Lviv Medical Journal (Львівський медичний часопис / Acta Medica Leopoliensia)

P.16-19

Authors: O.E. SKLYAROVA

Aim. To investigate prostaglandin E2 (PGE2) levels in patients with peptic ulcer, along with their H. pylori-status, and to determine their value in predicting gastroduodenal erosive and ulcerative lesion relapse. Methods. 62 patients with peptic ulcers at different locations were examined using esophagogastroduodenoscopy, stool tests, and immunological determination of serum prostaglandin E2 levels. Results. There were no significant differences in the PGE2 levels between patients with duodenal and combined peptic ulcers. However, the PGE2 level was significantly different between patients with gastric and combined ulcers. A significant increase in the PGE2 level was noted with healing of peptic ulcers, and there was a PGE2 level decrease during disease exacerbations. No differences in the PGE2 level by H. pylori status were found. On logistic regression analysis, the risk of peptic ulcer development was found to depend on the patient's age and PGE2 levels. Conclusions. Risk factors for peptic ulcer development included patient age and PGE2 levels. Keywords: peptic ulcer, prostaglandin E2

P.28-31

Authors: J.M. PANCHYSHYN, O.Y. KOMARYTSYA, Z.O. HUK-LESHNEVSKA, M.P. ILCHUK

Aim. Overweight and obesity are considered risk factors for gastroesophageal reflux disease, pancreatitis and pancreatic cancer, nonalcoholic steatohepatitis, and liver fibrosis, as well as predictors of low efficacy of eradication of Helicobacter pylori infection. The aim of this study was to determine the distribution of body mass index (BMI) values among patients with disorders of the digestive tract. Methods. The medical records of 115 patients treated during a one-month period in the Department of Gastroenterology were analyzed retrospectively. This cohort included patients with peptic duodenal ulcers, chronic gastritis caused by H. pylori infection, gastroesophageal reflux disease, chronic hepatitis, chronic acalculous cholecystitis, and chronic pancreatitis. The diagnoses were confirmed by conventional clinical methods. Patients were grouped by their BMI values, based on the WHO classification. Results. Both overweight and obesity were seen frequently. In the subgroup of patients with gastritis, peptic ulcer, and gastroesophageal reflux disease, the highest incidence of obesity and overweight was among patients with peptic ulcers, whereas underweight was often observed among those with gastritis (using the chi-square test). Analysis of patients with cholecystitis, pancreatitis, and hepatitis showed an equal prevalence of both overweight and obesity among persons with hepatitis and pancreatitis, while individuals with pancreatitis were more frequently obese. Conclusions. Overweight and obesity were observed in 59% of patients with disorders of the digestive tract. Higher prevalences of overweight and obesity were seen among patients with peptic ulcer compared to those with chronic gastritis. In the subgroup of patients with hepatobiliary diseases, overweight was more frequent among individuals with hepatitis, but obesity was significantly more common among patients with pancreatitis. Keywords: overweight, obesity, diseases of the digestive tract

P.5-7

Authors: R.V. KUKHLENKO

Aim. The aim of this study was to compare the cellular immune status in patients in the early recovery period following ischemic stroke with and without depressive disorders. Methods. The presence of depression in 64 patients with primary cerebral ischemic stroke of mild to moderate severity was assessed 3 months after onset using the Hamilton depression scale. The absolute and relative numbers of lymphocyte subpopulations in venous blood were evaluated by immunofluorescent indirect reaction with monoclonal antibodies. Results. In poststroke patients with depression, there was a relative increase in CD4+ lymphocytes, an increase in the absolute and relative numbers of cytotoxic CD8+ lymphocytes, a reduction of the immunoregulatory index, and an increase in the number of mature B-lymphocytes (CD19+). However, the percentage of mature B-lymphocytes did not change significantly. Conclusions. The observed changes show signs of a chronic humoral inflammatory response.

