Lviv clinical bulletin
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255
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Published By Danylo Halytskyi Lviv National Medical University

2520-2898, 2306-4269

2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 50-57
Author(s):  
D. Volynskyi ◽  

Introduction. Coronary heart disease (CHD) is one of the main causes of high mortality, disability and reduced quality of life for patients in both Europe and Ukraine. Modern drug therapy of coronary heart disease in combination with arterial hypertension (AH) does not always achieve a satisfactory therapeutic effect. The use of meldonium, which has antioxidant properties, has a positive effect on NO release and has a lipid-lowering effect is promising for patients with AH. The aim of the study. To evaluate the influence of meldonium on lipid metabolism and echocardiography parameters in combination therapy in patients with CHD with stable angina and concomitant AH. Materials and methods. We examined 66 patients with CHD, stable angina pectoris II-III functional class, 40 of them with concomitant AH stage II-III. Patients were divided into 2 groups of 40 and 26 patients, respectively. The first group included patients with CHD and concomitant AH, the second - without pre-existing hypertension. Each of the groups was further divided into 2 subgroups: 1) Patients who were prescribed meldonium at a dose of 750.0 mg/d for 6 months in addition to the basic therapy of the underlying disease (n = 20 for CHD + AH and n = 14 for CHD without hypertension). 2) Patients who continued basic antianginal, disaggregating, hypolipidemic therapy (n = 20 for CHD + AH and n = 12 for CHD without hypertension). Serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol were assessed. Indicators of cardiac hemodynamics were determined by echocardiography with assessment of left ventricular end systolic and diastolic volumes and diameters (LVESV, LVEDV, LVESD, LVEDD respectively), the thickness of the interventricular septum and posterior wall of the left ventricle (IVST, LVPWT respectively), pulmonary artery pressure (PAP), LV myocardial mass (LVM) and LV myocardial mass index (LVMI). Results. The use of meldonium for 6 months in patients with CHD and concomitant AH led to a decrease in the concentration of total cholesterol from 5.07 to 4.34 mmol/l and LDL from 2.07 to 1.70 mmol/l. In the group of patients without concomitant hypertension there was a decrease in the concentration of total cholesterol from 4.80 to 3.93 mmol/l, LDL from 1.62 to 1.18 mmol/l and an increase in HDL from 1.18 to 1.37 mmol/l. At 6-month administration of meldonium as a part of combination therapy of patients with CHD with concomitant AH, there is a decrease in LVM from 216.90 g to 181.50 g and LVMI from 109.10 g/m2 up to 91.20 g/m2. In patients without concomitant hypertension, a decrease in LVM from 232,20 g to 183.90 g and LVMI from 121.50 g/m2 to 96.40 g/m2 was observed. Conclusions. Our study showed that meldonium has a positive effect on lipid metabolism and echocardiography. In the group of patients with coronary heart disease and concomitant hypertension on the background of additional use of meldonium for six months, we registered a decrease in TC, LDL and AI. LVPWT, PAP, LVM and LVMI also significantly decreased. In the group of patients with coronary heart disease without concomitant hypertension, we registered a decrease in TC, LDL, AI and an increase in HDL. LVM and LVMI also decreased significantly. Therefore, we consider it appropriate to use meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension. Keywords: coronary heart disease, arterial hypertension, meldonium, echocardiography, blood lipid spectrum.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 8-15
Author(s):  
V. Serhiyenko ◽  
◽  
M. Hotsko ◽  
S. Azhmi ◽  
O. Serhiyenko ◽  
...  

