Наукові праці. Кафедра неврології № 2

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2-х річний катамнез пацієнтів на мозковий інсульт (МІ) та транзиторні ішемічні атаки (ТІА) атеротромботичного ґенезу
(ХНМУ, 2018-03-16) Лапшина, Ірина Олександрівна
Серцево-судинні епізоди розвинулися у тих хворих, у яких було 2 і більше факторів ризику, найчастіше це були: артеріальна гіпертензія, цукровий діабет, куріння, абдомінальний тип ожиріння. На розвиток повторних серцево-судинних епізодів впливають лікувальні заходи, які здійснюються в межах вторинної профілактики. Спостереження за групою хворих показало, що призначення адекватної медикаментозної терапії (антиагреганти, гиполіпідемічні та антигіпертензивні засоби) впливає на частоту розвитку серцево-судинних ускладнень.
Cerebrovascular in-sufficiency and diabetic encephalopathy in patients with type 2 diabetes mellitus
(2014) Tovazhnyanska, Elena; Bezuglova, Irina
The peculiarities of cognitive dysfunction structure in patients with type 2 diabetes mellitus and stage 2 diabetic encephalopathy characterized by disorders of memory, verbal fluency, attention and orientation, were revealed. Association of cognitive disorders with disease duration, glycosylated hemoglobin concentration, impaired brain activity, cerebral hemodynamics and cerebrovascular reactivity was established.
Changes in S100 protein expression in the cerebellum of rats orally exposed to energy drinks
(The Official Publication of The Malaysian Society for Biochemistry and Molecular Biology, 2019-12-20) Ткаченко, Антон Сергійович; Губіна-Вакулік, Галина Иванівна; Каук, Оксана Іванівна; Оніщенко, Анатолій Ігорович; Шеховцова, Есміра Вадимівна; Tkachenko, Anton; Gubina-Vakulyck, Galina; Kauk, Oksana; Onishchenko, Anatolii; Shekhovtsova, Esmira; Nakonechna, Oksana
The aim of our study was of assess the rate of S100 protein expression in the cerebellum of rats orally exposed to caffeinated energy drinks (CED) during 2 and 4 weeks. Twenty WAG rats were enrolled in the experiment. They were subdivided into three groups. The animals from group 1 and group 2 (n=7 in each) were orally exposed to a caffeinated energy beverage “Black” at a dose of 12 ml per kg of body weight during two and four weeks, respectively. The control group consisted of 6 intact rats obtained drinking water instead of a caffeine-containing energy drink. Cerebellar S100 expression was evaluated immunohistochemically. Against the background CED oral administration during two and four weeks, the density of granule cell layer becomes lower indicating neuronal loss. S100 protein was upregulated in group 1 in the entire cerebellar cortex. Thus, CED oral exposure resulted in the development of cerebellar astrogliosis. Four-week-long CED consumption resulted in S100 downregulation in the molecular and granular layers. Our findings demonstrate the damage to the cerebellum in rats exposed to CEDs with overexpression of S100, followed by a decrease in its expression.
Changes of vitamins B1, B12 as predicting factors of peripheral polyneuropaty in pulmonary in tubercolosis patients
(Balkan Medical Union, 2020-03) Швець, Ольга Миколаївна; Шевченко, Ольга Станіславівна; Тодоріко, Лілія Дмитрівна; Товажнянська, Олена Леонідівна; Дубинська, Ольга Ігоровна; Островський, Микола Миколайович; Макойда, Ірина Яремівна; Єременчук, Інга Василівна; Shvets, Olga; Shevchenko, Olga; Todoriko, Liliia; Tovaznyanska, Olena; Dubynska, Olga; Ostrovskyi, Mykola; Makoyda, Iryna; Yeremenchuk, Inga
Patients with newly diagnosed pulmonary tuberculosis (TB) had lower initial plasma levels of vi- tamins B1 and B12, compared to age- and sex-matched healthy persons. We did not find significant chang- es in vitamin B status and electroneuromyography during the treatment with combinations of isoniazid and first-line anti-TB drugs. During the treatment with combinations of linezolid and second-line anti-TB drugs, we identified significant decreases of plasma vi- tamin B1 and B12 levels and worsening of electroneu- romyography indices by sensory and motor fibers. The deficiency of vitamins B1 and B12 during treatment with linezolid can be considered as one of the pathogenetic mechanisms of progressive damage of peripheral nervous system in pulmonary tu- berculosis patients, which must be taken into account during the course of antitubercular therapy.
