Наукові праці. Кафедра пропедевтики внутрішньої медицини № 1, основ біоетики та біобезпеки
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Item Activity of the main no synthesis enzymes of the combined therapy of fosinopril and hydrochlorothiazide at overweight hypertensive patients(2014-11-27) Gerasimchuk, Nina; Safargalina-Kornilova, Nadia; Potabenko, SvetlanaThe aim of the study was to investigate the activity of the main NO synthesis enzymes (endothelial-NO (e-NOS) and inducible-NO (i-NOS) synthases) at overweight patients with arterial hypertension therapy on the dynamics combined fosinopril and hydrochlorthiazide.Item Antihypertensive treatment effects on systemic inflammation, oxidative stress and proinflammatory cytokines(2020-12) Ashcheulova, Tetyana; Gerasimchuk, Nina; Kovalyova, Olga; Kompaniiets, Kira; Honchar, OleksiiHypertension in its origin is a heterogeneous and multisystemic disease. Evaluatation of the oxidative stress activity based on the level of 8-iso-PgF2α, of proinflammatory cytokines based on tumor necrosis factor-α and its type I soluble receptor and C-reactive protein is relevant for further understanding of pathogenesis of hypertension and improvement of the early diagnostics of heart failure.186 hypertensive patients have been observed during the 2-months course of treatment, aged 30 to 65 years. The serum levels of 8-iso-PgF2α (n = 34), tumor necrosis factor-α and its type I soluble receptor were determined by ELISA before and after course of treatment. C-reactive protein level was determined by biochemical method. The control group included 16 practically healthy individuals, aged 27 to 55 years. Hypertensive patients enrolled into study had been randomized into 3 arms that received different protocols of combined anti-hypertensive therapy. I clinical group – а combination of a bisoprolol and indapamid, II – а combination of a lacidipine and candesartan, III – а combination of а fosinopril sodium and hydrochlorothiazide. On the background of combined antihypertensive therapy, we observed favorable dynamics of 8-iso-PgF2α, tumor necrosis factor-α and its type I soluble receptor and C-reactive protein. Taking into account the insignificance of the correlations revealed, a one-factor dispersion analysis was applied which allows to determine with certainty the influence of the grade and duration of hypertension on the dynamics of the studied indices levels. It has been found that the grade of hypertension is related to the increase in TNF-α and 8-iso-PgF2α serum levels, but not on to TNF-α type I soluble receptor, and the duration of hypertension is related to the increase in activity of the C-reactive protein, TNF-α and its type I soluble receptor, with no relation to the level of 8-iso-PgF2α. Thus, oxidative stress possibly promotes the activation of potentially damaging immune mechanisms mediated by pro-inflammatory cytokines, nonspecific inflammation and drives the further progression of the target organs lesions.Item Beneficial effects of combined therapy with lacidipine and candesartan in obese hypertensive patients(2018-11) Ashcheulova, Tetyana; Gerasimchuk, Nina; Kovalyova, Olga; Honchar, OleksiiIntroduction Obesity is becoming one of the leading risk factors of coronary heart disease, hypertension, cerebrovascular disease. Despite the presence of a large number of antihypertensive agents and scientific substantiation of antihypertensive treatment principles it would be wrong to assume that the problem is completely solved. Development of endothelial dysfunction is one of the key pathogenic mechanisms in hypertension. This process is proven to be contributed by immune inflammation activation which is mediated by pro-inflammatory cytokines and oxidative stress. Aims: To investigate the additional benefits of the combined antihypertensive therapy with lacidipine and candesartan on the basis of studying their antioxidant properties, impact on endothelial function and pro-inflammatory cytokines activity in hypertensive patients with overweight and obesity. Methods A combination of a calcium channel blocker and angiotensin receptor blocker (lacidipine 2 mg, 4 mg, and candesartan 4mg, 8mg, 16mg) was prescribed to 30 patients with essential hypertension of grades 1-3, 30 to 65 years old (mean age – 54.7 ± 5.8 years), who previously have not been receiving regular