Introduction. Currently, there is no unified treatment algorithm of cardiac autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM). The aim of the study was to investigate the effects of simvastatin (SIM) and -3 polyunsaturated fatty acids (-3 PUFAs) on blood lipid profile and insulin resistance (IR) in patients with type 2 diabetes mellitus and definite cardiac autonomic neuropathy. Materials and methods. The study involved 72 patients with T2DM and definite CAN. Patients were divided into four groups: 1st - received standard hypoglycemic therapy - control (n = 15); 2nd (n = 22) – in addition simvastatin (SIM) 20.0 mg/q.d.; 3rd (n = 18) - in addition 1 capsule/q.d. of the ω-3 PUFAs; 4th (n = 17) - in addition SIM 10.0 mg/q.d and 1 capsule/q.d of the ω-3 PUFAs for three months. The concentration of glucose, glycated hemoglobin A1c, immunoreactive insulin (IRI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) in the blood were determined. Homeostasis model assessment IR (HOMA-IR), atherogenic coefficient (AC), TG/LDL-C, TG/TC, TG/LDL-C and TG and glucose index (TyG) were calculated. Results. Prescription of SIM was accompanied by a statistically significant decrease in TC, LDL-C, TG concentrations. In parallel, SIM induced a decrease of AC, TG/HDL-C, increase in HDL-C, and does not affect the IRI, HOMA-IR, TG/LDL-C, TG/TC, TC/LDL-C/HDL-C, TyG. The use of ω-3 PUFAs has contributed to a significant reduction in TG, AC, TG/LDL-C, TG/TC, TG/HDL-C, TyG index, increase in HDL-C, and was not accompanied by changes in IRI content, HOMA-IR, TC, LDL-C, and TC/LDL-C/HDL-C. The combined prescription of SIM and -3 PUFAs was accompanied by more pronounced, statistically significant changes in the blood lipid spectrum, as well as a decrease in the IRI and HOMA-IR. Conclusions. Obtained results justify the appropriateness of combined simvastatin and -3 polyunsaturated fatty acids prescription to patients with type 2 diabetes mellitus and definite cardiac autonomic neuropathy. Keywords: diabetes mellitus, cardiac autonomic neuropathy, treatment.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 23-26
Author(s):  
N. Drobinska ◽  
◽  
O. Abrahamovych ◽  
Z. Bilous ◽  
M. Ferko ◽  
...  

Introduction. Investigation of changes in certain laboratory blood parameters, and verification with their help of laboratory syndromes, and detection of constellations of laboratory syndromes in patients with liver cirrhosis (LC), which is possible for clinicians of all levels of medical care, need to clarify their features, which would suspect or verify disorders of bone mineral density (DBMD). The aim of the study. Investigate the features of changes in blood parameters of some laboratory syndromes and their constellations in patients with liver cirrhosis with disorders of bone mineral density. Materials and methods. 90 patients (27 women (30.0 %) and 63 men (70.0 %) aged 18 to 66 years) with LC were stratified into several groups: experimental (EG) (patients with LC with DBMD) (72 patients (80.0 %))), from which two subgroups were formed - EG A (patients with LC with osteopenia) (46 patients (63.9 %))), and EG B (patients with LC with osteoporosis) (26 patients (36.1 %)))) and the comparison group (CG) (patients with LC without DBMD) (18 patients (20.0 %))). Among the laboratory syndromes and their blood parameters were studied such as: cytolysis (increased in plasma alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST)), mesenchymal-inflammatory syndrome (increased thymol test (TT) and/or gamma-globulins), hepatocellular insufficiency (decreased fibrinogen, prothrombin index (PTI), total protein, or albumin), cholestasis (increased alkaline phosphatase (AP), gamma-glutamyltranspeptidase (GGTP), total bilirubin), porto-systemic shunting (decreased sodium and/or potassium, and/or increased creatinine) and dyslipidemia (increased serum cholesterol, B-lipoproteins, triglycerides, low-density lipoprotein (LDL), decreased high-density lipoprotein (HDL)). The study was performed in three stages, the first of which studied the features of laboratory syndromes and blood parameters that characterize them, the second - constellations of laboratory syndromes, and the third - the simultaneous manifestation of a number of different laboratory syndromes in patients with LC with DBMD, osteopenia and osteoporosis. Each stage involved three steps: the first was to study the frequency of laboratory syndromes and their laboratory blood parameters in patients with LC and determine their share in each of the study groups, the second was to identify significant differences in the frequency of cases, and the third was to identify a direct stochastic relationship between the studied trait and DBMD, including osteopenia and osteoporosis. Results. After performing all three stages and each of the planned steps, it was found that laboratory syndromes and their constellations are more common among patients with bone lesions. However, there are statistically significant differences