Репозитарій

УДК 615.9+661.682:615.246.2-08+615.372

Ентеросорбенти мають широке застосування в сучасній медичній практиці, як у наданні невідкладної допомоги при гострих інтоксикаціях, так і в лікуванні хронічних захворювань, зокрема, патології органів травної і сечовидільної систем, гельмінтозів і алергічних станів. Мета – проаналізувати сучасні наукові дані щодо ентеросорбентів; оцінити їхню ефективність і безпечність, а також надати рекомендації щодо вибору препаратів для клінічного застосування. Погіршення екологічної ситуації та техногенне забруднення довкілля призводять до накопичення екзотоксинів в організмі людини і перевантажують природні системи детоксикації, що зумовлює зростання рівнів захворюваності та смертності. Тому актуальним є пошук ефективних і безпечних препаратів із високою сорбційною здатністю і селективністю дії. Призначаючи ентеросорбенти, слід враховувати їхню ефективність, безпечність і фармакологічні властивості. Проаналізовано сучасні наукові дані щодо механізмів дії ентеросорбентів, їхнього клінічного застосування, ефективності та критеріїв вибору препарату в практиці лікаря. Висновки. Найефективнішими на сьогодні є кремнієвмісні ентеросорбенти IV покоління на основі високодисперсного діоксиду кремнію, які мають високу сорбційну активність, демонструють селективність дії – зв’язують токсини, не впливаючи на вітаміни і мікроелементи, володіють цитопротекторною і бактеріостатичною дією, повністю виводяться з організму, дозволені до застосування у вагітних, жінок, які годують груддю і дітей. Автори заявляють про відсутність конфлікту інтересів.

The use of enterosorbents is widespread in modern medical practice — both in emergency care for acute intoxications and in the treatment of chronic diseases, including disorders of the digestive and urinary systems, helminthiases, and allergic conditions. Aim – to analyze current scientific data on enterosorbents; assess their effectiveness and safety, and provide recommendations on the choice of drugs for clinical use. Deterioration of the ecological situation and increasing environmental pollution contribute to the accumulation of exotoxins in the human body, overwhelming natural detoxification systems and leading to increased morbidity and mortality. Therefore, the search for effective and safe preparations with high sorption capacity and selectivity remains highly relevant. The administration of enterosorbents should take into account their efficacy, safety, and pharmacological properties. This article reviews current scientific data on the mechanisms of action of enterosorbents, their clinical application, efficacy, and criteria for selecting an appropriate preparation for medical use. Conclusions. The most effective today are silicon-containing enterosorbents of the IV generation based on highly dispersed silicon dioxide, which have high sorption activity, demonstrate selectivity of action – bind toxins without affecting vitamins and trace elements, have cytoprotective and bacteriostatic effects, are completely excreted from the body, and are approved for use in pregnant women, breastfeeding women, and children. The authors declare no conflict of interest

УДК 615.9+661.682:615.246.2-08+615.372

Objective. The study aims to evaluate the severity of endogenous intoxication and characterize morpho-functional liver changes during experimental acute generalized peritonitis (AGP) in diabetic rats.
Methods. Fifty-six adult male Wistar rats were used, including 8 controls and 48 males with experimental pathology. Diabetes mellitus was induced by an intraperitoneal (i.p.) injection of streptozotocin (60 mg/kg). On day 14, AGP was induced by i.p. injection of a 10% filtered fecal suspension. Endogenous intoxication was assessed by measuring hydrophilic and hydrophobic molecular products in the blood. Liver function was evaluated by serum aminotransferase activity, total protein, and protein fractions. Histological analysis of liver tissue was performed using standard hematoxylin-eosin staining.
Results. A progressive increase in endogenous intoxication was observed peaking on day 7. This was marked by a significant elevation in middle molecular weight molecule (MMWM) concentrations at wavelengths of 254 nm and 280 nm by 103.0% (p<0.001) and 340.0% (p<0.001), respectively. The erythrocyte intoxication index (EII) increased by 148.8% (p<0.001) compared to controls. Concurrently, aminotransferase activity increased, while serum total protein and albumin levels decreased. Histologically, inflammatory infiltration and vascular congestion were evident on day 1 progressing to hepatocellular dystrophy and necrosis by day 3. By day 7, signs of hepatic failure were present including disruption of trabecular architecture, hydropic degeneration, intracellular cholestasis, and portal tract expansion due to vascular hyperemia.
Conclusions. Experimental acute generalized peritonitis in diabetic rats resulted in a pronounced endogenous intoxication accompanied by progressive morpho-functional liver damage culminating in hepatic insufficiency by day 7.

