PECULIARITIES OF THE FUNCTIONAL STATE OF THE LIVER IN PATIENTS WITH CHRONIC HEPATITIS C IN THE PRESENCE OF CHRONIC PANCREATITIS.

OBJECTIVE: The aim: To study the features of the functional state of the liver in patients with chronic hepatitis C (CHC) in the presence of CP, depending on the enzymatic activity of the pancreas. PATIENTS AND METHODS: Materials and methods: 72 patients were under observation: 52 with CHC and CP with exocrine secretory insufficiency (EI) of the pancreas and 20 - with CHC and CP without EI. In all patients, the degree of liver fibrosis, levels of aminotransferases, total bilirubin, gamma-glutamyltransferase, albumin, stool coproscopy and pancreatic fecal elastase-1 (FE-1) were determined. RESULTS: Results: It was revealed that in patients with CHC combined with CP+EI of the pancreas, higher activity of the necroinflammatory process and deeper stages of liver fibrosis is more often noted than in patients with preserved exocrine function of the pancreas. A statistically significant association was established between the degree of liver fibrosis and the presence of EI of the pancreas (p=0.03), namely, in patients with CHC and CP with EI of the pancreas, the degree of fibrosis F2-4 was 2.8 times more frequent. Also, higher levels of aminotransferases and lower levels of albumin were noted in this group of patients than in patients with CHC and CP with preserved exocrine function of the pancreatic gland. CONCLUSION: Conclusions: In patients with CHC combined with CP+EI of the pancreas, higher levels of fibrosis and necroinflammatory activity of the liver are more often detected, as well as a tendency to lower albumin levels, than in patients with CHC and CP without EI.

NON-INVASIVE METHODS OF DIAGNOSTICS OF GASTRO-ESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH ISCHEMIC HEART DISEASE.

OBJECTIVE: The aim: To determine the diagnostic value of non-invasive methods of GERD diagnosis based on questionnaire data and a diagnostic test with a proton pump inhibitor (PPI) with Rabeprazole in patients with coronary heart disease (CHD). PATIENTS AND METHODS: Materials and methods: 90 patients were under observation, namely, 68 patients with coronary heart disease with concomitant essential arterial hyperten¬sion (EAH), 6 patients with coronary artery disease + arrhythmias, and 18 - others diseases. All patients were surveyed according to the GerdQ questionnaire, followed by PPI testing with Rabeprazole, and body mass index (BMI) was calculated for all the patients. A BMI of 18.5-24.9 kg/m2 was considered as normal body weight, and a BMI > 24.9 kg/m2 was considered overweight. RESULTS: Results: Based on the results of the questionnaire, it was established that the most common complaints typical for GERD were noted by patients with CHD in combination with EAH. There were 48 of such patients and, depending on BMI, they were divided into 2 groups: 1st group (n=14) - patients with CHD+EAH+GERD with normal body weight and 2nd group (n=34) - overweight patients with CHD+EAH+GERD. In patients of group 1, typical symptoms of GERD prevailed (in 71.4% of patients), and in patients group 2, the distribution of typical and extra-esophageal symptoms did not differ significantly (52.9% vs. 47.1%). Among the extraesophageal manifestations, pain behind the sternum (in the projection of the esophagus) was significantly more often recorded in patients of group 1, and rhythm disturbances in patients of group 2 (43.8% and 75.0% of patients, respectively, p<0.05). The results of the GerdQ questionnaire showed a direct relationship between GERD, body weight and symptom score. Patients with GERD+normal body weight had a mean score of 6 for classic gastroesophageal reflux symptoms, while patients with GERD+increased body weight had a mean score of 7. The sensitivity of the questionnaire was 78.7%, and the specificity - 92.9%. According to the PPI test, in the 1st and 2nd groups, already in the first three days, 28.5% and 23.5% of patients noted the disappearance of heartburn and after 10 days - 85.7% and 64.7%, respectively. Over the entire period, that is, after 14 days of observation, 85.7% of patients in the 1st group and 73.5% in the 2nd group noted improvement. CONCLUSION: Conclusions: It has been established that questionnaires based on the GerdQ questionnaire followed by a PPI test with Rabeprazole in patients with coronary heart disease combined with essential arterial hypertension have a high diagnostic value and can be used for early diagnosis and effective treatment of GERD.

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.

ASSOCIATION BETWEEN SERUM ZINC, COPPER AND SELENIUM LEVELS AND THE DEGREE OF LIVER DAMAGE IN PATIENTS WITH CHRONIC HEPATITIS C.