in the frequency of cases between EG and CG in the case of a decrease in HDL and the simultaneous manifestation of five different laboratory syndromes; between EG A and CG - decrease in HDL and simultaneous manifestation of two and three different laboratory syndromes; between EG B and CG - increase in AP, decrease in HDL and simultaneous manifestation of five different laboratory syndromes; between EG A and EG B - cytolysis syndrome, increase in AST, gamma-globulins, AP, constellation of cytolysis syndrome with hepatocellular insufficiency syndrome or cholestasis syndrome and constellation of all three syndromes. Confirmed direct stochastic association was found: with all manifestations of DBMD - increase in TT, a decrease in HDL, and constellations of cytolysis, mesenchymal-inflammatory and dyslipidemic syndrome, which may be supplemented by hepatocellular insufficiency syndrome and/or cholestasis syndrome; with osteopenia - increase in TT, increase in blood cholesterol, decrease in HDL, and constellations containing dyslipidemia syndrome and supplemented by mesenchymal-inflammatory, and/or cytolysis and/or hepatocellular insufficiency and/or cholestasis syndromes, and simultaneously only two laboratory syndromes in a patient with LC; with osteoporosis - increase in blood AST, TT, gamma-globulins, AP, decrease in PTI, potassium, HDL, the presence of cytolysis, cholestasis syndromes, constellations of cytolysis syndrome with hepatocellular insufficiency syndrome and/or cholestasis syndrome, which are supplemented by mesenchymal-inflammatory and dyslipidemic syndrome, and the simultaneous manifestation only three or five different laboratory syndromes. Conclusions. Laboratory syndromes, blood parameters that characterize them, and constellations of laboratory syndromes have certain features in patients with cirrhosis of the liver with disorders of bone mineral density, as in most cases are more common in patients with bone lesions and have a confirmed stochastic relationship with disorders of mineral density bone tissue in general, and osteopenia and osteoporosis separately. Keywords: cirrhosis, bone mineral density, osteopenia, osteoporosis, cytolysis, mesenchymal-inflammatory, hepatocellular insufficiency, cholestasis, porto-systemic shunting, dyslipidemia, alanine aminotransferase, aspartate aminotransferase, thymol test, total protein, albumin, gamma-globulin, fibrinogen, prothrombin index, alkaline phosphatase, gamma-glutamyltranspeptidase, bilirubin, sodium, potassium, creatinine, cholesterol, B-lipoproteins, triglycerides, low-density lipoproteins, high-density lipoproteins.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 16-22
Author(s):  
N. Nyankovsky ◽  
◽  
M. Yatsula ◽  
A. Tytusa ◽  
◽  
...  

Introduction. The nutrition of primary school children does not always meet modern nutritional standards. The frequency of nutritional deficiencies, including calcium and vitamin D, among this age group remains unstudied. The aim of the study. To establish the characteristics of nutritional provision and the prevalence of nutrient deficiencies in the daily nutrition of primary school children, including calcium and vitamin D deficiencies and to propose methods of correction. Materials and methods. 5 consecutive stages of the study were conducted. At the first stage in 2019, the assessment of eating behavior in 190 children of grades 1-4 of two schools in the city of Lviv was conducted using a questionnaire. In the second stage, the features of the diet and ration and daily nutritional intake were determined using a special licensed program Dietplan 7 (UK). The analysis of daily nutrient intake was performed for 172 children. In the third stage, a study was conducted on the level of total, ionized calcium and 25-hydroxyvitamin D in the blood, and a study on the calcium content in the hair of 56 children with insufficient daily intake of calcium and / or vitamin D. In the fourth stage, 30 children with reduced levels of calcium in the hair were detected, differentiated correction measures were performed. To do this, the children were divided into two groups: the control group - 15 children whose deficiencies were corrected by diet modification, and the main group - 15 children - whose deficiencies were corrected by diet modification and the intake of calcium at a dose of 500.0 mg and vitamin D at a dose of 5.0 mg (200.0 IU) once a day for three months. In the fifth stage, to evaluate the effectiveness of treatment after three months of follow-up, all 30 children were re-analyzed for calcium content in the hair using atomic absorption spectrophotometry. Results. Appetite disturbance was observed in 28.9 % of schoolchildren, 17.4 % ate under duress, 14.3 % ate irregularly, 13.7% ate insufficient portions, 11.0 % were on different diets, many schoolchildren had eating disorders: ate before sleep (83.6 %), while watching TV (33.6 %). The diet was often unbalanced, children consumed insufficient fish (58.9 %), vegetables (43.2 %), dairy