Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.052
R. Kovalchuk, U. Bahan
Introduction. Acute coronary syndrome, in particular acute ST-elevation myocardial infarction (STEMI), is often accompanied by complex hemodynamically significant arrhythmias and conduction disorders. Such patients have a worse prognosis compared to patients with sinus rhythm. Arrhythmias in patients with STEMI are facilitated by the presence of comorbidities such as arterial hypertension, diabetes mellitus, obesity, and post-COVID-19 syndrome. The aim of the study. To elucidate the nature of arrhythmias in patients with acute STEMI induced by various risk factors during the first day after myocardial reperfusion by primary percutaneous coronary intervention. Materials and methods. The study involved 50 patients aged 45 to 83 years (average age – 63,4 ± 9,6 years; men – 70,97 %, women – 29,03 %), who were treated during 2021-2023 at the cardiology and reperfusion therapy department of Cardio-vascular center of ʺSaint Panteleimon Hospital in Lvivʺ and the infarction department of ʺLviv Regional Clinical Cardiological Centerʺ. The patients under investigation were subjected to daily electrocardiogram (ECG) monitoring for 24 hours after stenting of the infarct-related coronary artery, using a 7-channel ECG recorder Solvaig 06000.7 with computer processing of the recording using the DiaCard2 software. The obtained material was further subjected to software packages Microsoft Excel 2022, Statistica 10. Results. It was established that among supraventricular rhythm disturbances the most common were premature contractions, the average number of which per patient was significantly higher in the presence of obesity. Similarly high it was in post COVID-19 patients, as well as in those with hypertension. In post-coronavirus infection and in hypertension cases, extrasystoles were often in the form of pairs, triplets, bigemia, and trigemia; paroxysms of supraventricular tachycardia were also recorded in these patients. Among the ventricular arrhythmias also the most frequent were premature cardiac contractions, significantly more oftenly recorded in patients with hypertension and those experienced COVID-19; only in these patients were documented extrasystoles in the form of pairs, triplets, bigeminy, trigeminy, runs of ʺR to Tʺ, which are currently considered as harbingers of life-threatening ventricular arrhythmias. In the presence of hypertension and post-COVID-19, episodes of unstable ventricular tachycardia were also observed. Conclusions. In patients with STEMI, both supraventricular and ventricular premature contractions and episodes of supraventricular and unstable ventricular tachycardia are quite common during the first day after primary percutaneous coronary intervention with infarct-related coronary artery stenting, which is evidence of myocardial electrical instability. The nature of rhythm disturbances in the presence of hypertension and post-COVID-19 is prognostically unfavorable and indicates a higher risk of lifethreatening arrhythmias in thes
{"title":"Arrhythmias in patients with acute ST-elevation myocardial infarction induced by various risk factors during the first day after myocardial reperfusion by primary percutaneous coronary intervention","authors":"R. Kovalchuk, U. Bahan","doi":"10.25040/lkv2023.03-04.052","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.052","url":null,"abstract":"Introduction. Acute coronary syndrome, in particular acute ST-elevation myocardial infarction (STEMI), is often accompanied by complex hemodynamically significant arrhythmias and conduction disorders. Such patients have a worse prognosis compared to patients with sinus rhythm. Arrhythmias in patients with STEMI are facilitated by the presence of comorbidities such as arterial hypertension, diabetes mellitus, obesity, and post-COVID-19 syndrome. The aim of the study. To elucidate the nature of arrhythmias in patients with acute STEMI induced by various risk factors during the first day after myocardial reperfusion by primary percutaneous coronary intervention. Materials and methods. The study involved 50 patients aged 45 to 83 years (average age – 63,4 ± 9,6 years; men – 70,97 %, women – 29,03 %), who were treated during 2021-2023 at the cardiology and reperfusion therapy department of Cardio-vascular center of ʺSaint Panteleimon Hospital in Lvivʺ and the infarction department of ʺLviv Regional Clinical Cardiological Centerʺ. The patients under investigation were subjected to daily electrocardiogram (ECG) monitoring for 24 hours after stenting of the infarct-related coronary artery, using a 7-channel ECG recorder Solvaig 06000.7 with computer processing of the recording using the DiaCard2 software. The obtained material was further subjected to software packages Microsoft Excel 2022, Statistica 10. Results. It was established that among supraventricular rhythm disturbances the most common were premature contractions, the average number of which per patient was significantly higher in the presence of obesity. Similarly high it was in post COVID-19 patients, as well as in those with hypertension. In post-coronavirus infection and in hypertension cases, extrasystoles were often in the form of pairs, triplets, bigemia, and trigemia; paroxysms of supraventricular tachycardia were also recorded in these patients. Among the ventricular arrhythmias also the most frequent were premature cardiac contractions, significantly more oftenly recorded in patients with hypertension and those experienced COVID-19; only in these patients were documented extrasystoles in the form of pairs, triplets, bigeminy, trigeminy, runs of ʺR to Tʺ, which are currently considered as harbingers of life-threatening ventricular arrhythmias. In the presence of hypertension and post-COVID-19, episodes of unstable ventricular tachycardia were also observed. Conclusions. In patients with STEMI, both supraventricular and ventricular premature contractions and episodes of supraventricular and unstable ventricular tachycardia are quite common during the first day after primary percutaneous coronary intervention with infarct-related coronary artery stenting, which is evidence of myocardial electrical instability. The nature of rhythm disturbances in the presence of hypertension and post-COVID-19 is prognostically unfavorable and indicates a higher risk of lifethreatening arrhythmias in thes","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"23 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512703","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}
Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.045
T. Telehina, O. Zinchuk
Introduction. Leptospirosis is one of the most common zoonoses in the world, pathogenesis of which is based on the damage of vascular endothelium. Violation of endothelial functions leads to damage of these cells plasma membranes, loss of vascular integrity, ischemia, necrosis, and, finally, the development of organ dysfunction. In current literature there is sparce information concerning endothelial dysfunction in patients with leptospirosis, therefore the development and standardization of methods for the assessment of vascular endothelium imbalance in patients with leptospirosis of different severity degrees is an urgent task. Detection of endothelin-1 (ET-1) one of the best markers of endothelial dysfunction, can become an important tool for predicting the severity of the disease. The aim of the study. To investigate ET-1 indices in patients with leptospirosis of different severity degrees and to estimate their changes after the seven-day treatment. Materials and methods. ET-1 content in the blood serum of patients with diagnosed leptospirosis was detected by ELISA method. Absolute values were compared using Mann-Whitney test (U-test); the results were statistically processed using Fisher’s bilateral test (F-test). Correlation analysis was carried out according to Spearman’s method. The difference was considered statistically significant with p less than 0.05. Results. ET-1 content was detected at time of hospitalization and after 7 days of leptospirosis treatment. Patients (n = 43) were divided into two groups depending on the severity of leptospirosis course: the first group with a moderate course included 21 patients; second group with a severe course included 22 patients; the control group consisted of 20 healthy individuals. Both groups of leptospirosis affected patients demonstrated significantly higher ET-1 concentration in comparison with the control group (p less than 0.01). Moreover, the proportion of patients with high (more than 5.5 pg/ml) concentration of ET-1 in the blood post the 7 days treatment was documented in 13.3% patients of the first group, and 43.8 % patients of the second group (p less than 0.05). It was also estimated that in both groups patients 7 days treatment of leptospirosis induced a credible increase in the concentration of ET-1 (p less than 0.05). Conclusions. Our results claim that at time of hospitalization and after 7 days treatment both groups of leptospirosis affected patients demonstrated significantly higher level of ET-1 in comparison to control group individuals (p less than 0.01). 7 days of leptospirosis treatment caused a credible enhancement of ET-1 content (p less than 0.05). Patients with a severe course of leptospirosis after 7 days treatment exposed significantly higher ET-1 concentration compared to patients with moderate course (p less than 0.05).
