Saratov JOURNAL of Medical and Scientific Research

Internal Diseases

The role of polymorphism of the genes COL1A1, MMP12, EPHX1 in osteoarthritis and cardiovascular comorbidity

Year: 2018, volume 14 Issue: №3 Pages: 373-379
Heading: Internal Diseases Article type: Original article
Authors: Kabalyk M.A., Nevzorova V.A., Sunyaykin А.В.
Organization: Pacific State Medical University
Summary:

Aim: to analyze polymorphic variants of genes of connective tissue remodeling, biotransformation and their role in the development of cardiovascular comorbidity and osteoarthritis (OA). Material and Methods. The study included 70 patients with OA. As a control group, 30 patients without OA of comparable sex and age were included in the study. All patients were assessed total (absolute) cardiovascular risk according to the SCORE scale. The pain was assessed by visual analog pain scale. The physical dysfunction was assessed on a WOMAC scale. Single-nucleotide polymorphisms of the genes COL1A1 (rs1107946), EPHX1 (rs1051740), MMP12 (rs652438) were studied by PCR-RT. Results. In patients with OA, there is a twofold increase in the frequency of the heterozygous genotype of the GT gene COL1A1. The presence of the T allele of the COL1A1 gene is a risk factor for the development of OA. Patients with OA have a fourfold increase in the frequency of genotype AG of the MMP12 gene. The patients with severe pain significantly present the difference in the distribution of allele frequencies of the polymorphic locus G1997T of the COL1A1 gene from the control sample. The frequencies of heterozygous genotypes COL1A1 and MMP12 differed significantly in patients with different cardiovascular risk. Conclusion. The results partially confirm the integration theory of the pathogenesis of OA, suggest the existence of general mechanisms of connective tissue remodeling.

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The influence of different variants of glucose-lowering therapy on indices of inflammation in patients with diabetes type 2 on a background of gastroesophageal reflux disease and obesity

Year: 2018, volume 14 Issue: №3 Pages: 368-372
Heading: Internal Diseases Article type: Original article
Authors: Andreeva E.l.
Organization: Stavropol State Medical University
Summary:

Aim: to evaluate the effect of different types of hypoglycemic therapy on the level of leptin, interleukin-6, C-reactive protein, tumor necrosis factor-alpha, as well as body mass index. Material and Methods. The study involved 250 people. 200 case histories of patients with the main diagnosis Gastroesophageal Reflux Disease were analyzed. Group I consisted of 50 suffering from diabetes type II diabetes in combination with obesity of varying severity and GERD. Treatment of diabetes in this group was carried out with the help of Metformin. Group II consisted of 50 patients with type II diabetes mellitus combined with obesity of varying severity and gastroesophageal reflux disease. Patients in this group took exenatide. Group III consisted of 50 patients suffering from obesity of different severity and gastroesophageal reflux disease. The comparison group (IV) consisted of 50 patients with gastroesophageal reflux disease without overweight and comorbidities. For the treatment of GERD in the study subjects used — omeprazole. The control group (V) consisted of 50 healthy volunteers. Laboratory tests (General blood test, biochemical, immunological parameters) were performed on automated hematological (Ruby), immunochemical (Architect 2000) and biochemical (Architect 4000) analyzers (Abbott, USA). Results. In the course of assessing the indicators before therapy, we can note an increase in the level of leptin in the group of patients with obesity, while against the background of type 2 diabetes. Assessing the level of interleukin-6, C-reactive protein, tumor necrosis factor-alpha statistically significant increase in indicators was observed in the groups of patients with obesity (I, II, III study group). As a result of treatment, weight loss in patients of group II correlated with a decrease in the level of leptin, interleukin 6, C-reactive protein and TNF. Conclusion. As a result of treatment with exenatide, weight loss in patients of group II correlated with a decrease in the level of leptin, interleukin 6, C-reactive protein and TNF, indicating a decrease in the metabolic activity of visceral fat, which consists in the activation of lipolysis, release of free fatty acids and adipocytokines

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Norm and disease. Monomorbidity, comorbidity and methodology for their diagnostics

Year: 2018, volume 14 Issue: №2 Pages: 209-216
Heading: Internal Diseases Article type: Review
Authors: Kats Y.A., Parkhoniuk E.V., Skriptsova S.A.
Organization: Saratov State Medical University
Summary:

