Lviv Clinical Bulletin

8-11

Authors: Ivaniv Y., Lozynska N., Ivaniv I.

Introduction. Bicuspid aortic valve (BAV) is a widespread structural anomaly of the heart that occurs at a frequency of 0.9-1.5% in the general population. As usual, this feature of the structure of the valve is combined with the expansion of the ascending part of the aorta. However, the degree of dilation of the aorta does not correspond to the severity of the valve function disorder. In many studies, it is emphasized that in persons with BAV the elastic properties of the proximal aorta are significantly reduced. This can be explained by the fact that the genetic defect, through which the BAV is formed, is also responsible for the dilatation of the root of the aorta. The analysis of the pedigree of individuals with BAV indicates the family prevalence of this heart disease with the auto-dominant inheritance of inheritance and reduced penetrance. According to various sources, among the relatives of the first degree (FDR) of affinity the prevalence of BAV is 9.0-21.0%. However, there is no convincing information that would confirm the hereditary nature of the onset of aortic aneurysm in these individuals. If this is true, then even those relatives of persons with BAV who have a normal valve of the aorta of a tricuspid structure should have some hidden signs of pathology of the aortic root that are not clinically detected, but in the case of acute or chronic hemodynamic overload (for example, arterial hypertension ) can cause aneurysm of the aorta or even its dissection. Aim. To find out whether close relatives of patients with bicuspid aortic BAV with aortic valve of the normal tricuspid formulation have hidden changes in the ascending aortic region based on studying its diameter at different levels and elastic properties of the aorta, both in patients with BAV and their FDRs with the normal aortic valve, comparing the appropriate parameters with the control. Materials and methods. The study included 36 adults (14 women, 22 men) aged 18 to 56 years old with BAV who underwent echocardiographic examination during 2009-2013. In addition, their FDRs were invited to a survey, of which 68 individuals (28 women, 40 men aged 18-62). Of these, 8 patients (12.0%) also had BAV. So, the aortic root diameters on four levels and distensibility index have been examined in 44 patients with BAV, their 60 FDRs with normal aortic valve and 40 healthy subjects. Results. It was revealed that FDRs have significantly bigger indexed diameter of aortic annulus in comparison with the controls (1.740 ± 0.031 сm/m VS 1.600 ± 0.019 сm/m) and diameter of sinuses of Valsalva (2.780 ± 0.019 cm/m VS 2.200 ± 0.018 сm/m). Also both FDRs and BAV s have significantly lower aortic distensibility (1.28 ± 0.26 and 1.47 ± 0.31 mm Hg•10–3) than the controls (3.32 ± 0.29 mm Hg•10–3). Conclusions. So, the aortic root in FDRs of patients with BAV is wider and demonstrates functional abnormality with potential pathological meaning in a future.

17-22

Authors: Ilnуtskуy G.