antihypertensive therapy. Results During the course of combined antihypertensive therapy with lacidipine and candesartan, a significant reduction in i-NOS activity, TNF-α to its type I soluble receptor ratio (TNF-α/sTNF-αRI), and oxidative stress marker – 8-iso-PgF2α has been observed. Activity of e- NOS, levels of SOD and catalase, in contrast, have increased by the end of observation period. Conclusion The improvement of endothelial function due to lower level of oxidative stress and a significant decrease of immune activation has been observed in hypertensive patients with overweight and obesity under the influence of combined antihypertensive therapy with lacidipine and candesartan.Item Carbohydrate and lipid disorders and adipokines levels in relation to body mass index in hypertensive patients(Revista Mexicana de Cardiología, 2018) Ashcheulova, Tetyana; Demydenko, Ganna; Ambrosova, Tetyana; Kysylenko, Kateryna; Gerasimchuk, Nina; Kochubiei, OksanaObesity is considered as a valid risk factor for cardiovascular disease, due to the fact that the risk of morbidity and mortality from various causes in obese people is signifi cantly higher. Exact mechanisms of metabolic disorders in hypertension with obesity is still discussible. The aim of the study – to determine the peculiarities of carbohydrate, lipid metabolism changes and activity of adipokines and interleukin-22, in patients with hypertension according to nutritional status. Methods: 80 patients (37 males and 43 females) with essential hypertension (EH) of average age 60.17 years were examined. Carbohydrate, lipid profi les, apolipoprotein B (apo B), tumor necrosis factor-α (TNF-α), plasminogen activator inhibitor-1 (PAI-1), adiponectin, interleukin-22 (IL-22) were estimated. Results: In patients with EH and obesity was found carbohydrates metabolism abnormalities, that was manifested as hyperinsulinemia, glucose and HbA1c levels elevation and insulin resistance (according to HOMA index). Lipid metabolism disorders were observed as valid increasing of triglycerides and apo B. Body mass index elevation was associated with progressive increasing of TNF-α and PAI-1 concentration with reducing of adiponectin level in the patients with EH. Positive relationships between TNF- and HbA1c, apo B; PAI-1 with glucose levels: negative correlation adiponectin with body mass and waist to hip ratio were detected in the patients with obesity associated (BMI ≥ 30 kg/m2) EH. Positive signifi cant correlations between apo B and insulin levels, HOMA index, and TNF-α concentration were defi ned. IL-22 in overweigh and obese patients was signifi cantly higher, correlates negatively with HDL-C. Conclusion: In patients with EH and obesity the adipokine dysfunction was revealed, that correlates with carbohydrate and lipid parameters that indicate increased proinfl ammatory and prothrombogenic processes.Item Diastolic Dysfunction: from Discovery to the Last Updates(Zaporozhye medical journal., 2019-08) Ashcheulova, Tetyana; Demydenko, Ganna; Gerasimchuk, Nina; Rezunenko, Yuri; Kochubiei, Oksana; Ambrosova, TetyanaOver a long period, chronic heart failure was primarily associated with impaired contractility of the myocardium of the left ventricular, which is a manifestation of systolic dysfunction. Based on modern ideas about the pathophysiology of CHF syndrome, systolic dysfunction is considered as one of the etiological factors along with changes in wall tension and the structure of diastolic filling, i.e. everything that is included in the concept of "LV remodeling". The objective is to present a review of the key parameters of chronic heart failure and left ventricular diastolic dysfunction according to the last updates. Material and methods. The role and significance of diastolic dysfunction as the cause of chronic heart failure syndrome, have only been started to be determined over the past three decades, which can be explained by the difficulty of early diagnostics of diastolic dysfunction. The article describes the historical evolution of estimating heart failure and left ventricular diastolic dysfunction. It is important to note the high prevalence of diastolic dysfunction. The signs of myocardial diastolic dysfunction are detected in people with almost any heart disease. The universal review of the most important parameters which determine this disorder has been presented. It