Zaporizhzhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine

Abstract Background Previous studies demonstrated that insulin resistance, hyperglycemia contribute to the development of a pro-thrombotic state characterized by increased platelet activation, activation of coagulation cascade and elevated number of extracellular vesicles (EVs) in type 2 diabetes mellitus (T2DM) patients. There is a less known impact of glycaemia control in T2DM patients with concomitant heart failure (HF) and atrial fibrillation (AF) on a number of erythrocytes-derived EVs. The aim of the study was to elucidate whether glucose control in T2DM patients with HF and AF affect a circulating number of erythrocytes-derived EVs. Methods The entire patient population composes of 417 patients (231 male, 55.4% and 186 female, 44.6%) with average age of 53 years as well as 25 healthy volunteers and 30 T2DM non-HF individuals. As inclusion, age ≥ 18 years, T2DM, established HF, and written consent to participate in the study was used. Patients after successful ablation procedure (mainly radiofrequency ablation) were included in the group non-AF in 6 weeks after procedure if cardiac rhythm is sinus. All patients were divided into two groups depending on criteria of poor glycemic control (HbA1c < 6.9% and ≥7.0%, respectively). Hemodynamics features, conventional biochemistry parameters and EVs measure were performed at the baseline. Flow cytometry was performed according to conventional protocol with FMO standards to detect and measure EVs. Results Circulating levels of CD235a+ PS+ erythrocytes-derived vesicles differed amongst T2DM patients depending on HF presentation when compared with healthy volunteers (Figure 1). Figure 2 illustrated the differences in circulating amount of CD235a+ PS+ RBC-derived vesicles in AF and non-AF patients with T2DM and HF depending on glycaemia control. There were significantly lower levels of CD235a+ PS+ RBC-derived vesicles were detected in those with HbA1c < 6.9% than in patients with HbA1c ≥ 7.0%. To note, there were no significant differences in circulating amount of CD235a+ PS+ erythrocytes-derived vesicles between patients in entire cohort (p = 0.24) and in non-AF sub-cohort (p = 0.40) with HbA1c < 6.9% and HbA1c ≥ 7.0%, respectively. The Receive Operation Characteristics curve analysis revealed that the well-balanced cut-off point for circulating amount of CD235a+ PS+ erythrocytes-derived vesicles (HbA1c ≥ 7.0% versus HbA1c < 6.9%) were 545 particles in µL (area under curve = 0.91, sensitivity = 74.2%, specificity = 90.3%; p = 0.0001). Multivariate linear regression yielded that NT-proBNP (OR = 1.07; 95% CI = 1.02–1.10, p = 0.04) and CD235a+ PS+ erythrocytes-derived vesicles ≥ 545 particles in µL (OR = 1.06; 95% CI = 1.01–1.11, p = 0.044) remained independent predictors for HbA1c ≥ 7.0%. Conclusion Poor glycaemia control is associated with elevated levels of CD235a+ PS+ EVs, which were found to be independent predictor for AF presentation in T2DM patients with HF.Circulating levels of EVsEVs in AF and non-AF patients