P.44-50

Authors: O.Yu. RODYCH

Aim. To further optimize perinatal care in the three northwestern regions of Ukraine, it is necessary to predict the distribution of the rate of low birth weight in these areas. Methods. Anonymized primary data about the number of infants born with low birth weight (<2500 g) were examined in three regions from 2001 to 2010. Data were obtained from the "Register of infants" and according to the "Notice of birth and screening for the presence of birth defects" data for the last 10 years. The total sample size was 3329 newborns. The analysis included infants with low birth weight (<2500 g). Exclusion criteria were: stillborn, newborn with unknown sex, and babies with birth defects. Predictions were performed using the exponential smoothing method of Holt with two parameters. Results. The number of infants with low birth weight (under 2500 g) in Rivne and Volyn regions, with other things being equal, showed a clear tendency to increase in the short term. In Khmelnytsky region, there was a clear trend for an increase only among boys, while among girls, a decrease is expected. In the short term, the absolute number of boys with low body weight will increase by 23.6% in Rivne region, by 29.0% in Volyn region, and by 36.0% in Khmelnytsky region. Thus, in 2016 compared with the last analyzed period, there is expected to be a decrease of 0.82% in the proportion of girls with low birth weight among all girls born. Conclusions. Among the three regions analyzed, the number of girls with low birth weight is forecast to decrease only in Khmelnytsky region, whereas in Rivne and Volyn regions, it is expected to increase. At the same time, the number of boys born with low birth weight is expected to increase in all regions analyzed. These results are useful for the optimization of perinatal care in Rivne, Volyn, and Khmelnytsky regions. Keywords: low birth weight, forecasting, perinatal care

P.56-61

Authors: R.I. BILOBRYVKA

Aim. To demonstrate that life is eternal and consists of halfbirths and death. Methods. Phenomenological analysis of modern and ancient philosophical treatises. Results. Consciousness cannot be interpreted as a physiological process of the brain, since it is impossible to reduce human activity to anatomy and physiology. One of the most significant determinants of life in every self-conscious being is death. According to Heraclitus "The Strength of Mind is outside the body." In the opinion of the contemporary philosopher A. Maneev, a structure that generate ideas is a biological field, "field formation of biosystem." Thereafter, all lifetime experiences of a person, everything that happens to him or her, is fixed in a biofield and stored in the form of original holograms. This is how the Eastern Tradition understands Death: it is a decomposition, which is possible only for things that are a result of composition, and a soul is not a result of composition, it is alone, separated from mind and body, so it cannot be decomposed, it cannot die. According to Nobel laureate J. Eccles, the output reality in my perception of myself cannot be identified with brain, neurons... ... I cannot believe the experience of consciousness doesn't have another elongation... ... in any case, I claim a possibility of future being that cannot be rejected on a scientific basis. The subject of immortality of the soul permeates all Christian doctrine. We can also find a belief in the afterlife, the possibility of achieving immortality, in all nations, at all times. In particular, it is written in the Tibetan and Egyptian Books of Death. The ancients shared the same opinions, including Buddha, Plato, Descartes, Leibniz, Spinoza, Pythagoras, Heraclitus, and Aristotle. Nevertheless, to consider death, life, and birth, we assume that we live in a dual world, where all the phenomena and things have their opposites, and the transition in the opposite occurs through a point called "zero", or what is standing between them. Thus in the case of our three, the opposites are birth and death, and life is that uniting zero, the edges of which are birth and death, so that life is continuous, therefore eternal. Conclusions. Life is eternal and manifests in our consciousness in the form of birth and death; we are coming into the world and dying every moment. Keywords: life, birth, death

P.67-75

Authors: K.V. BARANNIKOV, Ya.B. SHVYDKYY, I.M. TUMAK, N.O. LUKAVETSKY

Aim. Gastric polyps are common on endoscopy and can be malignant or premalignant lesions. In contemporary papers, the views on their pathogenesis, histological interpretation, and treatment have changed significantly. Methods. 42 recent papers that sufficiently elucidated the prevailing positions and clinical guidelines for the diagnosis, interpretation, and treatment of gastric polyps were reviewed. Conclusions. The evaluation of patients with gastric polyps includes careful examination of the entire stomach, with multiple biopsies from polyps as well as remote gastric mucosa, because underlying gastritis may lead to focal dysplasia without polypoid lesions. The risk of carcinogenesis in fundal gland polyps is low; they rarely need treatment, but they can be markers of familial adenomatous polyposis. Keywords: gastric polyps, morphology, endoscopy, polypectomy, gastric cancer

