A DESCRIPTIVE, CROSS-SECTIONAL, POPULATION-BASED STUDY OF MEDICAL AND DEMOGRAPHICAL CHARACTERISTICS OF COPD AMONG KYIV (UKRAINE) POPULATION AS AN INDICATOR OF GENERALIZED TENDENCIES

OPISOWE, PRZEKROJOWE, POPULACYJNE BADANIE KLINICZNYCH I DEMOGRAFICZNYCH CECH POCHP
U MIESZKAŃCÓW KIJOWA (UKRAINA) JAKO WSKAŹNIK OGÓLNYCH TENDENCJI

Vasyl M. Mykhalchuk, Averian G. Vasyliev

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the key social and economic issues in the modern pulmonology and public health in general. Despite a tremendous interest in disease diagnostics and treatment as solitary problems of COPD management, epidemiology aspects around COPD prevalence and incidence still require further attention in some of the developing countries, including Ukraine. Modelling and implementation of complex healthcare measures improving quality and accessibility of medical care in patients with COPD is difficult with limited data around COPD prevalence, associated risk factors and comorbidities along with disease socio-medical characteristics in studied Ukrainian population.

The aim: This study is focusing on identification and measuring of COPD prevalence among adult population of Kyiv, Ukraine with clinical and demographical characteristics of COPD diagnosed subset with a particular focus on association of risk factors and comorbidities in diagnosed COPD cohort. This work is a part of the contribution to the research at the Shupyk National Medical Academy of Postgraduate Education – “Substantiation of healthcare subsystem management models and strengthening of public health in Ukraine in accordance with the European strategies” (2014-2019, State Registration Number 0115U002160).

Materials and Methods: The study was aiming at the descriptive cross-sectional population-based assessment of the burden of COPD in resident (last 10 years or longer) adult population in Kyiv as the largest urban agglomeration of Ukraine. Interview with standardized questionnaires (COPD Assessment Test™, Modified Medical Research Council dyspnea score (mMRC), American Thoracic Society respiratory symptoms questionnaire), anthropometry, spirometry (with reversibility test according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)) following informed consent and eligibility assessment were conducted during household visits. Household selection was randomized through the two-step cluster sampling. Case definition of COPD corresponded to the GOLD spirometry criteria for COPD diagnosis.

Results: 964 adult subjects completed all study-mandated assessments and were eligible for analysis. Self-reported COPD prevalence was 10.4 per 1000 and prevalence of COPD cases, evaluated with spirometry, was 31.9 per 1000 respectively. Positive relationship of COPD diagnosis was identified with age (≥40 y.o.), tobacco smoking, severe alcohol intake, increased BMI (odds ratio, OR 2.10), tuberculosis (OR 32.3, p < 0.001), and lower physical activity. Around one third of subjects with COPD diagnosis manifested with comorbidities (predominantly hypertension, diabetes mellites, cardiovascular diseases, and history of pneumonia), with occurrence significantly higher (p < 0.05) compared to the rest of the study sample.

Conclusions: Data on point prevalence of COPD in different age groups, frequency of comorbidities, association with key risk factors in adult population in Kyiv may well represent similar tendencies among the rest of urban population across other regions in Ukraine. These study data allow for enhanced modelling of the optimization system for the medical care in COPD patients and further advances around prevention and identification of COPD.

Wiad Lek 2018, 71, 2 cz. I,

 

COLON POLYPS’ DETECTION FREQUENCY IN ELDERLY AND SENILE PATIENTS ON THE BACKGROUND OF NSAIDS THERAPY

CZĘSTOŚĆ WYKRYWANIA POLIPÓW JELITA GRUBEGO U OSÓB W STARSZYM WIEKU STOSUJĄCYCH NLPZ

Andriy M. Bratasyuk, Stepan S. Filip, Vasyl Y. Ploskina

Department of Therapy and Family Medicine, Faculty of Postgraduate Education and Pre-university Training, Uzhhorod National University, Uzhhorod, Ukraine

ABSTRACT

Introduction: Polyps of the colon are very widespread in the general population (especially in older age groups), which can lead to the development of oncopathology. There is evidence that NSAIDs prevent the formation of colon polyps.

The aim: To conduct a comparative analysis of the frequency of colon polyps detection in patients who regularly receive NSAIDs with patients who take NSAIDs regularly with patients not taking drugs of this group.