products (33.7 %), meat (26.8 %) Low calcium intake was observed in 50.6 % boys and 70.7 % of girls, vitamin D in 84.9 % of boys and 96.9 % of girls. Among children with a reduced daily intake of calcium and vitamin D, 42.9 % of children had a reduced level of total and / or ionized calcium, 48.2 % had a reduced level of vitamin D in the blood serum, and 53.6 % had a reduced calcium content in the hair. After 3 months of correction, we found that in the hair of children in the main group, who underwent dietary correction and were prescribed calcium and vitamin D, a significant increase in the average calcium content (up to 293.6 ± 80.6 mg/kg; p < 0.01) was observed, while in control group children who received only a modified diet, had only a tendency to increase the average amount of calcium in the hair (up to 185.14 ± 82.38 mg/kg; p > 0.05). Conclusions. For most primary school children, nutrition is unbalanced, which does not meet all the needs of a rapidly growing and intensively developing child's metabolism. A significant number of children have eating disorders: they do not eat regularly, do not eat enough food, eat food while watching TV, just before bed, do not have lunch at school, like fast food, 10% of students are on various diets. Almost a third of schoolchildren have a deficiency of daily intake of proteins, fats, carbohydrates and energy, and half of schoolchildren have a deficiency in the consumption of dietary fiber, polyunsaturated fatty acids and monounsaturated fatty acids. Most students have a daily deficiency of iodine, magnesium, selenium, iron and calcium, vitamin E, biotin, vitamin D, retinol, vitamin C, carotene, pantothenate. Among children with reduced daily intake of calcium and vitamin D in 42.9 % of children a reduced content of total and / or ionized calcium in the blood was found, and in 53.6 % of children in this group - in the hair. The use of a non-invasive method of studying the calcium content in the hair allows to determine the calcium deficiency in the child's body and control the process of its recovery. For children with insufficient daily intake of calcium and vitamin D, it is advisable to recommend a diet modification with increased consumption of milk, dairy products, yogurt and cheese, beans, spinach, broccoli, other leafy greens, wheat germ, nuts, sesame seeds, fish. To correct the existing calcium deficiency, it is advisable to use calcium supplements with vitamin D, combining this with a modification of the diet with an increase in food that contains the nutrients mentioned above. Keywords: schoolchildren, food deficiencies, calcium, vitamin D.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 70-81
Author(s):  
О. Fayura ◽  
◽  
А. Маksymuk ◽  
О. Аbrahamovych ◽  
М. Аbrahamovych ◽  
...  

Introduction. Despite the latest advances in modern medicine, the direct etiological factors of many diseases remain unknown or it is impossible to determine the significance of each of them in their occurrence, so the theory of risk factors is extremely relevant for both theoretical and practical medicine. There are also often situations in which it is necessary to determine the optimal tactics of patient care, because preventive, curative and rehabilitation activities of the doctor require timely prediction of the occurrence probability, further course of the pathological process, its complications, recurrences under the influence of certain environmental factors, threatening and terminal stages, side effects of drugs. Therefore, the need for a practical solution to these problems has become the basis for the theory of risk factors and prognosis methods. The aim of the study. Describe the importance of risk factors and methods of their calculation and evaluation, prognosis in medicine, using literature sources, provide specific examples of their use in own clinical practice. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the current scientific researches concerning studying of the importance of risk factors and a technique of their calculation and estimation, prognosis in medicine were used. Sources were searched in scientometric databases: PubMed, Medline, Springer, Google Scholar, Research Gate by keywords: risk factors, one-way analysis, multi-factor analysis. 