P.86-93

Authors: Ya.Ye. BOYKO

Aim. Autoimmune syndromes are rare congenital diseases, characterized by relapsing fever and systemic inflammatory symptoms involving serous membranes, skin, and joints. The pathogenesis of these syndromes is related to congenital changes in the immune system leading to chronic inflammation. The study of changes in the immune system in patients with cryopyrin-associated syndromes enables exploration of chronic inflammation, which plays a principal pathogenic role in patients with systemic juvenile arthritis. Two patients with CAPS-group diseases (Familial Cold Urticaria and CINCA-syndrome) and their cytokine profiles are presented. Methods. In two patients with CAPS-group diseases, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-17, and IFN-γ cytokine levels were studied, along with their soluble receptors and agonists: interleukin 1 receptor agonist (IL-1Ra), soluble receptors to interleukin 2 (sCD25), interleukin 6 (sIL6R), and tumour necrosis factor (sTNFR1). Genetic investigations were performed in the clinical laboratory of Dresden Children's Hospital (Germany). Results. Clinical and immunological data of two patients with cryopyrin-associated periodic syndromes (CINCA-syndrome (Chronic Inflammatory Neurological Cutaneous Articular Syndrome) and Familial Cold Urticaria) are presented. Conclusions. Cryopyrin-associated syndromes resemble the clinical picture of juvenile rheumatoid arthritis. The cytokine profile of cryopyrin-associated syndromes shows increased IL-1, IL-6, and IL-1Ra levels, which reflect changes in congenital immunity. Keywords: cryopyrin-associated periodic syndromes, cytokines

8-14

Authors: V.I. KOVALYSHYN, O.D. LUTSYK, Y.H. KYYAK, O.Y. BARNETT, Ch.I. KOZAK, H.Y. KYYAK, S.V. FEDEVYCH

Aim. To determine whether it is possible to diagnose hibernating myocardium in ischemic heart disease by light microscopy of biopsies and express necropsies of myocardium stained with PAS (using the Schiff reaction). Methods. Semithin and ultrathin sections of biopsies taken during surgical interventions and express necropsies of human myocardium in ischemic heart disease, as well as biopsies of rat livers and of the wall of the left ventricle of rat myocardium, were fixed in 2% osmium tetroxide in 0.1 M phosphate buffer (pH 7.36) and then embedded in epone and araldite. Semithin sections of human myocardium and rat liver and myocardium were stained with PAS and analyzed by light microscopy with a digital camera. Ultrathin sections of human myocardium stained with uranyl acetate and lead citrate were also analyzed by transmission electron microscopy. The modified Schiff reaction was performed on semi-thin sections of the myocardial biopsies during surgical interventions for ischemic heart disease. Tissue samples were fixed in 2% osmium tetroxide and embedded in epone and araldite. Results. The red-pink color of the Schiff reaction was seen where glycogen granules accumulated in cardiomyocytes and the interstitium of hibernating myocardium. Ultrastructural studies confirmed that the light microscopically evaluated positive Schiff reaction (a red-pink colour) represented glycogen granule deposition in cardiomyocytes and the interstitium in ischemic heart disease. Conclusions. For the diagnosis of hibernating cardiomyocytes, which represent carbohydrate dystrophy with α- and β-glycogen accumulation in areas of sarcoplasm destruction, the Schiff reaction can be applied instead of using electron microscopy. In the presence of glycogen granules in the interstitium, the Schiff reaction facilitates the diagnosis of cardiomyocyte necrosis on the basis of the red-pink colour of the myocardial stroma. Most of the PAS intensities in cardiomyocytes and in the myocardial interstitial areas that approach the areas of necrotic cardiomyocytes with glycogen granule accumulation in the myocardial stroma and cicatrization were confirmed by ultrastructural examination for the presence of irreversible hibernating cardiomyocytes in ischemic heart disease. Keywords: myocardium, cardiomyocyte, ischemic heart disease, hibernation, necrosis, Schiff reaction (PAS)