Lviv Clinical Bulletin

8-12

Authors: Stanislavchuk L.

Introduction. One of the most common syndromes in pediatrics is stenotic laryngotracheitis (SLT), in which genesis has a leading role in viruses, and is also characterized by certain seasonal rhythms. In contrast to SLT, recurrent stenotic laryngotracheitis (RSL) is considered by some authors as a polyphaktorial disease in which pathogenesis has chronic allergic inflammation with respiratory tract hyperuricaemia, immunological disorders, genetic predisposition and persistence of some pathogens (viruses of influenza, parainfluenza, adenoviruses, respiratory-syncytial viruses (rs-viruses), chlamydia). Aim. To study (on the results of long-term observation) the monthly dynamics of the occurrence of SLT and RSL compared to the analogical dynamics in case of the presence of respiratory viruses. Materials and methods. The analysis of cases of SLT (1-3 episodes of the disease) and RSL (4 episodes of the disease and more) was performed in a cohort of children 1995-1999 years of birth for the period 1995-2008 in Vinnitsa on the basis of materials of the Ambulance Station and the Regional Clinical Infectious Disease Hospital. The spectrum of respiratory viruses (virus viruses, paraghirs, adenoviruses, rs-viruses), was detected by the direct immunofluorescence analysis (ELISA) in smears from the nasal mucosa in children with SLT and RSL. Results. It was found out that the cases of SLT occurred during the year with the highest rate in March and October, and with the lowest rate in the summer months. Unlike the SLT fluctuations the RSL fluctuations were less pronounced, with a peak in October and with a fall in May, July and August. Parainfluenza viruses were dominated among the pathogens identified in patients with SLT and RSL. The curve of monthly dynamic of the cases of SLT coincided with the curve of the dynamic of positive results of immunofluorescent assay on parainfluenza viruses. These data indicated a dominant role of parainfluenza viruses in the genesis of SLT. Dynamics of the cases of RSL coincided with the dynamics of parainfluenza viruses only in October (peak), and with the dynamics of all detected viruses in March (increase) and in July (decrease). There were no clear patterns between the curves of respiratory viruses and the curve of RSL in the other months. These data indicated the significant role of other factors in the development of RSL. Conclusions. Parasitic viruses play a decisive role in the genesis of SLT. The peak of the monthly dynamics of cases of RSL (October) coincided with the rise of the curve of the dynamics of the parainfluenza virus.

17-20

Authors: Kech N.

Introduction. In the opinion of scientists, the thyroid gland occupies the first place by the degree of sensitivity to the action of the negative influence of xenobiotics in a child’s organism then – the liver, lungs, kidneys and bone system. Various organs and systems are responsible for anthropogenic environmental impact. In addition to the endocrine system, the kidneys, stomach and intestines, the bone system of a child often reacts. Loss of bone mass and bone fractures lead to a decrease in the quality of life of patients and negatively affect the course of other diseases. The introduction of modern methods of assessing the structural and functional status of bone tissue in medical practice and conducting mass surveys of children in this direction made it possible to specify the age characteristics of the formation of bone tissue and the time to reach the optimal peak mass of bone mass in boys and girls, to identify factors that affect the processes of bone formation, To specify the criteria of the diagnosis of osteoporosis and to form an objective notion about the prevalence of these diseases among the children and adolescents in Ukraine Aim To examine the state of the bone system in children from ecologically clean and contaminated regions according to the ultrasonic densitometry indices. Materials and methods. During 4 years we investigated bone mineral density (BMD) in 527 children with ecologically determined bone diseases during 4 years. 287 children from ecologically unfriendly region, polluted with radiation and/or chemicals and 234 children from ecologically clean area were examined. The age of children – from 3 to 18 years, sex – 48.2 % boys and 51.8 % – girls. All children were clinically observed, instrumental (ultrasound investigation, ultrasound densitometry) and laboratory diagnostics was done. Bone mineral density and bone system degree of changes were measured by ultrasound densitometry: if BMD < 67.0 % – osteoporosis, BMD from 80.0–67.0 % – osteopenia, 100.0 ± 20.0 % – normal BMD, 120.0 % and more – osteosclerosis. Results. The frequency of osteopenic syndrome (osteopenia and osteoporosis) was higher (55.6%) in the ecologically disadvantaged region, contaminated by products of oil refining. The frequency of osteoporosis in ecologically unfriendly regions was 10-15 times higher than the frequency of osteoporosis in the control group. Conclusions. The level of BMD in children with osteopenic syndrome is significantly influenced not only by well-known causes, but also by the level of anthropogenic (technogenic) pollution of the environment.

