Vol 81, No 4 (2009)

Aim. Arterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV). Material and methods. We measured baPWV in 119 males (age 51.67 ± 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi). Results. The patients were divided into two groups by severity of stenosis (group 1 - less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 ± 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 ± 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis. Conclusion. The baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.

Aim. To compare autonomic nervous system activity estimated by power spectral analysis of heart rate variability in patients with vasovagal syncopes and healthy volunteers. Material and methods. Seventeen health volunteers and 25 patients with vasovagal syncope were included in the study. In 16 cases faints were induced by head-up tilt table test (HTT), in 9 cases - by bicycle exercise test (BET). Power spectral analysis of heart rate variability in 5-th min ECG records was performed in supine and upright position while breath was fixed. Results. In supine position the data of low frequency (LF) and high frequency (HF) of spectral power in both groups of patients were significantly higher than in volunteers. During upright the HF of spectral power significantly decreased in patients and volunteers. In upright position LF of spectral power significantly decreased in patients with syncope induced by HTT, did not change in patients with syncope induced by BET, but significantly increased in volunteers. Conclusion. Patients with vasovagal syncope had abnormal autonomic nervous system activity: a high level of parasympathetic influence in supine position and poor reaction of sympathetic nervous system during upright.

Aim. To study correlations between glycemia and duration of ventricular repolarization in children and adolescents with type 1 diabetes mellitus (DM). Material and methods. Parallel monitoring of ECG and glycemia was conducted in 43 type 1 MD patients (age 7-17 years, 12.8 ± 2.7) and 37 healthy children and adolescents. Results. Glycemia under 3 mmol/l and over 19 mmol/l is associated with significantly longer QTc interval compare to other blood glucose levels (437 ms and 447 ms versus 430 ms, p < 0.01). Also, in these glycemia values QTc interval duration over 440 ms (46 and 62% versus 33%; p<0.01) becomes more frequent. In healthy children and adolescents mean duration and frequency of a longer QTc interval were significantly less than in diabetic patients irrespective of glycemia degree in patients with type 1 DM (p < 0.01). A moderate correlation was found between a daily insulin dose and QTc duration (correlation coefficient 0.35, p = 0.02). Conclusion. Glycemia under 3 mmol/l and over 19 mmol/l can prolong QT interval and, therefore, raise the risk of cardiovascular death in patients with type 1 DM.

Aim. To study immune disorders in cell immunity and cytokine profile in integument lupus erythematosus (ILE) and systemic lupus erythematosus (SLE). Material and methods. Lymphocyte phenotype, oxygen-dependent and non-oxygen-dependent functions of circulating neutrophils and monocytes, serum levels of circulating immune complexes (CIC), cytokines (IL-1beta, IL-4, IL-6, TNFalpha), antibodies to aDNA were studied in 177 patients with lupus erythematosus aged 20-60 years (143 had SLE and 34 ILE) and 33 healthy controls. Results. CIC levels, serum aDNA, IL-1beta and IL-4, oxygen-dependent neutrophil metabolism were higher both in SLE and ILE. Only SLE was characterized by high oxygen stress of monocytes, acid phosphatase and cation proteins in neutrophils and monocytes. Lymphocyte phenotype both in SLE and ILE was characterized by low count of CD3+ lymphocytes and high count of cells with markers of activation and apoptosis. SLE patients had lower count of HLA-DR+ cells and higher count of CD16+ and CD25+ lymphocytes. Conclusion. Identification of metabolic functions of circulating phagocytes, serum cytokines and lymphocyte phenotype can be used for differentiation between SLE and ILE.

Aim. To evaluate HCV genome variability in acute and chronic phases of viral hepatitis C. Material and methods. The study of heterogeneity of HCV in acute hepatitis C has detected genetic heterogeneity and variability of individual HCV population circulating in the blood. Significant genetic heterogeneity of HCV was observed in 1b, 2a and 3a genotypes. Variability of HCV did not depend on virus load. Genetic HCV structure changed significantly both in patients with manifest ALT deviations and in normal ALT, mean number of HCV genetic variants in these groups being the same. No significant correlations were found between virus concentration in the patient's blood, its variability and ALT values. Genetic heterogeneity of interferon-sensitive region of gene NS5A subtype 1b HCV was studied in blood of 16 patients with chronic hepatitis C resistant to interferon therapy. Results. It is shown that genetic heterogeneity and variability of an individual HCV population circulating in blood serum can not be a prognostic criterion in assessment of variants of acute hepatitis C course. No mutations in ISDR region were found in 25% of 16 patients studied. 75% cases had 1-3 replacements of amino acid sequences, most frequent mutation was replacements in position 2218 (histidin/arginin). The above results are close to those obtained in Japanese and European populations. Results of ISDR sequence-analysis conducted before treatment may predict efficacy of interferon-alpha2 treatment in an individual patient in future. Large-scale trials are necessary for detection of mutations responsible for resistance to interferon-alpha2 in patients living in Russia.

Aim. To determine the role of noroviruses in the rise of hospital outbreaks of acute intestinal infections (AII), to study clinical and epidemiological aspects of hospital noroviral infection. Material and methods. Routine diagnostic methods and diagnostic tests on the base of polymerase chain reaction (PCR) were used for identification of group A rotaviruses, noroviruses, astroviruses, adenoviruses, salmonella, thermophilic campilobacteria, shigella, enteroinvasive echerichia (EIEC) in 70 adult patients with AII transferred from general hospital to infection hospital in 2003-2007. A part of the strains was typed with primers specific for genetic cluster G2/4. Results. Routine methods failed to identify causes of hospital infection. PCR detected AII etiology in 77.8% patients. Norovirus of the second genotype (G2) was identified as monoinfection in 87.8% verified cases, in association with other agents - in 12.2%. Typed noroviruses belonged to cluster G2/4. Nosocomial norovirus infection was characterized by winter-spring occurrence and a moderate course. Conclusion. An essential role of noroviruses in hospital AII outbreaks in elderly patients in winter-spring is shown.

Aim. To study the role of hypothyroidism and concomitant obesity in the development of metabolic syndrome (MS). Material and methods. We examined 60 women suffering from obesity and hypothyroidism (TTH 22.24 ± 4.031). We studied lipid spectrum, carbohydrate metabolism, BP and insulin resistance, fat tissue distribution, exercise tolerance. Results. According to IDF (2005) criteria the women had: metabolic syndrome (83.4%), newly diagnosed hypothyroidism (95%), decompensated hypothyroidism (90%), subclinical hypothyroidism (65%) after six-month replacement therapy with L-T4 MS symptoms declined. Conclusion. Abnormally high level of TSH may be a component of metabolic syndrome.

Aim. To study heart rate variability (HRV) in patients with biliary problems and hypertension depending on duration of their life in the North. Material and methods. A standardized screening of 1014 workers living in Mirny (Yakutia) according to the WHO/CINDI Euro regional committee program was performed. Conclusion. With an increase of duration of living in the North patients with biliary diseases combined with arterial hypertension develop disorders of humoral-metabolic regulation mechanisms, increased parasympathetic activity, imbalance of the autonomic nervous system

To state the diagnosis of early specific pulmonary disease, it is necessary to obtain clinical and/or serological data to reject manifest secondary or early latent syphilis. The most important differential-diagnostic criterion of early syphilis of the lungs is a rapid effect of specific antisyphilis therapy with further verification of complete resolution of pulmonary lesions. Two case reports are presented.