{"title":"Endothelin-1 indices in patients with leptospirosis of various severity degrees and their changes under the influence of seven-day treatment","authors":"T. Telehina, O. Zinchuk","doi":"10.25040/lkv2023.03-04.045","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.045","url":null,"abstract":"Introduction. Leptospirosis is one of the most common zoonoses in the world, pathogenesis of which is based on the damage of vascular endothelium. Violation of endothelial functions leads to damage of these cells plasma membranes, loss of vascular integrity, ischemia, necrosis, and, finally, the development of organ dysfunction. In current literature there is sparce information concerning endothelial dysfunction in patients with leptospirosis, therefore the development and standardization of methods for the assessment of vascular endothelium imbalance in patients with leptospirosis of different severity degrees is an urgent task. Detection of endothelin-1 (ET-1) one of the best markers of endothelial dysfunction, can become an important tool for predicting the severity of the disease. The aim of the study. To investigate ET-1 indices in patients with leptospirosis of different severity degrees and to estimate their changes after the seven-day treatment. Materials and methods. ET-1 content in the blood serum of patients with diagnosed leptospirosis was detected by ELISA method. Absolute values were compared using Mann-Whitney test (U-test); the results were statistically processed using Fisher’s bilateral test (F-test). Correlation analysis was carried out according to Spearman’s method. The difference was considered statistically significant with p less than 0.05. Results. ET-1 content was detected at time of hospitalization and after 7 days of leptospirosis treatment. Patients (n = 43) were divided into two groups depending on the severity of leptospirosis course: the first group with a moderate course included 21 patients; second group with a severe course included 22 patients; the control group consisted of 20 healthy individuals. Both groups of leptospirosis affected patients demonstrated significantly higher ET-1 concentration in comparison with the control group (p less than 0.01). Moreover, the proportion of patients with high (more than 5.5 pg/ml) concentration of ET-1 in the blood post the 7 days treatment was documented in 13.3% patients of the first group, and 43.8 % patients of the second group (p less than 0.05). It was also estimated that in both groups patients 7 days treatment of leptospirosis induced a credible increase in the concentration of ET-1 (p less than 0.05). Conclusions. Our results claim that at time of hospitalization and after 7 days treatment both groups of leptospirosis affected patients demonstrated significantly higher level of ET-1 in comparison to control group individuals (p less than 0.01). 7 days of leptospirosis treatment caused a credible enhancement of ET-1 content (p less than 0.05). Patients with a severe course of leptospirosis after 7 days treatment exposed significantly higher ET-1 concentration compared to patients with moderate course (p less than 0.05).","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"32 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512320","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}
Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.029
G. Lavryk, I. Tymchuk, T. Rumynska, S. Pavli, G. Herych, O. Korniychuk, A. Fedets
Introduction. During the war that has been going on in Ukraine for two years, the number of patients with mine-blast injuries has increased dramatically. The issue of wound colonization by resistant microorganisms and modification of their species spectrum, which increases during the evacuation of victims to various medical facilities, is of great importance. At the third stage of wounded military personnel evacuation 87.7 % of wounds were occupied by gram-negative bacteria in the form of monoculture, including strains of Pseudomonas aeruginosa and Klebsiella pneumoniae with multidrug resistance, which have a high potential for adaptation in hospital conditions. The aim of the study. To investigate the frequency of infection with Klebsiella and Pseudomonas of mine-blast wounds at the third stage of evacuation, to determine the spectrum of their resistance, sensitivity to antimicrobial drugs, and to present general recommendations for military medical care. Materials and methods. The material from purulent wounds was taken from victims with mine-blast injuries who were admitted for inpatient treatment to the surgical department. The sampling was carried out with sterile swabs with transport nutrient medium. The material was inoculated on blood agar, Endo medium, CHROMID® P. Aeruginosa Agar, MPA and incubated at 37°C for 24 hours. Biochemical identification was performed using the Enterotest 24 and Nefermtest 24 test systems (Lachema, Czech Republic). Antimicrobial susceptibility testing was performed using the Kirby-Bauer method and the determination of the minimum inhibitory concentration (MIC) using broth microdilutions according to the recommendations of the European Committee for the Antimicrobial Susceptibility Testing (EUCAST 2023). Healthcare-associated infections (HCAI) among the wounded servicemen were diagnosed according to the updated MoH Order No. 1447. Results. K. pneumoniae and P. aeruginosa were isolated from the wounds of 38 examined mine-blast injured patients. Out of these 17 (44.7 %) patients had P. aeruginosa; in 9 patients both pathogens were in association; in 2 patients P. aeruginosa was isolated in pure culture; in the remaining cases P. aeruginosa was in association with other microorganisms. Quantitatively, the bacteria were isolated in the range of 106-109 colony forming units (CFU/ml) of pathogen in the patient’s wound contents. In wounded servicemen, infectious wound complications appeared later than the 3-rd day of hospital stay, so they were classified as HCAI. 33.3 % and 22.2 % of K. pneumoniae isolates demonstrated susceptibility to amikacin and imipenem, respectively. Moderate susceptibility of P. aeruginosa to amikacin was detected in 29.4 % of isolates, and to ticarcillin-clavulanate – in 23.5 %. 41.2 % of P. aeruginosa isolates demonstrated sensitivity to piperacillin-tazobactam, 23.5 % – to imipenem, and 11.8 % – to ceftazidime. No significant difference was detected between the susceptibility of Pseudomonas a
