Multivariate analysis and mathematical modeling of the informativeness of patients cases data in chronic pancreatitis associated with concomitant pathology.

OBJECTIVE: Aim: To investigate and analyze homeostatic disorders in patients with a combination of Chronic Pancreatitis(CP) and Arterial Hypertension (AH) and to develop correcting ways of the detected changes. PATIENTS AND METHODS: Materials and Methods: General clinical, laboratory-instrumental examination of 121 patients, who were undergoing inpatient treatment with a diagnosis of Chronic Pancreatitis in combination with Arterial Hypertension of the II stage during 2021-2022. RESULTS: Results: In the majority of cases of patients signs the increasing in IL-1,6 and Cortisol levels were found. A decrease in Ca to the lower limit of the norm was observed (2.18 ± 0.26 mmol/l to the data of control group patients (2.32 ± 0.12 mmol/l, p= 0.01 ), the levels of trace elements Zn and Se were determined within the reference values. The Atherogenic Index was increased 1.8 times and was significantly different from the control group date. During the FE-1 study, a decrease in the level of this indicator was revealed by 151.71±13.91 mg/g of feces, both to the values of reference values and a significant difference to the data of the control group (241.28±29.17 mg/g of feces, p<0 .05). CONCLUSION: Conclusions: Based on the multivariate linear regression analysis of the obtained data, formulas have been developed that can be used to predict the dynamics of the dependent variable (FE-1, IL-1, Selenium level, Glutathione Peroxidase, blood pressure) according to changes in the studied influencing factors.

Analysis and interpretation of Coronavirus infection children's incidence, contributing factors, risks of complications and their relationship.

OBJECTIVE: Aim: To study and investigate the incidence of Coronavirus infection in children, the course of the disease, the risks of complications and their interrelationships. PATIENTS AND METHODS: Materials and Methods: Study included the analysis and observation of children (n=55, aged 14.36±3.62 years) with confirmed Coronerovirus infection, who were observed in the CNE ≪CMCH≫ in Uzhgorod in outpatient conditions. A study of clinical presentations, a clinical and laboratory examination followed by a mathematical analysis of the symptoms data in children with an identified Coronavirus infection and in the dynamics up to week 30 (with survey intervals in 3 weeks) from the diagnosis verification was carried out. RESULTS: Results: A dynamic analysis of the clinical manifestation of symptoms in children with an identified Corona virus infection and within 30 weeks (with survey intervals of 3 weeks) from the beginning of the diagnosis verification was carried out. Complaints from the respiratory system were prevailed. The most long-lasting complaint was observed ≪changes in the sense of taste and smell≫ (from 35(63.6%) to 6(10.9%) up to 18 weeks inclusive. Other complaints ≪Cough, Rhinitis, Shortness of breath, Pain in the chest≫ was observed for 6 weeks. Sore throat, muscular and joint pain were persisted for 3 weeks. Fever was not identified at week 3. Illness with other viral respiratory diseases started at week 9 and was observed until week 30 (from 10(18.2%) to 19(34.5%)) with varying levels. A decrease in cases of IgM identification was observed within 6 weeks (from 55, 100% to 20, 36, 4%). On the 9th week, the presence of IgM was not established. There is also an increase in the number of cases of detection of IgG in patients with a level maximum of 6 weeks. CONCLUSION: Conclusions: There is a positive effect of the CRP level on the occurrence of symptoms of cough, rhinitis, shortness of breath, chest pain, change in taste and smell, muscle and joint pain (r=0.33-0.55), with the most significant data for the symptom of pain in chest (p=0.00001). Ferritin level interactions mostly had a negative direction (r=-0.35-0.48, p=0.02-0.00001) on the development of symptoms, with the exception of rhinorrhea (r=0.48, p=0.00002) and chest pains (r=0.39, 0.003). According to multiple logistic regression analysis the chance of the symptom of a change in taste and smell increases due to an increasing in the level of Procalcitonin in 1.48 times. The chance of the symptom of shortness of breath increased due to an increasing in the Ferritin level in 1.025 times.

Dynamic indicators of acute respiratory diseases treatment in children after correction.

