Showing papers by "Belarusian State Medical University published in 2012"

Regional differences in AIDS and non-AIDS related mortality in HIV-positive individuals across Europe and Argentina: the EuroSIDA study.

Abstract: BACKGROUND Differences in access to care and treatment have been reported in Eastern Europe, a region with one of the fastest growing HIV epidemics, compared to the rest of Europe. This analysis aimed to establish whether there are regional differences in the mortality rate of HIV-positive individuals across Europe, and Argentina. METHODS 13,310 individuals under follow-up were included in the analysis. Poisson regression investigated factors associated with the risk of death. FINDINGS During 82,212 person years of follow-up (PYFU) 1,147 individuals died (mortality rate 14.0 per 1,000 PYFU (95% confidence interval [CI] 13.1-14.8). Significant differences between regions were seen in the rate of all-cause, AIDS and non-AIDS related mortality (global p<0.0001 for all three endpoints). Compared to South Europe, after adjusting for baseline demographics, laboratory measurements and treatment, a higher rate of AIDS related mortality was observed in East Europe (IRR 2.90, 95%CI 1.97-4.28, p<.0001), and a higher rate of non-AIDS related mortality in North Europe (IRR 1.51, 95%CI 1.24-1.82, p<.0001). The differences observed in North Europe decreased over calendar-time, in 2009-2011, the higher rate of non-AIDS related mortality was no longer significantly different to South Europe (IRR 1.07, 95%CI 0.66-1.75, p = 0.77). However, in 2009-2011, there remained a higher rate of AIDS-related mortality (IRR 2.41, 95%CI 1.11-5.25, p = 0.02) in East Europe compared to South Europe in adjusted analysis. INTERPRETATIONS There are significant differences in the rate of all-cause mortality among HIV-positive individuals across different regions of Europe and Argentina. Individuals in Eastern Europe had an increased risk of mortality from AIDS related causes and individuals in North Europe had the highest rate of non-AIDS related mortality. These findings are important for understanding and reviewing HIV treatment strategies and policies across the European region.

S-Nitrosoglutathione Reductase in Human Lung Cancer

Abstract: S-Nitrosoglutathione (GSNO) reductase regulates cell signaling pathways relevant to asthma and protects cells from nitrosative stress. Recent evidence suggests that this enzyme may prevent human hepatocellular carcinoma arising in the setting of chronic hepatitis. We hypothesized that GSNO reductase may also protect the lung against potentially carcinogenic reactions associated with nitrosative stress. We report that wild-type Ras is S-nitrosylated and activated by nitrosative stress and that it is denitrosylated by GSNO reductase. In human lung cancer, the activity and expression of GSNO reductase are decreased. Further, the distribution of the enzyme (including its colocalization with wild-type Ras) is abnormal. We conclude that decreased activity of GSNO reductase could leave the human lung vulnerable to the oncogenic effects of nitrosative stress, as is the case in the liver. This potential should be considered when developing therapies that inhibit pulmonary GSNO reductase to treat asthma and other c...

Spectrum of genetic changes in patients with non-syndromic hearing impairment and extremely high carrier frequency of 35delG GJB2 mutation in Belarus.

Abstract: The genetic nature of sensorineural hearing loss (SNHL) has so far been studied for many ethnic groups in various parts of the world. The single-nucleotide guanine deletion (35delG) of the GJB2 gene coding for connexin 26 was shown to be the main genetic cause of autosomal recessive deafness among Europeans. Here we present the results of the first study of GJB2 and three mitochondrial mutations among two groups of Belarusian inhabitants: native people with normal hearing (757 persons) and 391 young patients with non-syndromic SNHL. We have found an extremely high carrier frequency of 35delG GJB2 mutation in Belarus −5.7%. This point deletion has also been detected in 53% of the patients with SNHL. The 312del14 GJB2 was the second most common mutation in the Belarus patient cohort. Mitochondrial A1555G mt-RNR1 substitution was found in two SNHL patients (0.55%) but none were found in the population cohort. No individuals carried the A7445G mutation of mitochondrial mt-TS1. G7444A as well as T961G substitutions were detected in mitochondrial mt-RNR1 at a rate of about 1% both in the patient and population cohorts. A possible reason for Belarusians having the highest mutation carrier frequency in Europe 35delG is discussed.

Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

Abstract: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators. Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1) combination antiretroviral therapy (cART); 2) chemoprophylaxis; 3) frequency of laboratory monitoring; and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). 7097 EuroSIDA patients were included from Northern (n = 923), Southern (n = 1059), West Central (n = 1290) East Central (n = 1366), Eastern (n = 1964) Europe, and Argentina (n = 495). Patients in Eastern Europe with a CD4 < 200cells/mm3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p < 0.0001). Compared to Northern, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for Eastern Europe and Argentina (adjusted OR 0.16 [95%CI 0.11-0.23, p < 0.0001]; 0.20[0.14-0.28, p < 0.0001] respectively). This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.

