Children with RD showed a decrease in tolerance to the minimum physical load in the SMWT, as evidenced by the percentage increase in heart rate and the distance traveled. Tension in the cardiovascular system’s work and a decrease in its functional capabilities were also revealed, as evidenced by a significant increase in the Robinson index, Allgower index and the endurance coefficient both before and after the SMWT. In children with RD and the presence of comorbid pathology, higher values of adaptation potential, Allgover index and Kerdo vegetative index were established, which indicates the formation of disturbances in the circulatory system against the background of the breakdown of its adaptive capabilities.

Prevalence and Possible Causes of Infertility in the Perm Region

The aimof investigation was to assess the characteristics of the epidemic process of the incidence and prevalence of infertility and gonococcal infection, taking into account the demographic situation in Perm region.Materials and methods.The official statistics of the Center for Hygiene and Epidemiology in the Perm Region for 2003–2017 were analyzed (form 2), the territorial body of the Federal State Statistics Service in the Perm Region. The long-term dynamics of general morbidity, distribution of the patients by age, sex, social status, morbidity in combination with HIV infection, the detection of gonococcal infection by various specialists and methods of laboratory diagnostics were studied using the method of retrospective epidemiological analysis. Statistical processing was carried out using the program Statistica 7.0. To determine the relationship between the individual parameters, a simple correlation analysis was used with the calculation of the conjugacy coefficient of the Pearson traits (r).Results.In the Perm region, despite the positive rate of natural population growth, the number of inhabitants in 2010-2016 decreased by 14.5 thousand people. Every year the number of women in adolescent and youthful age falls. It has been shown that the leading factor in the formation of infertility is inflammatory diseases of the reproductive organs and the presence of comorbid pathology. It was established leading value in the pathogenesis of infertility of gonococcal infection. The features of the epidemic process of gonorrhea in the Perm region was shown.Conclusion.In a large number of cases, the complication of the demographic situation in the province is associated with infection of the genital tract. It is necessary to use more widely the possibilities of microbiological diagnostics.

Сombine therapy of patients with acne vulgaris comorbidity with functional disorder of hepatobiliary system and demodecosis

Introduction. One of the common chronic dermatoses that have a direct impact on the quality of life of patients is acne. The occurrence of psycho-emotional disorders due to the location of elements in the open areas of the body. Given the high prevalence of acne in puberty (up to 85 % of adolescents have episodes of acne of varying severity), there is a need to find new algorithms for acne treatment to prevent the progression of social maladaptation and depressive states. Materials and methods. The study included 140 patients who were divided into 3 groups depending on the presence of comorbid pathology and treatment methods: group 1 — patients with acne who were underwent standard treatment for 60 days, group 2 — patients with acne in comorbidity with demodecosis, group 3 — patients with acne in comorbidity with demodecosis and functional disorders of the digestive system, who were additionally treated with a laser therapy. Treatment efficacy was evaluated using the GAGS scale and the DLQI questionnaire on days 14, 28 and 60 of therapy. Results. Evaluation of the results on day 60 shows a decrease in the manifestations of inflammation by 50 % in groups 2 and 3, and by 29 % in the standard therapy group. Improving of the quality of life in groups 2 and 3 was by 70 %, while in the group 1 — by 35 %. The following correlations were established: r = + 0.9 — between the severity of VC manifestations and the presence of comorbid pathology, r = + 0.71 — between the severity of VC and the assessment of quality of life, r = + 0.69 — between the presence of acne comorbidity with demodecosis and FDGBS and the effect on quality of life (p < 0.005). Conclusions. Optimization of the treatment algorithm for acne patients in comorbidity with demodecosis and functional disorders of the hepatobiliary system is achieved by the use of combined treatment using laser therapy, which significantly improves the quality of life of patients.

DYNAMICS OF INDICATORS OF LIPID AND CYTOKIN PROFILES, SYSTEM OF OXIDANT AND ANTIOXIDANT PROTECTION IN PATIENTS WITH OSTEOARTHRITIS IN COMBINATION WITH ARTERIAL HYPERTENSION, OBESITY AND TYPE 2 DIABETES CONSIDERING GENOTYPES OF INTERLEUKIN 10 (IL-10, C-592