{"title":"Infection with klebsiella and pseudomonas in mine-blast wounds: frequency of their isolation at the third stage of evacuation; spectrum of their resistance; sensitivity to antimicrobial drugs; general rules of military medical care","authors":"G. Lavryk, I. Tymchuk, T. Rumynska, S. Pavli, G. Herych, O. Korniychuk, A. Fedets","doi":"10.25040/lkv2023.03-04.029","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.029","url":null,"abstract":"Introduction. During the war that has been going on in Ukraine for two years, the number of patients with mine-blast injuries has increased dramatically. The issue of wound colonization by resistant microorganisms and modification of their species spectrum, which increases during the evacuation of victims to various medical facilities, is of great importance. At the third stage of wounded military personnel evacuation 87.7 % of wounds were occupied by gram-negative bacteria in the form of monoculture, including strains of Pseudomonas aeruginosa and Klebsiella pneumoniae with multidrug resistance, which have a high potential for adaptation in hospital conditions. The aim of the study. To investigate the frequency of infection with Klebsiella and Pseudomonas of mine-blast wounds at the third stage of evacuation, to determine the spectrum of their resistance, sensitivity to antimicrobial drugs, and to present general recommendations for military medical care. Materials and methods. The material from purulent wounds was taken from victims with mine-blast injuries who were admitted for inpatient treatment to the surgical department. The sampling was carried out with sterile swabs with transport nutrient medium. The material was inoculated on blood agar, Endo medium, CHROMID® P. Aeruginosa Agar, MPA and incubated at 37°C for 24 hours. Biochemical identification was performed using the Enterotest 24 and Nefermtest 24 test systems (Lachema, Czech Republic). Antimicrobial susceptibility testing was performed using the Kirby-Bauer method and the determination of the minimum inhibitory concentration (MIC) using broth microdilutions according to the recommendations of the European Committee for the Antimicrobial Susceptibility Testing (EUCAST 2023). Healthcare-associated infections (HCAI) among the wounded servicemen were diagnosed according to the updated MoH Order No. 1447. Results. K. pneumoniae and P. aeruginosa were isolated from the wounds of 38 examined mine-blast injured patients. Out of these 17 (44.7 %) patients had P. aeruginosa; in 9 patients both pathogens were in association; in 2 patients P. aeruginosa was isolated in pure culture; in the remaining cases P. aeruginosa was in association with other microorganisms. Quantitatively, the bacteria were isolated in the range of 106-109 colony forming units (CFU/ml) of pathogen in the patient’s wound contents. In wounded servicemen, infectious wound complications appeared later than the 3-rd day of hospital stay, so they were classified as HCAI. 33.3 % and 22.2 % of K. pneumoniae isolates demonstrated susceptibility to amikacin and imipenem, respectively. Moderate susceptibility of P. aeruginosa to amikacin was detected in 29.4 % of isolates, and to ticarcillin-clavulanate – in 23.5 %. 41.2 % of P. aeruginosa isolates demonstrated sensitivity to piperacillin-tazobactam, 23.5 % – to imipenem, and 11.8 % – to ceftazidime. No significant difference was detected between the susceptibility of Pseudomonas a","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512207","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}
Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.016
N. Maruta, Y. Kushnir
Introduction. The prevalence of schizophrenia in the world reaches 1.4 %, and the number of patients with negative disorders in this group is 90.0 %. Negative symptoms (NS) can be considered the main category symptoms of schizophrenia. They are described as a change in the patient’s usual behavior, which is usually caused by a decrease or lack of motivation, interest, and a violation of the emotional component. Currently five signs are considered key manifestations of schizophrenia NS: flattened affect, alogia, anhedonia, asociality and abulia. The leading manifestation of NS is a flattened affect, characteristic with the weakness of emotional reactions, emotional blunting with a decrease in the brightness of feelings, empathy, indifference to others, misunderstanding of the subtleties of human communication, formality, superficiality of interpersonal relations, low expressiveness of gestures and facial expressions, modulation of voice, posture and emotions. All these manifestations have negative social consequences. At the moment, understanding disorders of the affective sphere manifestations in patients with NS in schizophrenia is far from complete; subsequently the development of innovative treatment of this particular condition has been far too slow, being considered an unsolved problem in modern psychiatry. Therefore, the investigation of the features of the affective sphere in patients with NS in schizophrenia is relevant and requires further careful studies. The aim of the study – to determine the peculiarities of the dynamics of the clinical-psychopathological structure and the severity of affective flattening in patients with NS in schizophrenia in order to improve the diagnosis and correction of the affective sphere in schizophrenia. Materials and methods. Clinical-psychopathological, psychometric (SANS scale) and statistical research methods were used to study the dynamics of the characteristics of the affective sphere in patients with negative symptoms in schizophrenia. In total 252 patients with NS of schizophrenia took part in the investigation, including: 83 patients with a first psychotic episode; 88 patients with schizophrenia in a state of exacerbation; and 81 patients with schizophrenia in a state of remission. Results. Verification of negative violations was carried out using the SANS scale. Affective flattening or blunting prevailed in 34.67 % of patients with a first psychotic episode, in 49.18 % of patients with schizophrenia in a state of exacerbation, and in 68.21 % of patients with schizophrenia in a state of remission. The main manifestation included impoverished expressiveness of reactions and emotional sensitivity. Weakening of emotional reactions, mental coldness, indifference, monotony were also observed. On this background, many patients lost all feelings for relatives and loved ones, and showed complete indifference to themselves and their condition. It was found that the most affected components in patients with
{"title":"Characteristics of the affective sphere in patients with negative symptoms in schizophrenia","authors":"N. Maruta, Y. Kushnir","doi":"10.25040/lkv2023.03-04.016","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.016","url":null,"abstract":"Introduction. The prevalence of schizophrenia in the world reaches 1.4 %, and the number of patients with negative disorders in this group is 90.0 %. Negative symptoms (NS) can be considered the main category symptoms of schizophrenia. They are described as a change in the patient’s usual behavior, which is usually caused by a decrease or lack of motivation, interest, and a violation of the emotional component. Currently five signs are considered key manifestations of schizophrenia NS: flattened affect, alogia, anhedonia, asociality and abulia. The leading manifestation of NS is a flattened affect, characteristic with the weakness of emotional reactions, emotional blunting with a decrease in the brightness of feelings, empathy, indifference to others, misunderstanding of the subtleties of human communication, formality, superficiality of interpersonal relations, low expressiveness of gestures and facial expressions, modulation of voice, posture and emotions. All these manifestations have negative social consequences. At the moment, understanding disorders of the affective sphere manifestations in patients with NS in schizophrenia is far from complete; subsequently the development of innovative treatment of this particular condition has been far too slow, being considered an unsolved problem in modern psychiatry. Therefore, the investigation of the features of the affective sphere in patients with NS in schizophrenia is relevant and requires further careful studies. The aim of the study – to determine the peculiarities of the dynamics of the clinical-psychopathological