International Journal of Medicine and Medical Research 2019-12-18T17:07:57+02:00 Prof. Mykhaylo Korda Open Journal Systems <p><em>International Journal of Medicine and Medical Research (IJMMR) is the peer-reviewed international journal published semiannually. The overall goal of the IJMMR is to promote medical research and to serve as a platform dedicated to increasing the exchange of experience and collaboration in all fields of medical research, including dentistry and pharmacology. IJMMR accepts original research, reviews, commentaries and letters to the editor in the areas of medicine and medical research covering non-clinical and clinical subjects, population health sciences and public health topics.</em><br><em><strong>ISSN 2414-9985 (Online), ISSN 2413-6077 (Print)</strong></em></p> PROXIMAL BRACHIAL MONOMELIC AMYOTROPHY OR HIRAYAMA DISEASE: NO LONGER AN ALIAS? (case report) 2019-12-18T17:07:57+02:00 Akshay Rao <p><strong>Background</strong>. Brachial Monomelic Amyotrophy (BMMA) has been called as Hirayama disease (HD) when it is characterized by unilateral distal upper limb weakness and atrophy that shows progression for a limited period and is associated with typical features on MRI of cervical spine in flexion.</p> <p><strong>Objective</strong> was to explore the differences when BMMA affects the proximal upper limb muscles with the help of case report.</p> <p><strong>Methods</strong>. A case report of BMMA in an adult Indian male is represented.</p> <p><strong>Results</strong>. A 30-year-old man presented to us with a history of weakness in the proximal aspect of his left upper limb that began four years ago. The weakness was progressive up until 6 months prior to his presentation since when the weakness had neither worsened nor improved. Cervical spine contrast enhanced MRI revealed mild loss of cervical lordosis, but no features of HD like localized cord atrophy, loss of attachment of dura from subjacent lamina on neutral position axial T2WI MRI, nor any presence of posterior epidural crescentic enhancing mass on flexion contrast sagittal T1WI MRI. The patient was managed with supportive therapy and has been under regular follow up ever since. His clinical status has been stable.</p> <p><strong>Conclusions. </strong>We support the suggestion to consider proximal Brachial Monomelic Amyotrophy to be a separate entity and to be distinguished from Hirayama disease that should be reserved for patients with distal upper limb involvement with cervical MRI findings on flexion studies.</p> 2019-07-11T00:00:00+03:00 Copyright (c) 2019 International Journal of Medicine and Medical Research EVALUATION OF SERUM γ-GLUTAMYL TRANSFERASE AND ITS ASSOCIATION WITH HIGH SENSITIVITY C-REACTIVE PROTEIN AND INSULIN LEVELS IN THE PATIENTS WITH METABOLIC SYNDROME 2019-08-23T08:29:58+03:00 R. Dharuni B. V. Maruthi Prasad MaruthiPrasad@tdmu.local H. L. Vishwanth Vishwanth@tdmu.local <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background. </span></strong><span lang="EN-US">Metabolic syndrome (MS), a collection of cardiovascular risk factors, is a major worldwide public health problem. The gathered data prove that serum gamma-glutamyl transferase (γGT) activity is a true marker of atherosclerotic cardiovascular disease (CVD) and is of a prognostic importance as well as the high-sensitivity C-reactive protein (hs-CRP). </span></p> <p class="a"><strong><span lang="EN-US">Objectives</span></strong><strong><span lang="EN-US" style="font-style: normal;">.</span></strong><span lang="EN-US"> In the study, we sought to evaluate serum γGT activity, hs-CRP and insulin resistance in patients with MS. </span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods</span></strong><span lang="EN-US">. The study involved 50 persons with metabolic syndrome and 50 healthy age and sex matched controls. Fasting serum samples of all participants were investigated for γGT, hs-CRP, insulin, blood glucose, lipid profile and liver function tests. Anthropometric measurements and BMI were also calculated</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> In that case 50% showed significantly high γGT compared to the controls, 30% proved increased hs-CRP levels above &gt;0.5 mmol/L, whereas 94% of the controls were within the reference range. 