Purpose. To study the dynamics of indicators of lipid and cytokine profiles, system of oxidant and antioxidant protection in patients with osteoarthritis in combination with arterial hypertension, obesity and type 2 diabetes considering genotypes of interleukin 10 (IL-10, C-592a) under the influence of treatment.Material and methods. The stage of screening was passed through by 74 patients with OA, AH and D 2 and 25 practically healthy individuals. Polymorphism IL-10 (C-592A) was determined by polymerase chain reaction, and when evaluating the effectiveness of treatment, the presence of comorbid pathology was taken into account.Results. Under the influence of treatment, the content of total cholesterol and LDL cholesterol after treatment significantly decreased in all patients with genotypes IL-10 gene (C-592A), with the possible intergroup difference in the indices with carriers of AA and CA-genotype IL-10 (C-592A). It was found that the TG (triacylglycerols) content among the carriers of the AA-genotype after treatment was the highest: so in comparison with carriers of the СС-genotype - by 29,3% (pCC=0,029) and 43,9% compared with carriers of the CA-genotype (p=0,006). The content of LDL cholesterol significantly decreased in the presence of the CC-genotype by 1.27 times (p=0.003) and the AA-genotype - about twice (p=0.0002), with the possible intergroup difference between the AA and CC-genotype carriers (pCC=0.0001) and the CA-genotype (pCA=0.001) IL-10 (C-592A). In patients with the AA-genotype after the application of complex treatment prescribing atorvastatin, the index of atherogenicity decreased significantly (1.66 times, p=0.002).The probable decrease in the activity of oxidative stress indicators was established (more effective in carriers of the C-allele of the IL-10 gene (C-592A)) against a background of an unlikely increase in antioxidant defense that did not depend on polymorphous variants of the IL-10 gene (rs1800872). The concentration of proinflammatory cytokine IL-18 in patients with osteoarthrosis decreased by 25.6% in the CC-genotype carriers, by 18.58% in the CA-genotype, by 15.37% in the AA-genotype (p>0.05). The content of anti-inflammatory IL-10, on the contrary, increased by 11.69%, 18.0% and 23.08% (p>0.05), respectively. Under the influence of treatment, an insignificant increase in the extracellular matrix protein matriline 3 was observed: in the carriers of the CC-genotype by 4.4%, in the CA-genotype - by 13.5%, and in the AA genotype - by 13.8% (p>0.05).Conclusions. After the treatment, the improvement of lipid profiles in the AA-genotype carriers was the most significant.

Comorbid pathology and prognosis of breast cancer in women in menopause.

Comorbid pathology is important in the survival of patients with breast cancer. The main aim of the present study was to investigate prognostic criteria of the 5-year survival menopausal women with breast cancer, including both the classic criteria (age, tumor size, lymph node status, hormonal status) and the presence of comorbid pathology (arterial hypertension, visceral obesity, diabetes mellitus, metabolic syndrome, immunodeficiency). A prospective cohort study included 98 patients with breast cancer (aged 63 ± 9 years, BMI 31.6 ± 4.8 kg/m2). Criteria favorable short-term (5 years) of the cancer prognosis of breast cancer in menopausal women are the size of the tumor less than 5 cm, the absence of metastases in regional lymph nodes, and the absence of the metabolic syndrome, dyslipidemia, high activity of suppressor cells. Age, anthropometric indices (BMI, waist circumference etc.), presence of arterial hypertension do not give information about the 5-year survival rate in breast cancer.

SOME CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF THE MAXILLOFACIAL AREA PHLEGMONS

Introduction. It is known that the number of patients with phlegmons does not tend to decrease, which can be due to both disease pathomorphosis and changes in the epidemiological features of this pathology. In addition, a significant contribution to the development of the disease makes the characteristics of the comorbidity background. The aim of the study was to assess the clinical and epidemiological aspects of the morbidity of the Perm city population with the maxillofacial area phlegmons. Materials and methods. A retrospective analysis of 137 case reports ofpatients with facial phlegmon was carried out. Results. It is shown that young and middle-aged patients dominated in the age structure of the disease. Phlegmons often localized in 1-2 spaces. In more than half the cases, the phlegmons was in the submandibular space. Among the etiological factors of the disease, the leading place is occupied by gram-positive cocci and their associations. An essential role of anaerobic microflora in the pathogenesis of phlegmons has been established. Microorganisms of the Enterobacteriaceae family play a significant role in the formation of inter-microbial associations in the development of this pathology. Often phlegmons of the maxillofacial region are found in patients with concomitant somatic pathology. With a comorbid component, more frequent detection of microorganism associations is indicated. In addition, such patients enter the hospital much later. Conclusion. Thus, when assessing clinical and epidemiological data, it is shown that the phlegmons of the maxillofacial region occur, as a rule, in young and middle age, and also in the presence of comorbid pathology. A significant contribution to the development of the disease is made by associations of microorganisms, which may include a change in the severity ofpathogenicity factors.