OBJECTIVE: Aim: To study the Respiratory pathology of the upper respiratory tract, markers of the inflammatory response of the organism, Oxidative stress, Metabolic adaptation and possibilities of correction. PATIENTS AND METHODS: Materials and Methods: The study group (n=111) included school-aged children (10-14 years old). The general group of inflammatory diseases of the respiratory tract (J000-J06) was considered, with a diagnosis of acute respiratory infection (ARI) of viral and bacterial origin and included local inflammationof the upper respiratory tract with presentation of acute pharyngitis (68.0%), acute bronchitis (22,0%), acute tonsillitis (10,0%). RESULTS: Results: Dynamic observation of groups of children who received optimized (group 1, n=60) and basic (group 2, n=51) treatment was carried out. The level of the erythrocyte pool correlated with IL-1 (r=-0,29, p=0,03), IL-4 (r=0,32, p=0,01), TNF-α (r=-0,35 , p=0,006). Creatinine value correlated with IL-10 (r=0,3, p=0,005), γ-IFN (r=0,42, p=0,001), TNF-α (r=0,25, p=0,05). Correlations of ferritin presented positive correlation values with the level of total protein (r=0,26, p=0,04) and TNF-α (r=0,41, p=0,001). CONCLUSION: Conclusions: After the optimized treatment, there was a significant decrease in the reliable levels of CRP and γ-IFN by 7 and 4,4 times (by groups) and 5,8 and 3,2 times (by groups), respectively. Correlation relationships of urea levels with IL-2,4 were detected. The level of the erythrocyte pool correlated with IL-1,4, TNF-α, Ferritin presented positive correlation values with the level of total protein,TNF-α .

RESPIRATORY MICROBIOME AND ITS RELATIONSHIP WITH INFLAMMATORY MARKERS.

OBJECTIVE: The aim: This study aims to investigate and analyze the microbiome of the nasopharyngeal zone in acute respiratory infections (ARI) and their relationship with inflammatory markers. PATIENTS AND METHODS: Materials and methods: Examination of 112 children (10-14 years old) with acute respiratory infections (ARI) of the upper respiratory tract was carried out. The control group consisted of 25 healthy children identical in age and examination parameters. RESULTS: Results: When analyzing the microflora of the nasopharynx of patients, 29,0% of strains were gram-positive bacteria and 71,0% were gram-negative bacteria (Escherichia coli representing 37,0%). Biochemical examination of the biomaterial revealed the presence of sucrase (n=69), maltase (n=87), lactorepoxidase (n-89) and alcohols - sorbitol (hexahydric alcohol, n=102), mannitol (hexahydric alcohol, n=84), xylitol (pentahydric alcohol, n=86). Regarding the markers of inflammatory response, the following dynamics was noted: increase in the level of IgM (3,91 ± 1,79 g/l, p<0,01) by 2,2 times, elevation of Ig G level by 10 times (145, 91 ± 53,04 g/l, p< 0,01), slightly higher than the reference values IgE level. In addition, increased IL-1, IL-4, IL-6, γ-IFN, TNF-α, Neopterin levels were detected. The level of Thyroid stimulating hormone (TSH) was significantly different compared to the control group (0,62 ± 0,57 vs. 1,98 ± 0,30 mIU/ ml, p< 0,01), but within the reference values. CONCLUSION: Conclusions: Predominance of Gram-negative bacteria in the nasopharyngeal microflora of patients along with elevated inflammatory markers and lactop-eroxydase enzyme predominance was detected in the study.

IMMUNE-INFLAMMATORY-ENDOCRINE REGULATION DISORDERS IN CHILDREN WITH CORONAVIRUS INFECTION.

OBJECTIVE: The aim: To study the of homeostasis links desorder and indicators imbalance in children with Coronavirus infection. PATIENTS AND METHODS: Materials and methods: A clinical and laboratory study was conducted in children (50 persons) with Coronavirus infection. The children were used outpatient treatment. RESULTS: Results: It was found that Direct bilirubin was increased in 3 times (10.55±7.67 vs. 3.63±0.49 µmol/l, p<0.01), Alanine aminotransferase - in 1.7 times (37,02±20.53 vs. 21.90±1.82 IU/l, p<0.01). An levels increassng of Ig G - in 12.3 times, Ig E - in 4.6 times, Ig M - in 3.4 times was observed. The CRP level was increased in 3.1 times (8.76 ± 2.16 vs. 2.54 ± 0.53 mg/l, p< 0.01), C-peptide (4.65±1.67 vs. 1.23±0.08 ng/ml, p<0.01) - in 3.8 times. Negative correlations of T3 with Procalcitonin (r=-0.30) and Creatinine (r=-34) were revealed. T4 values are correlated with Total cholesterol (r=-0.65) and Creatinine (r=0.29). Leptin was presented positive correlations with Alanine aminotransferase (r=0.48) and with C-peptide (r=0.39). CONCLUSION: Conclusions: There was an increase in the Ig G levels in 12.3 times, Ig E - in 4.6 times, and the Ig M level - in 3.4 times. The Thyroid stimulating hormone level was significantly lower (in 4.7 times). An increase in the C-reactive protein levels (in 3.1 times) and C-peptide (in 3.8 times) was observed. It should be noted that the strongest negative correlation between T4 and Total cholesterol (r=-0.65) and the highest positive correlation between Leptin and Alanine aminotransferase (r=0.48) and C-peptide (r=0. 39).

