PROGNOSTIC ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN THE CARDIOVASCULAR COMPLICATIONS DEVELOPMENT IN PATIENTS WITH POLYMORBID PATHOLOGY: THE COMBINED COURSE OF HYPERTENSION, TYPE 2 DIABETES MELLITUS AND SUBCLINICAL HYPOTHYROIDISM.

OBJECTIVE: The aim: To determine the prognostic value of vascular endothelial growth factor (VEGF) levels for the development of cardiovascular complications in patients with a combined course of hypertension, type 2 diabetes mellitus and subclinical hypothyroidism. PATIENTS AND METHODS: Materials and methods: 93 patients (mean age 61,71±0,87 years) with the combined course of hypertension, type 2 diabetes mellitus and subclinical hypothyroidism were examined. Parameters of lipid, carbohydrate metabolism, plasma insulin, VEGF (by ELISA), blood pressure levels were measured. Observation period was12 months. RESULTS: Results: VEGF levels in the patients group were significantly higher than in the controls (482,77±21,34 pg/ ml vs. 121,84±11,66 pg/ ml, p <0,001). The results of the ROC analysis made it possible to propose the level of VEGF ≥ 512.31 pg/ml as an identifier for the cardiovascular complications development in patients with studied comorbidity. VEGF levels in patients who developed cardiovascular complications during observation period were significantly higher the VEGF threshold levels (650,76 ± 52,04 pg / ml vs. 512,31 pg/ml, respectively, p = 0,038) and VEGF levels in patients without cardiovascular complications were significantly lower the threshold values (420,47± 21,67 pg/ml vs. 512,31 pg/ml, respectively, p = 0,047). CONCLUSION: Conclusions: Determination of the vascular endothelial growth factor plasma level allows to evaluate the long-term prognosis in comorbid course of hypertension, type 2 diabetes mellitus and subclinical hypothyroidism.

MORPHOLOGICAL AND STRUCTURAL CHANGES IN MYOCARDIUM, LIPID AND СARBOHYDRATE METABOLISM DURING DIFFERENT OUTCOMES OF CHRONIC HEART FAILURE IN PATIENTS WITH ISCHEMIC HEART DISEASE AND DIABETES MELLITUS TYPE II.

OBJECTIVE: The aim: To establish features of structural and functional changes in myocardium, carbohydrate and lipid metabolism, in patients with different outcomes of chronic heart failure (CHF), caused by IHD and DM type II. PATIENTS AND METHODS: Materials and methods: Examination of 100 patients who have CHF with IHF and DM type II was performed. Patients were divided in two groups, according to outcome: group I (n = 66) - patients with favorable outcome, mean age 60,0 [55,8; 63,3] years, group II (n = 34) - unfavorable outcome of CHF, mean age 58,0 [55,0;60,3] years. We analysed complaints, cardiologycal anamnesis, cardiovascular risk factors, physical examination data. Transthoracic echocardiography (TTE), carbohydrate and lipid panel were assessed to find out early specific signs of myocardial injury. RESULTS: Results: We find out statistically significant associations between TTE results, lipid panel and CHF progression in study population. CONCLUSION: Conclusions: Comparative analysis showed that degree of CHF in patients with IHD and DM type II that have preserved LV EF is associated with: duration of DM and CHF, arterial hypertension (AH) level and degree of carbohydrate and lipid metabolism disturbances. Early TTE signs of unfavorable outcome are: increase of transmitral deceleration time (Dt), increase of mean PA pressure (PA MP) even in range lower the 20mmHg.

PECULIARITIES OF METABOLIC CHANGES IN ASTHMA.

OBJECTIVE: The aim: Revealing of clinical-pathogenetic peculiarities in manifestations of uncontrolled As+MS. PATIENTS AND METHODS: Materials and methods: Sixty-five cases, divided into 2 groups: Group I - severe As (n=20), Group 2 - severe As+MS (n=45). The general clinical examination included fasting blood glucose, insulin level, HOMA-IR index, body mass index (BMI), spirometry, levels of ММР-9, МСР-1, IL-8 and IL-12. RESULTS: Results: In Group I, 20 patients (100%) had obstructive respiratory dysfunction. Group II had 13 cases (28.88%) with the restrictive, 15 (33.33%) with the obstructive and 17 (37.77%) with the mixed types. BMI revealed: Group I had the normal mass (BMI averaged 24.62 [22.76; 25.71]; Group II had 21 overweighed cases (46.66%) and 24 (53.33%) with grade 1 obesity, averaging 29.70 [28.35; 31.23]. Correlation analysis in Group II showed significant correlations between: age and WHR (r=0.52, p<0.001) (increase of abdominal fat depots during life), FEV1 and BMI (r=-0.63, р<0.001) (obesity affects pulmonary function). IL-8 and IL-12 levels in Group II were increased, respectively, by 27.86 and 13.18 times versus Group I. A relationship was found between MCP-1 and MMP-9 (r=0.77, р<0.05), Group II revealed direct correlation between MCP-1 and total FEV1 (r=0.53, р<0.05). CONCLUSION: Conclusions: Overweight and obesity in As+MS deteriorate respiratory function versus the same indices in isolated As. Relationships between proinflammatory cytokines and MMP-9 and MCP-1 prove pathogenetic peculiarities of systemic inflammation and metabolic homeostasis. As and MS can cause their coexistence, facilitating development of mutual aggravation.

The influence of various methods of anesthesia on time of postoperative recovery of patients' conciousness after curettage of uterine cavity.

OBJECTIVE: Introduction: Scientific information sources point to the significant effectiveness of curettage of uterine cavity (CUC) as a diagnostic and treatment mode of gynecologic oncology. Today the anesthesia service is able to satisfy virtually all the requirements of a surgeon and a female patient, however, some institutional factors, as for example postoperative recovery of consciousness, and factors influencing it, remain unaddressed. The aim: to explore the possibilities of influence of different combinations and dosages of medical preparations used to provide monitored anesthesia care of CUC, to change the time of postoperative recovery of patient's consciousness. PATIENTS AND METHODS: Materials and methods: an interview of 96 patients by VAS, studies of cortisol, insulin and glucose levels in blood serum, measurements of time from the end of surgery to the awakening and complete recovery of consciousness and statistical processing of the results have been conducted. RESULTS: Results: A combination of 50 mg of dexketoprofen and half-dose drugs for narcosis can hasten the postoperative wake-up time by 38%, while maintaining dosages can prolong by 37% on the contrary. There is a dose-dependent effect of drugs for narcosis on the time of full post-operative recovery of consciousness. The reduction of their dosages by half can reduce this time by almost 40%. CONCLUSION: Conclusions: the dosage modification of anesthetic drugs and their combinations may have a significant effect on the time of postoperative awaking and complete recovery of consciousness in female patients after CUC. As a result, it has a positive physiological, psychological and social effect.