54 literary sources in English and Ukrainian, which highlight the importance of risk factors and methods of their calculation and evaluation, prognosis in medicine were selected and analyzed, we describe the results of their use in our own clinical practice. Results. The concept of risk, as the probability of an adverse event or outcome, is most often used in analytical studies, which are planned to identify the causes and their prevalence of certain conditions. "Risk" cannot be measured directly by the results of information evaluation in one person, but is calculated on the basis of selective observation of a group of persons who are under the influence (exposed group) of a certain factor. Risk factors are potentially pathogenic factors, in contact with which a person may develop a disease. A full analysis of pathological processes, assessment of risk factors and actual risks are impossible without prognosis, as well as multivariate analysis, which is often based on the probabilistic method of A. Wald or the survival curves construction. In practical health care, cases of medical and social research and in clinical studies, it is often necessary to identify the trends (predict) in changes of a certain condition. Conclusions. Determining the risk factors, calculating the actual risks and prognosis play an important role in medicine, because in the doctor's practice there are daily situations that need to determine the optimal tactics taking into account trends, course, severity and results of treatment, therefore, their definition/calculation must be clear and understandable. Depending on the case, the doctor can use the analysis of the score for certain factors, create risk groups, develop a monitoring plan etc. As a result, it becomes possible to create a plan of preventive measures and timely correction of treatment. Keywords: risk, relative risk, absolute risk, chance, forecast.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 44-49
Author(s):  
V. Bereznyakov ◽  

Introduction. Сommunity-acquired pneumonia (COP) is a global socio-medical problem. At emergence of pneumonia by any genesis, hypoxia develops. Oxygen homeostasis of the body is provided by the coordinated interaction of external respiration, circulatory system and oxygen-transport system of the blood. Hypoxia, due to the malfunction of the external respiratory system, causes the formation of compensatory changes, in the implementation of which involved components of the oxygen transport system. Molecular genetic mechanisms play an important role in the body's adaptation to oxygen deficiency. Fetal hemoglobin (FetHb), having an increased affinity for oxygen, makes a significant contribution to the body's adaptation to new conditions with altered gaseous environment in the presence of pathological processes occurring with hypoxia. In this regard, it is interest to determine FetHb in adults with COP to study its effect on the diagnosis, prognosis and outcome of the disease. The aim of the study. To determinate the participation of the organism adaptation mechanisms to the lack of oxygen according to the assessment of the content of fetal hemoglobin in the peripheral blood of patients with community-acquired pneumonia. Materials and methods. We examined 34 adult patients (18 women and 16 men) with COP, aged 18 to 80 years, who were in the therapeutic department of the City Clinical Hospital № 25 in Kharkiv. The control group was formed of 20 healthy individuals. Spirography was performed on the diagnostic complex "Valenta"; hematological examinations – on the analyzer "ADVIA 60"; measurement of pO2 and pCO2, oxygen saturation, content of fetal hemoglobin – on the device "RAPIDLAB865". Results. In patients with community-acquired pneumonia, there was a decrease of the ventilatory function of external respiration, which is confirmed by a marked decrease in partial oxygen pressure. Oxygen saturation of blood was reduced in the group of patients with COP, but the difference was not statistically significant 94.8 ± 1.0 %. This indicates the presence of compensatory mechanisms aimed at maintaining adequate blood oxygen saturation. Significant increase in pH (from 7.40 to 7.53) and decrease in standard bicarbonate (from 1.27 to 0.68 mmol/l) resulting from violation of the gas composition of the blood can be regarded as a manifestation of partially compensated respiratory alkalosis. In patients with COP, there was a reduction in the total time of hemolysis, a shift of the maximum erythrogram to the left and an increase in the maximum itself, indicating a sharp decline in erythrocyte resistance. The proportion of erythrocytes with reduced resistance was twice as large as similar forms in the control group and the number of highly resistant cells in patients with COP sharply decreased. Obviously, oxygen starvation-mediated stress erythropoiesis is accompanied by the entry into the circulation of functionally defective erythrocytes. They are subject to accelerated elimination from the vascular bed, which causes a decrease in the quantitative indicators of red blood (erythrocyte content, hemoglobin) while maintaining corpuscular parameters (Mean Corpuscular Volume, Mean Cell Hemoglobin Concentration). At the same time, the analysis of individual hemoglobin fractions revealed an increase in the proportion of fetal hemoglobin (from 2.90 ± 0.31 % in the group of healthy individuals to 5.43 ± 1.05 % in patients with COP) (p less than 0.05). Conclusions. Changes in the parameters of acid hemolysis, fetal hemoglobin in the peripheral blood of patients with community-acquired pneumonia with impaired pulmonary ventilation function indicate their participation in the mechanisms of adaptation to oxygen deficiency and they have informative potential. Elevated fetal hemoglobin in peripheral blood in these patients can be used as an indicator of hypoxia, accompanied by impaired oxygen delivery to tissues, which should be used as an additional criterion for diagnosing tissue hypoxia and justify the timely appointment of antihypoxia drugs. Keywords: hypoxia, community-acquired pneumonia, red blood cells, fetal hemoglobin.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 37-43
