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.

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).

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION.

OBJECTIVE: The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. PATIENTS AND METHODS: Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) - circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). RESULTS: Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. CONCLUSION: Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

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.