Lviv clinical bulletin最新文献

{"title":"Diagnostic Value, Predictive Value and Likelihood Ratio of Changes in Some Parameters of Laboratory Syndromes and Their Constellations in Patients with Liver Cirrhosis with Disorders of Bone Mineral Density","authors":"N. Drobinska, O. Abrahamovych, M. Abrahamovych, O. Fayura, M. Ferko, I. Korniychuk, R. Ivanochko","doi":"10.25040/lkv2022.01-02.041","DOIUrl":"https://doi.org/10.25040/lkv2022.01-02.041","url":null,"abstract":"Introduction. Changes in some laboratory blood parameters, the laboratory syndromes they appoint, and their constellations require investigation of their value for clinicians to identify or exclude disorders of bone mineral density (DBMD) in patients with liver cirrhosis (LC). The aim of the study. To investigate diagnostic value, predictive value and likelihood ratio of changes in certain parameters of laboratory syndromes and their constellations in patients with liver cirrhosis with disorders of bone mineral density. Materials and methods. 90 patients with LC (27 women, 30.0 %), 63 men (70.0 %),18–66 years of age were randomly examined and stratified for bone lesions according to the T-score in accordance with WHO recommendations. 72 (80.0 %) patients combining LC with DBMD formed a research group (RG), out of which: 46 (63.9 %) patients combined LC with osteopenia (RG-A); 26 (36.1 %) patients combined LC with osteoporosis (RG-B). 18 (20.0 %) patients with LC without DBMD formed a comparison group (CG). Laboratory syndromes were diagnosed on the basis of abnormalities detection in laboratory blood parameters, namely: cytolysis – in the case of increased levels of aspartate aminotransferase or alanine aminotransferase in blood plasma; mesenchymal-inflammatory syndrome – increased thymol test or gamma-globulins; hepatocellular insufficiency – decreased fibrinogen or prothrombin indeces, or total protein, or albumin; cholestasis – increased alkaline phosphatase (AP), or gamma-glutamyltranspeptidase or total bilirubin; portosystemic shunting – decreased sodium or potassium, or increased creatinine indeces; dyslipidemia – increased cholesterol or B-lipoproteins, triglycerides or low-density lipoproteins, or decreased high-density lipoproteins (HDL) levels. The investigation was conducted in two stages. At the first stage the indicators of diagnostic value, predictive value and likelihood ratio of changes in laboratory parameters were figured out (first step of the first stage of research). Laboratory syndromes and their constellations (second step), and simultaneous manifestation of a number of laboratory syndromes (third step), which exposed statistically significant differences, or had a significant direct stochastic relationship with the certain bone lesion were identified. The most informative of them, which were confirmed by both statistical criteria at the same time, were selected and therafter, during the second stage, the post-test probability of DBMD manifestations in case of their presence or absence was calculated and represented by the nomogram of Bayes’ theorem. Results. At the first stage were identified markers of bone lesions that have higher sensitivity, negative predictive value, likelihood ratio of negative result, which could be of interest for excluding DBMD, or those that have higher specificity, positive predictive value, likelihood ratio of positive result, which could confirm the diagnosis. During the first step the most ch","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116144664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peculiarities of Arterial Hypertension Course in Patients with Concomitant Diabetes Mellitus in the Post-COVID Period","authors":"O. Voloshyna, V. Zbitneva, E. Zubok, I. Balashova, I. Lysyi, О. Dukova, A. Voloshyn, О. Chekhlova","doi":"10.25040/lkv2022.01-02.075","DOIUrl":"https://doi.org/10.25040/lkv2022.01-02.075","url":null,"abstract":"Introduction. Recent publications indicate that the most common comorbidities in hospitalized patients with coronavirus infection were arterial hypertension (AH), diabetes mellitus (DM), and coronary heart disease. However, the peculiarities of AH course in post-COVID-19 patients, especially with concomitant DM, are insufficiently covered in the relevant literature. The aim of the study. Тo investigate the peculiarities of hypertension course in patients with concomitant diabetes mellitus previously affected with COVID-19 infection. Materials and methods. We examined 48 patients with essential hypertension of stage II-III of 1-3 degrees, and concomitant DM, previously affected with Covid-19, 52-72 years of age. Results. It has been estimated that more than 1/3 of patients with hypertension who relapsed to COVID-19 complained of frequent headaches, palpitations, coughs, muscle and joint pain, fatigue and sleep disturbances. However, patients with concomitant DM were significantly more likely to complain of general weakness and indigestion. In many patients, regardless of the presence of concomitant pathology, in the postcocious period there was indicated an increase in C-reactive protein more than 3 