[Comorbidity of depressive disorders and coronary heart disease: general aspects of pathogenesis].

AIM: The high level of comorbidity of coronary heart disease (CHD) and depressive disorders and general aspects of their pathogenesis is an actual problem of modern research. Authors studied the content of cholesterol, platelet serotonin, platelet aggregation, activity of pro-inflammatory markers in CHD patients with comorbid depressive disorders. MATERIAL AND METHODS: The study included 76 patients with CAD. The diagnosis of depressive disorder was set according to ICD-10, The Hamilton depression scales was used. RESULTS AND CONCLUSION: Depressive disorders in CHD patients were associated with an increase in the activity of pro-inflammatory markers (IL-6 and TNF-α), and with high levels of low density lipoproteins. In patients with CAD and depressive disorders with high contents of platelet serotonin, the level of cholesterol was higher compared to those with low contents of serotonin. No significant differences in the functional platelet activity were identified in patients with CAD and comorbid depression compared to patients without mood disorders.

[Efficacy of donor lymphocyte infusion in patients after different types of allogeneic hematopoietic stem cell transplantation].

AIM: To evaluate the efficacy of donor lymphocyte infusion (DLI) to prevent and treat recurrences in patients after different types of allogeneic hematopoietic stem cell transplantation (allo-HSCT). SUBJECTS AND METHODS: Data from 118 patients with malignant blood diseases were analyzed. Allo-HSCTs from HLA-matched related donors (n=49), HLA-matched unrelated donors (n=50), partially HLA-matched unrelated donors (n=2), and haploidentical donors (n=24) were performed. The indications for DLI were underlying disease relapse (59 DLIs), resistant disease course (n=40), minimal residual disease (n=1 6), falling donor chimerism (n=1 5), and recurrence prevention (n=1 3). RESULTS: Therapy response was obtained after 57 (44%) DLls. There were 36 (25%) and 30 (21%) cases of acute and chronic graft-versus-host reactions (GVHR), respectively. The use of DLI from HLA-matched donors, its performance in the periods of D+100 to one year after allo-HSCT, a donor chimerism level of over 90% at the moment of DLI, the administration of the initial DLI dose of below 1.10(6) CD3+/kg, and the development of chronic GVHR after DLI were associated with the highest rate of therapy responses. The overall survival rates of patients with DLI were significantly influenced by factors, such as DLI periods, donor chimerism levels at DLI, and the development of chronic CVHR after DLI. CONCLUSION: The choice of the optimal dose of cells, the periods of DLI and its preventive administration improve prognosis in patients after allo-HSCT. The occurrence of acute GVHR is affected by the degree of HLA matching and the type of a donor. The development of chronic GVHR after DLI is associated with the highest rate of responses to DLI and higher survival rates.

[Invasive mycoses during hematopoietic stem cell transplantation].

AIM: To define the frequency, etiology, and risk factors of invasive mycoses (IM) in patients with allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (HSCT) and to evaluate the impact of IM on overall survival (OS). MATERIALS AND METHODS: Data on 356 patients after allo-HSCT (n = 237) and auto-HSCT (n = 119) from 2000 to 2010 were analyzed. The diagnosis of IM was established according to the EORTC/MSG 2008 criteria. RESULTS: The incidence of myocardial infarction (MI) was 19.1%; that was 23.2 and 10.9% in allo-HSCT and auto-HSCT recipients, respectively. The incidence of MI following allo-HSCT was significantly higher than that after auto-HSCT. Aspergillus spp. (82.3%), Candida spp. (11.8%), zygomycetes (Mucor spp., Rhizopus spp.) (4.4%), and Cryptococcus neoformans (1.5%) are involved in the etiology of MI. Its risk factors are acute lymphoblastic leukemia; non-myeloablative conditioning regimen; use of fludarabine and antilymphocyte globulin; peripheral blood stem cells as a source for grafting; long-term lymphopenia, neutropenia; use of granulocyte colony-stimulating factor (G-CSF); acute graft-versus-host reaction; grade 3-4 mucositis; infections, such as cytomegalovirus, sepsis. The development of MI in HSCT recipients did not significantly reduce one-year OS after allo-HSCT and auto-HSCT--53.6 and 55% and 86.7 and 90.3% (with and without MI, respectively). In patients with invasive aspergillosis, OS (12 weeks after IM being diagnosed) was significantly longer in those with other invasive mycoses (91.3 and 50%, respectively). CONCLUSION: The incidence of MI after allo-HSCT was higher than that after auto-HSCT. MI induced by the fungal genus Aspergillus spp. was most common. Along with known risk factors, there was a poor prognostic factor, such as G-CSF. The development of MI failed to affect one-year OS, which was indicative of the adequate quality of its early diagnosis and therapy. The prognosis was poor in patients with invasive candidiasis, zygomycosis, and cryptococcosis. Investigations need to be continued to specify the reasons for high morbidity rates and the factors provoking discussion by investigators worldwide.