Materials and methods: We conducted colonoscopy in 138 elderly and senile patients. 78 (56.52%) patients regularly received NSAIDs more than 5 years and 60 (43.48%) patients denied regular intake of anti-inflammatory drugs. The indications for the colonoscopy were a positive test for hidden blood in stool and the age of the patients. Patients were prescribed NSAIDs because of the presence of concomitant pathology of the cardiovascular and musculoskeletal system.

Results: As a result of our data analysis, we found that colon polyps were detected in 28 (35.89%) patients who regularly received NSAIDs. In patients who did not take NSAIDs colon polyps were detected in 43 (71.67%) cases.

Tubular adenomas occurred most often and accounted for 104 (75,36%) cases of all adenomas, whereas tubulovillous adenomas were found in 12 (8.70%) cases, and villous adenomas – in 9 (6.52%) cases. Tubular adenomas are relatively smaller in size. 73.91% of tubular adenomas were less than 3 cm in size, while only 24.64% of tubulovillous and 15.21% of villous adenomas had dimensions up to 1 cm.

Conclusions: In patients receiving NSAIDs, the incidence of polyps is significantly lower (p <0.05) compared with patients who does not receive NSAIDs. NSAIDs intake reduces the risk of colon polyps development.

Wiad Lek 2018, 71, 2 cz. I,

 

DIAGNOSTIC VALUE OF MATRIX METALLOPROTEINASE-9 AMONG PATIENTS WITH ACUTE CORONARY SYNDROME WITH ELEVATION AND WITHOUT ELEVATION OF ST SEGMENT

WARTOŚĆ DIAGNOSTYCZNA METALOPROTEINAZY MACIERZY ZEWNĄTRZKOMÓRKOWEJ MMP-9 U PACJENTÓW Z OSTRYM ZESPOŁEM WIEŃCOWYM Z PRZETRWAŁYM, JAK I BEZ PRZETRWAŁEGO UNIESIENIA ODCINKA ST

Eugene V. Sid’, Oleksandr S. Kulbachuk

State Institute «Zaporizhzhia Medical Academy of Postgraduate Education of Ministry of Health of Ukraine», Zaporizhzhia, Ukraine

 

Introduction: Cardiovascular diseases remain the leading cause of death in Ukraine. One of the most prognostically significant consequences of acute myocardial infarction (AMI) is the development of unfavorable left ventricular remodeling.

Changes in the extracellular collagen matrix of the myocardium occupy a central place in the LV remodeling process after AMI. In a healthy state, the structure and function of the extracellular matrix is maintained by the family of matrix metalloproteinases (MMPs). In his study, D. Kelly et al. showed that MMP-9 may be one of the markers in the risk-stratification of patients with AMI (Kelly D., 2007).

The aim to determine the diagnostic value of matrix metalloproteinase-9 among patients with acute coronary syndrome with elevation and without ST segment elevation.

Material and methods: The results of the study were obtained during the screening of 158 people of comparable age and social status. The patients were examined at the Regional Medical Center for Cardiovascular Diseases of the Zaporizhzhia region in the period from 2015 to 2017.

The patients were grouped according to compliance with the inclusion / exclusion criteria, depending on the presence of persistent ST elevation: the first group included 162 patients with coronary artery disease with acute coronary syndrome (ACS) and persistent elevation of the ST segment (average age (59.2 ± 0.6) years); the second group – 81 patients with IHD with ACS without ST segment elevation (average age (60.3 ± 0.7) years) and a third group – 25 healthy volunteers (average age (57.7 ± 0.9) years).

Immune enzyme analysis. Blood sampling was performed from the ulnar vein and gathered into tubes with 50 mg of EDTA, the samples were centrifuged at 3000 rpm during 15 minutes. The resulting plasma was separated, then immediately frozen and stored at a temperature of at least -24 ° C until the analysis was performed. The level of MMP-9 in blood plasma was defined by the enzyme immunoassay using standard Human MMP-9 ELISA kits (RayBio, USA) according to the procedure described in the test system manual. The minimum detectable concentration was 10 pg / ml. The analysis was carried out with the help of the enzyme analyzer SUNRISE TS (Austria).

The obtained data are presented as a median and interquartile range of Me [Q25; Q75]. The results of the study were processed by parametric or nonparametric statistics, depending on the nature of the sample distribution. When testing statistical hypotheses, the null hypothesis was rejected at the level of statistical significance (p) below 0.05. We carried out the ROC analysis (ROC-Receiver Operating Characteristic curve); we also calculated the area under the ROC curve (AUC) and its 95% confidence interval (CI), sensitivity (Se) and specificity (Sp). The model was considered adequate with a statistically significant AUC greater than 0.5. Cut off was determined using Youden index J.