Clinical features of different forms of myasthenia depending on structural changes in thymus
(CPN Publishing Group, 2019-10-21) Samoilova, Hanna
This article presents the features of the clinical picture of myasthenia gravis on the background of the presence or absence of structural changes in the thymus, based on the use of classical neurological examination, pharmacological tests. Assessment of the severity of the patient's condition was performed on the MGFA scale using neurological data as well as the quantitative QMGS test
Clinical, neurophysiological and immunological peculiarities of myasthenia gravis in patients with different histologic types of thymoma
(Galician medical journal, 2016-10-24) Tovazhnyanska, Olena; Samoilova, Hanna; Protsenko, Olena; Remnyova, Natalia; Kostya, Yuri
Thymoma is characterized by various clinical manifestations. About half of them are manifested as an asymptomatic course, others occur in a combination with different syndromes. 25% of patients develop compression of tumor blood vessels, nerves and organs of the mediastinum or clinical signs of germination of thymic tumor in other organs. 40% of patients are diagnosed with autoimmune diseases due to dysfunction of the thymus. Generalized myasthenia gravis (75%) is most frequently observed. The objective of the research was to study clinical and immunological peculiarities of myasthenia gravis depending on the size and histological type of thymoma. Materials and methods. The results of clinical and immunological, instrumental and histological examination of 30 patients with myasthenia on the background of thymoma were analyzed. The severity of the disease was assessed using clinical classification of the Myasthenia Gravis Foundation of America (MGFA, 2001).To determine the barrier function of phagocytic cells, phagocytosis activity of neutrophils was evaluated using the light microscope. The phagocytic index, the phagocytic number and the index of phagocytosis completion were determined. The suspension culture of Saccharomyces cerevisiae was used as a microbial agent. Preparations were stained using the Romanovsky-Himze methods. Neutrophilic leukocytes were separated from leukocyte suspension of peripheral blood. The expression of differentiation clusters CD3+, CD4+ and CD8+ on subpopulation of T- and B-cells were evaluated by indirect ELISA using monoclonal antibodies labeled with FITC-dye. To diagnose thymoma, we used spiral CT “Marconi” SeleCT/SP. For histologic study thymoma samples were fixed in 10% neutral formalin for 24 hours. The material was embedded in paraffin after posting through the chloroform in the usual way; then, sections with the thickness of 5-7 μm were prepared. Preparations were stained with hematoxylin and eosin.
Clinical-morphological pecularities of the peripheral nervous system in different types of the multiple sclerosis course
(Белорусский государственный медицинский университет, 2018) Марковская, Елена Владимировна; Шапкин, Антон Сергеевич; Лунина, Алина Олеговна; Markovska, Olena; Shapkin, A.; Lunina, A.
Summary: in the study of peripheral nervous system structures in patients with multiple sclerosis, demyelination and dystrophic changes of nerve fibers were revealed in the form of defibration, sclerosis, focal shrinkage of Schwann cells, as well as inflammatory changes with the expression of large amounts of cyclooxygenase-2 and inducible fraction of synthase nitric oxide.
Effectiveness of intravenous Isoniazid and Ethambutol administration in patients with tuberculosis meningoencephalitis and HIV infection
(2019-08) Butov, Dmytro; Feshchenko, Yurii; Kuzhko, Mykhailo; Gumeniuk, Mykola; Yurko, Kateryna; Grygorova, Alina; Tkachenko, Anton; Nekrasova, Natalia; Tlustova, Tetiana; Kikinchuk, Vasyl; Peshenko, Alexandr; Butova, Tetiana
A significant improvement in the clinical symptoms and X-ray signs in patients treated intravenously with isoniazid and ethambutol was observed and compared to group 2. The sputum Mycobacterium tuberculosis positivity was observed during the second month of the treatment in 25.0% of patients from group 1 and 76.1% of the patients from the control group (p=0.003). In addition, nine patients (39.1%) died up to 6 months when isoniazid and ethambutol were prescribed intravenously compared with 22 (70.9%) in group 2 (p=0.023). In patients with acute progressive form of tuberculosis/tuberculous meningoencephalitis with HIV, the intravenous isoniazid and ethambutol treatment was more effective than oral isoniazid and ethambutol treatment at 2 months of intensive treatment in sputum conversion as well as in clinical improvement, accompanied by significantly higher mean serum concentrations. In addition, the mortality rate was lower in intravenous isoniazid and ethambutol treatment compared to oral treatment.
