Study objective: to study the adipokines content and echocardiography indicators of women with hypothyroidism.

Materials and methods. 30 women with hypothyroidism were included into the study with the average age of 55.2 ± 2.2 years old and the duration of disease of 8.53 ± 0.84 years. Anthropometric parameters of all patients were measured. Levels of leptin, resistin, adiponectin were investigated with enzyme multiplied immunoassay. Morphometric parameters of the left ventricle (LV) were assessed with echocardiography.

Results. The examined patients with hypothyroidism displayed increased concentration of leptin and resistin, as well as decreased concentration of adiponectin. Concentric and eccentric hypertrophy of the left ventricle is revealed in more than half of cases with patients with the hypofunction of the thyroid gland.

Conclusion. Evident decreasing of the level of adiponektin and increasing of the level of leptin and resistin was revealed with examined patients on the background of the excessive body weight. Hypertrophy of the left ventricle and diastolic dysfunction of the myocard with its relatively preserved contractile ability was revealed with women that suffer from hypothyroidism. Age, excessive body weight, increasing of arterial blood pressure, and hypoadiponectinemia play a significant role in the left ventricle myocardial remodeling.

Study objective: study of the nature of changes in the immune system of patients with type 2 diabetes mellitus (DM) in combination with autoimmune thyroiditis (AIT) and without it; comparative analysis of similar indicators of patients with type 1 DM in combination with AIT and without it.

Materials and methods. 104 patients at the age of 22 to 62 y.o. (57 women and 47 men) took part in the study. They were divided into 4 groups (type 2 DM, type 2 DM and AIT, type 1 DM, type 1 DM and AIT). Groups of patients who were examined regarding the state of carbohydrate and lipid metabolism, indicators of the T-cell link of the immune system, concentration of interleukin 4 (IL-4), IL-6, interferon-gamma, and leptin level, were comparable regarding their sex, age, duration of disease.

Results. Unidirectional relationship between body mass index (BMI), amount of CD4 +-, CD8+- lymphocytes, level of leptin, IL-4, IL-6 concentrations and BMI and immunoregulatory index of patients with type 2 DM both with AIT and without it was determined. Patients with type 2 DM displayed decreasing activity of the T-cell link of the immune system and increasing of the concentration of pro-inflammatory cytokines irrespectively of the availability of accompanying AIT, which evidenced primary development of autoimmune processes. At the same time, positive
correlating relationship between the level of leptin and BMI and immunoregulatory index of patients with type 2 DM both with AIT and without it was revealed (r = 0.83; р < 0.005; r = 0.77; р < 0.01; r = 0.9; р < 0.001, and r = 0.53; р < 0.05 respectively), which demonstrates autoimmune directivity of immune system disorders in combination with metabolic shifts.

Conclusion. For the purpose of performance of simultaneous correction of metabolic and immunological disorders of patients with type 2 DM, it is necessary to determine immunological indicators (of the CD+- range of lymphocytes). The latter is caused with higher occurrence of AIT with patients with type 2 DM as compared to the general population.

Objective: to study the activity of proapoptotic signal protein caspase-3 for determination of peculiarities of apoptosis regulation under liver chronic diseases.

Subjects and methods. The immunohistochemical analysis of caspase-3 activity in 5 liver biopsies of the patients with mono infection of chronic hepatitis B and 5 liver biopsies of the patients with mixed infection of tuberculosis, chronic hepatitis C and human immunodeficiency virus was fulfilled. Morphological and morphometric analysis of serial microphotographs was performed using an image analysis system (microscope Leica DM 2500, digital camera Leica DFC320 R2 and a computer).

Results. The activity of caspase-3 as dark brown granularity was revealed in all tis-sue components of liver (hepatocytes, epithelium of bile ducts, endotheliocytes, Kupffer cells of sinusoids, in compositions of lymphohistiocyte infiltrations). The maximal activity was discovered in hepatocytes nuclei. The expression of caspase-3 was significantly higher in liver biopsies of the patients with mixed infection. It is typical that the immunoreactive hepatocytes had not any morphological marks of apoptosis.

Conclusion. The caspase-3 expression of proapoptotic signal protein caspase-3 may serve as an early marker of liver damage including the possibilities of apoptosis development.

Objective of work: to study the peculiarities of intercellular substance metabolism of patients with osteoarthritis (OA) and connective tissue dysplasia (CTD).