ABSTRACT
Aim: To investigate hepcidin as a marker of iron status in chronic kidney disease (CKD) patients (stage 5 vs. stage 3), and to assess its association with iron injection status within the maintenance hemodialysis group.
Materials and Methods: This cross-sectional study compared 69 hemodialysis (stage 5 CKD [G1]) and 19 non-dialysis (stage 3 CKD [G2]) patients, assessing hepcidin, ferritin and hemoglobin. As a part of their standard anemia management, patients requiring iron administration received scheduled injections of ferric carboxymaltose.
Results: Hemodialysis patients (G1) had significantly lower hemoglobin and higher anemia prevalence than non-dialysis patients (G2), while baseline hepcidin and ferritin levels were comparable. Importantly, hepcidin levels were above the normal range in 85,5% and 84,2% of G1 and G2 patients, respectively. Hepcidin
correlated positively with ferritin in both groups (G1: ρ=0,66, p<0,001; G2: ρ=0,87, p<0,001). Within G1, recent iron injections, administered in 24 patients, were significantly associated with higher hepcidin and ferritin, but not hemoglobin, as compared to patients without additional ferric therapy (n=45) (effect size: r=0,09 [by hemoglobin], r=0,80 [by hepcidin] and r=0,58 [by ferritin]).
Conclusions: Significant iron metabolism impairment, marked by high hepcidin and ferritin prevalence, exists in both CKD stages studied. Although hemodialysis patients had lower hemoglobin, baseline hepcidin/ferritin levels were similar between groups. Within the hemodialysis group, recent iron injections were associated with increased hepcidin/ferritin but not hemoglobin. Findings suggest hepcidin may be a crucial indicator of functional iron availability in CKD, potentially offering more insight than ferritin, particularly reflecting acute changes following iron administration in hemodialysis patients.
KEY WORD S: hepcidin, ferritin, chronic kidney disease, hemodialysis

ABSTRACT
Aim: To investigate the relationships of kidney function with clinical and laboratory parameters in multiple myeloma (MM) patients.
Materials and Methods: A cross-sectional study involved 105 MM patients. Data included clinical manifestations and standard laboratory parameters.
Kidney function was assessed via estimated glomerular filtration rate (eGFR), serum creatinine, urea, uric acid (UA), calcium (Ca), and albumin-to-creatinine
ratio (ACR). The markers of MM activity and burden included M-protein, beta-2 microglobulin (β2m), albumin, hemoglobin (Hb), lactate dehydrogenase (LDH)
and platelets (PLT). Rank biserial correlation assessed associations between symptoms and laboratory parameters. Rank-based canonical correlation analysis
(RCCA) explored the multivariate relationship between six kidney function indicators and six MM-related markers.
Results: Common laboratory abnormalities included elevated β2m (90,5 %) and anemia (indicated by low Hb in 52,4 % of patients). Frequent symptoms
included bone pain (71,4 %) and weakness (68,6 %). Symptoms like weakness/breathlessness correlated significantly with (β2m, M-protein) and renal impairment (creatinine, ACR, eGFR). RCCA identified one significant canonical correlation (R1=0,497; p=0,013), linking impaired renal function (characterized by low
eGFR, high ACR, creatinine and urea) with a myeloma profile indicative of disease activity and burden (high β2m, low Hb, low albumin, and high M-protein).
Conclusions: The study confirms a significant multivariate association between a profile of impaired renal function and markers reflecting MM activity, hematopoietic suppression and systemic burden. These findings underscore the multifactorial nature of MM-related kidney injury and highlight the clinical utility
of monitoring key laboratory markers (including eGFR, ACR, creatinine, β2m, Hb and albumin) alongside clinical evaluation for comprehensive assessment
and management of MM patients.
KEY WORDS: multiple myeloma, chronic kidney disease, anemia