The aim: To evaluate the structural changes of the brain in relation to the formation of cognitive disorders (CD) in patients with arrhythmias

Materialsand methods: 147 patients with different clinical forms arrhythmias against the background of ischemic heart disease were examine. At the first stage, all patients with arrhythmias assessed cognitive functions. At the second stage, patients were distributed divided into two groups: the main group patients with CD, control – patients without CD. These groups underwent computed tomography examination of the brain.

Results:CD were established in 83% patients with arrhythmias. Mild CD were more often diagnosed in patients with persistent form of atrial fibrillation (AF), severe CD – in patients with permanent form of AF and atrioventricular blockade ІI-III degrees. Neuroimaging changes were found in 73.8% patients with CD and in 36% patients without CD. They were manifested by atrophic changes of the cortex, internal hydrocephalus, a decrease in the density of the brain sub- stance of the periventricular area. In patients with CD, compared to patients without CD, showed lacunar foci with predominant localization in the parietal and frontal lobes of the brain, periventricular and subcortical leukoaraiosis. Multiple correlations were established between CD and structural changes of the brain.

Conclusions: The increase in the severity of CD in patients with arrhythmias is associated with atrophic changes at the cortical-subcortical level, accompanied by the phenomena of internal hydrocephalus, periventricular and subcortical LA, lacunar foci, with a predominant localization in the frontal-temporal-occipital lobes, in the visual hump and basal ganglia of both cerebral hemispheres.

UDC 616.12-008.313:073.96:616.89-008.45/.46/.47

Background. The purpose of our work was to find out the dependence of changes in the cognitive sphere on the features of the structural and functional state of the heart and central hemodynamics in patients with arrhythmias.

Material and methods. We have examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing and central hemodynamic studies. The state of central hemodynamics was assessed by an ultrasound examination of the heart. The state of intracardiac hemodynamics, structural changes in various parts of the heart were evaluated; based on this, the type of heart remodeling was determined. Correlations of hemodynamic indicators with the results of neuropsychological testing were evaluated.

Results. In patients with mild cognitive disorders (CD), the left ventricular myocardial contractility index did not differ significantly from that in patients without CD, but in people with moderate CD it was 9.6 % lower (p = 0.044). With moderate CD, the dilatation of the left parts of the heart increased (end-diastolic volume — by 16.5 %, p = 0.049; left atrium — by 9.9 %, p = 0.049), which, along with increased hypertrophy of the interventricular septum by 12.8 % (p = 0.048) and of the left ventricular posterior wall by 12.9 % (p = 0.048), led to an increase in the pulmonary artery pressure by 24.8 % (p = 0.015). Among patients with CD, concentric (42.2 %) and eccentric (22.6 %) left ventricular hypertrophy was more often detected (p = 0.048 and p = 0.027); in those without CD, concentric remodeling of the left ventricle prevailed (p = 0.037). In patients with mild CD, higher stroke volume was recorded — by 8.3 % (p = 0.049) compared to those without CD. However, according to indicators of cardiac output, cardiac index and total peripheral vascular resistance, differences were unreliable (p > 0.05). Patients with moderate CD reported an increase in stroke volume and cardiac output by 7.6 (p = 0.043) and 14.9 % (p = 0.014), respectively, compared to those without CD. Indicators of central hemodynamics had the greatest impact on the sphere of attention, regulatory functions, visual-spatial and mnestic deficits. The highest odds ratio for the development of CD were found for left ventricular ejection fraction (2.52, 95% confidence interval: 1.82–3.29, p < 0.001).

Conclusions. The identified associations of cognitive dysfunction, central hemodynamics and heart remodeling are important for optimizing an individualized approach to patient management and predicting the development of CD.