Introduction. In many countries of the world, including in Ukraine, the epidemiological situation with tuberculosis in patients is unfavorable and indicates an increase of the main epidemiological indicators (illness, prevalence, mortality, infectivity), as well as the difficulties of its diagnosis, treatment and prevention. An important component of high-quality tuberculosis control at the present stage is a comprehensive monitoring of epidemiological parameters, using not only the generally accepted statistical criteria, but also modern information technologies for the recording and creating a data bank that enables to objectivize individual indicators as fully as possible and to work out the quality programs of anti-tuberculosis care to the population. Aim. To study the epidemiological situation on tuberculosis in the patients of different age groups based on the analysis of digital criteria for the random evaluation of official statistics materials for the period 2000-2009 in Ukraine in general and in the Lviv region. Materials and methods. Owing to the computer and informational technologies a selective assessment of the tuberculosis disease in different age groups was carried out. For this purpose the annual reporting forms provided by the Ministry of Health of Ukraine, the results of the proper observations and the data of the bank of information accumulation system MS Excel have been used. The starting positions were formed taking into account the epidemical indexes in Ukraine and Lviv region during the decade (2000–2009), which, taking into consideration different primary characteristics, was divided into two stages. The first stage (2000–2004) was indicating a progressive deterioration of the epidemiological situation on tuberculosis and in the second (2005–2009) a relative stabilization of the disease was stated. The results were processed with the use of the statistical and mathematical functions of the MS Excel, parametric and nonparametric, for the establishing of the correlational relation assessing the dynamics of epidemiological parameters. Results. The dynamical observation of tuberculosis infection among adolescents in Ukraine showed an increase (from 29.2 to 34.9 per 100 thousand adolescents) of this indicator in 2000-2004, followed by a downward trend in 2005-2009 (from 34.9 to 31.2 per 100 thousand teenagers). In Lviv region, the results of the first observation period (2000-2004) showed an unstable fluctuation of this indicator (from 39.1 to 29.8 per 100 thousand adolescents) with a further significant decrease (from 27.2 to 14.2 per 100 thousand adolescents) in the second observation period (2005-2009). In Ukraine, the average rate of tuberculosis in adolescents (31.7 ± 1.9) exceeded this rate in children (9.1 ± 0.7). In adults, it was lower and equaled 96.8 ± 2.2. The average rate of tuberculosis in Lviv region among the adolescents (26.7 ± 9.8) was higher than in children (6.7 ± 0.5) and lower than in adults (72.9 ± 2.3) per 100 thousand population. The prevalence of the tuberculosis among the adolescents in Ukraine for the first time in relation to the adult population was stable, followed by a slight downward trend (from 2.3 to 1.8%) both in 2000-2004, and in 2005-2009 (from 1 , 8 to 1.7%). In Lviv region, the rate of decline in the percentage of tuberculosis among the adolescents was more pronounced (from 2.8 to 1.6%) during the first and (from 1.6 to 0.8%) during the second stage of observation. The incidence of tuberculosis in Ukraine among the adolescents from the centers of tuberculosis infection was 10.3 ± 0.3 per 1000 contacts, which is 2.1 times lower than in children (4.9 ± 0.2) and 1.8 times lower than in adults (4.3 ± 0.1). Сonclusions. The level of the average incidence of tuberculosis in Ukraine significantly exceeded that in Lviv region, regardless of the age of the population. At the same time, the incidence of the morbidity due to the tuberculosis grows in the Lviv region in children, teenagers and adults, which justifies the necessity of the implementation of the preventive and curative actions of a higher quality.

27-30

Authors: Markin L., Popovych A., Shatylovych K.

Introduction. Asymptomatic bacteriuria (AB) refers to the category of pathological conditions that are caused by the infection of the urinary tract and are in particular importance for pregnant women, as in the case of late diagnosis or inadequate treatment in 20.0–40.0 % of cases they realizes in gestational pyelonephritis and becomes one of the factors of the development of intrauterine infection. Aim. To study the results of the use of Nefrokea in the treatment of AB in pregnant women. Materials and methods. The study group was made up of 60 women for whom, during the first trimester of pregnancy, during the first visit to the physician, the bacteriological examination of the urine received by the catheter was made and showed an increase of bacterial cultures in the urine (≥ 105 CFU/ml), on the basis of which it was diagnosed AB. The study group included 30 patients who, after the diagnosis of AB, took amoxicillin (500.0 mg twice daily for 5-7 days) and Nefrokea (1 tablet per day for 30 days). To compare clinical results, a control group of 30 pregnant women with AB, who was prescribed antibiotic therapy, was created. At the end of treatment, a urine culture study was performed, after what nephrologist and therapist conducted a clinical examination. Results. The efficacy of AB treatment during the pregnancy in this study was evaluated within 4-12 weeks from the time of diagnosis and onset of treatment. The results showed in the study group the normalization of the results of bacteriological and general urine analysis after the first course of treatment in 73.3% of pregnant women (in the control group – 63.3% of pregnant women, which is almost 1.2 times less). At the same time, the results of fetometry showed that the size of the fetus was normal for a gestational period (16-18 weeks), and during the echography of the kidney of pregnant women, no pathological changes were recorded. 26.7% of the patients in the main and 36.7% of the controls revealed the recurrence of the AB and prescribed a re-treatment course according to the abovementioned schemes. The use of Nefrokea’s herbal compound in the complex treatment of pregnant women with AB showed its high efficacy, good tolerability, reduction in the incidence of gestational pyelonephritis by 2.5 times, other obstetric complications (fetal growth retardation syndrome, premature births) twice. Taking into account the high incidence of urinary tract infections during the second trimester of pregnancy, we consider that it is advisable to prescribe Nefrokea to women with diabetes mellitus with 11-12 weeks of pregnancy with a preventive and curative purpose. Conclusions. The usage of the herbal remedy Nefrokea in the treatment of asymptomatic bacteriuria helpes to reduce the incidence of pyelonephritis and associated obstetric complications.