INFLAMMATORY RESPONSE AND METABOLIC ADAPTATION IN CHILDREN WITH ACUTE RESPIRATORY PATHOLOGY.

OBJECTIVE: The aim: To investigate the parameters change of the general immune responds and endocrine metabolism in the children with Acute Respiratory Pathology and their correlational relationship. PATIENTS AND METHODS: Materials and methods: The study group included: school-age children (10-14 years old) with a diagnosis of acute respiratory disease (ARI) as a general group of respiratory tract inflammatory diseases, of viral and bacterial origin (n=40), which included local inflammatory lesions of the respiratory tract and presented with acute pharyngitis (60.0%), acute bronchitis (20%), acute tonsillitis (22%) and a control group (n=25), identical in age and sex. The research was conducted at the clinical base of the CNE «UCChH¼ of the Uzhhorod City Council. General clinical, immunological studies, inflammatory response of the child's body were conducted. Statistical analysis of the results of the examination of patients was carried out using the Statistics for Windows v.10.0 computer program (StatSoft Inc, USA). The evaluation of the obtained results was carried out using parametric and non-parametric methods. RESULTS: Results: The inflammatory response parameters of the child's organism present indicative increases in the levels of cytokines with a significant predominance in comparison with the data of the children control group: the level of IL-1 increased in 2 times, IL-4 - in10 times, IL-6 - in 1.5 times, γ-IFN - in 3 times, TNFα - in 25 times, Neopterin - in 9 times. The data of the general immune response indicate a 2-times increasing in the level of IgM (3.85 ± 1.89 g/l, p<0.01) and IgG level increased in 10 times (147, 35 ± 56.12 g/l, p< 0.01). The, according to the obtained data but, in comparison with the data of the control group. There are significant differences in the levels of Leptin (р< 0.01), C-peptide (р< 0.01), Thyroid stimulating hormone ( p<0.01), Free thyroxine (p=0.002). The Leptin level, which is at the upper limit of the reference, the level of Thyroid stimulating hormone at the lower limit of the reference, and the slight predomi¬nance of the C-peptide level are noteworthy. Predominance of reliable correlations of pro-inflammatory cytokines IL 1, 4, 6 of varying degrees (r=0.34-0.45) are observed. Only IgG with Free triiodothyronine (r=0.45,p=0.004), IgE with Thyroid peroxidase antibody (r=-0.45,p=0.004) were identified as statistically significant correlations with high reliability. CONCLUSION: Conclusions: The obtained date presents the increasing of the levels Cytocines (Il -1,4,6) in 2-10 times. The IgG level increased in 10 times and IgM - in 2 times. The indicators of endocrine metabolism are within the reference values. Reliable correlations of pro-inflammatory cytokines IL 1, 4, 6 of varying degrees (r=0.34-0.45) are observed. IgG with Free triiodothyronine (r=0.45,p=0.004) have significant reasonableness.

LIVER CIRRHOSIS WITH CRYPTOGENIC GENESES. CLINICAL CASE.

The article presents clinical observation of a patient with cryptogenic cirrhosis of the liver, a chronic diffuse progressive liver disease, which is manifested by structural rearrange¬ment of its parenchyma. Cryptogenic cirrhosis is cirrhosis of uncertain etiology that lacks definitive clinical and histological criteria for a specific disease. Cryptogenic cirrhosis accounts for nearly 5% to 30% of cases of cirrhosis and nearly 10% of liver transplants. The problem of cirrhosis of the liver is extremely relevant, because this pathology is observed mainly in young and able-bodied people. In addition, it takes the first place among the causes of mortality from diseases of the digestive system. To clarify the diagnosis, laboratory and instrumental diagnostic methods of investigation were performed. Due to severe thrombocytopenia and minor leukopenia, myelodysplastic syndrome was suspected. Metabolic disorders that can be considered as probable in the occurrence of the above-mentioned changes in the liver parenchyma had been ruled out.