has been shown that nowadays Doppler echocardiography is the noninvasive “golden standard” for estimation of diastolic dysfunction. We have presented methods of treatment for diastolic dysfunction, based on updated recommendations of the American College of Cardiology / American Heart Association in treating patients with heart failure in 2017. Conclusions. The experimental studies show that the survival rate of patients with heart failure with a preserved ejection fraction depends not so much on its indices, but on the severity of diastolic dysfunction. Diastolic dysfunction in patients with heart failure is a more prognostic mortality rate than the ejection fraction, which needs further research for better treatment.Item Dislipidemia, definition, diagnostics and treatment(2017-12) Ashcheulova, Tetyana; Gerasimchuk, Nina; Demydenko, Ganna; Kompaniiets, Kira; Kochubiei, OksanaThe review article presents the pathogenetic role of atherosclerotic vascular lesions in the development of cardiovascular diseases. The relationship between atherosclerosis and inflammation, which is characterized by the identical mechanism in the early phases, which includes the enhancement of the interaction between the vascular endothelium and circulating leukocytes is shown. The definition of such concepts as dyslipidemia, hyperlipoproteinemia and hyperlipidemia is given. The classification of hyperlipoproteinemia by Fredrickson, the clinical classification of dyslipidemia, proposed by the Ukrainian Scientific Society of Cardiologists, 2007 is considered. The correction of dyslipidemia, by both non-medicamentous measures, and drug treatment according to different variants of dyslipidemia is shown. The main groups of lipid-lowering drugs are listed. Their main mechanisms of action to reduce blood lipid levels are noted, and their side effects are listed. General recommendations are given on the monitoring of lipids and liver enzymes in patients taking lipid-lowering therapy.Item Early repolarization syndrome in modern interpretation(2019-08) Ashcheulova, Tetyana; Gerasimchuk, Nina; Sytina, IrynaRelevance of the study of early repolarization syndrome is associated with a high degree of its occurrence among the general population, namely among young people and people doing sports. Objective is to generalize the data of experimental and clinical studies which have found that the early repolarization syndrome is an idiopathic electrocardiographic phenomenon, which is considered by various specialists ambiguously; to assess the state of the cardiovascular system in the subjects, both adults and children with early repolarization syndrome, and to propose a diagnostic algorithm for detecting this phenomenon on the ECG when admitting to physical exercise and sports. The history of the development of early repolarization syndrome has been shown since 1936 to present time, which was first described by R. Shipley and W. Halleran. Clinical interest in ERS appeared as a result of a clinically established relationship with lethal arrhythmias in healthy people without structural changes in the heart. According to existing recommendations, the opinions of leading experts, including members of Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), the Asia-Pacific Society for Heart Rhythm (2015), it should be distinguish between the pattern and the syndrome of early ventricular repolarization. The Shanghai scale for the diagnosis of early repolarization syndrome, as well as the etiology, electrophysiology of early repolarization syndrome, its modern classification and electrocardiographic signs are presented. The features of early repolarization syndrome in athletes and in children, as well as the features of its treatment and prevention are shown. Conclusions. Thus, the early repolarization syndrome is an important cardiac problem. Future clinical and experimental studies should focus on finding out the exact causes and mechanisms for the development of the early repolarization syndrome and, ultimately, on developing strategies to prevent premature death from cardiac causes in individuals with this electrocardiogram disorder.Item Endothelial function in patients with COPD and cardiovascular disease (review)(2021-09-30) Ashcheulova, Tetiana; Gerasimchuk, Nina; Kompaniiets, Kira; Honchar, Oleksii; Ащеулова, Тетяна Вадимівна; Герасимчук, Ніна