Consistent trajectories of rhinitis control and treatment in 16,177 weeks: The MASK-air® longitudinal study.

INTRODUCTION: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air®, these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air® longitudinally, clustering weeks according to reported rhinitis symptoms. METHODS: We analyzed MASK-air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results. RESULTS: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control. CONCLUSIONS: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.

UCRAID (Ukrainian Citizen and refugee electronic support in Respiratory diseases, Allergy, Immunology and Dermatology) action plan.

Eight million Ukrainians have taken refuge in the European Union. Many have asthma and/or allergic rhinitis and/or urticaria, and around 100,000 may have a severe disease. Cultural and language barriers are a major obstacle to appropriate management. Two widely available mHealth apps, MASK-air® (Mobile Airways Sentinel NetworK) for the management of rhinitis and asthma and CRUSE® (Chronic Urticaria Self Evaluation) for patients with chronic spontaneous urticaria, were updated to include Ukrainian versions that make the documented information available to treating physicians in their own language. The Ukrainian patients fill in the questionnaires and daily symptom-medication scores for asthma, rhinitis (MASK-air) or urticaria (CRUSE) in Ukrainian. Then, following the GDPR, patients grant their physician access to the app by scanning a QR code displayed on the physician's computer enabling the physician to read the app contents in his/her own language. This service is available freely. It takes less than a minute to show patient data to the physician in the physician's web browser. UCRAID-developed by ARIA (Allergic Rhinitis and its Impact on Asthma) and UCARE (Urticaria Centers of Reference and Excellence)-is under the auspices of the Ukraine Ministry of Health as well as European (European Academy of Allergy and Clinical immunology, EAACI, European Respiratory Society, ERS, European Society of Dermatologic Research, ESDR) and national societies.

Metabolic, Apoptotic and Fibro-Inflammatory Profiles of the Heart Exposed to Environmental Electromagnetic Fields.

Environmental stress can disturb the integrative functioning of the cardiovascular system and trigger a number of adaptive and/or maladaptive cell responses. Concomitant with the expanding use of mobile communication systems, public exposure to electromagnetic fields (EMFs) raises the question of the impact of 900 MHz EMFs on cardiovascular health. Therefore, in this study, we experimentally investigated whether 915 MHz EMF exposure influenced cardiac metabolic, antioxidant, apoptotic, and fibro-inflammatory profiles in a mouse model. Healthy mice were sham-exposed or exposed to EMF for 14 days. Western blot analysis using whole cardiac tissue lysates demonstrated that there was no significant change in the expression of oxidative phosphorylation (OXPHOS) complexes between the control and EMF-exposed mice. In addition, the myocardial expression of fibro-inflammatory cytokines, antioxidant enzymes, and apoptosis-related markers remained unchanged in the EMF-challenged hearts. Finally, the structural integrity of the cardiac tissues was preserved among the groups. These findings suggest that the apoptotic, antioxidant, metabolic, and fibro-inflammatory profiles of the heart remained stable under conditions of EMF exposure in the analyzed mice.

Comparison of rhinitis treatments using MASK-air® data and considering the minimal important difference.

BACKGROUND: Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., "real-world data"). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT. METHODS: We assessed the MASK-air® app data (May 2015-December 2020) by users self-reporting AR (16-90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co-medication. RESULTS: We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co-medication than in monotherapy (including the fixed combination azelastine-fluticasone) schemes. In adjusted models, azelastine-fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine-fluticasone was the drug class with the lowest chance of being used in co-medication (adjusted OR = 0.75; 95% CI = 0.71-0.80). CONCLUSION: Median VAS levels were higher in co-medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.

Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK-air® real-world data.

BACKGROUND: Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. METHODS: We analysed 2015-2020 MASK-air® European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. RESULTS: We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H1 -antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. CONCLUSIONS: Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.

Manifesto on inhaled triple therapy in asthma: an Interasma (Global Asthma Association - GAA) document.

Objective: The optimal use of drug combinations for the management of asthma is providing significant results. This has prompted Interasma (Global Asthma Association) to take a position on inhaled triple therapy in asthma.Methods: We performed an extensive literature research to clinical trials, meta-analyses, randomized controlled trials and systematic reviews.Results: Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto, developed by Interasma scientific network (INES) members.Conclusions: The manifesto describes the evidence gathered to date and states, advocates, and proposes issues on inhaled corticosteroid (ICS) plus long-acting beta 2 agonist (LABA) and long-acting muscarinic antagonists (LAMA) with the aim of challenging assumptions, fostering commitment, and bringing about change.

Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence.

The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on many factors. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines have considerably improved the treatment of allergic rhinitis. However, there is an increasing trend toward use of real-world evidence to inform clinical practice, especially because randomized controlled trials are often limited with regard to the applicability of results. The Contre les Maladies Chroniques pour un Vieillissement Actif (MACVIA) algorithm has proposed an allergic rhinitis treatment by a consensus group. This simple algorithm can be used to step up or step down allergic rhinitis treatment. Next-generation guidelines for the pharmacologic treatment of allergic rhinitis were developed by using existing GRADE-based guidelines for the disease, real-world evidence provided by mobile technology, and additive studies (allergen chamber studies) to refine the MACVIA algorithm.

THE ROLE OF CIRCADIAN REGULATION OF GHRELIN LEVELS IN PARKINSON'S DISEASE (LITERATURE REVIEW).

The paper is aimed at the analysis of the role of the circadian regulation of ghrelin levels in patients with Parkinson's disease. Based on the literature data, patients with Parkinson's disease have clinical fluctuations in the symptoms of the disease, manifested by the diurnal changes in motor activity, autonomic functions, sleep-wake cycle, visual function, and the efficacy of dopaminergic therapy. Biological rhythms are controlled by central and peripheral oscillators which links with dopaminergic neurotransmission - core of the pathogenesis of Parkinson`s disease. Circadian system is altered in Parkinson`s disease due to that ghrelin fluctuations may be changed. Ghrelin is potential food-entrainable oscillator because it is linked with clock genes expression. In Parkinson`s disease this hormone may induce eating behavior changing and as a result metabolic disorder. The "hunger hormone" ghrelin can be a biomarker of the Parkinson's disease, and the study of its role in the pathogenesis, as well as its dependence on the period of the day, intake of levodopa medications to improve the effectiveness of treatment is promising.

PATHOGENETIC ROLE OF MACROPHAGE COLONY-STIMULATING FACTOR (CSF-1) IN PREDICTING ENDOMETRIOID DISEASE.

OBJECTIVE: The aim: To assess the CSF - 1 level in peritoneal fluid and menstrual blood of women with endometrioid disease and to investigate its diagnostic and prognostic specificity. PATIENTS AND METHODS: Materials and methods: The study included 80 women of child-bearing age (mean age 30.95 ± 6.49 years) with benign gynaecological pathology of the ovaries and / or fallopian tubes. The women included in the study were divided into two groups: study group (n = 50, mean age 31.04 ± 6.3 years), consisting of patients with confirmed endometrioid disease, and control group (n = 30, mean age 30.8 ± 6.8 years), involving individuals without signs of endometriosis (p> 0.05). RESULTS: Results: We have found significantly higher level of CSF-1 content in the peritoneal fluid in the subjects of the study group (2027.05 ± 732.64 pg / ml) compared with those in the control group (1725.62 ± 466.06 pg / ml) (p = 0.029). There is a tendency towards an increase in CSF-1 level in women with endometriosis in its more severe stages and more severe and extended adhesions. The investigation of CSF-1 content in menstrual blood has demonstrated significant increase in its values in the women of the study group (9431.6 ± 2866.22 pg / ml) compared with the values in the control group (6637.12 ± 954.05 pg / ml), (p = 0.00004). Thus, there is a tendency towards the growth in CSF-1 level in peritoneal fluid and menstrual blood in women with endometriosis and concurrent increase in severity of the disease. CONCLUSION: Conclusions: There has been found significant increase in CSF-1 content in women with endometrioid disease in both peritoneal fluid and menstrual blood (1.2 and 1.4 times, respectively). Thus, macrophage growth factor (CSF-1) can be used as a diagnostic and prognostic criterion in evaluating the progression of endomertioid disease.

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology.

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.

2019 ARIA Care pathways for allergen immunotherapy.

Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.

Patterns in Google Trends Terms Reporting Rhinitis and Ragweed Pollen Season in Ukraine.