Author(s):  
O. Kovalenko ◽  
◽  
N. Prityko ◽  

Introduction. The syndrome of chronic venous cerebral dysfunction (SCVCD) - widely studied at present nosology. In the presence of anxiety-depressed disorders, this disease is complicated. Specific clinical manifestations of SCVCD, as pronounced practical experience, are found in people of different age and social groups, usually in conditions of comorbidity, in particular, with different arterial pressure (AP) and accompanying anxiety-depressive disorders, which is reflected in the general intellectual potential of society. In our opinion, it is an interesting and relevant issue that contributes to changes in the emotional-volitional sphere of a person carries out a SCVCD in combination with different indicators of arterial pressure (AP). The aim of the study. To conduct a comparative analysis of the interconnections of the indicators of the emotional-volitional sphere (anxiety and depression), estimated using the scales of the anxiety Ch. D. Spieberger - Yu. L. Hanin and depressions A. T. Beck, in patients with chronic cerebral venous dysfunction syndrome and without it and various indicators of arterial pressure. Materials and methods. 153 patients tested on a series of reactive and personal anxiety and depression. The main group amounted to 125 people who were elected by clinical signs of the existence of the SCVCD and various indicators of AP, and they were distributed to three clinical groups: 33 people - people with increased indicators of AP (157.20 ± 12.20 / 98.30 ± 4.20 mm Hg - hypertonics; 21 person with reduced blood pressure (100.32 ± 7.23 / 65.45 ± 6.40 mm Hg) - hypotonic; 24 people with labile AP with predominantly normal average digits of AP (125.23 ± 12.20 / 82.22 ± 4.14 mm Hg) - "conditional" normotonics. For comparison of indicators, 28 patients of the control group were involved - people without clinical signs of SCVCD and various indices of AP, distributed on the same principle: hypertension - eight people, hypotonics - five people, "conditional" normotonics - 15 people. The statistical elaboration of the results was carried out using the Medstat application package. Since the law of distribution of indicators differed from normal, for the presentation of data calculated median value and the inter-quatering interval (QI-QIII), for comparison used nonparametric criteria for U. Kruskala A. Wallis, criteria for J. Dannah and Chi-square. Results. The level of personal and reactive anxiety (among persons with chronic cerebral venous dysfunction) in hypertonics was statistically significantly higher than hypotonics. The level of depression (among persons with chronic cerebral venous dysfunction) in hypotonics was statistically significant than in hypertension and "conditional" normotonics. In patients in the control group, there is no statistically significant connection between the numbers of personal and reactive anxiety and the level of depression with the digits of arterial pressure. Anxiety is most often an essential part of depression. Transformation of hypotension in hypertension (and vice versa) in persons with chronic cerebral venous dysfunction syndrome may be accompanied by a transition of anxiety in depression or depression in anxiety. Conclusions. The assessment of personal and reactive anxiety on the scale of anxiety and depression revealed statistically significant bonds with arterial pressure in persons with chronic cerebral venous dysfunction syndrome. The figures of personal and reactive anxiety were statistically significant in hypertension compared to normotonics (p less than 0.001) an hypotonic (p less than 0.001). The figures of depression were statistically significant in hypotonics compared with hypertonics and normotonics (p less than 0.001). In persons from the control group, the level of reactive anxiety and blood pressure in hypertonics (p = 0.003) in comparison with hypotonic and normotonics is statistically significant. In hypеrtonics with chronic venous dysfunction syndrome, it was statistically significantly higher (p less than 0.001) level of personal anxiety compared with hypertonic control group, and among the hypotonics of the main group noted statistically significant (p less than 0.001) higher level of depression. Key words: Syndrome of chronic cerebral venous dysfunction, reactive anxiety, personal anxiety, arterial pressure, depression.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 58-64
Author(s):  
B. Panarin ◽  
◽  
O. Abrahamovych ◽  
U. Abrahamovych ◽  
O. Fayura ◽  
...  

