Наукові праці. Кафедра пропедевтики внутрішньої медицини № 1, основ біоетики та біобезпеки
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Item A Prognostic Model and Pre-Discharge Predictors of Post-COVID-19 Syndrome After Hospitalization for SARS-CoV-2 Infection(Frontiers Media S.A., 2023-11) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна Вадимівна; Chumachenko, Tetyana; Чумаченко, Тетяна Олександрівна; Chumachenko, Dmytro; Чумаченко, Дмитро Ігоревич; Bobeiko, Alla; Бобейко, Алла Євгенівна; Khodosh, Eduard; Ходош, Едуард Михайлович; Blazhko, Viktor; Блажко, Віктор Іванович; Matiash, Nataliia; Матяш, Наталія Михайлівна; Ambrosova, Tetiana; Амбросова, Тетяна Миколаївна; Herasymchuk, Nina; Герасимчук, Ніна Миколаївна; Kochubiei, Oksana; Кочубєй, Оксана Анатоліївна; Smyrnova, Viktoriia; Смирнова, Вікторія ІванівнаBackground. Post-COVID-19 syndrome (PCS) has been increasingly recognized as an emerging problem: 50% of patients report ongoing symptoms 1 year after acute infection, with most typical manifestations (fatigue, dyspnea, psychiatric and neurological symptoms) having potentially debilitating effect. Early identification of high-risk candidates for PCS development would facilitate the optimal use of resources directed to rehabilitation of COVID-19 convalescents. Objective. To study the in-hospital clinical characteristics of COVID-19 survivors presenting with self-reported PCS at 3 months and to identify the early predictors of its development. Methods. 221 hospitalized COVID-19 patients underwent symptoms assessment, 6-minute walk test, and echocardiography pre-discharge and at 1 month; presence of PCS was assessed 3 months after discharge. Unsupervised machine learning was used to build a SANN-based binary classification model of PCS development. Results. PCS at 3 months has been detected in 75% patients. Higher symptoms level in the PCS group was not associated with worse physical functional recovery or significant echocardiographic changes. Despite identification of a set of pre-discharge predictors, inclusion of parameters obtained at 1 month proved necessary to obtain a high accuracy model of PCS development, with inputs list including age, sex, inhospital levels of CRP, eGFR and need for oxygen supplementation, and level of post-exertional symptoms at 1 month after discharge (fatigue and dyspnea in 6MWT and MRC Dyspnea score). Conclusions. Hospitalized COVID-19 survivors at 3 months were characterized by 75% prevalence of PCS, the development of which could be predicted with an 89% accuracy using the derived neural network-based classification model.Item Cardiac remodeling in hypertensive patients with COVID-19: pre-discharge assessment and a 1-month follow-up(2023-06) Honchar, Oleksii; Гончарь, Олексій ВолодимировичObjective: To study the impact of hypertension on the formation of structural and functional cardiac changes during hospitalization for COVID-19 and the dynamics of detected changes in the early post-discharge period. Design and method: 212 hospitalized COVID-19 patients (mean age 53.4+-13.6 years, 53% female) underwent comprehensive transthoracic echocardiographic examination and the 6-minute walk test at the baseline 1-2 days prior to discharge and after 31 days of follow-up, being compared to 88 matched controls. Results: COVID-19 patients had increased absolute (10.1 ± 1.5 vs 9.1 ± 0.9 mm, p < 0.001) and relative LV walls thickness (0.45 ± 0, 07 vs 0.39 ± 0.04, p < 0.001), LV myocardial mass index (38.1 ± 8.9 vs 33.9 ± 5.8 g/m2.7, p < 0.001) and left atrial volume index (28.6 ± 6.6 vs 25.1 ± 4.9 ml/m2, p < 0.001), as well as decrease in LV global longitudinal strain (-17.5 ± 2.4 vs -18.6 ± 2, 2%, p < 0.001) and diastolic filling parameters (e’ 9.2 ± 2.2 vs 11.3 ± 2.6 cm/s, p < 0.001; E/e’ 7.5 ± 1.8 vs 6.8 ± 1.7, p = 0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted among normotensive patients, resulting in a high prevalence of concentric LV geometry (78% and 43%, respectively, p < 0.001 between groups and vs control), predominantly grade I diastolic dysfunction (51% and 25%, p < 0.001 between groups and vs control), and abnormal values of global longitudinal strain (32% and 19%, p = 0.027 between groups, p < 0.001 vs control), all of which persisted throughout 1-month follow-up. The increase in the % of predicted 