THE ROLE OF ENDOTOXICOSIS AND INFLAMMATION IN DEEPENING THE PANCREATIC FUNCTIONAL INSUFFICIENCY IN CHRONIC PANCREATITIS IN COMBINATION WITH TYPE 2 DIABETES.

OBJECTIVE: Aim: To analyze the state of parameters of inflammation, endotoxicosis, and their influence on the functional capacity of the pancreas in the comorbid course of chronic pancreatitis and type 2 diabetes mellitus (DM2). PATIENTS AND METHODS: Materials and methods: 115 patients with CP in the phase of mild therapeutic exacerbation in combination with DM2 in the stage of subcompensation were examined. To assess the impact of comorbid DM2 on the clinical condition of patients with CP, a comparison group of 25 patients with CP in the exacerbation phase was included in the study. The assessment of the presence and depth of pancreatic exocrine insufficiency (PEI) was carried out according to the "gold standard" - determination of the content of fecal α-elastase-1, which was determined by the method of enzyme immunoassay using standard kits. As the main criterion for diagnosis and monitoring of DM, the measurement of HbA1c was used, which was determined by the method of ion exchange chromatography. C-reactive protein (CRP) was determined by the immunoturbidometry method by photometric measurement of the antigen-antibody reaction to human CRP antibodies; reference values of CRP in blood serum are up to 3 mg/l. Endogenous intoxication (EI) was assessed based on the levels of medium-mass molecules (MMM) - MMM1 and MMM2 at wavelengths 254 and 280 nm. The level of circulating immune complexes (CIC) was determined by the method of selective precipitation in 3.75% ethylene glycol followed by photometry. RESULTS: Results: Moderate and moderate inverse correlations were established between CRP and fecal α-elastase in CP and CP-DM2 comorbidity (r=-0.423 and r=-0.565, p<0.05). This proved a reliable influence of the depth of inflammation according to the content of CRP on the increase in PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to CP. A deeper level of secretory insufficiency of the pancreas was established in CP with concomitant DM2, which deepened when the CRP level increased, compared to that in isolated CP: an increase in the strength of reliable direct moderate HbA1c-CRP correlations in patients with CP in combination with DM2 was proved in relation to such cases isolated CP (respectively r=0.313 and r=0.410, p<0.05). CONCLUSION: Conclusions: We proved a reliable influence of the index of endogenous intoxication on the level of PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to isolated CP: moderate and medium-strength inverse correlations were established IEI-fecal α-elastase in patients with CP and CP-DM2 comorbidity (r=-0.471 and r=-0.517, p<0.05). An increase in the strength of reliable direct, moderate, and moderate correlations between the levels of HbA1c and the index of endogenous intoxication in patients with isolated CP and CP-DM2 comorbidity (r=0.337 and r=0.552, p<0.05), which proved a deeper level of secretory pancreas insufficiency with concomitant DM2, which worsened with increasing endotoxicosis according to the value of the index of endogenous intoxication.

THE STRUCTURAL AND FUNCTIONAL STATE OF THE PANCREAS AND LIVER IN CHRONIC PANCREATITIS IN COMBINATION WITH CHRONIC VIRAL HEPATITIS C DEPENDING ON THE INDEX OF THE SURVEY ACCORDING TO THE INTERNATIONAL CAGE QUESTIONNAIRE.