[Algorithm of anxiety-depressive disorders detection in patients with coronary heart disease in general clinical practice].

AIM: To estimate a diagnostic algorithm for anxiodepressive disorders (ADD) in coronary patients in general therapeutic practice. MATERIAL AND METHODS: A total of 163 coronary patients were examined using Seattle, Moriski and Green, Hospital questionnaires for anxiety and depression. Patients with clinical and subclinical anxiety and/or depression by Hospital testing responded to Hamilton anxiety and depression questionnaire. An analysis of clinical, anamnestic and socioeconomic parameters was made to create a multifactor model for ADD detection in coronary patients basing on the method of multiple logistic regression. RESULTS: A model of ADD dependence Z = -3.446 x [presence or absence of anxiety and/or depression in the past]-2.451 x [presence or absence of stress for a year] - 2.452 x [drinking alcohol or rejection of alcohol] + 0.071 x [the disease perception in percent from Seattle angina questionnaire]. In certain combination of responses (presence or absence of parameters) and digital result in 7 combinations the patients can be diagnosed to have ADD. CONCLUSION: The diagnostic algorithm proposed helps ADD detection in coronary patients in general therapeutic practice without participation of psychotherapists and medical psychologists.

[Efficacy of thyroxine and potassium iodide treatment of benign nodular thyroid lesions]. / Otsenka éffektivnosti lecheniia dobrokachestvennykh uzlovykh obrazovanii shchitovidnoi zhelezy tiroksinom i kaliia iodidom.

AIM: To study efficacy of thyroxine (TX) and potassium iodide (PI) in the treatment of benign nodular thyroid lesions (BNTL). MATERIAL AND METHODS: 118 patients with BNTL (colloid or colloid hypercellular as shown by thin needle aspiration biopsy, 'cold" or "warm" by scyntigraphy findings) were randomized into two groups: 59 patients were given thyroxin and the other 59 patients PI. The day dose of TX (75-150 mcg) was prescribed according to serum concentration of TTH trying to diminish it to 0.5 mIU/l and lower. PI dose was 200 mcg/day. Most of the patients were treated for 6 months. The response was evaluated with ultrasound investigation which measured thyroid volume, the size and number of the nodes in it before and in the end of therapy. The treatment was found effective if the dominant node decreased in size by 50% and more compared to pretreatment values. RESULTS: The size of the dominant node decreased by 50% and more in 14 of 59 (23.73%) patients on TX and in 20 of 59 (33.90%) patients on PI. Both TX and PI prevented growth of the dominant node size and number of the nodes in approximately 2/3 cases. TX was more effective in young patients (40.92 +/- 3.45 years) vs older ones (47.50 +/- 1.46 years, p = 0.047) and patients with colloid nodes. PI was more effective in patients with shorter node existence (3.93 +/- 1.21 and 8.59 +/- 1.74 months, p = 0.02). TX reduced thyroid volume from 20.42 +/- 1.69 to 15.18 +/- 1.30 ml (p = 0.001), PI--from 18.34 +/- 1.57 to 15.36 +/- 1.25 ml (p = 0.001). CONCLUSION: TX and PI can inhibit or prevent the growth of thyroid benign nodes in approximately 2/3 patients especially in young patients with colloid nodes (TX) and in short existence of the node (PI).

[I/D polymorphism in the angiotensin-converting enzyme gene in men with myocardial infarction at young age]. / I/D polimorfizm gena angiotenzinprevrashchaiushchego fermenta u muzhchin, perenesshikh infarkt miokarda v molodom vozraste.

The rate of D allele did not differ between patients with ischemic heart disease (IHD) who had myocardial infarction before the age 45, and healthy males. The DD genotype of the ACE gene was much more frequently encountered in the patients than in healthy males. The findings suggest that the DD genotype is an independent risk factor of the IHD and myocardial infarction in young patients.