Objective: Type 2 diabetes mellitus (T2DM) is a powerful risk factor for heart failure (HF) contributing to untoward clinical course of the condition. Although natriuretic peptides are validated biomarkers to rule out HF, the accuracy of them in prediction of HF in T2DM is not optimal. The aim of the study was to investigate whether serum irisin has additional discriminative capacity for HF in patients with T2DM. Design and method: We prospectively included 183 T2DM patients with aged 41 to 65 years (153 patients with any phenotypes of HF and 30 patients without HF) in the study. The following criteria such as age > 18 years, established T2DM regardless of HF, and the levels of HbAc1 less 6.9% were used as inclusion ones. All patients underwent general examination, echocardiography and Doppler. The plasma levels of NT-proBNP and irisin were measured using ELISA Results: The Receive Operation Characteristics curve analysis showed that the well-balanced cut-off point for serum concentration of irisin (HF vs non-HF) were 10.4 ng/mL (area under curve [AUC] = 0.96 (95% CI = 0.88 – 1.00), sensitivity = 81.0%, specificity = 88.0%; P = 0.0001). Cutoff point of NT-proBNP (HF vs non-HF) was 750 pmol/L (AUC = 0.96; 95% CI = 0.59 - 0.98; sensitivity = 72.7%, specificity 76.5%, p = 0.0001). Multivariate logistic model yielded that the serum levels of irisin < 10.4 ng/mL (OR = 1.30; P = 0.001) and NT-proBNP > 750 pmol/mL (OR = 1.17; P = 0.042), left atrial volume index (LAVI) > 34 mL/m2 (OR = 1.06; P = 0.042) remained to be strong predictors for HF, whereas LAVI did not. Add-on of irisin levels < 10.4 ng/mL to the predictive model constructed from NT-proBNP (> 750 pg/mL) significantly improved discriminatory potency of the whole model for HF. Conclusions: We found that decreased serum levels of irisin significantly predicted HF in T2DM patients. This finding may open a new approach for HF risk stratification in T2DM patients.

Objective. The purpose of the study is to reveal the features of the course of the wound process in patients with acute paraproctitis against the background of diabetes.
 Methods. An analysis of the results of treatment of acute parаproctitis against the background of diabetes in 328 patients over the past 5 years was carried out.
 Results. It was found that these patients are define by extensive tissue damage in area and the predominance of gram-negative bacteria in mixed aerobic flora, the addition of anaerobic flora is the cause of the spread of the purulent process and deep destruction of tissues. The synergism of the aerobic-anaerobic flora in combination with the pathogenetic factors of diabetes contribute to a severe and prolonged course of the inflammatory process, as evidenced by the preservation of a high index of intoxication until the 14th day.
 Conclusions. The criteria for choosing the method of operation are based on the localization of the abscess and the main purulent course, its relationship to the elements of the external anal sphincter, the nature of the scarring process in the area of internal diversion and the function of the closing apparatus of the rectum.

Objective. One of the most common gynecological pathologies among women of reproductive age is non-specific vaginitis. Bacterial vaginosis and aerobic vaginitis cause many obstetric and gynecological complications, and disease recurrence remains high. The aim of the study is to assess the effectiveness of complex therapy in the treatment of non-specific vaginitis in women of reproductive age.
 Materials and Methods. 160 women (100%) were examined, which were divided into 2 clinical groups with subgroups: the main group - 94 (58.8 %) patients with nonspecific vaginitis, who received treatment according to developed clinical diagnostic algorithms and schemes. The comparison group included 66 (41.2 %) patients with nonspecific vaginitis, who received treatment according to known protocols. Research methods: general (collection of complaints and anamnesis, gynecological examination, assessment of microscopy of vaginal smears according to the Amsel, Nugent and Donders criteria), laboratory (determination levels of follicle-stimulating, luteinizing hormones, prolactin, estradiol, adrenaline, noradrenaline, cortisol, magnesium in the blood), statistical.
 Results. Treatment of non-specific vaginitis according to complex schemes in the main group showed a significant decrease in the average follicle-stimulating hormone indicators – by 2.7 times, luteinizing hormone – by 2.6 times, prolactin – by 1.3 times (р<0,05) compares to the indicators before treatment. The estradiol level in the main group probably increased 1.3 times (р<0,05). The magnesium level also increased by an average of 1.4 times (р<0,05). Complex therapy in the main group significantly reduced the adrenaline levels by an average of 1.6 times, noradrenaline by 2.4 times, and cortisol by 1.8 times compared to the values before treatment (р<0,05). The proposed complex schemes are likely to improve the clinical effectiveness of drug treatment of non-specific vaginitis in the near and distant periods, which is accompanied by faster disappearance of complaints and normalization of the local condition during the gynecological examination (p<0,05), restoration of the vaginal microflora (p<0,05), a decrease frequency of recurrence in the main group of patients (c2=4,32; p<0,05).
 Conclusions. It is appropriate to use complex treatment of bacterial vaginosis and aerobic vaginitis in women of reproductive age.