OBJECTIVE: The aim: To conduct a comparative analysis of parameters of the structural and functional state of the liver and pancreas in patients with chronic pancreatitis in comorbidity with treated etiologically chronic viral hepatitis C, depending on the results of testing according to the international CAGE questionnaire. PATIENTS AND METHODS: Materials and methods: 100 ambulatory patients with CP with concomitant HCV, treated etiotropically, were examined. All patients were examined ac-cording to generally accepted algorithms. To establish the role of alcohol on the formation of CP and the condition of patients with treated HCV, latent craving for alcohol was verified using the international CAGE questionnaire. The study of the density of the liver parenchyma and the liver of the patients was carried out not only according to the ultrasound data in the B-mode, but also with the simultaneous measurement of the shear wave elastography (SWE) method on the Ultima PA scanning ultrasound device with the further determination of the median of the parameters, which characterizes the stiffness in kilopascals (kPa). Determination of the presence and depth of pancreatic exocrine insufficiency (PEI) was carried out by the content of fecal elastase-1 (FE-1), which was determined by the enzyme immunoassay method. RESULTS: Results: Screening-testing of patients with CP on the background of etiotropically treated HCV using the CAGE scale made it possible to state that 65.0% of such patients had a hidden craving for alcohol, and 21.0% of this cohort were women, which needs to be taken into account in the management of such patients. It has been proven that in the group of patients with CAGE≥2.0, the level of functional and structural changes in the liver and liver was significantly more severe (according to the deepening of the PEI, a decrease in fecal α-elastase by 13.01%, according to an increase in the total index of the coprogram by 15.11% and the total US-indicator of the pancreas structure by 28.06%, and the total US-indicator of the liver structure - by 40.68% (p<0.05) and corresponded to the average degree of severity of the process in panceas according to the criteria of the Marseille-Cambridge classification, and in the group with CAGE<2.0 - only a mild degree. CONCLUSION: Conclusions: The negative effect of the factor of increased alcohol use according to CAGE was proven by increasing the density of the echostructure of the liver by 5.73% (p<0.05), and the liver by 5.16% (p<0.05). According to the results of the correlation analysis of the dependence of the structural state of the liver and PW of the studied patients on the value of the CAGE scale, which was R=0.713, p<0.05, and R=0.686, p<0.05, respectively, it was established that there is a strong direct dependence of the structural state of the liver and PW from the value of the CAGE questionnaire, which proved an independent, reliably significant role of alcohol consumption for patients with a comorbid course of CP and HCV.

EFFECTIVENESS OF LISINOPRIL AND AMLODIPINE COMBINATION AT HYPERTENSION WITH COMORBIDITY OF ARTERIOSCLEROSIS OBLITERANS IN GENERAL PRACTICE.

OBJECTIVE: The aim: To analyze the dynamics of daily monitoring of blood pressure, intracardiac (according to echocardiography), peripheral hemodynamics (according to ultrasound of the vessels of the lower extremity), the thickness of the intima-media complex (according to carotid sonography) in patients with hypertension the effect of treatment with a combination of lisinopril and amlodipine. PATIENTS AND METHODS: Materials and methods: The study included 40 patients with hypertension with 2 (29 patients) and 3 (11 patients) degrees of hypertension in combination with AOLE with I-III stages of chronic insufficiency of the lower extremity, which revealed hyperkinetic, eukinetic, and hypokinetic types of hypertension with a predominance of the sympathetic nervous system. The groups are comparable in age, sex, duration of hypertension, and medications received in the previous stages. For antihypertensive therapy, the most common drugs for use were selected - lisinopril + amplodipine in fixed doses of 10 and 5 mg, respectively. If after 2 weeks we did not reduce the mean level of SBP and DBP by 10% or more from baseline, we doubled the dose of lisinopril without changing the dose of amlodipine. RESULTS: Results: After 6 months of treatment, in particular, an increase in the pulse index - by 24.8%, a decrease in the resistance index - by 21.1%, an increase in linear and volumetric blood velocity - by 25.6% and 27.4%, respectively, while achieving the target blood pressure. CONCLUSION: Conclusions: It is proved that in the absence of individual contraindications the combination of lisinopril and amlodipine is optimal and universal for effective treatment of patients with hypertension in combination with AOLE in all types of central hemodynamics.

POSSIBILITIES OF METABOLIC AND FUNCTIONAL DISORDERS CORRECTION IN OSTEOARTHRITIS WITH COMPLEX COMORBIDITY.

OBJECTIVE: The aim: To assess the impact of complex metabolic therapy of primary osteoarthritis and type 2 diabetes mellitus under conditions of comorbidity on the course and progression of these pathologies. Patients with comorbidities of primary osteoarthritis and diabetes mellitus are a special group of patients because the importance of these comorbidities is the additional difficulty in diagnosing and conducting adequate therapy, given the close etiopathogenetic links of these conditions, which leads to poor quality of life, increased costs of diagnosis and treatment, increasing the frequency and duration of hospital stay. PATIENTS AND METHODS: Materials and methods: We examined 67 patients with primary osteoarthritis in comorbidity with diabetes mellitus. Patients were comparable by clinical, gender criteria, the severity of primary osteoarthritis, and treatment received and were divided into two groups: 1st group (n=32) - patients received treatment for OA and diabetes mellitus in accordance with international recommendations; 2nd group (n=35) - patients received treatment as in group 1 + drug alpha-lipoic acid. Determination of the level of the studied parameters was performed before and after treatment. RESULTS: Results: The analysis of the obtained results revealed statistically significant positive dynamics after treatment for symptoms of primary osteoarthritis in both study groups of patients (p<0.05), but the therapeutic effect in the 2nd group was more significant (p<0.05). There was a statistically significant positive dynamics on the scale of VAS at rest and movement (p<0,05), WOMAC index for pain, stiffness, and functional insufficiency (p<0,05), and Leken index in the 2nd group after treatment compared with the 1st (p<0.05). CONCLUSION: Conclusions: The obtained results indicate a statistically significant positive effect of alpha-lipoic acid on the course and progression of primary osteoarthritis under conditions of comorbidity with diabetes mellitus.