OBJECTIVE: The aim: To evaluate the content of trace elements Zn, Cu and Se in blood serum and their relationship with viral load and the degree of liver fibrosis according to the results of the FibroMax test in patients with CHC. PATIENTS AND METHODS: Materials and methods: 62 outpatients with a verified diagnosis of CHC were under observation, in which serum Zn, Cu and Se levels, viral load and degree of liver fibrosis were determined according to the FibroMax test. RESULTS: Results: HCV 1b genotype was detected in all patients. The proportion of patients with a high viral load was 32%, with a low viral load - 68%. In 19% of patients, the level of Zn was below normal, and the levels of Cu and Se were within the reference values. The proportion of patients without fibrosis was 32%, 16% had minimal fibrosis, 40% had moderate fibrosis, 8% had progressive fibrosis, and 3% had severe fibrosis. 68% of patients had active inflammation of various degrees, liver steatosis - 65%, non-alcoholic steatohepatitis - 48%, inflammation caused by alcohol consumption was absent. No statistically significant difference was found in serum trace element levels and viral load (p>0.05). A weak negative correlation between the level of Zn and the degree of fibrosis (ρ=-0.340, p=0.007) and a negligible negative correlation between the level of Zn and inflammation activity (ρ=-0.286, p=0.024) were revealed. Patients with fibrosis grade ≥F2 had lower Zn levels compared to patients with fibrosis ≤F1 (0.607 (0.540, 0.691) mg/l vs. 0.716 (0.593, 0.875) mg/l, p=0.01), and when comparing there was no difference in Cu and Se levels (р>0.05). CONCLUSION: Conclusions: Thus, there is a relationship between the level of Zn in blood serum and the degree of liver damage in patients with CHC, which indicates the prospects for further research.

ASSESSMENT OF COLON MICROBIOCENOSIS DISORDERS IN PATIENTS WITH CHRONIC HEPATITIS C.

OBJECTIVE: The aim: To investigate the peculiarities of colon microbiocenosis disorders in patients with chronic hepatitis C. PATIENTS AND METHODS: Materials and methods: 142 patients with CHC were under observation, determination of the degree of liver fibrosis (FibroMax), bacteriological examination of stools and pancreatic elastase was performed. RESULTS: Results: It was found that 59.2% of patients with CHC had gut dysbiosis (DB), of which 61.9% had increased body weight. Intestinal microbiocenosis disorders were manifested by constipation in 57.1% of patients, diarrhea in 31% of patients, and alternating constipation and diarrhea in 11.9% of patients. Bacteriologically, gut dysbiosis was character¬ized by suppression of the growth of normal microflora: Escherichia coli in 47.6%, bifidobacteria in 61.9%, lactobacilli in 53.6%, complete absence of bifidobacteria in 20.2% of cases. In patients with CHC combined with DB deep stages of liver fibrosis (F2-3 and F3-4) are registered 3.6 times more often compared to patients without intestinal dysbiosis (53.6% versus 24.1% and 11.9% versus 3.4%). The degree of gut DB increased in proportion to the stage of liver fibrosis (p<0.05). 32.1% of patients with CHC with dysbiosis were diagnosed with exocrine insufficiency of the pancreas. CONCLUSION: Conclusions: Gut dysbiosis occurs more often in CHC patients with increased body weight and is characterized by constipation in 59.2% of patients. Intestinal microbiocenosis is characterized by suppression of the growth of normal microflora. In 32.1% of CHC patients with intestinal dysbiosis, according to the results of the pancreatic elastase-1 test, pancreatic exocrine insufficiency of various degrees was found.

DYNAMICS OF FIBROTIC CHANGES IN THE LIVER AFTER THE SUCCESSFUL ERADICATION OF HEPATITIS C VIRUS IN PATIENTS WITH NAFLD.