36-38

Authors: Zerbino D.

Introduction. Each disease consists of predictors, symptoms, syndromes, which form the signs of the disease. However, the syndrome is not identical with the disease, it is not a nosological unit. It can be a manifestation of various diseases. Syndrome is a collection of different symptoms. Often syndromes are present in the nosological form. And it is unlikely that in the doctrine of nosology to “open” new syndromes, including several known diseases. Aim. To discuss the problem of transformation of nosological forms into syndromes in medical practice. Materials and methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of studying the actual scientific opinions of scientists about the doctrine of the diagnose, the problems of transformation of nosological forms into syndromes, some new tendencies of formulation, completeness of the diagnoses were used. Results. The structure of the diagnosis was developed by Ukrainian pathologists in the second half of the last century. The expanded diagnosis – both clinical and pathologoanatomic – is based on a certain principle. At the centre of it are causal relationships. The full diagnosis is: the underlying disease, the complication of the underlying disease, and concomitant diseases. Several logical tendencies can be singled out in the wording in modern clinical practice. The first trend is the combination of several diseases into the syndrome, the second – the transfer of the symptom into the syndrome, the third trend – the obvious complication of treatment is called syndrome, the fourth – the desire to combine several diseases in one, replacing, for example, the well-known complication of a disease (lack of organs’ function), giving this complication a “new”, generalized “disease”, the fifth – comorbidity – the real situation when two or more syndromes or nosological forms are detected in the same patient. Full “diagnose should be nosological, etiologic, pathogenic and “historical”, that is to reflect the disease in the form of a consistent causally caused change in its various stages. It is a document that presents the history of the disease in a concretised, most concise statement. Conclusions. The concept and doctrine of the diagnoses for foreign clinicians are obviously not known. We do not know the theoretical justification of new foreign trends in constructing of the diagnose. And moreover, we emphasize, it is unlikely that the syndrome-molecular approach can contribute to nosological statistics, the search for primary prevention, and the resolution of the problems of preventive medicine.

43-51

Authors: Abrahamovych U., Abrahamovych M., Drobinska N.