EFFECTIVENESS OF HEPATOPROTECTOR IN THE COMPLEX CORRECTION OF CLINICAL MANIFESTATIONS OF CHRONIC PANCREATITIS AND TYPE 2 DIABETES MELLITUS COMORBIDITY.

OBJECTIVE: The aim: To investigate the effectiveness of complex protocol treatment with the additional inclusion of a course of the sublingual form of hepatoprotector on the clinical manifestations of patients with chronic pancreatitis in combination with type 2 diabetes mellitus. PATIENTS AND METHODS: Materials and methods: We studied 57 outpatients with chronic pancreatitis in the phase of stable or unstable remission in combination with diabetes mellitus in the phase of stable or unstable remission. Two groups were formed according to randomization principles to study the effectiveness of the proposed correction programs: 1stgroup (30 patients) took protocol treatment for one month, 2nd group (27 patients) - received protocol treatment with a course of hepatoprotector. RESULTS: Results: It was found the results of the impact of two treatment programs on some clinical symptoms and syndromes in patients with chronic pancreatitis. Positive dynamics of clinical symptoms/syndromes were found in both groups of patients, but the therapeutic effect in the 2nd group was more significant. Analysis of the dynamics of the Quality of Life parameters on the scales of a specialized gastroenterological questionnaire under the influence of two treatment programs found statistically significant (p<0.05) changes in the group with the inclusion of hepatoprotector for treatment for all parameters in contrast to the group of protocol treatment, where statistically significant changes on three scales (abdominal pain, gastric reflux, and dyspepsia). CONCLUSION: Conclusions: It is proved that the proposed inclusion in the protocol treatment of a combination of CP and DM2 course of sublingual a demethion in eledtoan increase in its effectiveness in the correction of abdominal pain - by 8.2%, dyspepsia - by 17.8%, constipation - by 7.4% , diarrhea - by 12.9%, astheno-neurotic - by 21.5%, allergic - by 15.9%, autonomic - by 20.1% (p<0.05). Found higher efficacy of treatment with the in clusion of a demethion in relation to that in the group of PL on the dynamics of the parameters of the scales of the GSRS questionnaire by a total of 13.7%, p <0.01: abdominal pain decreased by 22.6% vs. 16.7%, gastricreflux - by 34.7% against 16.9% (p <0.05), diarrhea - by 23.9% against 8.2% (p<0.001), constipation - by 20.6% against 5.9% (0.01), dyspepsia - by 32.4% against 17.9% (p <0.01), respectively. It proved the feasibility of using sublingual demethion in the complex rehabilitation treatment of patients with comorbidity of CP and diabetes mellitus in order to correct clinical symptoms.

HOLISTIC APPROACH IN COMMUNICATION SKILLS TEACHING OF MEDICAL STUDENTS.

OBJECTIVE: The aim: To analyze the relevance of communicative competence in medical practice and to choose the best pedagogical methods by improve communication skills in future doctors through the use of a holistic approach in teaching. PATIENTS AND METHODS: Materials and methods: Sociological, informational and analytical research methods were used in the research. CONCLUSION: Conclusions: The holistic direction in education promotes partnership between a student and a teacher, the achievement of mutual understanding and trust, better commitment and motivation to learn. The use of feedback forms helps to recognize and understand the needs and feelings of each student, work effectively with diversity, motivates the teacher to continuous self-development and self-improvement. Modern teaching methods such as working in small groups, Storytellling and role-play according to students are more valid in mastering the communicative competence of the future doctor.

EVALUATION OF PARAMETERS OF ACTUAL TYPICAL PATHOGENETIC SYNDROMES IN COMORBIDITY OF TYPE 2 DIABETES MELLITUS AND CHRONIC PANCREATITIS.