OBJECTIVE: The aim: To assess the dynamics of serum levels of angiopoietin-2 and transforming growth factor-ß1 in patients with chronic hepatitis C (CHC) with concomitant nonalcoholic fatty liver disease (NAFLD) after successful DAAs. PATIENTS AND METHODS: Materials and methods: 82 patients with CHC were examined, of which 56 were diagnosed with NAFLD and increased body weight. Ang-2, TGF-ß1, leptin, adiponectin, and the degree of liver fibrosis were determined for all participants. The patients were divided into groups: 1 gr. (n=23) - CHС + increased body weight + hepatic steatosis, 2 gr. (n=33) - СНС + increased body weight + nonalcoholic steatohepatitis, 3rd gr. (n=26) - CHC. All patients received DAAs for 12 weeks. RESULTS: Results: From 82 patients F3-4 had 31 people, F1-2 - 25, F0-1 - 11, F0 -15 patients. F3-4 and steatosis S2-3 (p<0.05) was more common in patients of 2 gr.. Serum Ang-2 levels were higher (p<0.05) in patients of 2 gr. with F3-4, than in patients with F0-2. Fibrosis regression occurred more often in patients with 1 and 3 gr. with F1-2 than in patients 2 gr. and F3-4 and was accompanied by a decrease in Ang-2 and TGF-ß1 levels. CONCLUSION: Conclusions: High levels of Ang-2 and TGF-ß1 are registered in patients with CHC+NAFLD, which correlate with the degree of liver fibrosis and significantly decrease after successful DAAs in patients with low initial stages of liver fibrosis and normal body weight.

THE CLINICAL EXPERIENCE OF THE EFFECTIVE USE OF DAPAGLIFLOZIN IN COMORBID CARDIAC PATIENTS WITH CONCOMITANT TYPE 2 DIABETES MELLITUS AND ARTERIAL HYPERTENSION ON THE BACKGROUND OF OVERWEIGHT IN OUTPATIENT SETTING.

OBJECTIVE: The aim: To assess the efficacy and safety of dapagliflozin in the treatment of comorbid cardiac patients with type 2 diabetes mellitus (T2DM) in combination with arterial hypertension (AH) and overweight in outpatient setting. PATIENTS AND METHODS: Materials and methods: Under observation were 19 patients who were treated in outpatient setting during 2019-2021 for AH and had T2DM, overweight or obesity. As part of complex treatment, patients received dapagliflozin 10 mg once a day for 12 months. RESULTS: Results: The normalization of blood pressure, elimination of heart failure symptoms on the background of increased ejection fraction, improved indicators of the functional capacity of the kidneys, and a decrease in the degree of proteinuria/albuminuria were noted after treatment. The patients had an easier time losing weight (body mass index and waist circumference decreased; p<0.05) and decreased levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). None of the monitored patients had cases of hypoglycemia or urinary tract infection. The number and/or doses of antihypertensive, hypouricemic and diuretic drugs were gradually reduced. CONCLUSION: Conclusions: Using dapagliflozin in a standard dose of 10 mg/day in the complex therapy of patients with T2DM in combination with arterial hypertension and overweight contributes not only to the normalization of blood pressure, but also to a reduction in body weight and waist circumference. The proposed therapy can be an alternative for the treatment of patients with T2DM with concomitant overweight or obesity, arterial hypertension, with or without heart and/or renal failure as a first-line antidiabetic drug.

ASSESSMENT OF THE IMPACT OF ANTIREFLUX THERAPY ON THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

OBJECTIVE: The aim: To examine the effect of antireflux therapy on the course of COPD. PATIENTS AND METHODS: Materials and methods: Under observation were 60 patients who were hospitalized in the «Transcarpathian Regional Clinical Hospital named after Andrei Novak¼ with a diagnosis of COPD II gr B in combination with GERD and 36 patients diagnosed with GERD who were treated on an outpatient basis. To study the effectiveness of antireflux therapy and its impact on the course of COPD, patients are divided into 2 groups: 1 group (main) (n = 60) - patients with COPD in combination with GERD, group 2 (control) (n = 36) - patients with isolated GERD. Patients with positive Helicobacter pylori status received antihelicobacter therapy. Patients in group 1 were divided into subgroups: 1a (n = 34) - COPD in combination with esophageal manifestations of GERD and 1b (n = 26) - COPD in combination with extraesophageal manifestations of GERD. Group 1a received complex therapy, which consisted of basic therapy of COPD in combination with antireflux and with rebapimide, group 1b - only basic therapy of COPD in combination with antireflux. RESULTS: Results: After treatment, the clinical signs of GERD significantly decreased in all patients receiving complex therapy, improved the course of respiratory symptoms of COPD. After treatment, patients showed a clinically significant reduction in systemic inflammation, which is best seen in the group with the use of rabipimide. CONCLUSION: Conclusions: Comprehensive treatment of combined pathology with the use of antireflux therapy has a positive effect not only on the clinical symptoms of the disease, but also on the indicators of external respiratory function in patients with combined COPD and GERD.