6-minute walk distance was 11.2 ± 7.5 in hypertensives vs 12.8 ± 7.6 in non-hypertensive participants, p > 0.05. Conclusions: Hospitalised COVID-19 patients at the pre-discharge period were characterized by the high prevalence of LV concentric geometry and diastolic dysfunction, as well as the minor decrease of its longitudinal contractility, which were more pronounced in the presence of concomitant hypertension and did not improve during 1 month of follow-up.Item Systematic long COVID symptoms assessment in hypertensive and non-hypertensive individuals during the 12-months follow-up after hospital discharge(2023-06) Honchar, Oleksii; Гончарь, Олексій ВолодимировичObjective: To study the impact of hypertension on the dynamics of physical, emotional and cognitive symptoms during the 12-months follow-up after hospitalization for COVID-19. Design and method: 212 patients hospitalized for COVID-19 (50% hypertensive, 53% female, mean age 53,4±13,6 years) underwent comprehensive questionnaire survey evaluating physical (CAT, CCQ and mMRC dyspnea scales for respiratory and EFTER-COVID for other related symptoms), emotional (HADS) and cognitive well-being (Memory, Thinking and Communication subscale of SBQ-LC questionnaire, MTC-SBQ-LC) that was performed pre-discharge and repeated after 1, 3, and 12 months. Results: Despite being older (57,8±11,8 vs 50,7±13,9, p<0,001) and having higher BMI (31,7±5,3 vs 27,4±4,4 kg/m2, p<0,001), hypertensive patrticipants had similar baseline summary scores of symptoms severity but slightly higher mMRC dyspnea score (2,7±1,1 vs 2,3±1,1, p = 0,023), and no significant difference in trends of summary scores have been detected by ANOVA (see graphic abstract). Non-hypertensive subjects had worse baseline limitation of everyday activity, cough and sputum production by respective CAT and CCQ sections that were characterized by better dynamics during follow-up. The residual level of respiratory-related symptoms at 12 months was higher in hypertensive cohort (CAT score 8,1±5,1 vs 5,8±5,0, p = 0,003, CCQ score 7,5±6,1 vs 4,5±5,1, p<0,001, mMRC dyspnea score 1,57±0,63 vs 1,27±0,54, p<0,001), most likely due to more frequent concomitant obesity and diastolic dysfunction. The most striking data was obtained in the MTC-SBQ-LC: yonger and healthier non-hypertensive participants displayed similar trends of most cognitive symptoms to the hypertensive cohort, but had persistently worse brain fog, difficulties in understanding others’ speech, planning, concentrating, and word-finding, that resulted in significantly higher summary score at 12 months after discharge (1,71±2,36 vs 0,96±1,30, p = 0,010). No differences were detected in anxiety and depression levels as assessed by HADS. Conclusions: Hypertensive patients that had been hospitalized for COVID-19 displayed similar trends of resolving physical, emotional and cognitive symptoms throughout the 12-month follow-up but had higher levels of residual respiratory-related symptoms and dyspnoea compared to the non-hypertensive participants, whereas the latter were characterized by significantly higher level of cognitive dysfunction as assessed by the dedicated SBQ-LC subscale.Item Pre-discharge systolic blood pressure in hospitalized COVID-19 patients is an independent predictor of imrovement in 6-minute walk test during 1-month follow-up(2023-06) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна ВадимівнаObjective: To study the relation of hypertensive status and systolic blood pressure (SBP) pre-discharge values to the dynamics of functional re-conditioning as assessed by 6-minute walk distance during the 1-month follow-up after hospitalization for COVID-19. Design and method: 6-minute walk distance (6MWD) was assessed pre-discharge in 176 patients hospitalized for COVID-19 (40% hypertensive, 47% male, mean age 53,2 ± 13,5 years) using the 20 m walkway and an extended protocol that included monitoring of peripheral pulse and capillary blood oxygen saturation (SpO2) every 30 seconds via bluetooth-connected pulse oximeter. The repeated evaluation was performed after 1 month of follow-up. Results: Hypertensive participants were characterised by older age (57,8±11,8 vs 50,7±13,9, p < 0,001), higher weight and body mass index (31,7±5,3 vs 27,4±4,4 kg/m2, p < 0,001). As a result, 6MWD in them was