Emergency conditions in the patients with myasthenia gravis. clinical case of complicated course of generalized myasthenia gravis after thymthymomectomy
(2015) Tovazhnyanska, Olena; Samoilova, Hanna
Myasthenic crisis may be defined as respiratory failure or delayed extubation after surgical treatment for more than 24 hours resulting from myasthenic weakness. Myasthenic crisis results from weakness of upper airway muscles leading to obstruction and aspiration, weakness of respiratory muscles leading to reduced tidal volumes, or weakness of both muscle groups. About 1/5 of patients with myasthenia gravis experience crisis, usually within the first year of illness. Over the last four decades, prognosis from myasthenic crisis has dramatically improved from a mortality rate of 75 % to the current rate of less than 5 %. Myasthenic crisis should not be fatal, as long as patients receive timely respiratory support and appropriate immunotherapy to reduce myasthenic weakness of the respiratory muscles. In the last years there are more reports about the development of urgent conditions in patients with myasthenia gravis in the early postoperative period after thymectomy. Long-term follow-up monitoring for the study effects of thymectomy in patients with myasthenia gravis, conducted in the department of thoracic surgery of State Institution «Institute of General and Emergency Surgery named after V.T. Zaitsev of National Academy of Medical Sciences of Ukraine» showed that the incidence of early postoperative myasthenic crisis amounted 9.2–12.3 % of cases and was associated with the degree of compensation of bulbar and respiratory disorders before the surgery. This reflects the importance of an adequate selection of the dose of anticholinesterase drugs in the preoperative stage for effective compensation neurosomatic disorders and favorable postoperative prognosis. As an example, the complicated course of generalized myasthenia gravis after thymthymomectomy was described.
Enzyme blood level disorder as a marker of metabolic processes severity in multiple sclerosis
(2014) Markovska, Olena
Dynamics of membrane-bound enzymes activity changes in the blood of 67 patients with multiple sclerosis was investigated depending on the variety and duration of the disease.
Intensification of educational and cognitive activities of interns in the process of training
(Scientific publishing house Infinity, 2020-04-12) Markovska, Olena; Tovazhnyanska, Olena; Markovskyi, Volodymyr; Shapkin, Anton
The introduction of modern teaching methods on the “Neurology” cycle for interns has significantly improved the assimilation of special skills and abilities and the acquisition of theoretical and practical knowledge in the diagnosis, treatment, prevention, and the provision of adequate assistance in emergency situations in people with pathology of the nervous system. The effectiveness of these activities was noted during the final exam. So, the percentage of “excellent” answers on emergency neurology has significantly increased - up to 50% against 27% with traditional approaches to training.
Methodical aspects of Doppler ultrasound of the vertebrobasilar system
(2019-01) Rizvan, Abdullaiev; Olena, Tovazhnyanska; Ruslan, Abdullaiev; Olena, Markovska; Mykhailo, Navruzov
Various pathologies of the cervical vertebrae (instability of the atlanto-axial junction, uncovertebral arthrosis, herniation of intervertebral disks) with combined rotational movements of the neck may contribute to the violation of vertebrobasillary hemodynamics. Doppler ultrasound imaging allows non-invasive recording of blood flow in all segments of the vertebral artery and the basal artery, to evaluate its quantitative parameters. Doppler ultrasound in triplex mode justify the noninvasive approach to obtain quantitative parameters of blood flow, which can be used in various pathological conditions leading to disruption of Vertebrobasilar system hemodynamics. To visualize the first segment of the vertebral artery, especially its mouth, it is advisable to use a micro-convex transducer. In most cases, the second segment of the PA is better to visualize with a linear transducer, and in patients with a short and wide neck - with a convex and microconvex transducers. The third and fourth segments, as well as the basal artery, are equally well visualized by convex and sector transducers. The maximum systolic and end-diastolic velocity, the resistance index in different segments of the vertebral arteries do not differ significantly.
