FEATURES OF THE DAILY PROFILE OF ARTERIAL BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS IN COMBINATION WITH ARTERIAL HYPERTENSION.

OBJECTIVE: The aim: To determine the features of daily shifts in blood pressure (BP), the influence of the presence of rheumatoid arthritis (RA) on BP control and identify factors that affect BP among patients with RA in combination with resistant hypertension (RH). PATIENTS AND METHODS: Materials and methods: All material for writing this scientific work were the results of a comprehensive survey of 201 people with RH and RA, hypertension (H) and RA, RA without H, H without RA and relatively healthy individuals. A laboratory study was performed: rheumatoid factor, C-reactive protein (CRP), K+ serum, and creatinine levels. All patients underwent office BP measurement and ambulatory BP monitoring for 24 hours. Statistical processing of the study results was carried out using "IBM SPSS Statistics 22". RESULTS: Results: Among patients with RA in combination with RH non-dippers (38.7%) are the most common type of BP profile. Patients with RH in combination with RA are characterized by an increase in BP more at night (p <0.003), which corresponds to the high frequency of night-peackers (17.7%). The presence of RA determines worse control of diastolic BP (p <0.01) and more vascular overload on organs and systems during the night (p <0.05). CONCLUSION: Conclusions: An increase in BP in patients with RA in combination with RH is more significant at night, characterized by poorer BP control and greater vascular load at night indicating the need for tighter control of BP during sleep. Non-dippers are most often detected among patients with RA in combination with RH, which is prognostically unfavorable for the development of nocturnal "vascular accidents".

Effect of a specific Escherichia coli Nissle 1917 strain on minimal/mild hepatic encephalopathy treatment.

BACKGROUND: Hepatic encephalopathy (HE) can be considered a result of dysregulated gut-liver-brain axis function, where cognitive impairment can be reversed or prevented by the beneficial effects induced by "gut-centric" therapies, such as the administration of nonabsorbable disaccharides, nonabsorbable antibiotics, probiotics and prebiotics. AIM: To assess the short-term efficacy and safety of the probiotic Escherichia coli Nissle (EcN) 1917 strain compared to lactulose and rifaximin in patients with minimal/mild HE. METHODS: From January 2017 to March 2020, a total of 45 patients with HE were enrolled in this prospective, single-centre, open-label, randomized study. Participants were randomly assigned at a ratio of 1:1:1 to one of the treatment groups: The EcN group (n = 15), lactulose group (n = 15) or rifaximin group (n = 15) for a 1 mo intervention period. The main primary outcomes of the study were changes in serum ammonia and Stroop test score. The secondary outcomes were markers of a chronic systemic inflammatory response (ІL-6, ІL-8, and IFN-γ) and bacteriology of the stool flora evaluated by specialized nonculture techniques after a 1 mo intervention period. RESULTS: Patients who were given rifaximin or EcN showed a more significant reduction in serum ammonia and normalization of Bifidobacteria and Lactobacilli abundance compared to the lactulose group. However, the most pronounced restoration of the symbiotic microflora was associated with EcN administration and characterized by the absence of E. coli with altered properties and pathogenic enterobacteria in patient faeces. In the primary outcome analysis, improvements in the Stroop test parameters in all intervention groups were observed. Moreover, EcN-treated patients performed 15% faster on the Stroop test than the lactulose group patients (P = 0.017). Both EcN and rifaximin produced similar significant reductions in the proinflammatory cytokines INF-γ, IL-6 and IL-8. EcN was more efficient than lactulose in reducing proinflammatory cytokine levels. CONCLUSION: The use of the probiotic EcN strain was safe and quite efficient for HE treatment. The probiotic reduced the ammonia content and the level of serum proinflammatory cytokines, normalized the gut microbiota composition and improved the cognitive function of patients with HE. The application of the EcN strain was more effective than lactulose treatment.

INFLUENCE OF ADVERSE PRODUCTION FACTORS ON CEREBRAL HEMODYNAMIC IN LOCOMOTIVE DRIVERS.

OBJECTIVE: The aim: To investigate the pathological changes in intra- and extra cranial blood vessels in workers of locomotive crews depending on their length of service. PATIENTS AND METHODS: Materials and methods: The study involved 249 male patients, aged from 21 to 60 years who worked as locomotive drivers. We used Doppler examination and studied Doppler Indexes of cerebral vessels. RESULTS: Results: Results of examination showed that with increasing length of work of workers of locomotive crews (together with increasing of their age) we have established: 1) Reduction the elasticity of blood vessels (77.6% of the patients); 2) Increased violation of venous circulation (86.4%); 3) Reduced blood flow in the basilar artery (64%); 4) Reduced blood flow in the right and left vertebral arteries (65.6% and 65.5% respectively); 5) Increase in the thickness of intimate / media complex more than 1.1 in 62 % of drivers. All of that also connected with length of their work. CONCLUSION: Conclusions: we founded that speed of blood flow and elasticity in intra- and extra cranial vessels reduced with increase the length of service of workers of locomotive crews. Also we received such results: increasing violation of venous circulation, reducing blood flow in the basilar artery and reducing of blood flow in right and left vertebral arteries, increase intima / media thicknesses greater than 1,1 in locomotive drivers.

Impact of the Synbiotics and Urate-Lowering Therapy on Gut Microbiota and Cytokine Profile in Patients with Chronic Gouty Arthritis.