INFLAMMATORY RESPONSE STATUS IN INFANTS WITH INTRAUTERINE INFECTION FROM MOTHERS WITH IDENTIFIED TORCH INFECTION.

OBJECTIVE: The aim: To investigate the status and possibilities of markers of the inflammatory response of organism in infants with identified IUI born to mothers diagnosed with TORCH infection. PATIENTS AND METHODS: Materials and methods: The study group included: infants diagnosed with IUI (n = 40), born to mothers (age 31.31 ± 2.08 years) with the diagnosis of TORCH infection and a control group (n = 25 infants). Childbirth in all newborns was physiological. The average weight of newborns was 1877.69 ± 981.78 g (min - 600 g; max - 4000 g). Gestational age: 32.25 ± 5.15 weeks. Observation and treatment of newborns lasted up to 7 days (included stay in the emergency department of the Uzhhorod maternity hospital in the Zakarpattia region). Cytokine profile, γ-IFN, TNF-α, Pg E2, serum neopterin and procalcitonin levels were studied. RESULTS: Results: The values of the parameters of the cytokine profile (IL-1, IL-6, IL-8, IL-10) varied within the reference values, but with significant differences with the values of the control group, which was 1,2; 4; 10; 6 times, respectively. The levels of inflammatory mediators (γ-IFN Procalcitonin Neopterin TNF-α Pg E2) differed significantly from the data of the control group of infants and exceeded the upper limit of the reference values by 1,3; 3; 25; 4 times, respectively. According to the correlation analysis, there are positive correlations of medium level: IL 1 and procalcitonin (r = 0.33); IL 6 and IL10 (r = 0.44); IL 10 and prostaglandin E2 (r = 0.44); neopterin and prostaglandin E2 (r = 0.39), which indicates synergism in the performance of biologically active processes. Negative correlations of moderate degree were observed between the following parameters: IL 1 and gestational age of infants (r = -0.36); IL 6 and IL 8 (r = -0.34); γ-IFN and TNF-α (r = -0.43), which indicates the diversity of interactions between participants in the inflammatory response of the organism. CONCLUSION: Conclusions: Various infectious agents can act as «primary affect¼ of sepsis as a complex pathological process involving the organism, and each of the infections has its own characteristics of the pathological process, therefore curent changes in infectious circumstances make new demands on research. It has been proven that intrauterine infection has a negative effect on the homeostatic parameters of infants, in particular, on the indicators of the inflammatory response of the child's organism. Symptomatic inflammatory biomarkers can be used to identify the pathological condition of the infant, in addition to routine laboratory tests, for early correction of VUI. This delay in identifying affected infants can lead to long and unnecessary therapy, the emergence of resistant strains of microorganisms, increased treatment costs and, in particular, a higher risk of complications such as cerebral palsy or intraventricular hemorrhage.

PAIN SYNDROM IN CASES OF PATIENTS WITH A COMBINATION OF CHRONIC PANCREATITIS AND HYPERTENSION: RELATIONSHIPS, INTERACTIONS, CORRECTION.

OBJECTIVE: The aim: To identify the relationships and interactions of the pain development in cases of patients with a combination of Chronic Pancreatits and Arterial Hypertension, with the next correction. PATIENTS AND METHODS: Materials and methods: We have conducted a comprehensive examination of 102 patients with a diagnosis of Chronic Pancreatitis in combination with stage II Arterial Hypertension during 2018-2020. The investigative contingent was divided by two study groups which depended from the treatment regimen. The first (I) group (n = 53) received basic therapy (BT) in accordance with the requirements of the relevant clinical protocols; the treatment of the second (II) group (n = 49) included the basic therapy with optimization (OT) by mineralocorrection (Zinc, Selenium, which have antioxidant properties), ω-3 polyunsaturated fatty acids and Folic Acid. The therapy duration was 8 weeks. RESULTS: Results: The performed regression analysis was mathematically substantiated the influence of the studied laboratory parameters of the inflammatory response and antioxidant system on the formation, dynamics of abdominal pain (the main clinical sign of CP) and the value of PAP (hypertensive vascular remodeling marker and risk predictor of cardiovascular events). The severity of abdominal pain is significantly influenced by leukocytes, ESR, α1-AT, cortisol, CRP, Bilirubin and Urea, and the value of PAP - CRP and selenium, from laboratory parameters of the inflammatory response and AOS. CONCLUSION: Conclusions: The effectiveness of the assigned optimized treatment scheme has been proven, which is indicated by the appearance of a reliable regression coefficient on the parameter of glutathione peroxidase after completion of treatment in comparison with patients used basic therapy.