Introduction. Traction in dynamic mode (kinesitraction) is a new direction protected by patents of Ukraine, which combines the procedure of traction and motor activity. Traction treatment of the spine in a dynamic mode plays an important role in the treatment of the musculoskeletal system, so it is important to understand the structure, mechanisms and features of the structures involved in these processes, including the bath developed by us. The aim of the study. To acquaint with a design of a bath for underwater horizontal polysegmental kinesitraction treatment of the spine and lower extremities lesions, methods of its use. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the actual scientific researches on baths’ designs for underwater horizontal polysegmental kinesitraction treatment of the spine and lower extremities lesions, methods of its use are used. Sources are searched in scientometric databases: PubMed, Medline, Springer, Google Scholar, Research Gate by tags: kinesitraction, musculoskeletal system, underwater horizontal treatment of the spine, traction, traction system. 22 English and Ukrainian literary sources which describe this problem were selected and analyzed. The description of the bath for underwater horizontal segmental traction treatment of the spine and lower extremities lesions in the dynamic mode was used (Certificate of copyright registration for a scientific work N 99985, 25.10.2020). Results. The designed by us bath for underwater polysegmental kinesitraction treatment of lesions of the spine and lower extremities (Certificate of registration of copyright to a scientific work N 99985, 2020) is intended for the treatment of diseases of the musculoskeletal system, internal organs, disorders of vital systems in the aquatic environment by exposure to dosed motor and traction loads. The design includes a water bath, armrests, handles, footrest, racks, cervical block system, chest block system, lumbar block system, head restraint belt, chest strap, pelvic girdle, shin strap, cable, load. Using a bath it is possible to carry out tractions of the cervical, thoracic, lumbar spine, their combinations, lower extremities, or total provide the traction. Conclusions. Traction treatment of the spine in a dynamic mode plays an important role in the treatment of the musculoskeletal system, being more effective than static. The understanding of the structure, methods and features of the structures involved in these processes, including our developed baths for underwater horizontal polysegmental hydrokinesitraction treatment of lesions of the spine and lower extremities, based on the correction of disorders of the nervous, musculoskeletal systems caused by morphological, biochemical, physiological mechanisms of stimulation of the functions of vital systems, regeneration processes, and the proposed methods of their use is an important component of effective treatment of diseases of the musculoskeletal system. Keywords: kinesitraction, musculoskeletal system, underwater horizontal treatment of the spine, traction, traction system.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 65-69
Author(s):  
L. Kobak ◽  
◽  
O. Abrahamovych ◽  
U. Abrahamovych ◽  
V. Chemes ◽  
...  

Introduction. The prevalence and incidence of systemic lupus erythematosus (SLE) in the world is significant. In recent years, there has been a tendency of the SLE prevalence increase. Despite the undoubted progress in understanding the etiology and pathogenesis of SLE, its diagnosis and treatment, the mortality of patients, including ones at young and working age, is higher than in the general population, and circulatory system lesions are ones of its main reasons in these cases. The aim of the study. To analyze the literature, devoted to the modern view on the problem of systemic lupus erythematosus with and without comorbid lesions of the circulatory system, describe the clinical case. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the current scientific studies on modern principles of diagnosis and treatment of patients with SLE are used. A clinical case is described. Results. A clinical case of a 43-year-old patient S., who was hospitalized for SLE, she considers herself ill for eighteen years and she has been constantly taken outpatient and periodically inpatient treatment due to the frequent deteriorations in her general condition, clinical and laboratory parameters, is described. Based on the received results of the examinations, applying the method of determining the functional class of SLE, the patient was diagnosed with a clinical diagnosis indicating comorbid lesions of various organs and systems (skin, joints, kidneys, vessels, heart, blood system, immune system, eyes). The generally accepted basic medical complex of the patient includes drugs, taking into account the lesions to the circulatory system. The conducted complex pathogenetic treatment gave a positive result. Conclusions. In the described clinical case demonstrated the development of comorbid lesions of many organs and systems, including circulatory system, in a patient with systemic lupus erythematosus. Inclusion in the treatment complex in addition to basic and drugs for the treatment lesions of circulatory system has improved the general condition of the patient, stabilized clinical and laboratory parameters, as evidenced by a prospective study during three years. The information provided in our clinical case is consistent with the results of the literature review. Systemic lupus erythematosus needs further in-depth study due to its widespread prevalence among young and people of working age, lack of accurate knowledge about the etiology and pathogenesis of the disease, comorbid lesions of many organs and systems, including circulatory system, the development of severe and often life-threatening manifestations, the lack of clear recommendations that would predict the differentiated use of drugs taking into account comorbid syntropic lesions. Keywords: SLE, circulatory system lesions, atherosclerosis, diagnosis and treatment of SLE.


2021 ◽  
Vol 2-3 (35-36) ◽  
pp. 82-90
Author(s):  
N. Ilenkiv ◽  
◽  
Z. Bilous ◽  
O. Abrahamovych ◽  
M. Abrahamovych ◽  
...  

