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VORONTSOVA T.O., KUBEI I.B., YAREMA N.M., KOROBII M.I. Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine
Manifestations of Genetically Determined Conditions Depending on the Degrees of Exogamy
Introduction. A tendency of increasing of undifferentiated connective tissue dysplasia syndrome (UCTDS) cases in children has been occurring lately. A significant attention to this pathology is associated with lesions of organs and systems, clinical polymorphism and late diagnosis. There are different scientific facts on the causes of UCTDS formation in children, which indicate the multifactorial nature of the disease. The role of the genetic factor in development of UCTDS in children is studied in our research. It is known that the rise of genetic anomaly is possible in the presence of genetically related material of the parents of a child. The genetic medical history was investigated; it allowed to identify the susceptibility for growth delay depending on the degree of exogamy that was based on marriage of children's parents who had medical examination. Three degrees of exogamy were distinguished: I degree — parents are from one village or different villages, which are distant from each other no more than 30 km; II degree — parents are from different population centers within the same region or the same city; III degree — parents are from different regions.
To analyze the influence of exogamy degree we have chosen a syndrome which may be diagnosed by the objective examination of the child; it is connective tissue dysplasia syndrome with hypermobility ofjoints. 64 children of school age were examined to identify the dependence of their health condition from the degrees of exogamy. The following degrees of exogamy were distributed during medical examination: I degree was found in 40 children, II degree was detected in 11 children and III degree was revealed in 9 children. UCTDS was exposed depending on the degree of exogamy in the following children: I degree — 11 children (27.5 %), II degree — 2 children (18.2 %), III degree — 0 children (0 %). UCTDS was manifested in 4 children more, but these indices were not taken into consideration due to the absence of information about their parents. The inverse average correlation connection between UCTDS and degree of exogamy (r = —0.36, p < 0.05) was showed and it confirmed the genetic component of UCTDS etiology. In addition to complexes of the UCTDS phenotype signs, every child with I exogamy degree had signs of some dysfunctions of different organs and systems. Some disturbances were functional (the presence of gallbladder deformations of different configuration), others had a morphological character (little anomalies of heart, scoliosis and flat-foot disease). Therefore, we can suppose the dependence of connective tissue dysplasia syndrome from exogamy degree, i.e. the genetic factor in etiology of UCTDS. This syndrome is a background pathology, and it is manifested by phenotype and changes in organs and systems of the human body.
VYBYRANA R., ZHULKEVYCH I.
Ternopil State Medical University named after
I.Ya. Gorbachevsky, Ternopil, Ukraine
Structural Analysis of Bone Tissue Lumbar Spine in Patients with Chronic Lymphoid Leukemia and Possible Ways to Correct
Introduction. Modern chemotherapy and immunotherapy of chronic lymphoid leukemia (CLL) has increased the overall survival of patients, so the question of the quality of life is particularly relevant. It's not actually studied the prevalence of secondary osteoporotic lesions (OL) of bone tissue (BT) at patients with CLL in different age groups and therefore there is no scientific basis of depending on the state of BT on age, sex and stage of lymphoproliferative process and methods of chemotherapy treatment that prevents timely diagnosis of osteoporotic (OP) and osteopenic changes BT at this category of patients and their adequate medical treatment and prevention.
Identify the major factors of modification BT at patients with CLL, depending on age, sex and stage lymphoproliferative process and methods of chemotherapy. Conduct clinical trials of treatment programs for correcting reduced bone mineral density (BMD) in patients with CLL. To improve the quality of life of patients with CLL.
Materials and methods. At the dual energy X-ray bone absorptiometry DPX-A «LunarCorp» company (USA) examined the lumbar spine (LS) at 180 patients with CLL.
There were clinically tested the treatment programs for the correction of reduced bone mineral density at patients with CLL: 1) treatment program number 1 with usage of the integrated product Calcium-D3 Nycomed;
2) treatment program number 2 using the drug Ostalon;
3) treatment program number 3 with the drug Bivalos.
Treatment regimens due to the presence of osteopenia
and OP changes BT LS surveyed 57 patients (37 women, 20 men) with CLL. The choice of treatment options depend on the depth of osteopenic changes BT identified by two-photon absorptiometry, and indications and contraindications to pharmacological stimulants.
Using the method of evaluation of clinical efficacy of medical facilities two groups of criteria were selected: 1) the state of BT LLS, which was assessed by BMD, total content of minerals and calcium BT LS; 2) changes of the general condition of patients (on a scale Karnofsky and impact on quality of life — in the main questionnaire EORTC QLQ-C30).
The drug Calcium-D3 Nycomed was appointed to 9 women aged 47 to 83 years old (middle age 64.00 ± 3.94 years), duration of menopause from 0 to 27 years (middle duration of menopause 10.44 ± 3.18), CLL duration from 1 to 108 months (average length of42.00 ± 12.30) and disease stage B and C for 4 months and 16 men aged 48 to 85 years (mean age 65.38 ± 2.89 years) with duration CLL from 0 to 132 months (average length of 37.44 ± 9.28 months) for 4 months at a dose of 1,000 mg per day.
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The drug Ostalon was appointed to 11 women aged 53 to 79 years (middle age 67.82 ± 2.71 years), duration of menopause from 0 to 32 years (average length of 13.73 ± 2.97 years) and duration of CLL 1 to 240 months (average length of 46.27 ± 20.76 months) and 4 men aged 46 to 75 years (middle age 61.75 ± 6.18 years) with disease duration from 2 to 18 months (middle duration of 7.50 ± 3.66 months.) with stage B and C disease.
