S-AMLODIPINE AS A MODERN EFFECTIVE ANTIHYPERTENSIVE AND AN ANTIANGINAL AGENT.

OBJECTIVE: The aim: Study of the clinical and hemodynamic effects of S-amlodipine in patients with arterial hypertension associated with coronary artery disease, in individuals with preserved LV systolic function. PATIENTS AND METHODS: Materials and methods: The study includes 51 patients with arterial hypertension associated with coronary artery disease, who were treated with S-amlodipine. RESULTS: Results: This study shows the high clinical effectiveness of the use of S-amlodipine in patients with arterial hypertension associated with coronary artery disease. We reveal that treatment of hypertensive patients with coronary artery disease with S-amlodipine leads to improvement of LV diastolic dysfunction, bringing it closer to normal values. CONCLUSION: Conclusions: Clinical effectiveness was associated with positive changes in hemodynamics, and was expressed in the normalization of the left ventricle diastolic function parameters, about which indirectly indicates decreasing of end-diastolic pressure.

Comorbidity severity index as a new tool for assessment of co-existing diseases in patients with non-alcoholic fatty liver disease at the carbohydrate metabolism disorder background and concomitant subclinical hypothyroidism.

OBJECTIVE: Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common disease which is characterized by comorbidity. However, no comorbidity index for its assessment has been described yet. The aim of this study was to develop a new index for evaluation of comorbidity in patients with NAFLD. PATIENTS AND METHODS: Materials and methods: 226 patients with NAFLD and associated carbohydrate metabolism disorders were examined. Besides, 60 persons with subclinical hypothyroidism, 30 patients with type 2 diabetes mellitus (T2-DM) and 30 NAFLD patients were examined. 30 healthy persons formed the control group. Clinical diagnoses were based on the laboratory tests and liver sonography. A new index of comorbidity has been used. Calculation of comorbidity severity index (ComSI) includes the possible presence of NAFLD, thyroid disorders, abdominal obesity, dyslipidemia, anemia, chronic complications of T2-DM, aggravated anamnesis. RESULTS: Results: The contradiction in the calculation of the well-known comorbidity indices values (CIRS - Cumulative illness rating scale, CCI - Charlson's comorbidity index, Kaplan-Feinstein index) was shown. So, their limited suitability for using in patients with carbohydrate metabolism disorders who have NAFLD was detected. According to our results an increasing of patients' age is associated with the increasing of concomitant diseases number and with deteriorating of the patients' general condition, which is reflected in an increasing of the ComSI value. The increasing of concomitant diseases number is associated not only with the higher ComSI, but also with the number of persons with a severe comorbidity according the ComSI value. Instead, the persons without comorbidity (groups 6, 7, 8) were marked as the patients with mild or moderate disease according the ComSI. CONCLUSION: Conclusions:The new ComSI index can be used to evaluate the severity of comorbidity in patients with NAFLD.

Subclinical hypothyroidism in patients with non-alcoholic fatty liver disease at the background of carbohydrate metabolism disorders.

OBJECTIVE: Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) is 25-30% in the general population and more than 75% among patients with carbohydrate metabolism disorders. One in six patients with NAFLD has concomitant subclinical hypothyroidism. The aim is to compare lipid and carbohydrate metabolism states in patients with NAFLD depending on the functional state of the thyroid gland. PATIENTS AND METHODS: Materials and methods:215 patients with NAFLD and type 2 diabetes mellitus (T2-DM) or pre-diabetes (PD) were involved in study and devided into 6 groups according to the functional state of the thyroid gland. RESULTS: Results: In cases of adding subclinical hypothyroidism systolic and diastolic blood pressure are rising. In patients with overt hypothyroidism average HOMA-IR index is 29,98±1,05, which exceeds the corresponding figure in patients with concomitant subclinical hypothyroidism. In patients whose hypothyroidism has been compensated by levothyroxine, HOMA-IR index was reduced to 18,56±1,58, indicating a tendency to restore the sensitivity of peripheral tissues to insulin, on the assumption under the medicatedcorrection of thyroid functional status. Levels of common cholesterol and triglycerides were higher in cases of NAFLD with subclinical or overt hypothyroidism than in patients with NAFLD and normal thyroid function. Replacement therapy by levothyroxine leads to improving of lipid changes in patients with NAFLD and concomitant overt hypothyroidism: the levels of common cholesterol and triglycerides were reducing from 6,04±1,18 mmol/l and 3,96±1,34 mmol/l to 5,97±1,1 mmol/l and 3,45±1,13 mmol/l in accordance. CONCLUSION: Conclusions: Concomitant subclinical hypothyroidism in patients with NAFLD at the background of carbohydrate metabolism disorders leads to atherogenic dyslipidemia, increasing of blood atherogenicity. The index of lipid accumulated product (LAP) and the resistance of peripheral tissues to insulin also increases.