Миколаївна; Компанієць, Кіра Миколаївна; Гончарь, Олексій Володимирович; Ащеулова, Татьяна Вадимовна; Герасимчук, Нина Николаевна; Компаниец, Кира Николаевна; Гончар, Алексей ВладимировичCardiovascular pathology is one of the frequent comorbidities in patients with chronic obstructive pulmonary disease, due to both genetic predisposition and common risk factors (smoking, senile age, male gender, sedentary lifestyle, obesity). The article shows that development of endothelial dysfunction is one of the earliest phases of pathogenesis in this setting. Endothelial dysfunction mechanisms are defined and characterized, including imbalance of vasoconstricting and vasodilating agents with the emergence of "vicious circles" that violate hematovascular homeostasis. The role of nitric oxide, endothelin-1, intercellular adhesion molecule-1 (ICAM-1) in the development of endothelial dysfunction in COPD patients is discussed. The article defines the concept of oxidative stress, the most potent oxidants and mechanisms of their damaging effect are listed. A particular attention is paid to 8-isoprostane as a golden standard in assessment of oxidative stress in patients with COPD. Keywords: chronic obstructive pulmonary disease, hypertension, coronary artery disease, heart failure, nitric oxide, endothelin-1, intercellular adhesion molecule-1, 8-isoprostane.Item Fibreoptic bronchoscopy- modern methods of examination in pulmonology(2014-12) Udodi, Onwujekwe; Ogunyemi, Opeyemi Oluwafunmilayo; Gerasimchuk, NinaBronchoscopy is an endoscopic technique used for visualizing the inside of the respiratory tract for diagnostic and therapeutic purposes. It can also be used for obtaining samples of tissue from the airways. It is usually performed using a rigid bronchoscope (older instrument) or a flexible (fibreoptic) bronchoscope.Item Left ventricular remodeling in hypertension: evolution of the approach(2017-12) Ащеулова, Тетяна Вадимівна; Ащеулова, Татьяна Вадимовна; Ashcheulova, Tetyana; Гончарь, Олексій Володимирович; Гончарь, Алексей Владимирович; Honchar, Oleksii; Іванченко, Світлана Володимирівна; Иванченко, Светлана Владимировна; Ivanchenko, Svitlana; Герасимчук, Ніна Миколаївна; Герасимчук, Нина Николаевна; Gerasimchuk, Nina; Смирнова, Вікторія Іванівна; Смирнова, Виктория Ивановна; Smyrnova, VictoriiaItem Level of TNF-α, sTNF-RI and 8-isoprostane in the combined therapy of bisoprolol and indapamid at overweight hypertensive patients(2016-10-21) Ashcheulova, Tetyana; Kovalyova, Olga; Gerasimchuk, NinaOne of the manifestations of the pathogenesis of such combined pathology as hypertension (AH) and obesity is the development of endothelial dysfunction (ED). Recent studies suggest a possible role of immune-inflammation activation mediated by pro-inflammatory cytokines, and oxidative stress (OS) in the development of ED.Item Level of tnf-α, stnf-ri and 8-isoprostane in the combined therapy of fosinopril and hydrochlorothiazide at overweight hypertensive patients(2016-09-21) Ashcheulova, Tetyana; Kovalyova, Olga; Gerasimchuk, NinaOne of the manifestations of the pathogenesis of such combined pathology as hypertension (AH) and obesity is the development of endothelial dysfunction (ED). Recent studies suggest a possible role of immune-inflammation activation mediated by pro-inflammatory cytokines, and oxidative stress (OS) in the development of ED. Aim. Assessment of the level of TNF-α, sTNF-RI and 8-isoprostane, as the main marker of OS, at overweight patients with arterial hypertension in combined fosinopril 20 mg and hydrochlorothiazide 12.5 mg (fozid-20).Item Level of TNF-α, sTNF-RI and 8-isoprostane in the combined therapy of lacidipine and candesartan at overweight hypertensive patients(2016-05) Ashcheulova, Tetyana; Kovalyova, Olga; Gerasimchuk, NinaOne of the manifestations of the pathogenesis of such combined pathology as hypertension (AH) and obesity is the development of endothelial dysfunction (ED). Recent studies suggest a possible role of immune-inflammation activation mediated by pro-inflammatory cytokines, and oxidative stress (OS) in the development of ED.Item Oncostatin M, Interleukin-6, glucometabolic parameters and lipid profile in hypertensive patients with prediabetes and type 2 diabetes mellitus(2017-12) Kochubiei, Oksana; Кочубєй, Оксана Анатоліївна; Кочубей, Оксана Анатольевна; Ащеулова, Татьяна