Multiple sclerosis. Possible options for the onset of the disease in a clinical example
(Scientific publishing house Infinity, 2020-05) Markovska, Olena; Tovazhnyanska, Olena; Nadozirna, Yevheniia; Lapshyna, Iryna
Multiple sclerosis (MS) is a neurological problem of great socioeconomic importance, as it develops mainly in young and middle-aged people and, in the absence of timely and adequate treatment, leads to the formation of severe neurological deficit and early disability of patients in the first year after diagnosis. The clinical manifestations of MS are diverse and the well-known slow onset and development of the disease are not always found. A variety of clinical forms and options for the onset of MS, an increase in the age interval for debut, various rates of disease progression indicate different mechanisms for the development of the demyelinating process and thereby increase interest in studying the clinical features and pathogenetic mechanisms of the development of this pathology.
Tourette syndrome or PANDAS—a case report
(2020-09-21) Singh, Rhoa; Nekrasova, Natalya; Butov, Dmytro
Tourette syndrome (TS), a relatively common disorder, has been gaining more attention during the past two decades because of an increased number of reports. Nevertheless, it is still not completely understood. Furthermore, a clinical entity called “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections” (PANDAS) has been introduced, which describes a tic disorder, accompanied by psychiatric disorders such as obsessive compulsive disorder (OCD), after a streptococcal infection in childhood. We present a case report of a 19-year-old adolescent Ukrainian female, with a history of anxiety disorder and OCD, who, despite TS remission during childhood, presented with new-onsetmotor and phonic tics after 1 month of severe tonsillitis. Blood and cerebrospinal cultures showed Streptococcus pyogenes, with magnetic resonance imaging revealing hypo-intense changes in the caudate nucleus on both sides. Treatment with clonazepam and fluoxetine, along with behavioral therapy, have improved the severity of her condition. This report presents a case of TS reemergence against the background of immunological reaction or PANDAS with a late adolescent onset.
Transcranial dopplerography in acute left-hemispheric ischemic stroke
(2018-03) Абдуллаев, Ризван Ягубович; Сисун, Лариса Анатольевна; Товажнянская, Елена Леонидовна; Посохов, Николай Федорович; Марковская, Елена Владимировна; Abdullaiev, Rizvan; Sysun, L.; Tovazhnyanska, O.; Posokhov, N.; Markovska, Olena
In patients with hemispheric chemical stroke, stenosis of the middle cerebral artery is often observed, a systolic blood flow velocity less than 70 cm/s, an increase in the resistance and pulsation index. On the contralateral side, in persons up to 60 years of age, the blood flow velocity may be slightly increased in comparison with healthy individuals. Reduction of systolic blood flow velocity, increase in resistance index more than 0.70, pulsative index more than 1.35, presence of deep incision on Doppler spectrum of blood flow in middle cerebral artery are prognostic signs of unfavorable course of ischemic stroke. With ischemic stroke on the side of the lesion, visualization of the deep veins of the brain improves because of the increase in speed in them
Two-Dimensional Ultrasonography in the Diagnosis of the Causes of Various Types of Low Back Pain
(2018-02-20) Товажнянская, Елена Леонидовна; Абдуллаев, Ризван Ягубович; Цимбалюк, Виталий Иванович; Абдуллаев, Роман Ризванович; Abdullaiev, Rizvan; Tsymbalyuk, Vitaliy; Tovazhnyanska, Olena; Abdullaiev, Roman
An accurate definition of the cause and mechanism of low back pain remains an urgent problem in medicine. Pain in the lower back can manifest as lumbago, sciatica, inflammation of the epidural space. Among the causes of lower back pain, the leading place is occupied by degenerative changes in the intervertebral discs with the development of a hernia or protrusion. The size and location of a hernia or protrusion, the presence of an inflammatory process in the epidural space often determine the nature of the clinical symptomatology. MRI is the main method of diagnosing changes in discs and ligamentous apparatus. In some cases, interpretation of MRI images may vary considerably among different specialists. In some patients, its use may be limited. Ultrasonography is an alternative method for diagnosing degenerative-dystrophic changes in the motor segment and the causes of low back pain.