The absence of a single classification and generally accepted terminology of comorbidity leads to a different understanding of the issues of diagnosis of comorbidity. Comorbidity is a complex system in which the patient is both an integral object and part of this system, which includes diseases complexes. As it is known, the success of solving diagnostic problems, especially in the presence of comorbidity ultimately determines the consistency and validity of the findings, and, consequently, the effectiveness of the diagnosis as a whole. Previously, we proposed an integrative method which, preserving the system approach and the method of comparison, suggests using the sum of data from genetic, constitutional, immunological, anthropological and other types of examination to obtain the most complete representation not only of the nature of the disease, but, first of all, the patient himself. Proceeding from the foregoing, the present review focuses not only on the features of compiling a "patient diagnosis" in the presence of comorbidity but also on the sequence in which the pathological conditions should be considered and reflected in the main diagnosis in the presence of several active processes.

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Clinical case of favourable outcome at a patient with eosinophilic granulomatosis with polyangiitis complicated by severe heart disease

Year: 2018, volume 14 Issue: №2 Pages: 207-209
Heading: Internal Diseases Article type: Case report
Authors: Alexandrova O.L., Skryabina E.N., Nikitina N.M., Romanova I.A., Alexandrova N.L.
Organization: Saratov State Medical University
Summary:

The aim of the article is to present a clinical case of rapid generalization of eosinophilic granulomatosis with polyangiitis. The course of disease with multiple organ lesions and the heart being affected the most is described. Remission is achieved by combined therapy with corticosteroids and cyclophosphamide.

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Irritable bowel syndrome: epidemiological and pathogenetic aspects

Year: 2018, volume 14 Issue: №1 Pages: 53-60
Heading: Internal Diseases Article type: Review
Authors: Tikhonova Т.А., Kozlova I.V.
Organization: Saratov State Medical University
Summary:

The literature review focuses on some epidemiological aspects, molecular-genetic predictors of irritable bowel syndrome formation, the role of psychosocial and infectious factors, low-grade inflammation, imbalance between neu-rotransmitters and cytokines, as well as changes in the intestinal microbiome in the development of irritable bowel syndrome.

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Prediction of heart remodeling in patients with bronchial asthma

Year: 2018, volume 14 Issue: №1 Pages: 49-52
Heading: Internal Diseases Article type: Original article
Authors: Ryabova A.Yu., Shapovalova T.G., Shashina M.M., Lekareva L.I., Kudishina M.M.
Organization: Saratov State Medical University
Summary:

The aim of the study was to identify cardiac remodeling in bronchial asthma (BA), to construct a mathematical model for its prediction to optimize diagnosis. Material and Methods. Atotal of 283 patients with asthma who underwent a comprehensive examination including general clinical, immuno-enzymatic (determination of the N-terminal fraction of the brain natriuretic propeptide, activity of the angiotensin-converting enzyme) and instrumental methods: ECG, ECHO, daily Holter monitoring of ECG, FVD. Results. The analysis of the obtained results showed that in patients with asthma, structural, geometric changes of the myocardium of the right and left ventricles were noted, increasing as the disease became more severe. The activation of local neurohormonal systems, primarily myocardial is no less important. An analysis of the relationship between the concentration of natriuretic peptide and the end-diastolic size of the right ventricle in BA patients revealed a moderate correlation relationship. There was a weak correlation between the right ventricular end-diastolic size, the right ventricular frontal wall thickness and the ACE level. The analysis of the relationship between the above dimensions of the right ventricle and the index of the balance of the autonomic nervous system was reliable. Conclusion. Thus, the development of cardiac remodeling in AD patients occurs against the background of the hyperactivation of neurohumoral systems, including sympathoadrenal, renin-angiotensin-aldosterone and the system of natriuretic peptides.