structure and the severity of affective flattening in patients with NS in schizophrenia in order to improve the diagnosis and correction of the affective sphere in schizophrenia. Materials and methods. Clinical-psychopathological, psychometric (SANS scale) and statistical research methods were used to study the dynamics of the characteristics of the affective sphere in patients with negative symptoms in schizophrenia. In total 252 patients with NS of schizophrenia took part in the investigation, including: 83 patients with a first psychotic episode; 88 patients with schizophrenia in a state of exacerbation; and 81 patients with schizophrenia in a state of remission. Results. Verification of negative violations was carried out using the SANS scale. Affective flattening or blunting prevailed in 34.67 % of patients with a first psychotic episode, in 49.18 % of patients with schizophrenia in a state of exacerbation, and in 68.21 % of patients with schizophrenia in a state of remission. The main manifestation included impoverished expressiveness of reactions and emotional sensitivity. Weakening of emotional reactions, mental coldness, indifference, monotony were also observed. On this background, many patients lost all feelings for relatives and loved ones, and showed complete indifference to themselves and their condition. It was found that the most affected components in patients with ","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"59 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512354","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}
Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.024
T. Nazaruk
Introduction. The combination of arterial hypertension and chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular complications. During exacerbations of COPD, almost every second patient has hypomagnesemia. In particular, intravenous magnesium (Mg) administration in stable patients with COPD has been shown to improve lung function and respiratory muscle strength. Numerous publications report positive impact of various magnesium compounds causing the decrease in blood pressure. The above justifies the expediency of further studying the effectiveness of magnesium compounds in hypertension with concomitant COPD. The aim of the study. To determine the effectiveness of a fixed combination of magnesium and vitamin B6 in the complex treatment of patients with hypertension accompanied by COPD. Materials and methods. 60 patients with stage II hypertension and concomitant COPD were subjected to clinical examination. The data of office and home blood pressure monitoring was supplemented with spirometry, electrocardiography, laboratory tests and results of EQ-5D, mMRC, CAT. Results. Treatment with the additional fixed combination of magnesium and vitamin B6 (MgB6) in patients with hypertension accompanied by COPD reduced complaints and improved quality of life from (52.6 ± 3.4) points to (74.2 ± 3.8) points (р less than 0.001). In 25 (83.3 ± 6.8 %) patients treated with MgB6, it was possible to achieve the target blood pressure; while in the control group similar results were obtained only in (26.6 ± 8.1%) (р less than 0.001). Aplication of a fixed MgB6 combination in patients with hypertension and COPD reduced the frequency of tachycardia from (23.3 ± 7.7)% to (3.3 ± 3.3)% (р less than 0.02), and frequency of supraventricular extrasystole from (36.7 ± 8.8)% to (13.3 ± 6.2)% (р less than 0.05). Improvement of repolarization processes was observed in (46.7 ± 9.1)% of patients who additionally received FC MgB6 and only in (16.7 ± 6.8)%, (p less than 0.02) of the control group. Complex treatment with the addition of a fixed combination of MgB6 contributed to the improvement of spirometry parameters: FEV1 – from (55.9 ± 3.0) to (65.8 ± 4.4) (р less than 0.05) and FEV1/FVC – from (62.3 ± 3.1) to (71.6 ± 3.4) (р less than 0.05). Conclusion. Complex treatment of patients with arterial hypertension and chronic obstructive pulmonary disease, in which a fixed combination of magnesium and vitamin B6 is added to the basic treatment, improved the clinical course of comorbidities, bioelectrical activity of the heart, reduced blood pressure, improved spirometry and quality of life.
{"title":"The effectiveness of magnesium compounds in the complex treatment of patients with arterial hypertension with concomitant chronic obstructive pulmonary disease","authors":"T. Nazaruk","doi":"10.25040/lkv2023.03-04.024","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.024","url":null,"abstract":"Introduction. The combination of arterial hypertension and chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular complications. During exacerbations of COPD, almost every second patient has hypomagnesemia. In particular, intravenous magnesium (Mg) administration in stable patients with COPD has been shown to improve lung function and respiratory muscle strength. Numerous publications report positive impact of various magnesium compounds causing the decrease in blood pressure. The above justifies the expediency of further studying the effectiveness of magnesium compounds in hypertension with concomitant COPD. The aim of the study. To determine the effectiveness of a fixed combination of magnesium and vitamin B6 in the complex treatment of patients with hypertension accompanied by COPD. Materials and methods. 60 patients with stage II hypertension and concomitant COPD were subjected to clinical examination. The data of office and home blood pressure monitoring was supplemented with spirometry, electrocardiography, laboratory tests and results of EQ-5D, mMRC, CAT. Results. Treatment with the additional fixed combination of magnesium and vitamin B6 (MgB6) in patients with hypertension accompanied by COPD reduced complaints and improved quality of life from (52.6 ± 3.4) points to (74.2 ± 3.8) points (р less than 0.001). In 25 (83.3 ± 6.8 %) patients treated with MgB6, it was possible to achieve the target blood pressure; while in the control group similar results were obtained only in (26.6 ± 8.1%) (р less than 0.001). Aplication of a fixed MgB6 combination in patients with hypertension and COPD reduced the frequency of tachycardia from (23.3 ± 7.7)% to (3.3 ± 3.3)% (р less than 0.02), and frequency of supraventricular extrasystole from (36.7 ± 8.8)% to (13.3 ± 6.2)% (р less than 0.05). Improvement of repolarization processes was observed in (46.7 ± 9.1)% of patients who additionally received FC MgB6 and only in (16.7 ± 6.8)%, (p less than 0.02) of the control group. Complex treatment with the addition of a fixed combination of MgB6 contributed to the improvement of spirometry parameters: FEV1 – from (55.9 ± 3.0) to (65.8 ± 4.4) (р less than 0.05) and FEV1/FVC – from (62.3 ± 3.1) to (71.6 ± 3.4) (р less than 0.05). Conclusion. Complex treatment of patients with arterial hypertension and chronic obstructive pulmonary disease, in which a fixed combination of magnesium and vitamin B6 is added to the basic treatment, improved the clinical course of comorbidities, bioelectrical activity of the heart, reduced blood pressure, improved spirometry and quality of life.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"40 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512387","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}
Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.058
M. Yatsula, S. Nyankovskyy