[Dynamics of staphylococcus aureus antibiotic resistance to fluoroquinolones in vitro in patients with overweight].

OBJECTIVE: Introduction:S. aureus is the main pathogen of skin, soft tissue and otorhinolaryngological infections as well as the cause of osteomyelitis, meningitis and endocarditis. In recent years the importance of S. aureus mediated infections has grown not only because of their widespread, but also due to their antibiotic resistance. Recent observations showed that the resistance is developed to each new antibacterial agent after 5 years of its intensive use. Based on the studies conducted in Ukraine, it is known that the resistance of S. aureus to fluoroquinolones varies in different regions and ranges from 4-6% to gatifloxacin to 45.2-49% to norfloxacin and pefloxacin. Considering that in the overwhelming majority of cases antibacterials are prescribed empirically, an important background for successful antibiotic therapy is taking into account the regional and mostly the local antimicrobial resistance patterns. The aim of the study was to evaluate the antibiotic resistance profile of S. aureus isolates to fluoroquinolones and its changing during 2011-2016. PATIENTS AND METHODS: Materials and methods: 355 S. aureus strains isolated from adult with overweight (IBM=25,0-29,9) who were treated in Uzhhorod medical settings due to bacterial tonsillitis or pharyngitis during 2011-2016 were included in the study. After isolation of a pure culture, susceptibilities were tested by using the disk diffusion method. The following antimicrobial disks were tested on Müller-Hinton agar (Biolife, Italy): ofloxacin (5 µg), ciprofloxacin (5 µg), levofloxacin (5 µg), gatifloxacin (5 µg), Sparfloxacin (10 µg), pefloxacin (10 µg), and norfloxacin (10 µg). Research methods were used with respect for human rights, according to the current legislation in Ukraine in accordance to international ethical requirements and do not violate the ethical standards in science and standards for conducting biomedical research. RESULTS: Results: Analysis of S. aureus resistance to fluoroquinolones found that this parameter remained at a relatively low level and, in majority of cases, did not exceed 12%. However, constant increasement of antimicrobial resistance was noticed during 2011-2016. Thus, the S. aureus resistance to norfloxacin, levofloxacin and ciprofloxacin increased significantly from 0.00%, 0.00% and 1.54% in 2011 to 11.76%, 13.73% and 9.80% in 2016 respectively. Resistance to ofloxacin and gatifloxacin in 2011-2016 rised from 3.08% and 0.00% to 11.76% and 1.96%, respectively, but this difference was not statistically significant. The S. aureus susceptibility to fluoroquinolones fluctuated within 80-90% during 2011-2016 and gradually decreased. For instance, susceptibility to norfloxacin, ofloxacin and levofloxacin decreased significantly from 93.85%, 96.92% and 100.0% to 80.39%, 88.24% and 84.31% respectively over the past 6 years. However, for pefloxacin there was a significant increase in susceptibility from 90.77% to 100.00% during the investigated period. The prevalence rates of intermediate resistant S. aureus isolates during the study period was negligible and in majority of cases this type of strains were not detected at all. CONCLUSION: Conclusion: Relatively low rates of resistance and high rates of susceptibility aloud to recommend fluoroquinolones for the empirical therapy of S. aureus caused infections. However, the gradual increase of resistance to these antibiotics, requires strict compliance with the antimicrobial stewardship.

[Clinical and endoscopic efficacy of vedolizumab in patients with ulcerative colitis].

OBJECTIVE: Introduction: Ulcerative colitis (UC) is a chronic recurrent idiopathic inflammatory bowel disease that is characterized by a continuous or wave-like course with multifactorial etiopathogenesis. In recent decades, the number of patients with this pathology has been steadily increasing. Therefore, timely detection of UC at the diagnostic stage for the further qualified assistance providing is one of the most important tasks in modern gastroenterology. In recent years, a new group of drugs that can be an alternative to the surgical method of treatment has appeared. These are biological drugs, one of which is vedolizumab. The aim: to study the changes in clinical and endoscopic parameters in patients with ulcerative colitis, in response to the biological therapy with vedolizumab. PATIENTS AND METHODS: Materials and methods: 38 patients with ulcerative colitis were included in this study that lasted 52 weeks. 15 patients of the control group received standard therapy with 5-aminosalicylic acid (5-ASA). 23 patients in the study group received the vedolizumab infusions. RESULTS: Results: Clinical response was observed in 16 (69.6%) and 23 (100.0%) patients of the study group at the 6th and 52nd weeks respectively. In control group the clinical response was present in 5 (33.3%) and 9 (60,0%) patients at the 6th and 52nd weeks respectively. Mucosal healing at the 52nd week was observed in 22 (95.7%) patients in the study group and 7 (46.7%) patients in the control group. CONCLUSION: Conclusions: Patients who were treated with vedolizumab experienced significant improvement in clinical and endoscopic parameters 52 weeks after treatment initiation compared to the control group.