74% of cases revealed the presence of insulin resistance while 32% of the controls showed insulin resistance. High γGT levels were also observed in that case with deranged lipids levels and high BMI.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions.</span></strong><span lang="EN-US"> The study suggests that the patients with MS have a higher serum γGT activity. This study also proves that hs-CRP and HOMA-IR, which are independent risk factors of CVD, are also associated with MS. The correlation between γGT and the components of MS are also found significant compared to hs-CRP. Thus, γGT can be considered as an inexpensive and authentic predictor of MS, which can be a manifestation of CVD in near future.</span></p> 2019-07-11T15:59:54+03:00 Copyright (c) DEATH DUE TO CARDIAC ANGIOSARCOMA: AUTOPSY CASE REPORT 2019-08-23T08:29:54+03:00 F. Eren N. T. Inanır M. S. Gurses B. Eren U. N. Gundogmus B. Ioan <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Background</span></strong><span lang="EN-US">. Primary tumors of the heart are rarely detected at autopsy, especially angiosarcomas which are primary malignant one.</span></p> <p class="a"><strong><span lang="EN-US">Objective</span></strong><span lang="EN-US">. We presented autopsy case of cardic angiosarcoma with morphologic findings.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Methods</span></strong><span lang="EN-US">. We described adult man died in emergency service of the hospital.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Results.</span></strong><span lang="EN-US"> Reported case was 33 year-old-man who was died in emergency service of hospital where he was taken when he was ill after leaving home. According the prosecution documents, and the expressions of family, it was reported that he had a heart disease; his symptoms repeated 3 day ago before he died, he thought to attend the Cardiology Clinic due to his symptoms. At autopsy on macroscopic internal examination, mass with rough surface in the right atrium, hematoma at the posterior of the right atrium, blood in the pericardia, nodular lesions in hemorrhagic appearance in the sections of lung, liver and spleen were detected. In histopathologic examination; in the heart angiosarcioma as primary malign heart tumor and metastatic masses in the liver, spleen and lung were detected.</span></p> <p class="a"><strong><span lang="EN-US" style="font-style: normal;">Conclusions</span></strong><span lang="EN-US">. We aimed to discuss cardiac angiosarcoma case with autopsy and histopathologic findings in the aspect of medico legal literature.</span></p> 2019-07-11T16:20:22+03:00 Copyright (c) PULMONARY AND INTRACRANIAL RADIOGRAPHIC PRESENTATIONS OF LANGERHANS CELL HISTIOCYTOSIS 2019-08-23T08:29:53+03:00 D. Mohammed S. B. Patel Patel@tdmu.local <p><strong>Background.</strong> Langerhans Cell Histiocytosis is a rare disease that affects 1 to 2 adults per million worldwide and often consists of systemic manifestations including pulmonary, intracranial and osteolytic lesions and endocrinologic abnormalities such as Diabetes Insipidus.</p> <p><strong>Objective</strong><strong>.</strong> The objective of this case report was to expand the medical literature of this rare disease.</p> <p><strong>Methods.</strong> A case report of a 51-year-old female patient presenting with systemic symptoms as a result of Langerhans Cell Histiocytosis is presented.</p> <p><strong>Results.</strong> A 51-year-old female presented with epistaxis, fatigue, polydipsia, polyuria, headaches and dyspnea. After initial x-rays showed multiple lung and liver nodules and the patient suffered subsequently from a unilateral pneumothorax, an open lung biopsy was recommended. On a pathological basis, the patient was diagnosed with Langerhans Cell Histiocytosis. This report focuses on the radiological presentations of the manifestations of Langerhans Cell Histiocytosis, particularly the presentations in the lung and intracranial regions.</p> <p><strong>Conclusions.</strong> Langerhans Cell Histiocytosis is an incredibly rare disease that presents systemically. Recognizing and differentiating radiographic presentation of these patients is important to determine the need for confirmation by biopsy and early chemotherapeutic intervention.