Introduction. Vitamin D deficiency is currently considered a global epidemic. Recent data highlight its pivotal role in the development of metabolic disorders, including obesity in children and adolescents. The aim of the study. To review current literature on the problem of vitamin D provision in children and adolescents with obesity, and to present a clinical case of a child with obesity, vitamin D deficiency, and accompanying metabolic disorders. Materials and methods: The study included literary review using content analysis, systemic and comparative analysis methods, as well as biblio-semantic methods to explore current data on the problem of vitamin D provision in children and adolescents with obesity. Sources included PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate databases using keywords as follows: children, adolescents, insulin resistance, obesity, vitamin D deficiency, VDR (Vitamin D Receptor) gene polymorphism, leptin, adipocytes. 66 English-language articles were analyzed, highlighting the role of vitamin D in human metabolic processes, its association with obesity, mechanisms of its deficiency impact including the inhibitory effect of leptin and interleukin 6, and the peculiarities of vitamin D biological action through nuclear VDR-mediated control of target genes. The prevalence of vitamin D deficiency in obese children in various countries was determined. Results. Obesity can induce altered protein binding and accelerated metabolic clearance of 25(OH)D, leading to reduced levels of 25(OH)D in the blood serum. It was identified that lower serum vitamin D levels and VDR gene polymorphism are associated with a predisposition to obesity in children and its severe consequences, this link apparently can help to identify VDR features that predict an increased risk of developing obesity, potentially leading to new therapeutic strategies for this metabolic condition. This will also increase public awareness about the psychosocial and clinical consequences of vitamin D deficiency and VDR gene polymorphism in obese children. Children with excessive weight and obesity are often diagnosed with hypovitaminosis, including vitamin D deficiency. Many studies around the world have found that vitamin D deficiency in obese children is at a critical stage and requires a change in diagnostic and treatment strategies. The clinical case described involves a patient who had obesity in association with vitamin D deficiency, and characteristic biochemical changes typical of this pathology. Biochemical indices included vitamin D deficiency, dyslipidemia, insulin resistance, leptin resistance, and hypothyroidism. Bioimpedance analysis revealed the presence of excessive body fat and its abnormal abdominal distribution in the child. Conclusions. Currently vitamin D deficiency is considered a global epidemic, causing concern among physicians and researchers of various specialties. Recent data underscore its leading role in the onset of metabolic dis
引言维生素 D 缺乏症目前被认为是一种全球性流行病。最新数据显示，维生素 D 在代谢紊乱（包括儿童和青少年肥胖症）的发病过程中起着关键作用。本研究的目的回顾有关肥胖儿童和青少年维生素 D 供给问题的现有文献，并介绍一例肥胖、维生素 D 缺乏和伴有代谢紊乱的儿童的临床病例。材料和方法：本研究采用内容分析法、系统分析法、比较分析法以及书目语义法进行文学评论，以探讨有关肥胖儿童和青少年维生素 D 供给问题的现有数据。资料来源包括 PubMed-NCBI、Medline、CochraneLibrary、EMBASE、ResearchGate 等数据库，关键词为：儿童、青少年、胰岛素抵抗、肥胖、维生素 D 缺乏、VDR（维生素 D 受体）基因多态性、瘦素、脂肪细胞。研究分析了 66 篇英文文章，重点研究了维生素 D 在人体代谢过程中的作用、维生素 D 与肥胖的关系、维生素 D 缺乏的影响机制（包括瘦素和白细胞介素 6 的抑制作用）以及维生素 D 通过核 VDR 介导的靶基因控制发挥生物作用的特殊性。研究还确定了不同国家肥胖儿童维生素 D 缺乏症的发病率。研究结果肥胖会引起 25（OH）D 蛋白质结合的改变和代谢清除的加速，从而导致血清中 25（OH）D 水平的降低。研究发现，较低的血清维生素 D 水平和 VDR 基因多态性与儿童易患肥胖症及其严重后果有关，这种联系显然有助于确定预测患肥胖症风险增加的 VDR 特征，从而有可能针对这种代谢疾病制定新的治疗策略。这也将提高公众对肥胖儿童维生素 D 缺乏和 VDR 基因多态性的社会心理和临床后果的认识。体重超标和肥胖的儿童通常被诊断为维生素缺乏症，包括维生素 D 缺乏症。世界各地的许多研究发现，肥胖儿童的维生素 D 缺乏症正处于关键阶段，需要改变诊断和治疗策略。本临床病例涉及一名肥胖伴维生素 D 缺乏症的患者，以及这种病症典型的特征性生化变化。生化指标包括维生素 D 缺乏、血脂异常、胰岛素抵抗、瘦素抵抗和甲状腺功能减退。生物阻抗分析显示该患儿体内脂肪过多，且腹部分布异常。结论。目前，维生素 D 缺乏症被认为是一种全球性流行病，引起了各科医生和研究人员的关注。最近的数据显示，维生素 D 缺乏是导致代谢紊乱（包括儿童和青少年肥胖症）的主要原因。文献综述证实，维生素 D 对人体的主要生化和代谢过程有重大影响，在儿童和青少年肥胖症和各种并发症的出现中起着至关重要的作用。要判断这些患者是否存在超重或肥胖，需要进行一系列实验室检测，包括血清维生素 D、瘦素和甲状腺激素水平，以及蛋白质、碳水化合物和脂质代谢参数的估算。建议使用生物阻抗分析和甲状腺超声波检查。
{"title":"Contemporary perspectives on vitamin D provision in children and adolescents with obesity: a literature review and clinical case description","authors":"M. Yatsula, S. Nyankovskyy","doi":"10.25040/lkv2023.03-04.058","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.058","url":null,"abstract":"Introduction. Vitamin D deficiency is currently considered a global epidemic. Recent data highlight its pivotal role in the development of metabolic disorders, including obesity in children and adolescents. The aim of the study. To review current literature on the problem of vitamin D provision in children and adolescents with obesity, and to present a clinical case of a child with obesity, vitamin D deficiency, and accompanying metabolic disorders. Materials and methods: The study included literary review using content analysis, systemic and comparative analysis methods, as well as biblio-semantic methods to explore current data on the problem of vitamin D provision in children and adolescents with obesity. Sources included PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate databases using keywords as follows: children, adolescents, insulin resistance, obesity, vitamin D deficiency, VDR (Vitamin D Receptor) gene polymorphism, leptin, adipocytes. 66 English-language articles were analyzed, highlighting the role of vitamin D in human metabolic processes, its association with obesity, mechanisms of its deficiency impact including the inhibitory effect of leptin and interleukin 6, and the peculiarities of vitamin D biological action through nuclear VDR-mediated control of target genes. The prevalence of vitamin D deficiency in obese children in various countries was determined. Results. Obesity can induce altered protein binding and accelerated metabolic clearance of 25(OH)D, leading to reduced levels of 25(OH)D in the blood serum. It was identified that lower serum vitamin D levels and VDR gene polymorphism are associated with a predisposition to obesity in children and its severe consequences, this link apparently can help to identify VDR features that predict an increased risk of developing obesity, potentially leading to new therapeutic strategies for this metabolic condition. This will also increase public awareness about the psychosocial and clinical consequences of vitamin D deficiency and VDR gene polymorphism in obese children. Children with excessive weight and obesity are often diagnosed with hypovitaminosis, including vitamin D deficiency. Many studies around the world have found that vitamin D deficiency in obese children is at a critical stage and requires a change in diagnostic and treatment strategies. The clinical case described involves a patient who had obesity in association with vitamin D deficiency, and characteristic biochemical changes typical of this pathology. Biochemical indices included vitamin D deficiency, dyslipidemia, insulin resistance, leptin resistance, and hypothyroidism. Bioimpedance analysis revealed the presence of excessive body fat and its abnormal abdominal distribution in the child. Conclusions. Currently vitamin D deficiency is considered a global epidemic, causing concern among physicians and researchers of various specialties. Recent data underscore its leading role in the onset of metabolic dis","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"20 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512577","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}