27-31

Authors: Tarabrin O., Golubenko M., Lоshenko I.

Introduction. The system of hemostasis during pregnancy, as is known, undergoes a number of compensatory adaptive, adaptive changes, the physiological role of which consists in stopping bleeding and preventing excessive blood loss in the rocks. These changes are a unique feature of the gestational process, supported by the fetoplacental complex. At the same time, the state of hypercoagulability under the certain unfavorable conditions can lead both to the development of thrombotic complications, and to a rapid transition to the hypocoagulation stage of the disseminated coagulation syndrome. The aim of the investigation was the assessment of the efficacy of therapy with the use of the Tranexam medication in women with threatened abortion at the gestation term of 8-21 weeks, accompanied by the chorionic/placental abruption. Materials and methods. A prospective study was conducted including 38 pregnant women at the gestational age of 8-21 weeks with a threat of abortion and a diagnosed detachment of the chorion or placenta. The control group consisted of 30 women at the gestational age of 8-21 weeks with the physiological course of pregnancy. Results. It was established that pathological activation of the blood fibrinolytic activity is always observed in patients with this pathology. Inclusion of the tranexamic acid medication in the plan of the pathogenetic therapy of women with bleedings in the first and second trimesters of pregnancy with the chorionic/placental abruption is pathogenetically substantiated and necessary, and allows to achieve a rapid normalization of hemostasis, promoting the successful prolongation of pregnancy. Application of the method of low-frequency vibrating piezoelectric hemoviscosimetry allows to control the duration of therapy with tranexam acid timely and adequately as well as its adequacy and efficacy. The used scheme of application of the medication (15.0 mg/kg intravenously once, then – oral administration of 500.0 mg (2 tablets) 3 times a day for 5 days) is effective. Additional studies allow timely and adequate monitoring of the duration of treatment with tranexamic acid, its adequacy and effectiveness. In our studies there were no complications as a result of the use of tranexamic acid, which confirms the data on its safety and effectiveness. Conclusions. Selective influence of “Tranexam” on the fibrinolytic activity of the blood and the absence of effects on the vascular platelet and plasma links of the hemostasis explains the absence of thrombotic complications in its use and high clinical efficacy.

35-38

Authors: Smolyar N., Bodnaruk N.

Introduction. In the structure of diseases of graduates of preschool institutions, 37.2% occupy the illnesses of the musculoskeletal system. The obstetrician has detected more violations of the musculoskeletal system than in school-age children, but with higher percentage of underlying structural deformations. In view of this, the period of pre-school childhood is important for the formation and preservation of health. With age in bone tissue children accumulate minerals, forming “Reserve bone bank” for the future and maintaining the optimal mineral density of bone tissue (BMD) are important. The main factors in achieving the optimal bone marrow peak in childhood are the adequate level of calcium intake, its high bioavailability, adequate amount of vitamin D in the daily ration, physical activity, sexual development and peculiarities of the physical development of the child. Aim. To study and analyze the caries of temporary teeth in children with musculoskeletal system diseases. Materials and methods. In order to study and analyze this issue 357 children aged 3-6 years who were attending the specialized groups for the children with disorders of the musculoskeletal system in kindergardens were examined. The prevalence (in %), intensity (df) of caries and the degree of the caries process activity according to N. Bidenko (2005) were estimated in all of the children. Results. The following diseases of the musculoskeletal system were detected in the examined children: in 118 (33.05%) – flatulence, in110 (30.81%) – posture disturbances, in 129 (36.14%) – combined musculoskeletal diseases including chest deformity and X- or O-shaped deformation of the lower extremities.The prevalence of caries of primary teeth in children with pathology of musculoskeletal system was 87.40 ± 1.76 % with the intensity of df = 6.12 ± 0.16 of a tooth. In girls caries prevalence was much lower – 82.18 ± 2.90 % with the intensity of df = 5.95 ± 0.22 of a tooth compared with boys – 92.35 ± 1.96 % with the df = 6.30 ± 0.23 of a tooth respectively; (р1 < 0.01, р2 < 0.05). In children with combined pathologies the prevalence of caries of primary teeth is the highest and is 94.57 ± 1.10 % with intensity of caries process df = 6.47 ± 0.35 of a tooth. Conclusions. Among the children with combined pathologies of the musculoskeletal system the states of subcompensated and decompensated stages of the caries process activity (42.63 ± 4.35 % and 43.41 ± 4.36 % respectively) are significantly more common compared with the children with specific pathologies of the musculoskeletal system.

45-47

Authors: Sklyarov E., Pylypiv O., Gutor T.