Вадимовна; Ащеулова, Тетяна Вадимівна; Ashcheulova, Tetyana; Demydenko, Ganna; Демиденко, Ганна Валеріївна; Демиденко, Анна Валерьевна; Герасимчук, Нина Николаевна; Герасимчук, Нина Миколаївна; Gerasimchuk, Nina; Maliy, AllaBackground and aims: Essential hypertension and type 2 diabetes mellitus possess some common pathogenetic components, in particular, activation of immune inflammatory response, the intercellular mediators of which are cytokines. In our study, hypertensive patients were examined, depending on presence of concomitant prediabetes or type 2 diabetes mellitus, for the level of pro-inflammatory cytokines oncostatin M, interleukin-6 in conjunction with glucometabolic parameters and lipid metabolism parameters. Material and methods: 94 hypertensive patients were examined. Oncostatin M and Interleukin-6 plasma level detected using ELISA (BSM). Results and conclusions: The 1st group consisted of hypertensive patients. The 2nd group included hypertensive patients with prediabetes. The 3rd group were hypertensive patients with type 2 diabetes mellitus. We have revealed the increased circulating level of oncostatin M and interleukin-6 in patients 1st group, which confirms the pathogenetic value of hypertension as a stimulus for hyperproduction of these cytokines. In 2nd group the level of oncostatin M and interleukin-6 decreased, which could probably be explained, on the one hand, by dual effects of the family of interleukin-6 the representatives of which either contribute to the development of insulin resistance or, vice versa, enhance the insulin sensitivity of tissues.Item Pathogenetic advances of fosinopril sodium with hydrochlorothiazide in obese hypertensive patients(2017-10) Ashcheulova, Tetyana; Gerasimchuk, Nina; Rezunenko, Y.; Demydenko, Ganna; Kochubiei, OksanaEssential hypertension (EH) stays the important public challenge, because of leading positions in morbidity and mortality in not only Ukraine, but also worldwide. This number is predicted to increase 1.5 billion by 2025. Unfortunately half of that population is unaware of present hypertension [20]. Numerous clinical studies have established the relationship of high blood pressure with increasing body weight. In particular, in the INTERSALT study, carried out in 52 population groups, showed direct correlation between body mass index (BMI) and elevated blood pressure [21]. In Hypertension Control Program was found that 50% of surveyed middle-aged overweight have hypertension (EH), and 2/3 cases of the hypertension are associated with obesity [27]. Framingham study showed that 78% of men and 65% of women has hypertension and are obese [14]. Data confirmed by Swedish Obesity Study [28] where 44-51% of individuals with obesity have essential hypertension. Consequently, increasing in body weight is a potential risk factor for essential hypertension. Finally, the term "obesity induced hypertension" appears. Obesity-associated hypertension is a multicomponent process, and the pathogenesis includes increasing in circulating blood volume, vasoconstriction, hyperreactivity of sympathetic and renin-angiotensin-aldosterone system (RAAS), prediabetes, dyslipidemia and other metabolic disorders. Investigations of the last decade showed that one of the early phases of the pathogenesis of this comorbid pathology is the development of endothelial dysfunction (ED). Elevated levels of angiotensin secreted by the adipocytes, is an important link between visceral obesity and ED, as proved by the correlation of waist - to - hips ratio with the level of mRNA angiotensinogen in visceral and subcutaneous adipose tissue. The subsequent increasing of angiotensin II tissue level stimulates the secretion of superoxide that is known as leading - factor in the etiology of ED. Currently, leading role of the endothelium and nitric oxide in the pathogenesis of cardiovascular complications of hypertension is proved [24, 18, 19]. The leading role in reducing endothelium-dependent vasodilation belongs to the intracellular oxidative stress (OS) as free radical oxidation dramatically reduces the production of NO by endothelial cells [6,1]. Endothelial dysfunction and OS are becoming the new therapeutic targets in the treatment of hypertensive patients. It should be noted that the analyses of pharmacological properties of antihypertensive drugs pay little attention to this