Pub Date : 2024-01-08DOI: 10.25040/lkv2023.03-04.008
V. Ruden
Introduction. Since the implementation of ″Epidemiological transition concept″ (Abdel R. Omran, 1971), the predominance of non-communicative diseases (NCDs) among the population of European Union member states turned to reality that has been a heavy burden for the population, in the context of both individual and public health, as well as on life expectancy, economic and defense resources of countries. It is noteworthy that NCDs are strongly dependant on the behavior of each particular person, outlining its lifestyle due to existing risk factors. Taking into consideration total growth of NCDs in Ukraine since 1991 (the period of independence) by nNCDs = +1.5 times and their influence on the decreased count of country`s population (NNCDs = 80.3 ± 0.9 % of the total number of dead), the purpose of present investigation was to elucidate the level of awareness of Lviv Region heath care chief executives in the context of existing predominance of NCDs and its consequences. Materials and methods. General, applied, analytical-descriptive, monographic/single, medium-term, continuous sociological investigation was conducted using the elaborated “Questionnaire for studying the state of doctor`s awareness regarding the presence of non-communicative diseases in Ukraine” among post graduate students of specialization cycles and thematic improvement in the specialty “Organization and management in health care” of the Department of Public Health of the Faculty of Post Graduate Education of Danylo Halytskyi Lviv National Medical University in 2022 (∑ participants n = 327/Р = 100%) of total count of Lviv region health care chief executive officers (∑n = 392). The survey, compilation and processing of the available sociological material was carried out by the author with the research methods based on the principles of systematicity and corresponding to the Passport of the specialty 14.02.03 Social medicine. Results. It was established that М = 80.4 ± 0.3 % (n = 263) of respondents understand the essence of the concept of “Non-communicative diseases”; М = 40.1 ± 0.2 % (n = 131) of the respondents disclosed the content of the epidemiological transition from infectious to chronic diseases, which radically changed the structure of mortality by causes. The obtained results indicate that М = 98.2 ± 0.3 % (n = 321) of the respondents associated NCDs group with diseases of the circulatory system [I00-I99], while neoplasms [С00-D48] and mental and behavioral disorders [F01-F99] were attributed respectively to М = 85.0 ± 0.3 % (n = 278) of respondents and М = 75.2 ± 0.3 % (n = 246) of respondents; diabetes [E10-E14] was associated with M = 85.0 ± 0.3 % (n = 278) of respondents, while chronic diseases of the lower respiratory tract [J40-J47] were counted by M = 63.6 ± 0.2 % (n = 208) of the total number of participants (n = 327). Conclusion. The results testify low level of knowledge on the theoretical background of NCDs among the chief executives of health care institutions
{"title":"Level of awareness managers of medical institutions and health care bodies of Lviv Oblast regarding the theoretical foundations of non-infectious diseases (according to the results of a sociological study)","authors":"V. Ruden","doi":"10.25040/lkv2023.03-04.008","DOIUrl":"https://doi.org/10.25040/lkv2023.03-04.008","url":null,"abstract":"Introduction. Since the implementation of ″Epidemiological transition concept″ (Abdel R. Omran, 1971), the predominance of non-communicative diseases (NCDs) among the population of European Union member states turned to reality that has been a heavy burden for the population, in the context of both individual and public health, as well as on life expectancy, economic and defense resources of countries. It is noteworthy that NCDs are strongly dependant on the behavior of each particular person, outlining its lifestyle due to existing risk factors. Taking into consideration total growth of NCDs in Ukraine since 1991 (the period of independence) by nNCDs = +1.5 times and their influence on the decreased count of country`s population (NNCDs = 80.3 ± 0.9 % of the total number of dead), the purpose of present investigation was to elucidate the level of awareness of Lviv Region heath care chief executives in the context of existing predominance of NCDs and its consequences. Materials and methods. General, applied, analytical-descriptive, monographic/single, medium-term, continuous sociological investigation was conducted using the elaborated “Questionnaire for studying the state of doctor`s awareness regarding the presence of non-communicative diseases in Ukraine” among post graduate students of specialization cycles and thematic improvement in the specialty “Organization and management in health care” of the Department of Public Health of the Faculty of Post Graduate Education of Danylo Halytskyi Lviv National Medical University in 2022 (∑ participants n = 327/Р = 100%) of total count of Lviv region health care chief executive officers (∑n = 392). The survey, compilation and processing of the available sociological material was carried out by the author with the research methods based on the principles of systematicity and corresponding to the Passport of the specialty 14.02.03 Social medicine. Results. It was established that М = 80.4 ± 0.3 % (n = 263) of respondents understand the essence of the concept of “Non-communicative diseases”; М = 40.1 ± 0.2 % (n = 131) of the respondents disclosed the content of the epidemiological transition from infectious to chronic diseases, which radically changed the structure of mortality by causes. The obtained results indicate that М = 98.2 ± 0.3 % (n = 321) of the respondents associated NCDs group with diseases of the circulatory system [I00-I99], while neoplasms [С00-D48] and mental and behavioral disorders [F01-F99] were attributed respectively to М = 85.0 ± 0.3 % (n = 278) of respondents and М = 75.2 ± 0.3 % (n = 246) of respondents; diabetes [E10-E14] was associated with M = 85.0 ± 0.3 % (n = 278) of respondents, while chronic diseases of the lower respiratory tract [J40-J47] were counted by M = 63.6 ± 0.2 % (n = 208) of the total number of participants (n = 327). Conclusion. The results testify low level of knowledge on the theoretical background of NCDs among the chief executives of health care institutions ","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140512642","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}