Introduction. Cardiovascular diseases (CVD) in all epidemiological indicators continue to hold a leading position not only in Ukraine but also around the world and are a global medical and social problem. In the first place, such positions are provided by coronary heart disease (CHD) - the most common variant of SSC, despite the significant advances in modern clinical medicine. At the same time, sometimes the verification of the diagnosis is delayed or it is not possible to establish it during life, which contributes to the hyper- or hypodiagnosis of the most common nosologies, forgetting about diseases that are extremely rare. The aim of the study. To make the review of the literature and the description of a clinical case for the purpose of clarification of features of a clinical condition and diagnostics at patients with congenital absence of a pericardium in combination with noncompactness of a myocardium. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying current scientific researches concerning studying of congenital absence of pericardium in combination with noncompactness of myocardium are used. Sources were searched in scientometric databases: PubMed, Medline, Springer, Google Scholar, Research Gate by keywords: congenital absence of pericardium, not myocardial compactness. 51 sources in English and Ukrainian were selected and analyzed, which covered the epidemiology of congenital absence of the pericardium and myocardial compactness, their clinical and diagnostic features; described a clinical case. Results. Congenital absence of the pericardium is a rare congenital anomaly of the pericardium, which, depending on the extent of the defect is left-handed (from 0.0001 % to 0.044 % in the population and in 70.0 % of all cases of congenital absence of the pericardium), right-handed and total (9.0 % of all cases) is more common in men than in women, respectively, as 3.0:1.3. During embryonic development, both the cardiac and pulmonary rudiments, the beginning of the formation of which begins in 3-4 weeks, are displaced from the cervical region into the thoracic cavity, going to the pericardial and pleural cavities, respectively. Premature atrophy of the left cuvier duct leads to non-separation of the pericardial cavity from the left pleural cavity. Due to these reasons, the absence of the left half of the pericardium is the most common. If pleuropericardial folds are not formed, the rudiments of the heart and lungs are in a single pleuropericardial cavity. Quite often, congenital absence of pericardium is associated with other congenital heart defects, for example, with a defect of the atrial septum (MPP), open ductus arteriosus, tetrad E.-L. Fallot, mitral valve stenosis, with defects of the diaphragm, lungs, kidneys. Most cases of this defect are asymptomatic and may not be diagnosed for life, so they can often be confused with other diseases such as heart aneurysm, coronary heart disease, mitral valve or atrial septal defects. Some informative signs may appear during X-ray diagnosis (radiograph may show convexity of the left upper border of the heart, high position of the heart), but the main emphasis in the diagnosis is on echocardiography (Echo-CG) (enlarged pancreas and right atrium), significant regurgitation tricuspid valve), magnetic resonance imaging (MRI), and the gold standard is the so-called multimodal imaging using multislice computed tomography (MSCT) (no visualization of the pericardial layer, rotation of the heart to the left, interposition of the pulmonary artery and lung tissue). At the same time, any of these techniques may have more or less pronounced shortcomings, which sometimes make it difficult to diagnose pericardial abnormalities. Myocardial noncompactness is a genetic malformation whose prevalence is not high, although its final prevalence cannot be established, as it is not uncommon for such individuals to have an asymptomatic course. On the ECG, myocardial noncompactness may be accompanied by supraventricular and ventricular arrhythmias, blockades of varying degrees, and one of the most accurate methods of visualizing myocardial noncompactness is Echo-CG. During this examination, two layers of the myocardium are visualized: subepicardial with a compact myocardium and subendocardial with a non-compact myocardium, and an important diagnostic and prognostic feature is the ratio of these layers at the end of systole. Conclusions. A review of the literature and described a clinical case of pericardial absence in combination with myocardial infarction. Elucidation of clinical features of absence of a pericardium in combination with incompatibility revealed that this anomaly is usually asymptomatic, however at patients with a left defect can be disguised under an ischemic heart disease, followed by ventricular arrhythmias (ventricular tachycardia), lengthening of a Q interval. Of particular value for the diagnosis of congenital absence of the pericardium in combination with myocardial infarction is Echo-CG and MRI, and the gold standard is considered to be MSCT, but these methods can sometimes have limited diagnostic capabilities. Keywords: congenital absence of pericardium, anomaly of the cardiac sac, myocardial non-compactness, prolonged QT interval.


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