Materials and methods. 95 female patients with OA take part in the study; 70 of them have signs of CTD. Inclusion criteria: female sex, age from 20 to 60 y.o., OA diagnosed on the basis of criteria of the American Association of Rheumatology. Exclusion criteria: injury of the lower extremities in medical history, systemic connective tissue diseases, ovariectomy, prolonged (over 6 months) intake of glucocorticoid hormones. 50 almost healthy women were included into the reference group. Study of clinical phenomena of the CTD of patients with OA was performed, as well as the study of levels of cartilage oligomeric matrix protein (COMP) and glycosaminoglycans (GAGs) in the blood serum.

Results. In 500 of patients examined, OA was revealed with 95 cases (19 %) including combinations with CTD in 70 cases (14 %). Polyosteoarthrosis was revealed with 38 (40 %) patients, isolated gonarthrosis was revealed with 30 (31.5 %) patients, coxarthrosis was revealed with 20 (21 %) patients, and osteoarthritis of ankle joints was revealed with 7 (7.3 %) patients. Increasing of the COMP concetration was revealed with patients with combined pathology of up to 24.15 ± 11.35 μm/l, with OA – up to 18.26 ± 6.35 μm/l, with CTD – up to 14.32 ± 3.96 μm/l. Maximum variability of indicators was marked in the group of people with the combination of OA and CTD. Serum GAG concentrations were increased with female patients with the combined pathology and isolated OA of up to 53.65 ± 21.5 and 46.96 ± 15.82 μm/l, respectively. No increasing of GAG concentration was revealed with patients with CTD.

Conclusion. Increasing of the intercellular substance metabolism is observed with persons that suffer from CTD. To a greater degree, CTD affects the state of the fibrillar component of the intercellular substance as compared to its matrix component. Degradation of cartilage with patients on the CTD background is higher than of patients with isolated OA, which is expressed with the debut of disease at an earlier age. COMP is a sensitive marker of both OA and CTD, which allows considering it as a prospective marker for early laboratory diagnostics of these states, while serum concentrations of GAG do not display the peculiarities of the cartilage metabolism of persons that suffer from CTD.

Study objective: to examine the comparative efficacy and tolerability of the Nanoplast forte therapeutic patch as compared with placebo patch with patients with osteoarthritis (OA) of the knee joint (KJ) in conditions of a prospective randomized multi-centered study approved by the local ethics committee.

Materials and methods.120 patients with OA of the KJ of the I to III radiographic stages according to Kellgren and Lаwrence take part in the study, 2 groups with 60 patients each compared in major clinical parameters. The primary efficacy criterion was relieving of pain in the target KJ (WOMAC index, section A) by ≥ 50 % as compared to the initial level. Assessment of B and C section of the WOMAC index in dynamics was performed in the course of the study. Visual and analogous scale (in mm) was used for general assessment separately by the patient and the doctor; daily assessment of pain intensity was performed by the patient. The total efficiency of the Nanoplast forte patch was studied on the 14th day separately by the doctor and the patient in accordance with the following grades: significant improvement; improvement; no effect; aggravation. The need for intake of nonsteroidal anti-inflammatory drugs (NSAIDs) was determined during the study as follows: daily dose, dose reduction or elimination of NSAIDs was determined due to the decrease in the intensity of pain. The patch was applied onto the target joint one a day at 12 o’clock (from 9 a. m. to 9 p. m.). Tolerability of the Nanoplast forte patch and the placebo patch was assessed in accordance with the frequency and manifestation of local and / or systemic undesired effects (from 1 to 3 points). The frequency of achievement of 50 % of pain decreasing (WOMAC index, section A) was evidently higher in the group of active Nanoplast forte patch than in the placebo group (38.2 as compared to 16.7 %, respectively; p = 0.013; Fisher exact criterion). Intensity of pain during walking was decreased only with the use of the active Nanoplast forte patch (p = 0.05; ANOVA two-factor analysis), and evident decreasing of pain was marked as quickly as on the 4th day of application. Due to the therapy, morning stiffness was evidently decreased and functional activity was increased in the main group. The general state of patients in accordance with their subjective assessment (p = 0.05) and with the doctor’s opinion (p = 0.01) was improved with statistic significance. Elimination and decreasing of the dose of NSAIDs took place evidently more frequently (p = 0.007; Fisher exact criterion) in the group of patients that applied active Nanoplast forte patch than in the placebo group. All patients completed the study in the active therapy group. No side effects associated with application of the Nanoplast forte patch were revealed. Due to application of the Nanoplast forte patch, 50 percent of patients eliminated or decreased the dose of previously prescribed NSAIDs, while only 25 % of patients did the same in the placebo group.

Conclusion. Nanoplast forte may be recommended as an efficient and safe method of local therapy of OA of the KJ.

Objective of work: to describe the apical form of hypertrophic cardiomyopathy (AFHC) developing under the "mask" of the ischemic heart disease not diagnosed for a long period.