Introduction. Arterial hypertension is taking one of the leading places in the structure of cardiovascular morbidity. As you know, obesity, hypodynamia, excessive intake of food salt, hypercholesterolemia, tobacco smoking, excessive use of alcohol are important among the risks of hypertension. Particular attention deserves not only the generally accepted, but also insufficiently researched predictors of development of hypertension and complications associated with it. Among such factors asymptomatic hyperuricemia should be distinguished, which is considered as an independent risk factor for cardiovascular disease. The relationship between the hyperuricemia and hypertension, obesity, kidney disease, carbohydrate and fat metabolism disorders, diabetes mellitus, insulin resistance and ovarian dysfunction were found. Aim. To investigate the dependence of the level of uric acid from the body mass index and creatinine in women and men with arterial hypertension. Materials and methods. The study involved 74 patients with hypertension (37 females and 37 males) aged 30–78 years (mean age – 59.7 ± 1.7 years). Verification of the stage and degree of the arterial hypertension was conducted on the basis of the results of the clinical and instrumental examination and according to the classifications recommended by the experts of the ETG/ETC (2007) and the Ukrainian Association of Cardiologists (2007). The degree of obesity was assessed according to the criteria of the International Diabetes Federation (IDF, 2005) on the basis of the body mass index (BMI). The BMIwas calculated using the Kettle formula: BMI = body weight (kg)/height (m)2. Among the examined patients, 9 had normal body mass, 22 were excessive, 32 were obese (grade I), 8 were obese (grade II), and 3 were obese (III grade). The mean BMI was 30.8 ± 0.7 kg/m2. For all patients were made echocardiogram, ultrasound examination of internal organs, general clinical examination, blood lipid profile, creatinine and uric acid levels determinations. Results. It was demonstrated that increased levels of uric acid were combined with the high values of BMI (r = +0.20; p > 0.05) and creatinine (r = +0.76; p < 0.05). Predicted increase of uric acid level was confirmed for 88.6 % of females. Increased levels of uric acid had a weak tendency to correlate with low BMI (r =-0.10; p > 0.05) and high concentration of creatinine in men (r = 0.06; p > 0.05). The prediction of uric acid increase was correct only for 51.9 % of cases for males. Conclusions. The method of logistic regression determines the dependence of the indicators of the level of the uric acid from BMI and creatinine level in the blood, which has tender differences. For women, there is a significant increase of the level of uric acid in the combination of large values of BMI and high levels of creatinine (correct malformation in 88.6% of cases). Instead, the feminine model was false in men.

52-56

Authors: Vares Y., Kyyak S.

Introduction. A significant percentage of intra- and postoperative complications requires the search for the new approaches to making a decision on the appropriateness and choice of methods for atypical removal of the lower third molars, namely, the definition of objective criteria for preoperative prognosis of the complexity and trauma of the surgical intervention. Searching for the new approaches in making decision for removal and giving preference to this or that method of atypical removal is forced by continuously great number of intra- and postoperative complications. One of the main issues to consider is the determination of objective methods to predict the difficulty and level of injury of surgical removal. Aim. Based on the analysis of the current publications on the issue of the diagnosis and treatment regarding the retained lower third molars, the re is proposed an author program using computer modeling of retention and operations in cases of the atypical removal of teeth. Material and methods. Taking into account previously published research results and own previous long experience on the operation of atypical removal of lower “wisdom teeth”, we initiated the creation and introduction into clinical practice of computer the programs «X-ray analyzer» for the diagnosis of the retention of lower third molars, planning and prognosing of the course of the operation on their removal and analysis of possible postoperative complications, etc., on which we have received a patent of Ukraine for utility model. Results. Hence, we created and implemented a computer program for the evaluation of the mandibular third molar impaction and planning of their atypical removal. Using this program surgeon improves preoperative evaluation of the impacted third molars, reduces operative complications, operative time, postoperative complications (in particular pain, swelling, and trismus), and consequently postoperative period after the atypical removal of mandibular third molars. Therefore besides the convenience in using of the above mentioned program in everyday practice of experienced dental surgeon, it is highly valuable assistant for young specialists and is a great way of the visualization for students during the educational process. Conclusions. Planning of the operation of atypical removal of the lower third molars requires the consideration of a number of general-somatic and local clinical characteristics, the ability to interpret the anatomical structure of the tooth and the adjacent structures on X-ray diffraction and computer tomography, prediction of all possible complications for the safe operation and avoiding complications in the postoperative period, possession with a variety of surgical techniques. The computer program we have created pays attention of dental surgeons to the most advanced characteristics at the stages of diagnosis, surgical intervention and rehabilitation period, which helps to reduce the time of operation, the number of intra- and postoperative complications.