</p> 2019-07-11T16:41:15+03:00 Copyright (c) ADIPOSE TISSUE AND ITS ROLE IN MICROENVIRONMENT OF THE COLORECTAL ADENOCARCINOMA CANCER CELL 2019-08-23T08:29:51+03:00 A. A. Burlaka <p><strong>Introduction</strong>. The mechanisms of adipose-tissue’s influence on tumor progression has been studied a lot, but the way of interaction of adipocytes with tumor cells have not been well defined until now.</p> <p><strong>Objective</strong>. The aim of this study was to evaluate the mechanisms of adipocytes and tumor cells interaction under the influence of radiation and chemo-radiation therapy in locally advanced rectal cancer (LARC) patients.</p> <p><strong>Material and methods</strong>. A prospective randomized single-center study was conducted. It involved 110 patients with LARC and pre-obesity. The patients were randomized into a main group A (radiation therapy and oxaliplatin-based chemotherapy) and a comparison group B (radiation therapy and fluoropyrimidine-based mono-chemotherapy). Superoxide free radicals and NO levels generated by mitochondria of adipocytes were evaluated In both groups’. Also, there was estimated the indices of MMP-2, MMP-9, 8-oxoG, and free fatty acids (FFA) level.</p> <p><strong>Results</strong> <strong>and</strong> <strong>discussion</strong>. Level of superoxide radicals in tumor-adjacent adipose tissue was 0.58±0.15 (main group) and 0.70±0.12 nmol/g·min (comparison group) (p&lt;0.001). Blood levels of FFA increased in group A up to 2.05±0.15, and in group B up to 2.48±0.20 mmol/l (while in it was 0.57±0.11 mmol/L). 8-oxoG levels in tumor-adjacent adipose tissue had no statistically significant differences.</p> <p><strong>Conclusions</strong>. The tumor-adjacent adipose tissue is an energy depot that can act as a promoter of tumor progression supplying the locally advanced rectal cancer with an energy substrate FFA.&nbsp; It has been established that the level MMP-2 activity significantly reduces the degree of intercellular matrix remodeling by the XELOX chemotherapy.</p> 2019-07-11T16:49:00+03:00 Copyright (c) SIGNIFICANCE OF ADDITIONAL CHROMOSOMAL ABNORMALITIES FOR THE OUTCOMES AFTER THE SECOND LINE NILOTINIB THERAPY IN THE CHRONIC MYELOID LEUKEMIA PATIENTS 2019-08-23T08:29:48+03:00 I. V. Dmytrenko Zh. M Minchenko Minchenko@tdmu.local V. V. Fedorenko Fedorenko@tdmu.local I. S. Dyagil kovbasyuk_i@tdmu.local <p><strong>Background</strong>. There is limited information about impact of additional chromosome aberrations (ACA) on the efficacy of the 2<sup>nd</sup> line nilotinib therapy.</p> <p><strong>Objective</strong>. The aim of the study was to analyze significance of ACAs for the outcome after second line tyrosine kinase inhibitors (TKI) therapy with nilotinib in the chronic myeloid leukemia (CML) patients, who experienced previous imatinib therapy failure.</p> <p><strong>Methods</strong>. The CML patients in chronic phase treated with nilotinib after imatinib failure were analyzed for outcomes.</p> <p><strong>Results</strong>. Among a total of 114 patients, 18 patients (15.8%) had ACAs at the beginning of the 2<sup>nd</sup> line therapy with nilotinib. Seven patients (38.9%) of 18 had variant translocations and 11 patients (61.1%) had other chromosomal abnormalities in addition to t(9;22), known as clonal evolution. Complete cytogenetic response (CCR) at 12 months was achieved in 37.5%, 42.8% and 45.5% (p=0.842) of patients with classic t(9;22) translocation, variant translocations and ACAs respectively. In the patients with variant translocations t(9;V;22) or clonal evolution treated with nilotinib after the imatinib failure, the CCR and major molecular response (MMR), event free survival (EFS), progression free survival (PFS) and overall survival (OS) rates did not differ from those in the CML patients with t(9;22) only. At the same time quantitative characteristics of leukemic and ACA clones had prognostic value for CCR. The increased number of Ph-positive cells and the number of cells with the ACA at the start of nilotinib therapy reduced the probability of CCR.