mg/l and enhanced fibrinogen levels, indicating an increased risk of cardiovascular complications in this group patients. Most patients experienced worsening of blood pressure control during COVID-19 treatment. Uncontrolled hypertension was significantly more common in patients hospitalized for the treatment of acute COVID-19, regardless of DM presence. Conclusions. In patients with AH and concomitant DM significantly more often (76.0 % of cases (p is equal to 0.01)) – compared to patients with AH without DM (60.9 %) was detected uncontrolled hypertension in the post-COVID period. Worsening of blood pressure control in patients with concomitant DM is significantly more common (p value less than 0.001) in those patients who took three or more antihypertensive drugs, this notion require additional correction of antihypertensive therapy.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123733150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bath for Underwater Horizontal Polysegmental Kinesitraction Treatment of the Spine and Lower Extremities Lesions, Methods of Its Use","authors":"B. Panarin, O. Abrahamovych, U. Abrahamovych, O. Fayura, R. Ivanochko, M. Zavadka","doi":"10.25040/lkv2021.03-04.058","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.058","url":null,"abstract":"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 ","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131589931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Participation of the Organism Adaptation Mechanisms to the Lack of Oxygen According to the Assessment of the Fethemoglobin Content in the Peripheral Blood of Patients with Community-acquired Pneumonia","authors":"V. Bereznyakov","doi":"10.25040/lkv2021.03-04.044","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.044","url":null,"abstract":"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 acceler","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131005785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Risk Factors, Methods of Their Calculation and Evaluation, Prognosis in Medicine (Literature Review; Examples of Their Use in Own Clinical Practice) – Second Notice","authors":"О. Fayura, А. Маksymuk, О. Аbrahamovych, М. Аbrahamovych, L. Tsyhanyk, S. Tolopko, M. Ferko","doi":"10.25040/lkv2021.03-04.070","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.070","url":null,"abstract":"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 ","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130289838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern View on the Problem of Systemic Lupus Erythematosus with and without Comorbid Lesions of the Circulatory System (Literature Review, Clinical Case Description) – Second Notice","authors":"L. Kobak, O. Abrahamovych, U. Abrahamovych, V. Chemes","doi":"10.25040/lkv2021.03-04.065","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.065","url":null,"abstract":"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.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115410368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of Changes in Blood Parameters of Some Laboratory Syndromes and their Constellations in Patients with Liver Cirrhosis with Disorders of Bone Mineral Density","authors":"N. Drobinska, O. Abrahamovych, Z. Bilous, M. Ferko, R. Ivanochko, M. Zavadka","doi":"10.25040/lkv2021.03-04.023","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.023","url":null,"abstract":"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 - d","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131234360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic Cardiovascular Autonomic Neuropathy: Effects of Simvastatin and Omega-3 Polyunsaturated Fatty Acids on Insulin Resistance and Lipid Profile Parameters","authors":"V. Serhiyenko, M. Hotsko, S. Azhmi, O. Serhiyenko","doi":"10.25040/lkv2021.03-04.008","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.008","url":null,"abstract":"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.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123229434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absence of Pericardium in Combination with Myocardial Noncompactness (Literature Review; Clinical Case Description)","authors":"N. Ilenkiv, Z. Bilous, O. Abrahamovych, M. Abrahamovych, N. Mazur, R. Ivanochko","doi":"10.25040/lkv2021.03-04.082","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.082","url":null,"abstract":"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","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"64 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123485494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Deficiencies and Features of Nutritional Provision in Primary School Children","authors":"Данила Галицького, Харчові дефіцити, дітей молодшого, шкільного віку","doi":"10.25040/lkv2021.03-04.016","DOIUrl":"https://doi.org/10.25040/lkv2021.03-04.016","url":null,"abstract":"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 mod","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122646677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}