Characteristics of Hemodynamic Disorders in Patients with Severe Traumatic Brain Injury

Abstract: Purpose. To define specific features of central hemodynamic parameter changes in patients with isolated severe traumatic brain injury (STBI) and in patients with clinically established brain death and to determine the required course of treatment for their correction. Data and Research Methods. A close study of central hemodynamic parameters was undertaken. The study involved 13 patients with isolated STBI (group STBI) and 15 patients with isolated STBI and clinically established brain death (group STBI-BD). The parameters of central hemodynamics were researched applying transpulmonary thermodilution. Results. In the present study, various types of hemodynamic reaction (normodynamic, hyperdynamic, and hypodynamic) were identified in patients with isolated STBI in an acute period of traumatic disease. Hyperdynamic type of blood circulation was not observed in patients with isolated STBI and clinically established brain death. Detected hemodynamic disorders led to the correction of the ongoing therapy under the control of central hemodynamic parameters. Conclusions. Monitoring of parameters of central hemodynamics allows to detect the cause of disorders, to timely carry out the required correction, and to coordinate infusion, inotropic, and vasopressor therapy.

Natalizumab in aggressive multiple sclerosis after haematopoietic stem cell transplantation.

Abstract: High-dose cyclophosphamide followed by autologous haematopoietic stem cell transplantation (HDC-AHSCT) is a treatment option for aggressive and refractory multiple sclerosis (MS). Natalizumab is a monoclonal antibody approved for relapsing-remitting (RR) MS unresponsive to immunomodulating drugs. Nothing is known about the use of natalizumab in patients after HDC-AHSCT. We describe five female RR-MS patients with incomplete response to HDC-AHSCT. Natalizumab was then administered with abolition of both MRI and clinical activity. No severe adverse events, in particular opportunistic infections such as Progressive Multifocal Leukoencephalopathy (PML), were observed. Our results suggest that the use of natalizumab in aggressive RR-MS after HDC-AHSCT could be effective and safe. The very long-term risk of adverse events due to sequential aggressive immunosuppression has to be established.

Surgical treatment of pain in patients with chronic pancreatitis.

Abstract: Results: In the immediate postoperative period more complications were observed in the PD group (α<005) In both groups a positive effect on removing the painful syndrome and improvement of the quality of life (p<001) were observed In the PD group there were the best results of management by General Health difference criterion (α<001) A greater improvement of Physical Functiong value (α<001) was noticed in patients who underwent RDO Conclusions: Both PD and RDO adequately remove pain syndrome and improve the quality of life in patients suffering from CP Under equal conditions the preference should be given to RDO, as improvement in life quality of operated patients is greater

Lab-experimental (pre-clinical) therapeutics and pharmacology

Abstract: Ginsenoside Rg3 is a natural active ingredient that is extracted from Korean red ginseng root. It elevates the therapeutic effect of radiotherapy and chemotherapy, but previous studies found that the application of Rg3 is heavily limited by its low bioavailability and poor absorption via oral administration. To overcome these problems, Rg3-loaded PEG-PLGA-NPs (Rg3-NPs) were prepared by the modified spontaneous emulsification solvent diffusion (SESD) method, and the physicochemical characteristics of Rg3-NPs were investigated. We treated primary glioblastoma with 50 mM Rg3-NPs for 48h. We then used gene expression arrays (Illumina) for genome-wide expression analysis and validated the results for genes of interest by means of real-time PCR. Functional annotations were then performed using the DAVID and KEGG online tools. The results showed that the Rg3-NPs are slick and uniform, the average diameter of the nanoparticles is 75-90 nm, and their entrapment efficiency is 89.7+1.7%. MTT showed that the growth of cells can be significantly inhibited by Rg3-NPs in a dose-dependent manner. FCM testing showed Rg3-NPs can be released from the conjugate nanoparticle and react with the genes in the cell nuclei, causing changes in the gene molecules. We also found that cancer cells treated with Rg3-NPs undergo cell-cycle arrest at different checkpoints. This arrest was associated with a decrease in the mRNA levels of core regulatory genes BUB1, CDC20, TTK, and CENPE, as determined by microarray analysis and verified by real-time PCR. Furthermore, Rg3-NPs induced the expression of the apoptotic and antimigratory protein p53 in cell lines. The results of the present study, together with the results of earlier studies, show that Rg3-NPs target genes involved in theprogressionoftheM-phaseofthecellcycle.Itisassociatedwithseveralimportant pathways, which include apoptosis (p53). Rg3-NPs may be a potent cell-cycle regulation drug targeting the M-phase in glioblastoma cell lines.

Rheology dynamics of the blood and plasma of rats after transdermal laser irradiation of the tail vein in the infrared range

Abstract: Single transdermal laser irradiation of the tail vein of males of white mongrel rats with an average mass of 350–400 g in three different regimes has been carried out. The irradiation doses were chosen to be intermediate between therapeutic and surgical ones, and the radiation wavelengths were 806 nm and 2 μm. The dynamics of the packed cell volume, deformability and cytometric indices of erythrocytes, and of the plasma and blood viscosity have been investigated. The rheological and cytometric changes in the blood caused by the irradiation stayed for several days. The observed rheologial changes are due to the removal of irradiation-damaged erythrocytes and the arrival in the blood channel of young and highly deformable red cells.