We hypothesize that serum irisin can have additional discriminative potency for heart failure (HF) in individuals with type 2 diabetes mellitus (T2DM). The study group comprised 226 consecutive T2DM patients (153 patients with any HF phenotypes and 30 patients without HF) aged 41 to 65 years. The plasma levels N-terminal brain natriuretic pro-peptide (NT-proBNP) and irisin were detected by ELISA at the baseline of the study. We found that the most appropriate cut-off value of irisin (HF versus non-HF) were 10.4 ng/mL (area under curve [AUC] = 0.96, sensitivity = 81.0%, specificity = 88.0%; P = 0.0001). Cutoff point of NT-proBNP that distinguished patients with HF and without it was 750 pmol/L (AUC = 0.78; sensitivity = 72.7%, specificity 76.5%, p = 0.0001). Using multivariate comparative analysis we established that concentrations of irisin < 10.4 ng/mL (odds ration [OR] = 1.30; P = 0.001) and NT-proBNP > 750 pmol/mL (OR = 1.17; P = 0.042), left atrial volume index (LAVI) > 34 mL/m2 (OR = 1.06; P = 0.042) independently predicted HF. Irisin being added to NT-proBNP improved predictive modality for HF, whereas combination of NT-proBNP and LAVI > 34 mL/m2 did not. In conclusion, we established that irisin had independent predicted potency for HF in patients with established T2DM.

Abstract. The goal of the study was to investigate the effect of magnesium orotate as a part of complex therapy in sinus rhythm restoring in patients with AF paroxysm, as well as to evaluate its effectiveness and effect on LQo with long-term use.&#x0D; Materials and research methods. We examined 56 patients (16 women and 40 men) with an average age of (61,5 ± 4,3) years with paroxysmal atrial fibrillation. All patients were divided into two groups. Patients of the 1st group (n=28) underwent medical cardioversion with amiodarone and magnesium orotate. Patients of the 2nd group (n=28) received only amiodarone. The time of sinus rhythm restoration, parameters of electrical instability of the atrial and ventricular myocardium after sinus rhythm restoration, patients life quality 3 months after discharge - were assessed in both groups.&#x0D; Results. The study allowed to reveal that the addition of magnesium orotate to the basic therapy of patients with atrial fibrillation increases the effectiveness of medical cardioversion and reduces the time of its onset. When using amiodarone and magnesium orotate, signs of electrical instability of the atrial myocardium (the number of paired and supraventricular extrasystoles) are significantly less according to the results of Holter electrocardiogram monitoring compared with amiodarone monotherapy. Atrial fibrillation caused a life quality parameters deviations in the form of an increase in the severity of the disease symptoms, physical activity limitation and psycho-emotional sphere disorders. 3 months after the treatment, it was noted that life quality in patients of the 1st group (complex therapy using magnesium orotate) was higher compared to patients of the 2nd group due to the improvement in the indicators of the "psycho-emotional" component.&#x0D; Conclusions. The addition of magnesium orotate to the basic therapy of paroxysmal atrial fibrillation can significantly improve the clinical course of the disease in patients and their life quality after 3 months treatment period.