BACKGROUND: Google Trends (GT) may represent a new approach to assessing pollen allergy. However, the development of a pan-European sentinel network has raised a problem of translating terms in different languages. A precise definition of the pollen season onset is crucial for the confirmation of a pollen allergy diagnosis and personalized treatment. Ragweed pollen allergy was investigated due to its high allergenicity and wide expansion in Europe. OBJECTIVES: The study aimed to examine translations of "ragweed" and "hay fever" in native Cyrillic languages, especially in Ukrainian and Russian, and to compare the seasonality of queries in Ukraine with ragweed and mugwort pollen counts. METHODS: We used GT to search Google queries concerning ragweed allergy: "allergy," "hay fever," "running nose," "ragweed," "asthma," and "pollen." The Cyrillic terms in Ukrainian and Russian were used. Pollen collection for 2013-2015 was conducted using volumetric methods. Average daily temperatures were obtained from the website http://gismeteo.ua. Correlations were studied by using Pearson and Spearman tests. RESULTS: GT queries profile had the "B" pattern according to the classification developed by Bousquet et al. [Allergy. 2017 Aug; 72(8): 1261-6]. A peak of "ragweed" queries was observed after the maximum of average daily temperature. The terms "allergy," "hay fever," and "ragweed" in Cyrillic are required in Ukraine to calculate the ragweed pollen exposure by GT. The ragweed pollen season started with a concentration of pollen grains of 12.95 m-3. The Artemisia pollen season started between 19 and 25 days before the beginning of the Ambrosia pollen season. CONCLUSIONS: GT may be a useful tool in the differentiation of the pollen seasons, especially when they overlap as in the case of Arte misia/Ambrosia. Three terms, "allergy," "hay fever," and "ragweed" (in Cyrillic equivalents), are required in Ukraine to account for ragweed pollen exposure. The combination of GT tools with pollen counts may be used in large-scale epidemiological studies.

Quantitative assessment of CD68+ AND CD163+ macrophages in the primary focus and metastatic lesions of regional lymph nodes in non-luminal her2-positive invasive breast carcinoma

Introduction: Introduction: Tumor-associated macrophages are an important prognostic factor and have been shown to be associated with invasion and migration of various types of cancer. Unlike M1-macrophages, which have pro-inflammatory and anti-cancer activity, M2-macrophages are immunosuppressive, promoting the restoration of the intracellular matrix, and therefore they contribute to the tumor growth. The aim: To study the quantitative characteristic and localization of CD68+ and CD163+ M2-like TAM that infiltrate non-luminal HER2-enriched carcinomas of BC in the primary focus without metastases and in paired specimens with metastases in the lymph nodes, as well as the pathomorphological characteristics of this type of BC. Material and methods: The material of the study were intraoperative tissues of tumors and ipsilateral lymph nodes at radical removal of mammary glands. Immunohistochemical characteristics of the removed tumors (ER, PR, HER2, Ki67) were used to organize two groups of patients with primary BC according to the N1 / 0 status. Results: The statistical processing of the entire set of digital data confirmed a significant increase in CD68+TAM, but not CD163+M2 under metastatic conditions (p <0.0001), which may suggest an increase in M1-type TAM and their promotion of metastases in non-luminal HER2-enriched BC. Analysis of peculiarities of TAM localization showed that CD68+TAM was localized by clusters within the tumor nests and adjacent stroma, necrotized nests, whereas the typical localization of CD163+TAM M2-like macrophages predominated in the stroma and near the necrotic sites (where their quantitative characteristics coincide with those of CD68+TAM). This may indicate a relative predominance of M1 macrophages precisely in tumor nests. Along with the results on increased CD68+TAM (but not CD163+TAM) in metastases, it is possible to assume the contribution of M1 macrophages to the development / metastasis of BC, as prognosticated for other tumors. Conclusions: A significant decrease in the number of CD68+TAM in metastases of the lymph node as compared with the primary clusters of BC, along with the absence of correlations, may reflect other functions of TAM in the affected lymph nodes or change of the tumor type in the metastasis.

Genetic polymorphism ARG753GLN of TLR-2, LEU412PHE of TLR-3, ASP299GLY of TLR-4 in patients with influenza and influenza-associated pneumonia.