Materials and methods. Patient B., 73 y.o., female, was brought to the cardiology department with complains of severe pressing pain behind the breastbone caused with no apparent reason and lasting for over 4 hours. The following examination of the patient was performed: electrocardiography (ECG), echocardiography (EchoCG), Holter ECG monitoring, coronary angiography (CAG), ventriculography.

Results. The final diagnosis for the patient was set on the basis of the following readings: ECG data (basic rhythm – atrial fibrillation, left ventricle (LV) hypertrophy, negative T-waves in leads V1–6, ST segment depression up to 1–2 mm in leads V4–6), EchoCG (hypertrophy of apical segments of the LV with decreasing of its cavity, moderate dilatation of the left atrium, intraventricular obstruction in the apical third of the LV with the maximum pressure gradient of up to 48 mm Hg.), CAG (stenotic lesions of coronary arteries were found), ventriculography (LV volume is not increased, no violations of local contractility, narrowing of the LV cavity in the lower third is observed with thinning in the apex, which indicates
expressed apical hypertrophy of the LV myocard). AFHC, apical form with moderate obstruction in the lower third of the left ventricle. Stress angina syndrome. CAG and ventriculography were main diagnostic methods that allowed setting the final diagnosis.

Conclusion. The clinical case sets forth the peculiarities of diagnostics, therapy, and post-therapy management of patients with this form of AFHC.

Study objective: description of the case of diagnostics of rare anomaly of the coronary vessels: coronary and left ventricular fistulas.

Materials and methods. Patient L., 45 y.o. (height 168 cm, weight 55 kg), male, complained of periodical burning pain behind the breastbone without connection with physical activity, often disturbing at night, stopped with intake of nitrates. The following examination of the patient was performed: clinical and biochemical blood tests, electrocardiography (ECG), Holter ECG monitoring, bicycle ergometry, echocardiography, coronary angiography, computerized tomography.

Results. The following clinical diagnosis was set on the basis of complaints. data of objective and instrumental examination: congenital heart disease. Abnormal end of the coronary arteries: multiple coronary and left ventricular fistulas, steal syndrome. Hypoplasia of the right coronary artery (Q 24.5 in accordance with the International Classification of Diseases, revision 10). Coronary angiography has become the main diagnostic method that allowed diagnosis verification: left type of coronary blood circulation. The trunk of the left coronary artery, the anterior interventricular branch,  he diagonal branch, the envelope branch, the obtuse marginal branch, the right coronary artery, the posterior interventricular branch have with irregular contours. Direct abnormal connection (dense grid of fistulas) is observed in the medium and lower third of the anterior interventricular branch with the left ventricle cavity. The contrast agent practically completely comes into the left ventricular cavity. The parenchymal phase is very well expressed; the venous phase is not visualized. Conclusion. Congenital heart disease: multiple coronary and left ventricular fistulas. No angiographic evidence of hemodynamically significant stenotic coronary lesions.

Conclusion. The practical interest of this observation is due to rarity of disease, analysis of modern possibilities of diagnostics and complexity of the choice of the therapy tactics. Surgical correction of the disorder has appeared impossible due to large area of discharge and too dense grid of fistulas. Medication therapy has been selected that allowed stopping the pain syndrome, which is the major clinical manifestation of the congenital anomaly of coronary vessels: multiple coronary and left ventricular fistulas.

The relationship between renal damage and malignant neoplasms is one of the most actual problems of the medicine of internal diseases. Very often, exactly availability of renal damage determines the forecast of cancer patients. The range of renal pathologies associated with tumors is unusually wide: from the mechanical effect of the tumor or metastases on the kidneys and/or the urinary tract and paraneoplastic manifestations in the form of nephritis or amyloidosis to nephropathies induced with drugs or tumor lysis, etc. Thrombotic complications that develop as a result of exposure to tumor effects, side effects of certain drugs or irradiation also play an important role in the development of the kidney damage. The most frequent variants of renal damage observed in the practice of medical internists (therapists, urologists, surgeons, etc.), as well as methods of diagnosis and treatment approaches are described in the article. Timely and successful prevention and treatment of tumor-associated nephropathies give hope for retaining renal functions, therefore, a higher life standard after completion of anti-tumor therapy. Even a shortterm episode of acute renal damage suffered by a cancer patient must be accompanied with relevant examination and treatment. In the case
of transformation of acute renal damage into the chronic kidney disease, such patients need systematic and weighted renoprotective therapy and correct dosing of nephrotoxic drugs.

The article describes the mechanisms of development of cardiovascular disorders and dyslipidemia with hypothyroidism. Reference data are presented that are devoted to the study of adipokines content with hypothyroidism and their effect on echocardiographic indicators.