shorter (378±57 vs 418±75 m, p = 0,001) but no difference in reached percent of predicted distance (6MWD%) was detected (63,0±8,5 vs 63,2±11,1 %, p = 0,939). The described relation persisted at 1 month, with no difference in absolute (72±43 vs 68±43 m, p = 0,324) and percentage gain of 6MWD (12,8±6,6 vs 11,2±7,5 %, p = 0,266) between groups. Multiple regression analysis has allowed to build the model that accounted for 94% of variability in the 6MWD% gain between visits (85% for dedicated hypertensive cohort model). After adjustment for age, sex, height, weight, Remdesivir treatment, minimal SpO2 levels during acute COVID-19, changes of SpO2 and pulse rate throughout the 6MWT, SBP remained a potent independent predictor of 6MWD% gain, with 10 mmHg higher values at baseline evaluation being associated with 21,5% lesser 6MWD% gain in hypertensive subjects and 8,2% lesser – in normotensives. Conclusions: Hypertensive status did not have an impact on 6MWD% in pre-discharge COVID-19 patients. Moderate-to-high quality multiple regression models have demonstrated an independent role of SBP, demographic and anthropometric data, changes of SpO2 and pulse rate throughout the 6MWT in prediction of 6MWD% gain during 1 month after discharge, both in hypertensive and normotensive patients.Item COVID-19, ремоделювання серця та функціональне відновлення після виписки: вплив артеріальної гіпертензії(2023-09) Honchar, Oleksii; Ashcheulova, Tetiana; Гончарь, Олексій Володимирович; Ащеулова, Тетяна ВадимівнаItem One month follow-up of post-discharge COVID-19 patients shows persistent sonographic signs of cardiac remodeling and mildly impaired longitudinal function regardless of presence of hypertension(2023-05) Honchar, Oleksii; Гончарь, Олексій ВолодимировичBackground. Impaired functional status is one of the typical longterm sequelae of COVID19 infection. Minor impairment of cardiac function that is unable to cause manifestation of overt congestive heart failure may remain undetected in COVID19 convalescents, in the same time contributing to persistence of symptoms and development of long COVID syndrome. Purpose. To study the typical features and shortterm dynamics of cardiac remodeling and possible signs of cardiac dycfunction in hypertensive and nonhypertensive patients with COVID19 infection.Item Патогенетична обґрунтованість застосування сакубітрил/вальсартан при респіраторно-кардіальної коморбідності(2022-12) Ащеулова, Тетяна Вадимівна; Компаніець, Кіра Миколаївна; Герасимчук, Ніна Миколаївна; Ситіна, Ірина ВасилівнаСеред коморбідних станів, які значно погіршують показники якості та тривалості життя, є хронічне обструктивне захворювання легень та серцева недостатність. Труднощі медикаментозної терапії полягають у взаємовиключних підходах в лікуванні хронічної обструктивної хвороби легень і супутньої кардіоваскулярної патології. Мета роботи - пошук наукових доказів щодо можливого використання комбінованого препарату - LCZ696 (angiotensin receptor neprilysin inhibitor, ARNI), який містить інгібітор непрілізіна сакубітрил (AHU377) і блокатор рецепторів ангіотензину II валсартан, у пацієнтів з поєднаними хронічним обструктивним захворюванням легень та серцевої недостатності. Матеріали та методи. У статті представлено огляд літератури, який демонструє, що причиною летальності у хворих на хронічне обструктивне захворювання легень можуть статися як зміни з боку дихальної системи, так і ускладнення з боку серцево-судинної системи. Показано , що прогресуючи, хронічне обструктивне захворювання легень призводить до формування легеневої гіпертензії, гіпертрофії правого шлуночка, зниження його систолічної функції, подальшої дилатації правого шлуночка і розвитку правошлуночкової серцевої недостатності, що є одним з найсерйознішим і важким випробуванням у лікувальному процесі. Надалі такої сполученної патології є розвиток лівошлуночкової серцевої недостатності. Обговорено роль системи натрійуретичних пептидів, а саме мозкового натрійуретичного пептиду, мозкового натрійуретичного пропептиду, натрійуретичного пептид С-типу і N-кінцевого попередника натрійуретичного пептиду C-типу в якості маркерів хронічного обструктивного захворювання легень та серцевої недостатності. Результати. Натрійуретичний пептид на сьогоднішній день є загальновизнаним маркером серцевої недостатністі, висока цінність