Introduction. One of the topical issues of clinical medicine is the effective providing of help to patients with syntropic and polymorbid lesions, among which special attention is paid to patients with diffuse connective tissue diseases (DCTD), primarily with systemic lupus erythematosus (SLE) and syntropic involvement of the liver into the pathological process. In this sense, the role of TORCH infection deserves the special attention, as there is a fragmentary information that some representatives of this group may also have an effect on the DCTD, in particular, the SLE, and liver diseases, which gives the basis to assume the possibility of their participation in the pathogenesis of syntropic co- and polymorbid lesions of organs and systems. Aim. Analysis of scientific literature and a description of a clinical case to highlight the role of TORCH infection in the syntropic lesions of the liver in patients with SLE. Materials and methods. The results of scientific works are analyzed, an example of a clinical case concerning the possible participation of TORCH infection in syntropic affection of the liver of the patients with SLE is given. Results. Summarizing a retrospective analysis of the sources of scientific data, we can say that the majority of the representatives of TORCH-complex may be related to the diffuse connective tissue diseases, in particular SLE, and also to liver diseases. This gives grounds for suggesting the possibility of their participation in the pathogenesis of syntropic co- and polymorbid damages of the organs and organ systems. Methods of laboratory diagnosis occupy a central place in the detection of TORCH infection altogether, and their application requires the appropriate tactics. Today, the defining tests of microbiological diagnosis of TORCH infections are the ELISA and the polymerase chain reaction (PCR) method. Today, in world practice, there are no unified recommendations not only for diagnostic schemes, but also for the treatment of liver lesions in patients with SLE infected with TORCH infection, and doctors of all specialties have some difficulties in assisting such patients. The success of treating of TORCH infections in patients with liver damage can be achieved only if it is comprehensive, individualized for each patient and as safe as possible method. The clinical case describes the importance of diagnosing the TORCH-infection in SLE patients with syntropic liver damage. Conclusions. The information received on TORCH infection in patients with SLE and syntropic liver diseases does not allow to determine definitively whether it is the cause of one of the trigger mechanisms, whether it participates in the pathogenesis of comorbid lesions, if so, in what form, or it is an intercurrent infection. So, the information mentioned above indicates the relevance of the problem, that requires a comprehensive solution through the development of an adequate diagnostic and treatment algorithm for patients with SLE considering the possible presence of the TORCH infection and the involvement of liver into the pathological process.

56-62

Authors: Faynyk A., Faynyk M.

Introduction. According to the President of the European Congress of Cardiologists (European Society of Cardiology, ESC) Professor Panos Vardasa, despite the progress of medicine, the diseases of cardiovascular system is now the number one killer of the population of Europe. Clinical trials based on the clinical practice and guidelines were presented at the annual European Congress of Cardiologists in Amsterdam. Aim. To conduct a description and discussion of current successes and evidence of the results of the European Congress of Cardiologists in Amsterdam (30.08-04.09.2013). Materials and methods. Information is provided on the results of the European Congress of Cardiologists in Amsterdam (30.08 – 04.09.2013). The description of clinical trials and updated recommendations on the diagnosis, treatment and prevention of the diseases of the cardiovascular system, including arterial hypertension and cardiovascular disease in patients with diabetes mellitus and pre-diabetes. Results. Among a number of important issues presented during the Congress there were published the results of such studies: HOKUSAI-VTE – using of anticoagulant edoxaban per os for the treatment of venous thromboembolism showed the equal efficacy but better tolerability and safety as compared with warfarin for the primary purpose of low molecular heparin; TASTE – aspiration of blood clots and clots that cause heart attack before opening the artery balloon does not improve the survival compared to using only a balloon dilation or stenting without aspiration; ECHOCRT – the results confirmed the underlying principles that cardiac resynchronization treatment should not be performed for the patients with a narrow QRS complex; DECAAF – the results showed that in patients with atrial fibrillation magnetic resonance imaging prior to ablation allows to determine the extent of damage of the heart tissue. PRAMI – the primary endpoint was the combined death from the cardiac causes, nonfatal myocardial infarction or refractory angina in patients with STEMI and concomitant hemodynamically significant stenosis of the coronary arteries. In addition stenting of the infarct-dependent coronary arteries in all patients with acute elevation of ST-segment, additional preventive coronary artery stenting in the experimental group with hemodynamically significant stenosis showed the significant preference (p <0.001) of such treatment. The Congress also published the first findings on the elimination of the negative impact of lifestyle in the secondary prevention of cardiovascular diseases. At the Congress in Amsterdam there were also presented new recommendations – Recommendations of the European Society of Cardiologists and the European Society of Hypertension on the diagnosis, treatment and prevention of arterial hypertension and Recommendations for the prevention, diagnosis and treatment of cardiovascular disease in patients with diabetes and pre-diabetes. Conclusions. Presented description of the clinical trials and new guidelines for the diagnosis based on their findings, treatment and prevention of the cardiovascular diseases, especially arterial hypertension and cardiovascular diseases in patients with diabetes mellitus and pre-diabetes were provided that must be taken into account in the usual practice of a doctor.