Results: The level of MMP-9 was determined during screening. We noted a significant increase in MMP-9 among all patients with ACS compared with the level in the group of practically healthy individuals – 89.7 [74.8; 108.0] pg / ml. The highest level of MMP-9 was in the group of patients with ACS with persistent elevation of the ST segment – 5286.9 [4038.1; 6116,8] pg / ml and significantly exceeded the level of this parameter in the group of patients with ACS without ST-segment elevation – 1862.4 [1518.4; 2379.4] pg / ml, (p <0.05). To determine the diagnostic significance, we performed the ROC analysis. The level of MMP-9 had a statistically significant AUC and was 0.929; 95% CI was from 0.889 to 0.958. With a cut-off point > 3122.9 pg / ml, the sensitivity made up 83.3% and the specificity was 98.8%. This may mean that MMP-9 levels are progressively increasing with the severity of the clinical manifestations. Similar results have been obtained in other studies (Hamed G.M.¸. 2015; Tanindi A., 2011).

Conclusion: The level of MMP-9 is significantly elevated among patients with ACS. High levels of this indicator are closely related to the severity of the disease and the degree of manifestation of ACS, that can be used for adequate distinction of these patients according to the level of severity. Further studies, aimed at detecting the usefulness of MMP-9 to predict recurrent coronary events among patients after acute myocardial infarction, will be promising.

Wiad Lek 2018, 71, 2 cz. I,

 

ОЦІНКА ЯКОСТІ ЖИТТЯ У ХВОРИХ З МЕТАБОЛІЧНИМ СИНДРОМОМ

ASSESSMENT OF QUALITY OF LIFE IN PATIENTS WITH METABOLIC SYNDROM

Яна Ю. Гнепа, Іван В. Чопей, Ксенія І. Чубірко, Юрій В. Плоскіна

КАФЕДРА ТЕРАПІЇ ТА СІМЕЙНОЇ МЕДИЦИНИ, ФАКУЛЬТЕТ ПІСЛЯДИПЛОМНОЇ ОСВІТИ ТА ДОУНІВЕРСИТЕТСЬКОЇ ПІДГОТОВКИ,
УЖГОРОДСЬКИЙ НАЦІОНАЛЬНИЙ УНІВЕРСИТЕТ, УЖГОРОД, УКРАЇНА

Yana Y. Hnepa, Ivan V. Chopei, Kseniya I. Chubirko, Yuriy V. Ploskina

DEPARTMENT OF THERAPY AND FAMILY MEDICINE, FACULTY OF POSTGRADUATE EDUCATION AND PRE-UNIVERSITY TRAINING,
UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE

Вступ: Міжнародний опитувальник EQ-5D розроблений Європейською групою дослідження якості життя для використання в Україні та Росії. Даний опитувальник відноситься до стандартних та ідеально підходить для використання в процесі амбулаторного прийому. Опитувальник EQ-5D використовується для характеристики стану здоров´я та ефективності лікувальних заходів у пацієнтів з метаболічним синдромом.

Мета: Вивчити якість життя та провести аналіз у пацієнтів з метаболічним синдромом у порівнянні із практично здоровими особами .

Матеріали та методи: Нами обстежено ٦٥ пацієнтів, які було розділено на ٢ групи. Група ١ – пацієнти з метаболічним синдромом (٣٥ пацієнтів) та група ٢ – практично здорові (٣٠ осіб). Оцінку якості життя даних пацієнтів провели за допомогою опитувальника EQ-5D. Статистична обробка результатів виконувалась за допомогою програмного забезпечення MS Office Excel 2007.

Результати: В результаті проведеного дослідження середній бал якості життя пацієнтів групи 1 становив 10,7±0,19 бала (р= 0,238), а у осіб контрольної групи даний показник становив 5,6±0,11 бала (р<0,01), це довело, що якість життя пацієнтів з метаболічним синдромом достовірно нижча порівняно з контрольною групою.

У іншій частині опитувальника, де пацієнти самостійно оцінювали якість свого життя, середня оцінка у групі 1 становила (39,7±5,1) і була достовірно нижчою за оцінку в контрольній групі – 85,4±7,6 (р<0,01).

Висновки: Отже доведено достовірний зв´язок погіршення якості життя у пацієнтів з метаболічним синдромом (р= ٠,٢٣٨) у порівнянні з контрольною групою (р<٠,٠١).

КЛЮЧОВІ СЛОВА:.

Wiad Lek 2018, 71, 2 cz. I,