OBJECTIVE: The aim: To assess the state of typical pathogenetic syndromes (inflammation, endotoxicosis, liperoxidation, enzymatic and non-enzymatic antioxidant deficiency) in the comorbidity of type 2 diabetes mellitus (DM2) and chronic pancreatitis (CP). PATIENTS AND METHODS: Materials and methods: We examined 137 patients (112 patients with comorbidity of CP and DM2 and 25 patients with isolated CP. Typical pathogenetic syndromes (inflammation, endotoxicosis, liperoxidation, enzymatic and non-enzymatic antioxidant deficiency) were determined. RESULTS: Results: It was proved that patients with CP even in the remission phase of the active course of EI and LPO, which was significantly more significant in comorbidity with DM2. Statistically significant more significant changes in the parameters of antioxidant protection in the comorbidity of CP and DM2 in relation to those in isolated CP. CONCLUSION: Conclusions: Treatment of CP and DM2 is a difficult task and should take into account the impact on the studied common typical pathogenetic syndromes - inflammation, endotoxicosis, lipid peroxidation, and enzyme and non-enzymatic antioxidant protection - to address short-term and prevent long-term complications.

DEPENDENCE OF PANCREAS FUNCTIONAL CAPACITY AT CHRONIC PANCREATITIS ON ENDOTOXICOSIS AND OTHER METABOLIC FACTORS.

OBJECTIVE: The aim: Was to investigate the status of endotoxicosis parameters in patients with chronic pancreatitis depending on the presence of a combination with type 2 diabetes mellitus, as well as their impact on the functional capacity of the pancreas. PATIENTS AND METHODS: Materials and methods: 87 outpatients with CP with concomitant type 2 diabetes and without it were examined. The main group consisted of 62 patients with CP in the phase of therapeutic exacerbation in combination with diabetes mellitus in a state of sub- or full compensation, the comparison group - 25 patients with isolated CP, the control group consisted of 30 healthy individuals. The content of malonic aldehyde in the blood was determined by reaction with thiobarbituric acid, the levels of medium-molecular peptides MMP1 and MMP2 - by the method of Gabrielyan, circulating immune complexes - by precipitation in 3.75% ethylene glycol with followed photometry. RESULTS: Results: The presence of active endotoxicosis and lipid peroxidation in CP was established, which was significantly more significant in the comorbidity of CP with type 2 diabetes: erythrocyte intoxication index was higher by 19.2%, the content of medium molecules MMP1 - by 29.5%, MMP2 - by 35.4%, malonic aldehyde - 10.9%, circulating immune complexes - 23.9%, ceruloplasmin - by 11.9% (p <0.05). CONCLUSION: Conclusions: A deeper level of excretory and incretory insufficiency of the pancreas in concomitant diabetes mellitus 2, which deepened with increasing endotoxicosis by the level of erythrocyte intoxication index based on an increase in the strength of significant moderate and moderate inverse correlations between it and fecal α-elastase such in isolated CP (respectively r=-0.517 and r=-0.471, p<0.05) and significant direct moderate and medium strength correlations between levels of HbA1c and erythrocyte intoxication index - respectively r=0.552 and r=0.337, p<0.05.

THE INFLUENCE OF EXOCRINE PANCREATIC INSUFFICIENCY IN THE FORMATION OF OSTEOPENIA IN PATIENTS WITH PRIMARY OSTEOARTHRITIS.

OBJECTIVE: The aim: Make complex study of bone density in patients with primary osteoarthritis and exocrine pancreatic insufficiency and patients with primary osteoarthritis without exocrine pancreatic insufficiency. PATIENTS AND METHODS: Materials and methods: There were examined 140 patients with primary osteoarthritis without exocrine pancreatic insufficiency and combination osteoarthritis and exocrine pancreatic insufficiency. Diagnosis of osteoarthritis was based on diagnostic X-Ray criteria - according to J.H. Kellgren and J.S. Lawrence. The level of exocrine pancreatic insufficiency was based on result of Elisa test. State of mineral bone density was examined by using dual-photon densitometry. RESULTS: Results: It was established that there was a progressive, statistical, significant increase of mineral density of bone tissue in the 1-st group patients with osteoarthritis. Patients in the 2-nd group, with osteoarthritis in the comorbidity with exocrine pancreatic insufficiency, the densitogram rates were statistically significantly lower than in patients in the 1-st group. CONCLUSION: Conclusions: The changes of bone tissue can be explained by the formation of trophological insufficiency as a result of exocrine pancreatic insufficiency. One of the symptoms of trophic failure is bone and mineral changes, in particular, the decrease of bone density.