Differential diagnosis of follicular tumor by expert systems based on a set of quantitative features of thyrocyte nuclei and aggregates

Abstract: Objective To develop expert systems for classification of follicular thyroid tumor at a preoperative stage. Study design Fine needle aspiration biopsy of the thyroid gland with a histologic conclusion of follicular cancer and follicular adenoma were the object of the morphometric study. General sample size was 4500 nuclei and 3000 aggregates. Results Quantitative regularities of pathologic changes in thyrocyte nuclei and aggregates in follicular cancer and follicular adenoma were revealed. Threshold values and weighting coefficients of quantitative features of thyrocyte nuclei and aggregates characterizing cancer made the basis of the two expert systems. Expert systems included standard 2-D S-matrix containing threshold values of nuclei and aggregates in cancer and their weighting coefficients as well as 1-D scientific X-matrix designed for filling with quantitative features of the studied object. The diagnosis was verified by the value of a diagnostic index by means of comparing feature values in the corresponding elements of S- and X-matrices. After that, a diagnostic index was calculated taking into account the features' weighting coefficient. Conclusion The developed expert systems based on a set of quantitative features of thyrocyte nuclei and aggregates will allow assessing the malignant potential of a follicular thyroid tumor at a preoperative stage.

Magnesium in clinical practice

Abstract: Magnesium is a macronutrient that is needed for normal body functions. Magnesium deficiency resulting from the influence of exogenous and endogenous factors, is diagnosed by clinical manifestations, resembling the known disease. Magnesium deficiency corrected with the magnesium therapy. Studies show the effectiveness of magnesium orotate for many cardiovascular diseases.

Copeptin application in severe community-acquired pneumonia (SCAP) severity assessment and outcomes

Abstract: Background: Appropriate early prognostic assessement is crucial for SCAP patients management. Aim: We aimed to investigate copeptin levels in SCAP patients and their relationship with in-hospital outcomes (in-hospital mortality (IHM), length of in-hospital stay(LOS), duration of ICU stay), disease specific complications, need for invasive mechanical ventilation (IMV) and vasopressor support (VS). Methods: 20 ICU patients with proven SCAP CURB-65 class 3, 4 were enrolled to the study. Serum CP values were measured within the first 24 hours after the hospitalization. Results: Increasing CAP severity was associated with increased CP values(r=0,53;p=0,02). CP levels on admission appeared to be higher in CURB-65 4th class patients vs the 3rd class patients - 74,8 [55,06; 90] vs 47,6 [24,5;59,8] pg/ml, respectively (p=0,03). CP values on ICU admission correlated with need for VS (r=0,54; p=0,02 respectively) and showed higher concentrations in patients requiring VS compared with those with stable haemodynamics [74,8 vs 47,6 pg/ml, p=0,03] respectively. CP correlated with duration of ICU stay(r=0,43; p Conclusion: CP could add prognostic information in SCAP patients.

HIV-AIDS stigma and discrimination in health care sector in Belarus

Abstract: Background Stigma and discrimination are barriers to effective HIV treatment and care in Belarus. Results of the Stigma Index Survey conducted among people living with HIV (PLHIV) reveal that 40.5% of respondents experienced disclosure of their diagnosis and confidentiality breach by health care workers (HCW); 15.5% were refused medical care.

Comparative assessment of the preparations "Biosital" and "Kafam" influence combined with electroacupuncture on the healing of alveolar processes of the maxilla bones in experiment

Abstract: book. XV World congress on medical acupuncture (25-27 may 2012, Athens, Greece): 39-40, 2012. [4] Pashkevich L.A., Pohodenko-Chudakova I.O., Shevela T.L. Acupuncture inß uence on the processes of osteointegration in the system mandibula – dental implant by morphological examinations data, Medical Journal: 3 (37), 109-112, 2011. [5] Ulyanova T.M. et al. Application of the new bone-replaeng material «Kafam» in stomatology, Engeneering of biomaterials Cracow: 12-13, 2004.

Integrated Motile Orbital Implants Based on Ceramic Foam Scaffolds: Preparation and In Vivo Study

Abstract: Zirconia-alumina ceramic foam scaffolds with a nanocrystalline HAP coating were used for the preparation of integrated motile orbital implants. This study demonstrated that open-cell ceramic foams with enhanced strength-to-density ratio are quite suitable as biocompatible materials for the manufacture of orbital implants for post-enucleation syndrome treatment. In-vivo studies demonstrated that the application of a nanocrystallyne (not sintered) HAP coating facilitated the formation of dense fibrous capsule around the implant as well as the fast tissue ingrowth into the implant’s internal space. Orbital implants with the optimized pore size and HAP content were implanted to the animal’s eye cavity with their fixation to the extraocular muscles, and their motility was ensured.