</p> <p><strong>Conclusions</strong>. Higher nilotinib inhibitory activity compare with imatinib allows us to overcome imatinib resistance in the CML patients regardless of the ACA presence at the beginning of nilotinib therapy.</p> 2019-07-11T17:13:07+03:00 Copyright (c) MORTALITY ANALYSIS OF THE PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS 2019-08-23T08:29:46+03:00 N. R. Matkovska <p><strong>Background.</strong> Alcohol is considered to be the main risk factor for adverse event deaths around the world. In Ukraine, mortality due to alcoholic liver disease (ALD) has taken the second place in the structure of death causes from diseases of the digestive system.</p> <p><strong>Objective. </strong>The aim of the research was to study the peculiarities of the causes of death in the patients with alcoholic liver disease at the stage of liver cirrhosis (LC) based on the analysis of protocols of pathoanatomical research.</p> <p><strong>Methods.</strong> The analysis of 149 protocols of the pathoanatomical study of the patients, who died from alcoholic LC, has been carried out at the premises of the Pathoanatomical Department of the Ivano-Frankivsk Regional Clinical Hospital in 2006-2018.</p> <p><strong>Results.</strong> Most people were young and middle aged. Fatal cases were caused by decompensation of the LC with the development of hepatic, hepatic-renal, cardio-pulmonary insufficiency, pancreatic necrosis, gastrointestinal bleeding (GIB), sepsis, hepatocellular carcinoma (HCC). In 37.6 % of the patients the concomitant illness was coronary heart disease (CHD), 10.7 % of the people had hypertension. In 6 % of the patients, ischemic stroke of the brain was diagnosed. In most people atherosclerotic vascular changes were revealed.</p> <p><strong>Conclusions.</strong> Excessive consumption of alcohol and, consequently, the development of LC, can be considered as an adverse factor in the reducing social standard of living. In the majority of people, who died from the decompensation of alcoholic LC, atherosclerotic vascular lesions have been detected. This indicates a significant prevalence of lipid metabolism disturbance in the people with alcoholic LC.</p> 2019-07-11T17:18:14+03:00 Copyright (c) PROBING BREAST CANCER THERAPEUTIC RESPONSES BY DNA CONTENT PROFILING 2019-08-23T08:29:44+03:00 B. I. Gerashchenko K. Salmina J. Eglitis J. Erenpreisa <p><strong>Background.</strong><em> Discrepancies in the interpretation of breast cancer therapeutic responses still exist mainly because of lack of standardized assessment criteria and methods. </em></p> <p><strong>Objective.</strong><em> DNA content profiling of cells in the affected (cancerous) tissue before and after neoadjuvant chemotherapy (NAC) was applied to facilitate interpretation of therapeutic responses. </em></p> <p><strong>Methods.</strong><em> Both diagnostic biopsy and operation materials representing the tissue of primary tumors surgically removed after NAC were subjected to DNA image cytometry. Polyploidy and aneuploidy in DNA histograms were evaluated with a prognostic Auer typing. Stemline DNA index (DI) values and percentages of cells that polyploidize (&gt;4.5C) were also determined. Immunofluorescence staining was applied to evaluate proliferation (Ki-67), invasiveness (CD44), and self-renewal factors characteristic for stem cells (SOX2 and NANOG).</em></p> <p><strong>Results. </strong><em>DNA content profiles of 12 breast cancer cases, of which 7 were triple-negative, revealed the features of tumor non-responsiveness to NAC in 7 cases, of which 5 were triple-negative. Among non-responsive cases there were 3 cases that showed enhanced polyploidization, suggesting the negative NAC effect. Near-triploid (DI=1.26-1.74) triple-negative cases were determined as most resistant to NAC. Cycling near-triploid cells may contribute to the excessive numbers of &gt;4.5C cells. Polyploid cells were positive for Ki-67, CD44, SOX2, and NANOG.</em></p> <p><strong>Conclusions.