aspect. According to some researchers, OS can be a promotor of proinflammatory cytokines system activation. Among the pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α) deserves particular attention in context of hypertension [1,2,7,16,17,29]. Thus, Zahorska-Markiewiez [30] was found in blood of patients with essential hypertension increased content of C-reactive protein (CRP) and TNF-α. It hemodynamic stress caused by hypertension, is stimulus of increased release into the blood of proinflammatory cytokines, including TNF-α [10,15] which, in turn, can modulate the structure and function of the cardiovascular system. The most important predisposal for the maximum reduction in cardiovascular risk in hypertension is achieving the target BP, which may be a problem in presence of overweight and obesity. In many cases there is a need in combination of two antihypertensive drugs that should be metabolically neutral [8,25]. Thus, the scientific justification of treatment regimens in hypertensive patients with overweight and obesity, the study of the antioxidant efficacy of combined antihypertensive therapy is extremely relevant and important for today’s practical healthcare. Despite the large number of antihypertensive drugs and the scientific study of the principles of treatment of patients with hypertension, it would be a mistake to assume that the problem is completely solved.Item Polymorphism of the renin-angiotensin system genes and endothelial no-synthase gene in obese patients with arterial hypertension(2018-12) Ashcheulova, Tetyana; Gerasimchuk, Nina; Demydenko, Ganna; Kulikova, MariiaThe review is dedicated to relationships between the blood pressure and body mass. Endothelial dysfunction and imbalance of neurohumoral systems, namely, the pathological increase in the activity of the renin-angiotensin system, in combination with obesity are the main mechanisms of the of the hypertonic disease pathogenesis. Here we discuss the research on polymorphism of the renin angiotensinic system genes and the endothelial synthase nitric oxide gene. The difficulty lies in the correct assessment of associations of alleles which have clinical signifi- cance. It is essential to determine precisely the associations of gene polymorphisms in the hypertonic disease with obesity. This provides an opportunity to identify new personified approaches to the treatment of patients with this complex pathology.Item The influence of the combined therapy of fosinopril and hydrohlorthiazide on the serum 8-isoprostane level at overwight hypertensive patiens(2012) Kovalyova, Olga; Gerasimchuk, Nina; Safargalina-Kornilova, NadiyThe aim of the study was to investigate the level 8-isoprostane as a marker oxidative stress at overweight patients with arterial hypertension therapy on the dynamics combined fosinopril and hydrochlorthiazide.Item Активность эндотелиальной, индуцибельной NO синтаз и уровень ФНО-α, рФНО-αRI у лиц с гипертонической болезнью и ожирением на фоне комбинированной терапии лацидипина с кандесартаном(2016-05-11) Ashcheulova, Tetyana; Kovalyova, Olga; Gerasimchuk, NinaВо всем мире гипертоническая болезнь (ГБ) занимает одно из ведущих мест в структуре кардиальной патологии. Развитие эндотелиальной дисфункции (ЭД) является одним из первых проявлений патогенез ГБ. За последние годы в научных исследованиях, доказана роль иммунновоспалительной активации, опосредованной провоспалительными цитокинами, и в частности фактора некроза опухолей-α (ФНО-α), в развитии ЭД. Цель данного исследования состояла в определении активности эндотелиальной (e-NOS) и индуцибельной (i-NOS) NO-синтаз во взаимосвязи с уровнем ФНО-α и его растворимого рецептора I типа (РФНО-αRI) у лиц с ГБ и ожирением на фоне лечения комбинацией антагониста кальция (АК) лацидипина с антагонистом рецепторов к ангиотензину II (АРА II) кандесартаном.Item Оцінка ефективності інтерактивних методів навчання на кафедрі пропедевтики внутрішньої медицини №1, основ біоетики та біобезпеки(2016-05) Ащеулова, Тетяна Вадимівна; Ащеулова, Татьяна Вадимовна; Ashcheulova, Tetyana; Ковальова, Ольга Миколаївна; Ковалева, Ольга Николаевна; Kovalyova, Olga; Сафаргаліна-Корнілова, Надія Асхатівна; Сафаргалина-Корнилова, Надежда Асхатовна; Герасимчук, Ніна Миколаївна; Герасимчук, Нина Николаевна; Gerasimchuk, Nina; Гончарь, Олексій Володимирович; Гончарь, Алексей Владимирович; Honchar, Oleksii