OBJECTIVE: The aim of the research is to study the prevalence and to determine the prognostic significance of polymorphism ARG753GLN of the TLR-2 gene, Leu412Phe of TLR-3, Asp299Gly of TLR-4 in influenza. PATIENTS AND METHODS: Materials and methods: 112 patients with influenza were examined (63 patients with uncomplicated course and 49 with influenza-associated pneumonia). The genotyping of the polymorphic site of ARG753GLN of the TLR-2 gene, Asp299Gly of the TLR-4 gene, and Leu412Phe of the TLR-3 gene was carried out by polymerase chain reaction using oligonucleotide primers. RESULTS: Results: It has found that the prevalence of the mutant allele 299Gly of TLR-4 in patients with uncomplicated influenza is 6.4 %, with influenza- associated pneumonia - 7.1 %, which exceeds the population control indicators by 3.8-4.3 times (1.7 %, p<0.05). Mutant allele 412Phe of TLR-3 is significantly more common in patients with influenzaassociated pneumonia (42.9%), as compared with uncomplicated influenza (24.6%, p<0.01) and healthy people (30.0%, p<0.05). The increased risk of influenza development is associated with the Asp/Gly genotype of TLR-4 (OR=4.22) and combination of mutant genotypes Leu/Phe and Phe/Phe of TLR-3 with Asp/Gly of TLR-4 and Arg/Gln of TLR-2 (OR=15.0); influenza-associated pneumonia - with genotype Phe/Phe of TLR-3 (OR=4.5). CONCLUSION: Conclusions: It has been found out that among patients with influenza and influenza-associated pneumonia, the mutant allele 299Gly of TLR-4 and combinations of polymorphisms Arg753Gln of TLR-2, Leu412Phe of TLR-3, Asp299Gly of TLR-4 are detected reliably more often. The frequency of the mutant allele 412Phe of TLR-3 is higher among patients with influenza-associated pneumonia. Markers of increased risk of influenza are 299Gly allele and genotype Asp/Gly of TLR-4 and the combination of mutant genotypes Leu/Phe and Phe/Phe of TLR-3 with Asp/Gly of TLR-4 and Arg/Gln of TLR-2; for influenza-associated pneumonia - allele 412Phe and genotype Phe/Phe of TLR-3.

Differences in Reporting the Ragweed Pollen Season Using Google Trends across 15 Countries.

BACKGROUND: Google Trends (GT) searches trends of specific queries in Google, which potentially reflect the real-life epidemiology of allergic rhinitis. We compared GT terms related to ragweed pollen allergy in American and European Union countries with a known ragweed pollen season. Our aim was to assess seasonality and the terms needed to perform the GT searches and to compare these during the spring and summer pollen seasons. METHODS: We examined GT queries from January 1, 2011, to January 4, 2017. We included 15 countries with a known ragweed pollen season and used the standard 5-year GT graphs. We used the GT translation for all countries and the untranslated native terms for each country. RESULTS: The results of "pollen," "ragweed," and "allergy" searches differed between countries, but "ragweed" was clearly identified in 12 of the 15 countries. There was considerable heterogeneity of findings when the GT translation was used. For Croatia, Hungary, Romania, Serbia, and Slovenia, the GT translation was inappropriate. The country patterns of "pollen," "hay fever," and "allergy" differed in 8 of the 11 countries with identified "ragweed" queries during the spring and the summer, indicating that the perception of tree and grass pollen allergy differs from that of ragweed pollen. CONCLUSIONS: To investigate ragweed pollen allergy using GT, the term "ragweed" as a plant is required and the translation of "ragweed" in the native language needed.

Individual approach to the treatment of obese copd patients can reduce anthropometric indicators, the level of systemic inflammation and improve the quality of life.

OBJECTIVE: Introduction: Chronic obstructive pulmonary disease (COPD) and obesity are major causes of morbidity and mortality worldwide, and according to current estimates, the global burden of these conditions will be even greater. The basis for COPD treatment is bronchodilator therapy and non-pharmacotherapy approaches, such as respiratory rehabilitation and dietary counseling. The aim of this study was to assess the impact of lifestyle modification on anthropometric indices, markers of systemic inflammation, quality of life in patients with COPD and obesity. PATIENTS AND METHODS: Materials and methods: 53 patients with COPD in stable condition with BMI - 30.0-39.9 kg/m2 were included in the study. The patients were divided into 2 groups: the first group - obese COPD patients with lifestyle modification (n=26) and the second group (n=27) -without lifestyle modification. Lifestyle modification involved: nutritional correction and regular physical exercise. The duration of the study was 9 months. We evaluated body mass indices (BMI), waist circumference (WC), actual nutrition, dyspnea by the mMRC scale, quality of life (QL), 6-minute walking distance test (6MWD), spirometry, serum levels of C-reactive protein (CRP) and sputum level of interleukin-26 (IL-26). RESULTS: Results: After 9 months in obese COPD patients with lifestyle modification we found a decrease in body weight and BMI by 1.16 times (p <0.0001), WC by 1.07 times (p<0.0001), the basal metabolic rate by 1.07 times (p=0.02), the actual energy value of consumed food per work day and weekend by 1.19 times and 1.23 times, respectively (p<0.0001), the level of dyspnea by 1.42 times (p <0.0001), systemic inflammation markers decreased - serum CRP by 2.06 times (p < 0.0001), IL-26 level in the induced sputum by 1.65 times (p <0.0001); increased the walked distance by 9.38% (p = 0.0004) and QL (p <0.0001). CONCLUSION: Conclusions: Application of individually developed therapeutic measures incorporating the nutrition correction, taking into account the indicators of the basic metabolism in patients and regular physical activity against the background of inhaled basic therapy, allows us to the reduction of WC, BMI, activity of the inflammatory process, increase tolerance to physical activity and improvement of life quality.