</strong><em> DNA content profiling data provide additional helpful information for interpreting therapeutic responses in NAC-treated breast cancers. Polyploid tumor cells possessing stem cell features can be induced by NAC. Because NAC effects in some cases may be unfavorable, the use of the further treatment strategy should be carefully considered. </em></p> 2019-07-11T17:36:01+03:00 Copyright (c) PHARMACOKINETICS OF THE NEW CEREBROPETECTOR FERRUM BIS(CITRATO)GERMANATE AT THE STAGE OF ITS DISTRIBUTION TO THE ORGANS IN CLOSED HEAD INJURY 2019-08-23T08:29:40+03:00 V. D. Lukianchuk T. A. Bukhtiarova I. I. Seifullina Seifullina@tdmu.local E. M. Polishchuk O. E. Martsinko H. A. Topolnytska Topolnytska@tdmu.local <p><strong>Background</strong>. Previous studies showed that new coordinate compound Cerebrogerm (ferrum bis(citrato)germanate) is a promising cerebroprotector.</p> <p><strong>Objective</strong> of the study is a comparative analysis of the central stage of the pharmacokinetics of Cerebrogerm as well as its distribution in vital organs in cases of closed head injury.</p> <p><strong>Methods. </strong>On the experimental original model of closed brain injury in rats the parameters of the central stage of Cerebrogerm pharmacokinetics: the distribution in brain, liver, kidneys, were studied.</p> <p><strong>Results. </strong>It is established that, in cases of closed head injury Cerebrogerm reaches maximum concentration first in the brain (in 3.75 h), then in the kidneys (in 3.92&nbsp;h), and finally in the liver (in 4.17 h). In this case, the magnitude of the C<sub>max</sub> of the coordinating compound of germanium that is being investigated in different biosubstrates of the rats with closed head injury may be presented in descending order as follows: brain (7.95 mg/L) &gt; liver (6.22 mg/L) &gt; kidneys (1.79 mg/L).</p> <p><strong>Conclusions. </strong>The compound Cerebrogerm studied easily gets through the blood-brain barrier and meets the present requirements for cerebroprotectors and antihypoxants. The attained results allow noting that in the early post-traumatic period of closed head injury, the blood circulation in the kidneys does not change and cannot modify the absorption-elimination processes of xenobiotics. It has been also established that Cerebrogerm is distributed faster in the examined organs in cases of closed head injury. The highest concentration of the drug is present in the brain and the smallest one – in the kidneys.</p> 2019-07-12T10:38:28+03:00 Copyright (c) EFFICACY OF GRANULOCYTE COLONY-STIMULATING FACTOR AND ENTEROSORPTION IN MELPHALAN-INDUCED BONE MARROW SUPPRESSION IN GUERIN CARCINOMA GRAFTED RATS 2019-08-23T08:29:38+03:00 O. O. Shevchuk I. M. Todor N. Yu. Lukianova Lukianova@tdmu.local N. K. Rodionova V. G. Nikolaev V. F. Chekhun Chekhun@tdmu.local <p><strong>Background.</strong> Side effects of antineoplastic agents (especially leukopenia and neutropenia) could be the main limiting factors for efficient treatment.</p> <p><strong>Objective. </strong>The research is aimed at the study of myeloprotective capability of biosimilars of granulocyte colony stimulating factor (G-CSF) and granular carbon oral adsorbent C2 in melphalan-induced bone marrow suppression in Guerin carcinoma-grafted rats.</p> <p><strong>Methods. </strong>Melphalan at the dose of 5.5 mg/kg was used to promote bone marrow suppression in the Guerin carcinoma grafted rats. To fight myelosuppression, we used filgrastim and its analogue, designed and produced by IEPOR, a recombinant granulocyte colony-stimulating factor (r-GCSF). Carbon granulated enterosorbent C2 was used for enteral sorption therapy (bulk density γ=0.18&nbsp;g/cm<sup>3</sup>, diameter of granules 0.15-0.25 mm, BET pore surface – 2162 m<sup>2</sup>/g). All rats were sacrificed on the 17<sup>th</sup> day after carcinoma cells inoculation or on the 8<sup>th</sup> day after Melphalan injection.</p> <p><strong>Results.</strong> Alkylating cytostatic agent caused severe leukopenia (by 95.7%), neutropenia (by 73.9%), and thrombocytopenia (by 84.9%) in the experimental rats. Mortality rate was 57%. Filgrastim and enterosorption with carbon oral adsorbent C2 increased the studied indices, but the most prominent results were observed when combination of both factors was used. Studied means did not affect the anti-tumor efficacy of Melphalan alone and in combination.</p> <p><strong>Conclusions.