Introduction. With severe heart diseases, ventricular arrhythmias and atrial fibrillation can occur. The aim of the study. To analyze the achievements of arrhythmology in the field of predicting malignant arrhythmias over the past decades cardiology and to present the own results. Materials and methods. Literature surway of 34 articles supplemented with own results directed towards prediction of cardiac arrhythmia including the malignant arrhythmias. Results. Conducted investigation identified the following signs predicting the arrhythmias development: left ventricular hypertrophy, blockage of the bundle of His left limb, severe hypertension, diabetes. Left ventricle and left atrial remodeling are predictors of atrial fibrillation development. In patients with coronary arteries disease, predictors of atrial fibrillation development are increased heart volume and size, as well as decreased left ventricle ejection fraction. In 5 monographs on cardiac arrhythmias, predictors of prognosis and algorithms for the development of malignant cardiac arrhythmias are presented in details. Together with professor O. Sychov it was elaborated original classification of supraventricular extrasystoles. Conclusion. Over the past decades, a number of prognostic criteria for malignant cardiac arrhythmias and sudden cardiac death were elaborated. These include: pronounced left ventricle hypertrophy, blockage of the left limb bundle of His, severe form of hypertension, progressive chronic heart failure, the occurrence of T. Killip II and more, ventricular extrasystole 3-5 grades according to B. Laun, ventricular tachycardia of the “pirouette” type, reduction of the left ventricle ejection fraction is less than 40.0 %, thickening of the left ventricle posterior wall and interventricular membrane 14 mm and more, sino-atrial and atrio-ventricular blockage, prolongation of the Q-T interval, use of anti-arrhytmic drugs of IA and IS classes, etc. As a rule, the more of these arrhythmias predictors are exposed, the more often sudden cardiac deaths develops. Hovewer, certain exceptions of this rule sometimes appear. Keywords: coronary heart disease combined with hypertension, diagnostic criteria, predictors of complications progression.
{"title":"Achievements in Malignant Arrhythmias Prediction Over the Last Decades Cardiology and the Results of Own Research","authors":"V. Denesyuk","doi":"10.25040/lkv2023.02.053","DOIUrl":"https://doi.org/10.25040/lkv2023.02.053","url":null,"abstract":"Introduction. With severe heart diseases, ventricular arrhythmias and atrial fibrillation can occur. The aim of the study. To analyze the achievements of arrhythmology in the field of predicting malignant arrhythmias over the past decades cardiology and to present the own results. Materials and methods. Literature surway of 34 articles supplemented with own results directed towards prediction of cardiac arrhythmia including the malignant arrhythmias. Results. Conducted investigation identified the following signs predicting the arrhythmias development: left ventricular hypertrophy, blockage of the bundle of His left limb, severe hypertension, diabetes. Left ventricle and left atrial remodeling are predictors of atrial fibrillation development. In patients with coronary arteries disease, predictors of atrial fibrillation development are increased heart volume and size, as well as decreased left ventricle ejection fraction. In 5 monographs on cardiac arrhythmias, predictors of prognosis and algorithms for the development of malignant cardiac arrhythmias are presented in details. Together with professor O. Sychov it was elaborated original classification of supraventricular extrasystoles. Conclusion. Over the past decades, a number of prognostic criteria for malignant cardiac arrhythmias and sudden cardiac death were elaborated. These include: pronounced left ventricle hypertrophy, blockage of the left limb bundle of His, severe form of hypertension, progressive chronic heart failure, the occurrence of T. Killip II and more, ventricular extrasystole 3-5 grades according to B. Laun, ventricular tachycardia of the “pirouette” type, reduction of the left ventricle ejection fraction is less than 40.0 %, thickening of the left ventricle posterior wall and interventricular membrane 14 mm and more, sino-atrial and atrio-ventricular blockage, prolongation of the Q-T interval, use of anti-arrhytmic drugs of IA and IS classes, etc. As a rule, the more of these arrhythmias predictors are exposed, the more often sudden cardiac deaths develops. Hovewer, certain exceptions of this rule sometimes appear. Keywords: coronary heart disease combined with hypertension, diagnostic criteria, predictors of complications progression.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125408604","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}
Introduction. Headache (cephalgia) is one of the most common neurological disorders and is among the 20 most disabling diseases in the world. Most cases of headaches are benign, while others require constant monitoring and treatment, and some are life-threatening. For individuals with a history of headaches, the physician should determine whether headache belongs to a well-known primary headache disorder, is an exacerbation of primary headache disorder induced by another medical condition, or a new secondary headache. The aim of the study is to conduct an analysis of a vascular events in a patient with secondary headache, who was diagnosed in the Neurology Department in 2023. Materials and methods. Systematic and comparative analysis, biblio-semantic method used for the interpretation of the obtained results were supplemented with a survey of literature including 18 articles published in the international renowned sources. Results. Secondary cephalgias are those in which the headache is a symptom of another disorder recognized as a potential underlying cause. Secondary headache occurs much less often than primary one, but it can encompass life-threatening pathology. A clinician should be able to distinguish between primary and secondary headaches, elaborating a specific diagnosis for each particular patient with a headache. For this purpose doctor should know the criteria for each type of headache and be capable to recognize "red flags" of secondary headache. The paper contains thorough analysis of the basic principles of diagnosis and diagnostic criteria of all known forms of cephalgia, as well as European principles of management of patients with the most common forms of headache disorders for general practitioners. Scaffolding of the article is consistent with International Classification of Headache Disorders, third revision (ICHD-3), developed by the International Headache Society in 2018, which currently is the main tool for diagnosing different forms headache disorders. The most important aspect in the diagnosis of different forms of cephalgia is patients history and medical examination. Primary headache is not a diagnosis of exclusion, but rather is based on clinical findings obtained during examination. The presence of atypical signs or "red flags" should raise concern about secondary headache. Conclusions. Many types of primary headaches can be diagnosed based on a thorough history and physical examination without use of additional examination methods. Neuroimaging is not necessary if the patient has migraines or other primary headaches with normal neurological status and the absence of the "red flags" or signs of secondary headache. The SNOOP mnemonic method is useful tool for ensuring that "red flags" are not missed. In case the "red flags", signs of secondary headache are detected, neuroimaging or other additional diagnostic tests should be used, out of which the preference should be given to the MRI of the brain. Keywords: primary a