[Iron deficiency reduces systemic inflammation in obese women].

OBJECTIVE: Introduction: Iron plays an important role in the functioning of immunological monitoring due to its stimulating and differentiating effect on the immune system. Obesity is accompanied by chronic low grade inflammation and may be accompanied by a change in the concentration of iron in the blood serum. The aim of the study was to determine the level of systemic inflammation in iron deficiency anemia in patients with obesity. PATIENTS AND METHODS: Materials and methods: 40 women with iron deficiency anemia (30 with obesity and 10 without obesity) and 10 with obesity of a similar age (control group) participated in the study. We evaluated hemogram parameters, indicators of iron exchange (serum iron, ferritin, hepcidin, total iron binding capacity, transferrin saturation) and inflammatory markers: C-reactive protein and interleukin-6 in the blood serum. RESULTS: Results: All patients were females with an average age of 40.3 ± 7.59 years. In the distribution of patients by the cause and the severity degree of iron deficiency anemia, there is no probable difference between the groups. C-reactive protein was significantly higher in women in the control group as compared with the groups of women with iron deficiency anemia (p <0.05). Meanwhile, the groups with iron deficiency anemia had insignificant differences (p> 0.05). Interleukin-6 also had a higher level in the control group as compared with the groups of women who had iron deficiency anemia (p <0.05) and, in contrast to the C-reactive protein of the group with iron deficiency anemia, had a significant divergence (p <0.05). Hepcidin of blood serum was higher in women with iron deficiency anemia without obesity (p<0.05) as compared to women with obesity and control group who did not have a significant difference (p> 0.05). CONCLUSION: Conclusions: The level of systemic inflammation in iron deficiency anemia in patients with obesity is lower than in patients with iron deficiency anemia, which was determined by levels of interleukin-6 and C-reactive protein in the blood serum.

Effect of pioglitazone on insulin resistance, progression of atherosclerosis and clinical course of coronary heart disease.

INTRODUCTION: Pioglitazone, a medication of thiazolidinedione group, is capable of triggering the peroxisome proliferator-activated receptors (PPAR-γ). Activation of receptor PPAR-γ regulates carbohydrate and lipid metabolism, immune and inflammatory responses in heart tissues. THE AIM: Our aim was to study the effect of pioglitazone on insulin resistance, the clinical course of atherosclerosis and coronary heart disease (CHD). MATERIALS AND METHODS: The study included 43 patients with coronary artery disease. Patients were divided into the main group - 20 patients, in whom pioglitazone (Pioglar, Ranbaxy, India) was included in the combined therapy at a dose of 15 mg 1 time per day in the morning, and the comparison group - 23 patients receiving standard complex drug therapy over 6 months. Patients underwent clinical examination, ultrasound of neck vessels, study of carbohydrate and lipid metabolism. RESULTS: Joining pioglitazone to standard therapy resulted in the reduction of systolic (p<0.05) and diastolic (p<0.05) blood pressure; decrease in the duration of pain attacks (p<0.05); reduction in the frequency of angina attacks (p<0.05); regression of atherosclerosis of the carotid vessels (p<0.05), decrease in the thickness of the intima-media complex (p<0.05). The decline in oral glucose tolerance test (p<0.05), hyperglycemic factor (p<0.05), total cholesterol (p<0.05), and low density lipoproteins (p<0.05) were observed, as well as increased high-density lipoprotein (p<0.05). CONCLUSION: Long-term treatment with pioglitazone at low doses against the background of standard therapy contributes to functional and clinical condition of patients, promotes the prevention of atherosclerosis and reduction of insulin resistance, thereby improving the clinical manifestations of coronary heart disease.

Anti-inflammatory and endothelium protective effect of long-term pioglitazone intake in patients suffering from bronchial asthma concurrent with ischemic heart disease.