The role of cytocin imbalance in the development of man infertility.

OBJECTIVE: The aim: Study of the clinical and pathogenetic role of IL-17, IL-35 and their correlation in the development of infertility in men with chronic ureoprostatitis. PATIENTS AND METHODS: Materials and methods: 82 male aged 20 to 40 were examined. The patients were divided into three groups: the first - 10 practically healthy men, in which the levels of IL-17 and IL-35 in semen were taken as normal; second - 33 infertile men with chronic urethroprostatitis; third - 39 fertile men with chronic urethroprostatitis. In addition to conventional clinical and laboratory (clinical blood and urine tests) studies, all men in semen were tested for IL-17 and IL-35 cytokine levels. RESULTS: Results: The levels of the studied cytokines were found to have opposite tendencies to shifts in the semen of men with chronic urethroprostatitis. The level of IL-17 in sperm increases and the level of IL-35 decreases. The IL-17/IL-35 index increases more strongly in men with impaired fertility. CONCLUSION: Conclusions: Increas IL-17 concentrations, decreas IL-35 levels and increas their correlation may be an indicator of infertility in men with chronic ureoprostatitis. Determining the IL-17 / IL-35 correlation in general clinical practice will allow to single out a group of men with a high likelihood of developing infertility for follow-up and treatment by a doctor of family medicine.

Specific aspects of clinical course in case of combination of chronic pancreatitis and concomitant viral hepatitis C.

OBJECTIVE: Introduction: In this publication we analyzed the specific aspects of clinical course in case of combination of chronic pancreatitis and concomitant viral hepatitis C. The aim: Discover the clinical course of chronic pancreatitis with concomitant viral hepatitis C . PATIENTS AND METHODS: Materials and methods: 57 patients with chronic pancreatitis and concomitant viral hepatitis c were examined. Diagnosis of chronic pancreatitis and viral hepatitis c was verified based on disease history, clinical symptoms and the results of clinical-instrumental tests. Clinical and biochemical investigations in people with chronic pancreatitis were done in exacerbation and unstable remission phases and for people with viral hepatitis C - in stable remission phase. RESULTS: Results: In patients, who have chronic pancreatitis with concomitant hepatitis C, pain, dyspeptic syndromes and defecation disturbances take the major place in clinical course of the disease. These symptoms were more severe than in the control group (possible difference in numbers in the group of patents with isolate viral hepatitis C (p<0,05). CONCLUSION: Conclusions: According to the studies data-the negative influence of concomitant viral hepatitis C in clinical course of chronic pancreatitis was identified.

The effect of the proteolisis' system activity for the trophological status of patients with osteoarthrosis and excretory insufficiency of pancreas.

OBJECTIVE: Introduction:The excretory insufficiency of pancreas in patients with primary osteoarthrosis is formed at the comorbid pathologies and as a result of long-term treatment of osteoarthrosis using the non-steroidal anti-inflammatory drugs, steroids, chondroprotectors and chondrostimulators etc. The aim: to study the state of the proteolysis system and immune status, the presence and depth of the dysbiosis of colon in patients with primary osteoarthrosis against a violation of their excretory insufficiency of pancreas. PATIENTS AND METHODS: Materials and methods: There were 64 outpatients with primary OA (group 1) and 74 patients with primary OA in combination with diseases associated with EIP (group 2). The control group consisted of 30 healthy people.The age of the patients ranged from 29 to 74 years. The diagnosis of primary OA was established on the basis of unified diagnostic criteria, the X-ray stage of the primary OA, according to J. H. Kellgren and J. S. Lawrence. RESULTS: Results: It was proved that there is a deeper excitation of the excretory function of the pancreas in patient with osteoarthrosis and comorbid pathologies of the gastrointestinal tract with the excretory insufficiency of pancreas, as well as the presence of the excretory insufficiency of pancreas in patients with primary osteoarthrosis without the clinically available the excretory insufficiency of pancreas. In patients with primary osteoarthrosis that went through the isolation or in combination with the diseases accompanied by theexcretory insufficiency of pancreas, a statistically significant activation of the total proteolysis by the level of the proteolytic activity of the plasma was established. In group 2, dysbiotic changes were significantly deeper than in group 1. The obtained results indicate the presence of secondary immune deficiency in patients and non-specific activation of the humoral part of the immune system and the inflammatory process. CONCLUSION: Conclusion: Statistically more significant changes were observed in group 2, indicating the progression of the detected changes in comorbidity conditions.