якого досягається завдяки визначенню прогнозу і стратифікації ризику хворих серцевої недостатністі. Натрійуретичний пептид діє як судинорозширювальний засіб, надає антипроліферативну активність через шлях G-залежної протеїнкінази та сприяє бронходілятації, викликаючи вивільнення ацетилхоліну з клітин бронхіального епітелію. Висновки. Усі ці властивості наводять на висновок, що натрійуретичні пептиди можуть виявитися потенційним засобом лікування у пацієнтів із серцевими ускладненнями та хронічним обструктивним захворюванням легень. Найкращим способом продовження «терміну життя» натрійуретичного пептиду є пригнічення деградації натрійуретичного пептиду за допомогою інгібітора неприлізину сакубітрилу.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 Gender and chronic obstructive pulmonary disease(2021-04) Pytetska, Natalia; Letik, Ivan; Saini, EshaItem Gender features of sexual dysfunction in patients with hypertension(2021-04) Pytetska, Natalia; Kurinna, MarinaItem Major medical and ethical risks of abortion(2021-02) Pytetska, Natalia; Molodan, Dmitro; Al Abdul Razak, Mohamed TarekItem Аборт як глобальна проблема охорони здоров’я(2021) Питецька, Наталя Іванівна; Хорошун, Едуард МиколайовичAbortion is a growing problem around the world, regardless of the status of the country and the level of income. Whatever the reason, a woman should have the right to an independent decision regarding the birth of a child. In addition, she must always to have a posibility for a safe abortion. At the government level it is important to ensure access to all services in the field of sexual and reproductive health, including information about safe contraception and abortion.Item Surrogacy: blessing or curse to poor society in India(2021) Pytetska, Natalia; Molodan, Dmitro; Saini, EshaSurrogacy in India is not only a contractual agreement between the parties, which must be drawn up with care to avoid human rights violations. Surrogacy is a public health problem associated with both medical and social problemsItem Secondary prevention of chronic veins diseases in the early stages(Pytetska N. I. Secondary prevention of chronic veins diseases in the early stages / N. I. Pytetska // Secondary prevention of chronic veins diseases in the early stages : Abstracts of IX International Scientific and Practical Conference, Stockholm, Sweden, 15–17, November 2020. – Stockholm, 2020. – Р. 40–41., 2020) Pytetska, NataliaItem Особливості викладання курсу «Сестринська практика» у сучасних реаліях. Власний досвід(2021-05-20) Ащеулова, Тетяна Вадимівна; Ситіна, Ірина Василівна; Кочубєй, Оксана АнатоліївнаItem Самостійна робота студентів хнму з використанням технологій дистанційної освіти на платформі MOODLE(2021-05-20) Ащеулова, Тетяна Вадимівна; Кочубєй, Оксана Анатоліївна; Ситіна, Ірина Василівна; Компанієць, Кіра МиколаївнаItem Secondary prevention of chronic veins diseases in the early stages(Pytetska N. I. Secondary prevention of chronic veins diseases in the early stages / N. I. Pytetska // Secondary prevention of chronic veins diseases in the early stages : Abstracts of IX International Scientific and Practical Conference, Stockholm, Sweden, 15–17 November 2020. – Stockholm, 2020. – Р. 40–41., 2020-11) Pytetska, NataliaItem 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 Нові реалії вищої медичної освіти в дистанційному форматі(ТНМУ, 2020-11) Кочубєй, Оксана Анатоліївна; Ащеулова, Тетяна Вадимівна; Ситіна, Ірина Василівна; Kochubiei, Oksana; Ashcheulova, Tetyana; Sytina, IrynaПандемія Covid-19 у 2020 році загострила ряд етичних, гуманітарних та технологічних проблем. Але за допомогою сучасних передових цифрових технологій було можливо перебудувати сферу освіти та наладити дистанційне навчання. Дистанційне навчання суспільство придумало через гостру потребу в ньому. А історія з світовим карантином чи не найцікавіший цьому доказ. Бо всім відомо, що освіта, науковий прогрес, доступність інформації та глобалізація тісно пов’язані між собою і напряму впливають один на одногоItem Burnout study among medical students(Pytetska N. I. Burnout study among medical students / N. I. Pytetska // Modern approaches to the organization of the educational process for medical students: Internship proceedings, Lublin, January 20 – February 28, 2020. – Lublin, 2020. – P. 74–76., 2020) Pytetska, Natalia