Ultrasonographic characteristics of carotid and middle cerebral arteries in patients with ischemic stroke
(Research advances in brain disorders and therapy, 2018-07-05) Абдуллаев, Ризван Ягубович; Когут, Александра Валерьевна; Григорова, Ирина Анатольевна; Товажнянская, Елена Леонидовна; Посохов, Николай Федорович; Марковская, Елена Владимировна; Тесленко, Ольга Александровна; Abdullaiev, Rizvan; Kogut, A.; Hryhorova, I.; Tovazhnyanska, O.; Posokhov, N.; Markovska, Olena; Teslenko, O.
Atherosclerotic lesions of carotid and large cerebral vessels are an important cause of stroke, which leads to a higher risk of early recurrent ischemia than any other stroke subtype. Extra cranial ultrasound and Transcranial Dopplerography (TCD) in triplex mode is a non-invasive approach to obtaining qualitative changes in the carotid and middle cerebral arteries, and the quantitative parameters of the blood flow in them.The relationship between the nature of atherosclerotic plaque, the degree of stenosis of the internal carotid artery and the frequency of occurrence of ischemic stroke are established. Ulcerated and embologenic plaques in the carotid arteries, stenosis of the internal carotid artery more than 70% increase the risk of ischemic stroke. Hemodynamically significant stenosis of the middle cerebral artery can be diagnosed by color Doppler in more than 70% of patients with ischemic stroke.
Активізація навчально-пізнавальної діяльності лікарів- інтернів в процесі професійної підготовки
(Українська медична стоматологічна академія, 2019-11-08) Марковська, Олена Володимирівна; Шапкін, Антон Сергійович
Забезпечення ефективного соціально-економічного розвитку нашої країни і високого рівня надання медичної допомоги зумовлює необхідність професійної підготовки фахівців принципово нової формації. Важливим етапом підготовки у лікарській справі є післядипломне навчання - інтернатура. Основним завданням професійної підготовки інтернів є активізація їх навчально-пізнавальної діяльності, розвиток клінічного мислення, мотивація необхідності оволодіння практичними навичками.
Активізація навчально-пізнавальної діяльності студентів-іноземців у закладах вищої медичної освіти
(Харківський національний медичний університет, 2020-01) Соловйова, Євгенія Тарасівна
Метою роботи було розроблення моделі активізації навчально-пізнавальної діяльності студентів – майбутніх лікарів. В рамках моделі визначено комплекс організаційно-педагогічних умов, що забезпечує активізацію навчально-пізнавальної діяльності студентів в процесі підготовки до професійної діяльності. Лекції та семінарські заняття супроводжувались використанням засобів «інформаційного меседжу»: графіків, мультимедійних презентацій із схемами патогенезу та діагностики уражень нервової системи, відеофільмів, що демонстрували дослідження неврологічного статусу хворих. На практичних заняттях проводились дискусії, використовувались імітаційні ділові ігри та кейс-метод (активний проблемно-ситуаційний аналіз). Отримані результати свідчать про ефективність використання вказаних методів активізації навчально-пізнавальної діяльності серед студентів - медиків, що навчаються англійською мовою.
Аналіз порушень когнитивних функцій внаслідок перенесених менінгоенцефалітів у ВІЛ-інфікованих осіб
(ХНМУ, 2018-03-16) Соловьева, Евгения Тарасовна; Соловйова, Є.Т.
Результати дослідження вказували на високу поширеність та варіабельність когнитивних розладів у ВІЛ-інфікованих осіб, в тому числі й після перенесених опортуністичних нейроінфекцій. При цьому когнитивна дисфункція може спостерігатися та прогресувати із часом й при наявності адекватної ВААРТ. Особливої уваги потребують хворі, що перенесли туберкульозний менінгоенцефаліт, оскільки частота реєстрації когнитивних порушень у даної групи хворих потребує вчасної діагностики и корекції. Дані дослідження свідчать про те, що проблема раннього виявлення та лікування нейрокогнитивних розладів зберігає свій масштаб та потребує більш широкого застосування скринінгових методів їх оцінки.