Bivalos was intended for 3 months to 17 women aged 55 to 79 years (middle age 71.29 ± 1.56 years), duration of menopause from 0 to 39 years (average length of19.50 ± 2.23 years) with disease duration from 0 to 180 months (average length of 47.82 ± 12.61 months) with stage B and C disease.
Statistical analysis and visualization of the data were performed using the statistical package OpenStat and Statgraph-ics (version 3.0).
Results. The patients with CLL levels of minerals in the BT of the LS in a group of women with age categories up to and over 60 years was significantly lower than in groups of men in their respective age categories. Osteopenic and OP changes in bone LS were observed in the group of men and women with CLL, and to over 60 years. Osteopenic syndrome is part of the clinical course of CLL — his lowest percentage (25 %) found in the category of men to 60 years of disease duration of 1 year, and the largest (100 %) — a group of women 60 and older than 60 years in groups with a duration disease over 5 years. In general patients with CLL groups OP level changes than the general population BT parameters and is over 50 %. Osteopenic and OP changes in BT LS were observed in the group of men and women with CLL, and to over 60 years.
Statistical modeling methods were statistical models of BMD changes depending on: a) sex and stage of disease (p < 0.01); b) sex, stage of disease and relative terms due to the BMD in young age (R2 = 0.93; p < 0.05); c) the stage of disease and chemotherapy protocols (R2 = 0.96; p < 0.05), corresponding to a high level of predictive. The calculation of the interest component of effective model proved reliable factors significant contribution of sex and stage of disease, and depending on the method chosen and the last chemotherapy treatment, prediction of BMD at the patients with CLL.
The prescription of Calcium-D3 Nycomed for 4 months at a dose of1000 mg per day for women did not give any results in significant changes in BMD. Analyzing the state of BT LS at the men after treatment Calcium-D3 Nycomed marked
increase in BMD was significantly in all areas studied, except vertebra L2. The ratio of the detected BMD due to its the same age, expressed as a percentage, was significantly increased in the vertebrae L1 and L3 and the total areas L1-L2, L1-L3, L1-L4, L2-L3, L3-L4. In absolute terms was significant growth in all areas of study except L3-L4.
The prescription of the drug Ostalon for women with CLL has led to the increase of BMD statistically reliable data in L3, L1-L3, L1-L4 (at 5.4 %), L2-L3. Significant increase in the correlation between BMD diagnosed with due at a young age as a percentage observed in L3 and the total areas of the L1-L2, L1-L3, L1-L4, L2-L3. In absolute terms, it is statistically increased in areas of total L1-L3, L3-L4. The content of minerals has grown significantly in L2 and the total area of L1-L4 (8.5 %).
There was observed a significant increase in BMD LS at the women after therapy Bivalos and statistical reliability in all vertebrae. Significant increase in the correlation between BMD detected due to the young age as a percentage and in absolute terms the whole strength of LS. The same pattern was observed in relation to the value of BMD detected due to the same age. The content of minerals in BT was significantly increased after treatment Bivalos throughout the study area (total area at L1-L4 18.5 %), with the exception of vertebra L4. As for the geometric characteristics of LS — height, width and area of the vertebrae, changing these parameters were not statistically significant.
The index, which reflects the ratio of the width of the content of minerals vertebrae was significantly increased by vertebrae L1, L2, L3 and summary sections L1-L2, L1-L3, L1-L4 (13.5 %).
In assessing of the impact on EORTC QLQ-C30 there was revealed a significant increase in the basic indicators of women who received treatment programs correction BT, comparing with groups of men.
Conclusion. Structural and functional state of BT at the patients with CLL is characterized by a decrease in the strength of the main characteristics of BT mineral content and BMD decrease. Reduced BMD in osteopenic and os-teoporotic form changes require the development of adequate methods of medical treatment at different stages of the disease. Treatment with the drug program Calcium-D3 Ny-comed, drug Ostalon and drug Bivalos can be implemented in practice treatment of osteopenic syndrome at the patients with CLL.
ZAZDRAVNOV A.
Kharkiv National Medical University, Kharkiv, Ukraine
Duality of Genesis of Osteopenic Syndrome in Patients with Central Form of Ankylosing Spondylitis Complicated by Gastroesophageal Reflux
Introduction. Ankylosing spondylitis (AS) is a frequent (0.2—2 % in the population) rheumatic disease with systemic extraarticular manifestations. The main clinical form of the AS is the central form. Patients with central form of AS suffered by disorders in the cervical and thoracic spine. These changes negatively affect the
localization and the function of the neck and chest cavity, including the esophagus. It was found (on the basis of own previous studies) the clinical and endoscopic signs of gastroesophageal reflux (GER) were present in 3/4 patients with central form of the AS. Another frequent systemic manifestation of AS is osteopenic syndrome (OPS). OPS observed in 77-85 % of patients with AS. These disorders (GER and OPS) contribute to the progression of functional impairment and disability in patients with AS.
Aim. To investigate the mechanisms of formation of OPS in patients with central form of AS complicated by GER.
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Brnb. CyM06u. Xpe6eT, ISSN 2224-1507
№ 2 (18), 2015