INTRODUCTION: Treatment of co-morbidities, including bronchial asthma (BA) and coronary heart disease (CHD), is a relevant issue of modern therapy. The aim of the research is to study the impact of long-term intake of pioglitazone on the development of inflammation and ED in patients with BA concurrent with CHD. MATERIAL AND METHODS: The clinical study involved 50 people aged 40-75 who suffered from asthma concurrent with CHD. On the first day of the study, blood samples were collected and clinical examinations were performed, after which patients were randomized and divided into the control group who continued to receive only the standard therapy, and the study group, who received pioglitazone (Pioglar, Ranbaxy, India) 15 mg once a day along with comprehensive therapy. Re-examination was carried out in 6 months. RESULTS: It has been found that inclusion of pioglitazone in the course of standard therapy in patients with asthma concurrent with coronary heart within 6 months is a more efficient scheme than the course of standard therapies. According to the data obtained from the patients, there was a significant decrease in respiratory rate (p<0.01), levels of systolic blood pressure (p<0.001) and diastolic blood pressure (p<0.001). Administering pioglitazone contributed to the improvement of respiratory function and airflow obstruction, increased FEV1 performance (p<0.01) and Tiffeneau index (p<0.05). In patients of the study group, intake of pioglitazone helped to reduce angina. Intake of pioglitazone showed a significant decrease in the frequency of angina pectoris FC II (p<0.05) and a significant increase in the frequency of angina FC I (p<0.05), increase in the rate of threshold load power (p<0.05). In assessing endothelium-dependent vasodilation of the brachial artery, it has been noted that intake of pioglitazone by patients with asthma concurrent with coronary heart disease resulted in a statistically significant increase in the diameter of the brachial artery by an average of 4% (p<0.0001), the maximum blood flow velocity (TAMX) by an average of 40 % (p<0.0001), Δ% diameter increase in the brachial artery (p<0.0001), and achieved positive indicators of RI (p<0.0001). In assessing endothelium-dependent vasodilation of brachial artery in patients treated with pioglitazone, there was a significant increase in the diameter of brachial artery on average by 5% (p<0.0001) after taking nitroglycerin, an increase in ?% diameter of brachial artery (p<0.0001) and RI (p<0.0001). Inclusion of pioglitazone in the complex therapy for 6 months resulted in a significant decrease in the index of systemic inflammation hs-CRP (p<0.0001) and adhesion marker sVCAM-1 (p<0.0001), total cholesterol (p<0.001), triglycerides (p<0.001). CONCLUSION: Thus, these data demonstrate the anti-inflammatory and endothelium protective effects of pioglitazone against the background of standard therapy in patients with BA concurrent with CHD within 6 months, which may enhance the clinical efficacy in the treatment of these diseases.

Resveratrol more effectively than quercetin reduces endothelium degeneration and level of necrosis factor α in patients with coronary artery disease.

INTRODUCTION: endothelial dysfunction (ED) is one of the most important links in the pathogenesis of atherosclerosis (ASVD) - morphological basis of coronary artery disease (CAD). OBJECTIVE: to study the effect of polyphenolic antioxidants, resveratrol and quercetin, on endothelial degeneration factors in CAD patients. MATERIALS AND METHODS: the study involved 93 patients with coronary artery disease: stable angina pectoris, FC II. The cytofluorometric technique was applied to define the level of circulating endothelial microparticles (EMP) CD32+CD40+ in peripheral blood in order to identify ED. The content of tumor necrosis factor α (TNF-α), fibrinogen, hemocoagulation and lipid profile parameters were being determined in the blood, as well. Patients were divided into 3 groups. Basic therapy (ß-blockers, statins, aspirin) was prescribed to 33 persons of the comparison group, patients of the study group 1 (30 persons) additionally received resveratrol at a dose of 100 mg daily, patients of the study group 2 (30 persons) got quercetin at a dose of 3 g per day. In 2 months, the second examination of the patients was performed in the amount indicated. RESULTS: under the influence of resveratrol a significant reduction of the level of TNF-α and the number of EMP in peripheral blood was shown, in contrast to the results of other study groups. All groups showed a decrease in total cholesterol and low-density lipoprotein cholesterol, statistical differences between data of groups were not found. Indicators of coagulogramma in all study groups did not change significantly, however, there was a statistically significant reduction of fibrinogen in the blood. CONCLUSIONS: resveratrol, unlike quercetin, has a positive effect on the endothelial function and systemic inflammation, which may be the result of its influence on intracellular molecular cascades associated with the nuclear transcription factor of NF-kB.