</strong> Our results are perspective for further investigation of the efficacy of the combination of carbon oral adsorbents and hematopoietic cytokines in cases of ameliorate anti-cancer chemotherapy side effects, and its implementation into clinics.</p> 2019-07-12T11:20:12+03:00 Copyright (c) ANTHROPOMETRY OF THE EXTERNAL EAR AMONG ADULT IJAWS IN BAYELSA STATE OF NIGERIA 2019-08-23T08:29:35+03:00 E. I. Edibamode K. Mordi L. K. David A. M. Eghoi <p><strong>Background.</strong><em> External ear measurement is of utmost importance in reconstructive surgeries.</em></p> <p><strong>Objectives</strong><em>. The present study is aimed at ascertaining sexual dimorphism in external ear anthropometry and ear lobe attachments among adults Ijaws in Bayelsa, Nigeria. </em></p> <p><strong>Methods.</strong><em> A total of 112 adults within the age range of 18-50 yrs, who met the inclusion criteria, were involved in the study. Four linear dimensions of the ear, which are ear length (EL), ear width (EW), lobular length (LL) and lobular width (LW), were measured for both genders. The lobular attachment for both ears for males and females were also examined and results recorded. These data were subjected to Student t-test, Chi-square test, and Pearson’s correlation using SPSS version 20.0. </em></p> <p><strong>Results.</strong><em> The mean values for EL, EW, LL, and LW for the left auricle in the males and females were 58.14±0.60, 27.41±0.37, 14.47±0.27, 13.50±0.34 and 57.90±0.16, 27.45±0.65, 15.41±0.31, 13.43±0.38 respectively. However, for the right auricle in the males and females, the values were 58.40±0.45, 28.21±0.68, 14.32±0.31, 13.04±0.32, and 56.66±1.10, 27.51±0.65, 15.58±0.29, 13.28±0.34 respectively. The left and right lobular length were the only parameters that proved statistical significance (p&lt;0.05) in females compare to males. Pearson’s correlations between right and left sides for each of the parameters were positive and significant. Chi-square analysis revealed no significant relationship (p&gt;0.05) between earlobe attachments and gender. </em></p> <p><strong>Conclusions.</strong><em> Sexual dimorphism was thus established in the Ijaw population as regards lobular length dimensions. It is believed that the results of this study would be very useful for ear morphology and reconstructive surgeries.</em></p> 2019-07-12T11:45:56+03:00 Copyright (c) ANTIOXIDANT ENZYMES ACTIVITY IN EXPERIMENTAL ISCHEMIA-REPERFUSION INJURY 2019-08-23T08:29:32+03:00 N. V. Volotovska T. V. Kashchak <p><strong>Background.</strong> Blood loss during civil and military limb trauma is the most common cause of preventable death. Complications due to the use of a hemostatic tourniquet are widely investigated nowadays. Therefore, the standards of the past have to be improved.</p> <p><strong>Objective</strong>. The aim of the research is to study the reaction of the enzyme chain of the liver antioxidant system in the presence of modifications of ischemia-reperfusion injury (IRI).</p> <p><strong>Methods.</strong> 210 white male-rats, aged 5-5.5 months, were used in the research. The dynamics of antioxidant enzymes activity catalase (Cat) and superoxide dismutase (SOD) in liver tissue in cases of modifications of ischemia-reperfusion injury (IRI) were studied. The period of investigation was in 24 hours, 3, 7, 14 days after the injury.</p> <p><strong>Results.</strong> In cases of simulated IRI the catalase level mainly decreased at each period of the experiment. The peak of SOD activity was evidenced on the 1<sup>st</sup>, 3<sup>rd</sup> or 7<sup>th</sup> days after the experimental IRI according to the degree of trauma severity. Thus, IRI combined with severe blood loss and mechanical trauma caused the severest affection of the antioxidant system. Even a single application of hemostatic tourniquet caused similar wavelike reactions at different times.</p> <p><strong>Conclusions.</strong> The development of IRI is accompanied by a significant depression of the liver antioxidant system. The most significant changes were evidenced in cases of IRI combined with blood loss and mechanical trauma, but even a single application of a tourniquet caused active response of the antioxidant enzymes.</p> 2019-07-12T11:56:49+03:00 Copyright (c)