Type 2 diabetes mellitus (T2DM) patient outcomes, treatment options, and corresponding healthcare expenses are affected by the presence of different comorbidities. The aim of this work was to develop an algorithm for predicting the risk of hypothyroidism development in patients with T2DM according to a mathematical model obtained by regression analysis, for the timely implementation of appropriate preventive measures among T2DM patients. We analyzed 538 medical records of T2DM patients. It was found the following risk factors influencing the occurrence of hypothyroidism in patients with T2DM: hemoglobin, total cholesterol, non-HDL-cholesterol, glycated hemoglobin, and thyroid stimulating hormone levels. Prognostic model of the risk of hypothyroidism development in T2DM patients was built using multiple regression analysis. In order to stratify the risk of hypothyroidism development in T2DM patients, the following criteria were proposed: no risk at RC HT ≤ 5.0; low risk at 5.1≤ RC HT≤14,9; high risk at RC HT ≥15.0; where RC HT — risk coefficient for the hypothyroidism development in T2DM patients. Therefore, the developed algorithm and mathematical model for predicting the development of hypothyroidism in T2DM patients are highly informative and allow to determine in advance the contingent of patients with a high probability of hypothyroidism risk based on routine laboratory data.

Background. The issue of the pathogenetic influence of cortisol on the development of metabolic syndrome (MS) in children is considered. The above-threshold values of cortisol are proposed to be taken as a marker of MS. The purpose was to study the relationship between blood cortisol and MS components in children.

Materials and methods. We have examined 44 children with MS (study group; waist circumference > 90th percentile of the distribution according to age and sex) and 14 children without signs of MS (controls). The children of the study groups did not differ in age and gender. Anthropometric parameters (body weight, height, body mass index, neck, waist, and hip circumferences, waist/hip circumference index), blood cortisol and leptin, blood lipid and carbohydrate spectrum (total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, blood glucose, and insulin, HOMA-IR and glucose/insulin indices) were evaluated. The measurement of blood pressure with the calculation of the average level was conducted three times. The diagnosis of MS was formed according to the IDF guidelines, 2007.

Results. It was found that the level of blood cortisol in children with MS (362.9 (255.5–634.1) μg/l) was 37.9 % lower than in controls (р > 0.05). The frequency of the above-threshold blood cortisol values in children of both groups was 31.8 and 50.0 %, respectively (р > 0.05). The study of dependence using the Spearman’s rank correlation coefficient between blood cortisol and anthropometric parameters (rmax = 0.16; p > 0.05), lipids (rmax = 0.4; р > 0.05), carbohydrate metabolism (rmax = 0.26; р > 0.05), and blood leptin (r = 0.19; р > 0.05) did not reveal any significance. A significant correlation was found between cortisol and systolic blood pressure. Conclusions. In children with MS, there was no significant difference in the level of blood cortisol compared to those without MS criteria. The association of blood cortisol and MS criteria other than systolic blood pressure has not been found. Although cortisol is important in the formation of systolic blood pressure, it cannot serve as a marker of MS in children since it is not a criterion-forming sign of MS.

The aim: To investigate the relationship between serum bilirubin level and the presence of the APS in women with a history of spontaneous miscarriages.
Materials and methods: Fifty six women aged 22-38 (median 27) years with a history of spontaneous miscarriages were divided into two groups: 33 women with the APS and 23 without. Patients were tested for the presence of lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein 1, antiphospholipid antibodies and genetic thrombophilic defects.
Results: Groups were comparable by age, blood pressure, BMI, co-morbidity (anemia, heart abnormality, thyroid disease, overweight). Median serum total bilirubin levels were 7,2 μmol/L (interquartile range [5,8-9,7]) in women with the APS and 10,5 μmol/L (interquartile range [7,5-15,1]) in control group, p=0.005. The chance of detecting a total bilirubin level of less than 8 μmol/L is 4.1 times higher in the APS patients than in the control group (OR 4,1; 95% CI 1,274-13,213). Logistic regression analysis found a statistically significant association between total bilirubin and the presence of the APS (odds ratio, 0.856; 95% CI, 0.734-0.997, p =0.046). Patients with the APS had elevated serum C-reactive protein (medians 2,3 vs 1,1 mg/L, p=0.01) and fibrinogen (medians 2,8 vs 2,5 g/L, p=0.006) levels compared with controls. Correlation analysis revealed a significant correlation between all types of bilirubin and inflammatory markers.
Conclusions: All types of serum bilirubin (total, direct and indirect) are significantly reduced in women with APS, associated with higher inflammatory markers and lower levels of 25-hydroxyvitamin D, which may be the result of oxidative stress.