INTEGRATIVE MORPHOMETRIC CHARACTERISTIC OF ENDOTHELIAL DYSFUNCTION IN THE CASES OF CHILDREN WITH ESSENTIAL ARTERIAL HYPERTENSION.

OBJECTIVE: The aim: To optimize the treatment of children with Essential Arterial Hypertension (EAH) in assotiation with Endotelial Dysfunction (ED) by studying the clinical and morphofunctional characteristics of the cardiovascular system disorders and correction of endothelial dysfunction with the using of essential phospholipids. PATIENTS AND METHODS: Materials and methods: The study group consisted of 80 children and 30 - a control group. The next stage included the division of 80 children into 2 subgroups. Patients in the first subgroup received basic treatment (angiotensin-converting enzyme inhibitor of the third generation), the second - optimized treatment (basic treatment was with addition of certified drug lecithin). Doses were determined according to the instructions and age for 2 months. In the study were used: ECG, Echocardiography, Ultrasonography, Morphofunctional studies of the endothelium. RESULTS: Results: There is a dynamic decreasing in the level of left ventricular myocardial mass index (LV MMI), reduction of end-diastolic volume (EDV) and increase in the absolute values of shock volume (SV), ejection fraction( EF) under the influence of optimized treatment due to the inclusion of lecithin in the treatment of children with EAH with ED. The Ve/Va ratio had a tendency to increase. Vasoconstriction of vessels after the reactive hyperemia test was significantly reduced, but the degree of vasodilation varied depending on the method of therapy. The intima-media thickness (IMT) decreased in 1.12 times in the cases of children with an optimized treatment, accompanied by a decreasing of DEC by 2-times. Levels of the aortic stiffness index had a tendency of decreasing (from 0.88 ± 0.02 to 0.71 ± 0.01 and to 0.63 ± 0.01, respectively, by groups and in comparison with the control group - 0.55 ± 0 , 01), which reflects the improvement of hemodynamic parameters. The dynamic parameters obtained in the cases of patients with EAH in association with ED, taking into account the impact of the optimized treatment had positive correction on the total risk of cardiovascular complications, changes in the profile of LV diastolic filling, dysfunction of arterial endothelium. CONCLUSION: Conclusions: The inclusion of essential phospholipids in the treatment of children with EAH and ED helps to optimize the profile of LV diastolic filling and exclude vascular endothelial dysfunction and indicate a positive effect of optimized treatment on the overall risk of cardiovascular complications.

Discrete laboratory and morphometric markers of atherosclerotic lesions of lower extremity vessels.

OBJECTIVE: The aim: To investigate discrete laboratory and morphometric features of atherosclerotic lesions in patients with chronic ischemia of the lower extremities (CILE). PATIENTS AND METHODS: Materials and methods:The examined contingent consisted of 47 patients (age 56.32 ± 1.09 years) diagnosed with obliterating atherosclerosis of the lower extremities. The study included determination of levels of Homocysteine, Folic acid, C protein, quantitative determination of circulating Endothelial cells (DEC) in blood plasma, and morphometric study of DEC. RESULTS: Results: Protein C levels are within the reference values (0.97 ± 0.12 mg / l. In 37 (78.7%) patients Hypoacidofoliemia (<3.0 mmol / l) was observed. Homocysteine levels were clearly elevated in all patients. In the vast majority Hyperhomocysteinemia mild form (91.5%) was observed. The number of DEC in patients was -3.22 ± 0.39x105/l and after compression -6.12 ± 0.21x105/l. CONCLUSION: Conclusions: Protein C levels were within the reference values (0.97 ± 0.12 mg / l); Folic acid levels in the vast majority (37 patients, 78.7%) were <3.0 mmol /l. Blood plasma Homocysteine levels were clearly elevated in all patients. The mild form of Hyperhomocysteinemia (91.5%). was observed in the vast majority The number of DEC in patients was -3.22 ± 0.39x105 and after compression -6.12 ± 0.21x105/l, which confirmed the presence of the endothelial dysfunction.