The main goal of our study is the impact evaluation of complex urate-lowering therapy with the synbiotic addition on fecal microbiota and cytokine profile in patients with primary gout. During our study, 130 men (mean age 55.5 ± 9.4 years) with gout (duration 7.7 ± 7.1 years) were examined. All patients were divided into two treatment groups. The main group (n = 68) was taking allopurinol at 300 mg per day dose and additionally a synbiotic. The comparison group (n = 62) received allopurinol monotherapy without synbiotic intake. The therapy duration was 3 months. Evaluation of therapy efficiency was marked by blood uric acid changes, cytokine levels, CRP and fecal microbiota condition. After treatment, stabilization of the gut microbiota parameters was observed, which was leading to normalization uricemia levels (40.3% vs. 21%, p <0.01) in the main group patients. Addition of synbiotic to allopurinol leads to a blood uric acid lowering (18.7% vs. 13.3%, p <0.01), CRP reduction (75% vs. 26.3%, p <0.01) as well as decrease of cytokines level: IL-1ß, IL-6, IL-8, IL-10 and TNFα (all p <0.001). After a 3-month gout treatment, a group of patients who received complex therapy with synbiotic inclusion showed signs of disease remission characterized by inflammation activity reducing, fecal microbiota condition normalization and a more pronounced decrease in laboratory markers comparing to control group.

Role of immune system in development and progress of combined arterial hypertension and gout.

OBJECTIVE: Introduction: Multiple data available indicate high prevalence of comorbid abnormalities in gouty arthritis patients, namely, high incidence of arterial hypertension, coronary artery disease, stroke, atherosclerosis of carotid arteries, vascular dementia. For instance, hypertension is found in 36-41% gout patients, and combined with metabolic syndrome it may reach 80%. The aim: Studying features of clinical course, lipid profile and immune status in patients with combined hypertension and gout. PATIENTS AND METHODS: Materials and methods: The study involved examination of 137 male patients with stage II hypertension, average age 56.9±3.4. All patients underwent echocardiography with estimation of the left ventricular mass index to verify hypertension stage, blood chemistry test with estimation of uric acid level, as well as lipid profile and immune status. RESULTS: Results: We have found significant disorders in the lipid profile of blood serum in patients with combined hypertension and gout. Positively higher percentage of activated T-cells was found in patients with combined hypertension and gout, both with early (CD3+CD25+) and late (CD3+HLA-DR+) activation marker, as well as those expressing FAS receptor, and ready to enter into apoptosis. CONCLUSION: Conclusion: We have identified abnormalities in adhesion and cooperation of immune competent cells, resulting in more intense activation of the same, effector functions and migration to the area of inflammation in the vessel wall.

Public health and social supervision issues within public administration of ukrainian territories in the late 8th- early 9th centuries.

OBJECTIVE: Introduction: The public health system modernization history is based upon the progress in state country administration and administration of healthcare within the sectorwide approach. The WHO European Bureau pays much attention to the National Health Service systems development while implementing their basic policies. The Ukrainian state health service management was founded basing on the regulatory field of the Russian Empire, using the European healthcare promotion experience. Aim: of the article is the analysis of the regulatory field of police and amenity authorities of the Russian Empire and Ukraine within the medical and social service in the 18th-19th centuries. PATIENTS AND METHODS: Materials and methods: The structure of the article corresponds to the problem city and chronology principles, using the following methods and techniques of scientific learning: the systemic, historic, regulatory comparative, logical and structural-functional analysis of the studied medical-legal phenomena. The study sources are the scientific publications, collections of laws and executive orders of the Russian Empire and Ukraine in the 18th-19th centuries. RESULTS: Review: As a result of the performed work it can be determined were the main directions of the police competence in late 18th- early 19th centuries. CONCLUSION: Conclusion: Preserving health, treatment of the ill and injured, management of medical and social service of those in need, holding various preventive activities and supporting safe environment and regulating the safety of food were the main directions of the police competence in late 18th- early 19th centuries.

Effect of quercetin on the echocardiographic parameters of left ventricular diastolic function in patients with gout and essential hypertension.

OBJECTIVE: Introduction: Gout is associated closely with an increased risk of cardiovascular (CV) events including heart failure. The aim: Improvement of treating patients with gout and essential hypertension (EH) by applying course therapy of quercetin of the echocardiographic parameters of the left ventricular diastolic function. PATIENTS AND METHODS: Materials and methods: 84 male patients with gout and EH. The main group consists of 43 patients who have performed treatment with quercetin and a comparative group of 41 patients who were performed treatment without quercetin. RESULTS: Results: In patients with gout in combination with EH, the addition of quercetin to antihypertensive and urate-lowering treatment have a protective effect on cardiac diastolic function (the baseline-adjusted changes during 12 months were significantly lower in the quercetin group than in the comparative group for E/e' (-0,41± 0,01 vs. -0,08 ± 0,01, p = 0,001) and LV mass index, g/m2 (-3,28 ± 0,02 vs. -2,04 ± 0,03, p = 0,02). Also this combination contributed to faster and more pronounced achievement of the target level of uric acid (reduction by 33,7%), normalize renal function (the rate of glomerular filtration, ml/min/1,73 m2 level increase by 13,3%) and also had a cumulative antihypertensive effect (reduction of systolic blood pressure by 5,5% and diastolic blood pressure by 3,6%) without increasing the dose or adding new antihypertensive drugs. CONCLUSION: Conclusion: adding quercetin to antihypertensive and urate-lowering regimens for 12 months in patients with gout and EH improve echocardiographic parameter of diastolic function left ventricular, purine metabolism, renal function and additional normalize blood pressure.