Abstract Funding Acknowledgements Type of funding sources: None. Background Irisin is skeletal muscle-derived peptide that produced by a proteolytic cleavage of fibronectin type III domain-containing-5 transmembrane protein, the expression of which is under close control of peroxisome proliferator-activated receptor-γ co-activator 1α. Apelin is a powerful regulatory peptide having positive inotrope ability and acting as an autocrine regulator of cardiac and vascular reparation. The aim of the study was to investigate whether serum levels of both irisin and apelin predict HF with preserved ejection fraction (HFpEF) in patients with T2DM. Methods One hundred and eight HF patients with T2DM having HFpEF (EF&amp;gt;50%; n=58), HF with mildly reduced ejection fraction (HFmrEF, EF&amp;lt;40%; n=22), HF with reduced ejection fraction (HFrEF, EF&amp;lt;40%; n=28) aged from 41 to 62 years and 20 non-HF patients with T2DM. Healthy control group was consisted of 25 individuals matched with age and sex. We collected demographic and anthropometric information, data for hemodynamic performances by B-mode echocardiography, Doppler and TDI, and the levels of biomarkers including irisin, apelin, N-terminal pro-brain natriuretic peptide (NT-proBNP) by ELISA at the study entry. Results We found that the levels of irisin were significantly higher in HFpEF patients than in HFrEF individuals, whereas healthy volunteers and T2DM non-HF patients demonstrated lower concentrations of these peptides. On contrary, apelin levels were significantly increased in HF patients mainly with HFrEF. There were not significant differences between the levels of these biomarkers in HFrEF and HFmrEF (P=0.42 for all cases). Using ROC curve we revealed that cut-off points for irisin and apelin that distinguished HFpEF from HFrEF/HFmrEF were (6.50 ng/mL; AUC=0.78; 95% confidence interval [CI] = 6.85 - 10.66 ng/mL and 4.12 ng/mL, AUC=0.72; 95% CI=3.90-5.75 ng/mL, respectively). Then we divided all patients with HF having elevation of NT-proBNP &amp;gt; 750 pmol/mL into three subgroups depending on the biomarkers’ levels. Patients from subgroup A had both irisin and apelin levels higher cut-off points, individuals from group B had higher concentration of one of two biomarkers, and patients from subgroup C demonstrated levels of both peptides lower cut-off points. Multivariate logistic regression analysis revealed that discriminative value of irisin and apelin to predict HFpEF in subgroup B (Odds Ratio [OR]= 2.18; 95% CI=1.26-3.14; P=0.001) were substantially higher compared with subgroups A and C (OR = 1.03; 95% CI=1.00-1.05; P=0.64 and OR = 0.92; 95% CI=0.89-1.01; P=0.62, respectively). Adding irisin and apelin to NT-proBNP as independent variables to the predictive model sufficiently improved discriminative ability of whole model for HFpEF. In conclusion We found that multidirectional changes in the levels of irisin and apelin in T2DM patients had better predictive value for HFpEF that simultaneous increase and decrease in the circulating levels of these peptides.

Introduction. The advent of the COVID-19 pandemic has posed challenges to healthcare professionals. The most common manifestation of a new variant of coronavirus disease is pneumonia, and therefore, the doctor is faced with the question of the diagnostic value of certain indicators, as well as - the feasibility of prescribing antibacterial therapy.&#x0D; The purpose of the study was to assess the importance of clinical, imaging, laboratory methods for diagnosing the condition of patients with covid-associated pneumonia, to determine the nuances of the possible appointment of antibacterial therapy.&#x0D; Current text. The main problem in the diagnosis of covid-associated pneumonia is the need to differentiate between viral lung disease and the development of secondary bacterial pneumonia. Viral pneumonia can be of varying severity, but does not require antibacterial therapy. At the same time, the accession of bacterial flora on the background of viral lung disease, requires the immediate appointment of antibacterial drugs. It should be noted that the available data to date indicate that the accession of bacterial infection to viral lung disease is confirmed in no more than 8-10% of patients, ie most patients with coronavirus do not require antibiotics [1,2, 3]. At the same time, worldwide, antibiotics associated with pneumonia-associated pneumonia are unreasonably common and, according to some studies, the proportion of patients receiving antibacterial therapy ranges from 27% to 84% [1,4,5].&#x0D; Conclusions. The problem of managing patients with covid-associated pneumonia is due to the fact that, to date, there is no specific criterion that would clearly distinguish viral lung disease from viral-bacterial. Traditionally, data from clinical, laboratory and instrumental research methods are used for the differential diagnosis of viral and bacterial pneumonia. A common approach to antibiotic treatment in many cases is not only unjustified, but also leads to a massive increase in antibiotic resistance with subsequent complications. In each case, the decision must be made individually, taking into account the full range of diagnostic and clinical aspects.