{"title":"Headache: Classification, diagnostics, and principles of treatment (literature review; description of a clinical case)","authors":"N. Bozhenko, T. Nehrych, N. Negrych, M. Bozhenko","doi":"10.25040/lkv2023.02.096","DOIUrl":"https://doi.org/10.25040/lkv2023.02.096","url":null,"abstract":"Introduction. Headache (cephalgia) is one of the most common neurological disorders and is among the 20 most disabling diseases in the world. Most cases of headaches are benign, while others require constant monitoring and treatment, and some are life-threatening. For individuals with a history of headaches, the physician should determine whether headache belongs to a well-known primary headache disorder, is an exacerbation of primary headache disorder induced by another medical condition, or a new secondary headache. The aim of the study is to conduct an analysis of a vascular events in a patient with secondary headache, who was diagnosed in the Neurology Department in 2023. Materials and methods. Systematic and comparative analysis, biblio-semantic method used for the interpretation of the obtained results were supplemented with a survey of literature including 18 articles published in the international renowned sources. Results. Secondary cephalgias are those in which the headache is a symptom of another disorder recognized as a potential underlying cause. Secondary headache occurs much less often than primary one, but it can encompass life-threatening pathology. A clinician should be able to distinguish between primary and secondary headaches, elaborating a specific diagnosis for each particular patient with a headache. For this purpose doctor should know the criteria for each type of headache and be capable to recognize \"red flags\" of secondary headache. The paper contains thorough analysis of the basic principles of diagnosis and diagnostic criteria of all known forms of cephalgia, as well as European principles of management of patients with the most common forms of headache disorders for general practitioners. Scaffolding of the article is consistent with International Classification of Headache Disorders, third revision (ICHD-3), developed by the International Headache Society in 2018, which currently is the main tool for diagnosing different forms headache disorders. The most important aspect in the diagnosis of different forms of cephalgia is patients history and medical examination. Primary headache is not a diagnosis of exclusion, but rather is based on clinical findings obtained during examination. The presence of atypical signs or \"red flags\" should raise concern about secondary headache. Conclusions. Many types of primary headaches can be diagnosed based on a thorough history and physical examination without use of additional examination methods. Neuroimaging is not necessary if the patient has migraines or other primary headaches with normal neurological status and the absence of the \"red flags\" or signs of secondary headache. The SNOOP mnemonic method is useful tool for ensuring that \"red flags\" are not missed. In case the \"red flags\", signs of secondary headache are detected, neuroimaging or other additional diagnostic tests should be used, out of which the preference should be given to the MRI of the brain. Keywords: primary a","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126837389","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}
Introduction. Studies of vascular remodeling and endothelial dysfunction induced by different cardiological pathologies are far from complete. The aim of the study. To analyze recent advances in the investigation of vascular remodeling and endothelial dysfunction on the background of cardiological diseases according to literature database and own research results. Materials and methods. Literature survey of 49 articles was supplemented with own research results. Results. By means of dopplerography it was detected brachial artery hypertrophy, which is a risk factor for myocardial infarction and stroke. Endothelium, which secretes vasoactive substances (nitric oxide – NO, endothelin-1, prostacyclin, thromboxane, etc.) plays an important role in the histophysiology of coronary arteries. Dysfunction of endothelium plays a key role in the development of atherosclerosis, coronary heart disease, hypertension, heart failure even before the appearance of clinical signs of diseases. In myocardial infarction, the development of endothelial dysfunction was detected by various methods. The predictors of an unfavorable prognosis in patients with acute myocardial infarction with elevated ST-segment include a violation of endothelium-dependent vasodilatation as revealed by test for hyperemia. Similarly, an unfavorable prognostic factor in myocardial infarction is the increased level of endothelin-1. Conclusions. In patients with arterial hypertension, coronary heart disease, unstable angina pectoris, myocardial infarction, hypertrophic remodeling of the brachial artery alongside with a decrease in endothelium-dependent vasodilatation were detected by various older and new methodes. Currently it is generally accepted that changes in arteries and disruption of endothelial function are the root cause of diseases of the heart and blood vessels. On the basis of the conducted research, correction of the detected changes is carried out, aimed at preventing the progression of diseases of the cardiovascular system. Keywords: vascular remodeling, endothelial dysfunction, heart diseases.
{"title":"Advances in the Investigation of Vascular Remodeling and Endothelial Function in Heart Disease Over the Past Decades (Literature Review and Own Results)","authors":"V. Denesyuk","doi":"10.25040/lkv2023.02.072","DOIUrl":"https://doi.org/10.25040/lkv2023.02.072","url":null,"abstract":"Introduction. Studies of vascular remodeling and endothelial dysfunction induced by different cardiological pathologies are far from complete. The aim of the study. To analyze recent advances in the investigation of vascular remodeling and endothelial dysfunction on the background of cardiological diseases according to literature database and own research results. Materials and methods. Literature survey of 49 articles was supplemented with own research results. Results. By means of dopplerography it was detected brachial artery hypertrophy, which is a risk factor for myocardial infarction and stroke. Endothelium, which secretes vasoactive substances (nitric oxide – NO, endothelin-1, prostacyclin, thromboxane, etc.) plays an important role in the histophysiology of coronary arteries. Dysfunction of endothelium plays a key role in the development of atherosclerosis, coronary heart disease, hypertension, heart failure even before the appearance of clinical signs of diseases. In myocardial infarction, the development of endothelial dysfunction was detected by various methods. The predictors of an unfavorable prognosis in patients with acute myocardial infarction with elevated ST-segment include a violation of endothelium-dependent vasodilatation as revealed by test for hyperemia. Similarly, an unfavorable prognostic factor in myocardial infarction is the increased level of endothelin-1. Conclusions. In patients with arterial hypertension, coronary heart disease, unstable angina pectoris, myocardial infarction, hypertrophic remodeling of the brachial artery alongside with a decrease in endothelium-dependent vasodilatation were detected by various older and new methodes. Currently it is generally accepted that changes in arteries and disruption of endothelial function are the root cause of diseases of the heart and blood vessels. On the basis of the conducted research, correction of the detected changes is carried out, aimed at preventing the progression of diseases of the cardiovascular system. Keywords: vascular remodeling, endothelial dysfunction, heart diseases.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132003930","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：