Диференційно-діаґностичні особливості метаболічного синдрому з ожирінням при наявності та відсутності хронічної ішемічної хвороби серця з врахуванням статі

Aim. The differences between metabolic syndrome (MS) with obesity with or without comorbid pathology (chronic coronary artery disease i.e. CAD) were explicated in the research. Material and Methods. 126 patients with MS were examined. MS without chronic CAD was diagnosed in 82 patients and MS with chronic CAD was diagnosed in 44 patients. Levels of lipid spectrum, cortisol, prolactin, thyroid-stimulating hormone (TSH), free thyroxinе (fT4), glycosylated hemoglobin (HbAlc), and glucose were determined in all patients. Ultrasonography of the heart was taken into account. Results and Discussion. Increased levels of cortisol, TSH and prolactin (only in women) were observed in patients with MS without chronic CAD. Normal levels of cortisol and prolactin were observed in the patients with MS and chronic CAD simultaneously with increase of TSH levels in men and women the fT4 level was within normal limits. Changes in given parameters were accompanied by increase in total cholesterol (TCH), triglycerides (TG), low-density lipoprotein cholesterol (LDL CH) and very low-density lipoprotein cholesterol (VLDL CH) and decrease in high-density lipoprotein cholesterol (HDL CH) in patients with MS and chronic CAD regardless of gender, whereas only TG and VLDL CH were increased in patients with MS with obesity without chronic CAD. Interventricular septal thickness(IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end-diastolic size (LVEDS) as well as left atrium anteroposterior dimension (LA) increased in men and women with comorbid pathology, whereas only IVST and LA were increased in MS. Increased prolactin and TSH in women in contrast to men in MS with obesity have been established. High levels of TSH were recorded in the presence of combined pathology regardless of gender.  Conclusion. Thus, diagnostic features of MS with obesity without chronic CAD are characterized by hormonal abnormalities in women, in contrast to men, whereas endocrine changes are not gender-specific in the presence of comorbid pathology.

ARTERIAL HYPERTENSION ASSOCIATED WITH METABOLIC SYNDROME: FOCUS ON DAILY PROFILES OF CENTRAL AORTIC PRESSURE AND VASCULAR STIFFNESS

Purpose: to evaluate the parameters of the central aortic pressure and arterial stiffness during the day in patients with arterial hypertension (AH) with metabolic syndrome (MS) Material and methods: The study included 48 subjects divided into 2 groups: 23 (47,9%) subjects with AH, 25 (52,1%) subjects with AH with MS (AH+MS). Control group (CG) were 22 practically healthy subjects. All the subjects underwent examination ABPM with oscillometric sensor (BPLabVasotens, Russia) with assessment CAP (systolic blood pressure, SBPao; diastolic blood pressure DBPao; pulse pressure,PPao; Augmentation index, Alxao; amplification of pulse pressure, PPA) and arterial stiffness (pulse wave velocity, PWVao; Reflected Wave Transit Time, RWTT; Arterial Stiffness Index, ASI; Augmentation index, AIx). Results: Analysis of CAP demonstrated significant differences between the day / night SBP ao, DBP ao., mean BP ao in AH and AH + MS groups compared to the CG. No significant differences in the parameters of pulse pressure (PP) during the day in these groups are not mentioned, but PP is higher in AH + MS group. Augmentation Index for 24 hours significantly higher, amplification of pulse pressure was significantly lower in the AH + MS compared to CG and AH group. Evaluation of daily arterial stiffness parameters revealed significantly higher rates in PWVao in AH + MS group comparison with the CG and AH group. RWTT statisticaly significant lower in AH + MS and AH groups compared to CG. Conclusion: 24-hour monitoring of CAP and AS revealed a deterioration of the elastic properties of central arteries in hypertensive subjects with metabolic syndrome. Thus, the results of our study confirm the importance of the study of arterial stiffness and the CAP and in the long term could be considered as markers in hypertensive patients, especially in the presence of comorbid pathology.

TRIMEBUTIN IN THE TREATMENT OF IRRITABLE BOWEL SYNDROME AND OTHER FUNCTIONAL GASTROINTESTINAL DISORDERS

Irritable bowel syndrome is seen as a «reference» for understanding pathogenetic essence of functional gastrointestinal disorders. At the basis of functional gastrointestinal disorders are combined morphological and physiological abnormalities associated with visceral hypersensitivity, impaired gastrointestinal motility, the protective mucosal barrier, immune function and composition of the intestinal microbiota, as well as disorders of the central nervous system. An important problem is the optimization of drug therapy in the treatment strategy implying functional gastrointestinal disorders priority to the use of drugs that have a multipurpose effect, simultaneously affecting several pathogenetic links of these diseases, or have a beneficial effect in the presence of comorbid pathology. This review considered trimebutine possibilities for the treatment of functional gastrointestinal disorders.