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Comparative evaluation of autonomic regulation of circulation in patients undergone coronary artery bypass grafting or correction of acquired valvular heart disease

Year: 2018, volume 14 Issue: №1 Pages: 45-49
Heading: Internal Diseases Article type: Short message
Authors: Kiselev A.R., Vulf K.A., Shvartz V.A., Karavaev A.S., Borovkova E.l., Bockeria O.L.
Organization: Bakulev Center of Cardiovascular Surgery, Saratov State Medical University n.a. V.I. Razumovsky Research Institute of Cardiology, Saratov state university
Summary:

The aim of the research was to study the peculiarities of vegetative regulation of blood circulation in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or correction of acquired valvular heart disease (CAVHD). Material and Methods. In this study we included 42 patients (12 women; 63 (57; 67) years), who underwent CABG, and 36 patients (16 women; 58 (47; 65) years) who underwent CAVHD. The synchronous 15 minutes records of electrocardiogram and photoplethysmogram (PPG) were performed in all patients before and after surgery. Time domain and frequency domain measures of heart rate variability (HRV) and index of synchronization between low-frequency (LF) oscillations in HRV and PPG (index S) were analyzed. Results. Most studied autonomic indices did not have statistically significant differences between patients with CABG and CAVHD in the study stages, except for heart rate, which was higher in patients before CAVHD (p=0,013). Conclusion. The values of HRV and index S do not depend on the difference in the clinical status and the features of performed cardiac surgical interventions between patients with CABG and CAVHD.

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Features of the clinical course of gastroesophageal reflux disease associated with obesity

Year: 2018, volume 14 Issue: №1 Pages: 42-45
Heading: Internal Diseases Article type: Original article
Authors: Andreeva E.l.
Organization: Stavropol State Medical University
Summary:

The research goal is to reveal the features of clinical manifestations of gastroesophageal reflux disease (GERD) in obesity. Material and Methods. A survey and anthropometric study of 51 patients suffering from GERD and obesity aged 30 to 60 years were conducted. The average age of the patients was 42.3±2.11 years. Patients were divided into groups according to the BMI score. The control group consisted of patients suffering from GERD without obesity. Results. The main complaint of the patients of the control group was heartburn, while the patients of the main group had complaints of dyspeptic nature. With an increase in BMI, there was an increase in the incidence of complaints, in addition, complaints of an extra-esophageal nature associated with the direct effect of acidic gastric contents on the pharyngeal mucosa were detected. This regularity is explained in the article by pathogenetic mechanisms of GERD development. In patients suffering from GERD without obesity, the development of the disease is caused by a change in the motor activity of the esophagus due to a decrease in the tone of the lower esophageal sphincter, and in patients with co-pathology the main role is given to increased intragastric pressure, which leads to disruption of the sphincter. Conclusion. Thus, the clinical picture of combination of GERD and obesity differs atypical for GERD current, the main features of which are the predominance of dyspeptic complaints, motor-evacuation disorders, and the presence of extraesophageal complaints.

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Pulmonary lymphangioleiomyomatosis (case report)

Year: 2017, volume 13 Issue: №4 Pages: 828-833
Heading: Internal Diseases Article type: Case report
Authors: Shashina M.M., Shapovalova T.G., Kazimirova N.E., Ryabova A.Y., Arkhangelskaya Е.Е., Lifanova D.V., Chernyshkova M.A.
Organization: Saratov State Medical University, Saratov Clinical Hospital № 8
Summary:

This article presents a clinical observation of a patient with a proven diffuse-nodular form of lymphangioleiomyomatosis of the lungs. Features of the course of the process against the background of pathogenetic therapy which included sirolimus and progesterone have been considered. It is necessary to raise awareness of doctors about the disease that facilitates timely diagnosis and treatment.

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A rare case of Loeffler endocarditis associated with eosinophilic granuloma-tosis with polyangiitis

Year: 2017, volume 13 Issue: №4 Pages: 823-828
Heading: Internal Diseases Article type: Case report
Authors: Skryabina E.N., Safonova V.N., Agareva Т.А.
Organization: Saratov State Medical University
Summary:

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease that affects small and medium-sized blood vessels of different organs, characterized by asthma, prominent peripheral blood eosinophilia. Cardiac involvement was reported in 20-50% and it is the major cause of mortality. A case of EGPA in a 43-year-old female, who had endocarditis, associated with thrombus formation in left ventricle, thromboembolic syndrome and recurrent stroke has been reported. The described case has showed that it is of crucial importance to perform the full cardiac imaging even in asymptomatic patients with suspected EGPA. The early identification of cardiac involvement may lead to better prognosis.

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