CYTOMEGALOVIRUS AND VIRUS EPSTEIN- BARR INFECTION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ITS DEPENDENCE ON GENDER AND AGE OF PATIENTS

Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by various manifestations and clinical course, many aspects of the etiology and pathogenesis of which remain unclear. Recently, the interest of researchers in studying the role of cytomegalovirus (CMV) and Epstein - Barr virus (EBV) has been growing in the occurrence and course of a number of human diseases due to their ability to affect almost all organs and systems of the body, causing the formation of latent, active or chronic infection, which can often cause temporary disability, disability or even death, however, for the patients with SLE, despite the possibility of approaching the difficult problem of diagnosis and treatment of this disease, this issue is given insufficient attention, as evidenced by isolated studies.The aim of the study. Detect cytomegalovirus and Epstein - Barr infection in patients with systemic lupus erythematosus and its dependence on gender and age of patients. Materials and methods of research. The study involved 120 patients (15 men (12.50%) and 105 women (87.50%) aged 18 to 69 years with SLE, who were in the rheumatology department of the Communal Non-Commercial Enterprise of the Lviv Regional Council "Lviv Regional Clinical Hospital" in 2014-2019. To diagnose CMV and EBV infection by enzyme-linked immunosorbent assay, antibodies of IgM and IgG to viruses were detected in blood serum, and viruses were detected by polymerase chain reaction. According to the results of virus detection, formed groups of the patients, namely: patients with active CMV infection, active EBV, active CMV and EBV, without active CMV and EBV. All patients with SLE included in the study were subsequently stratified by age according to the classification of the World Health Organization (2015), according to which the following age limits were determined: young age, middle-aged, elderly, senile. Statistical analysis was performed on a personal computer in MS Excel and Statistica 6.0 using descriptive statistics. The frequency of cases of active CMV and EBV infection was calculated mathematically by the binomial coefficient of I. Newton. Research results and their discussion. We found in the vast majority of patients with SLE (117 patients, 97.50%) increase in the titer of specific antibodies to CMV. Only in 3 patients (2.50%) the titer of antibodies to this virus was within normal limits. Analyzing the frequency of EBV infection in patients with SLE, we recorded an increase in the titer of specific antibodies to the virus in 119 patients (99.17%). Among the examined patients with SLE in all (100.00%) found an increase in the titer of antibodies to CMV and / or EBV, of which 97.50% - infected with CMV and 97.17% - infected with EBV. The active phase of CMV and / or EBV infection was detected in 54.17%, of which 23.33% - active CMV infection, 17.50% - active EBV infection and 12.50% - a combination of active CMV and EBV infection simultaneously, which indicates a high frequency of CMV and EBV infection in patients with SLE and reflects the urgency of the problem of diagnosing herpesvirus infection in them. We found that activeCMV, EBV infections and their combinations are present only in women (64 patients, which is 60.96% of the total number of women with SLE), of which 28 patients (26.67%) there was only active CMV infection, in 21 patients (20.00%) - only active EBV infection and in 15 patients (14.29%) – combination of active CMV and EBV infection. 41 women (39.05%) and all (100.00%) men were not found to have active CMV and EBV infection, which indicates that men at the time of the survey were significantly more likely to have this infection in the integration phase. The most frequently active EBV infection was detected in patients with SLE of young age (17 cases, 24.64%), and in middle-aged patients 3 cases (6.52%) were recorded, which indicates a significant (p <0.05) difference in the frequency of cases of active EBV infection in patients of both groups. Only 1 case (20.00%) of active EBV infection was detected in elderly patients. Conclusions. All patients with systemic lupus erythematosus are infected - 97.50% with cytomegalovirus and 97.17% with Epstein-Barr virus infection, that was confirmed by the increased titer of antibodies to them. Among the mentioned patients 53.33% of them had the active phase of infection (23.33% - cytomegalovirus infection in the replication phase, 17.50% - the Epstein- Barr virus infection in the replication phase and 12.50% - their combination). The prevalence of active viral infection in patients with systemic lupus erythematosus depends on gender (active cytomegalovirus, active Epstein-Barr virus infection and their combination are significantly more common in women) and age - they are probably more common in young patients.  Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by various manifestations and clinical course, many aspects of the etiology and pathogenesis of which remain unclear. Recently, the interest of researchers in studying the role of cytomegalovirus (CMV) and Epstein - Barr virus (EBV) has been growing in the occurrence and course of a number of human diseases due to their ability to affect almost all organs and systems of the body, causing the formation of latent, active or chronic infection, which can often cause temporary disability, disability or even death, however, for the patients with SLE, despite the possibility of approaching the difficult problem of diagnosis and treatment of this disease, this issue is given insufficient attention, as evidenced by isolated studies.The aim of the study. Detect cytomegalovirus and Epstein - Barr infection in patients with systemic lupus erythematosus and its dependence on gender and age of patients. Materials and methods of research. The study involved 120 patients (15 men (12.50%) and 105 women (87.50%) aged 18 to 69 years with SLE, who were in the rheumatology department of the Communal Non-Commercial Enterprise of the Lviv Regional Council "Lviv Regional Clinical Hospital" in 2014-2019. To diagnose CMV and EBV infection by enzyme-linked immunosorbent assay, antibodies of IgM and IgG to viruses were detected in blood serum, and viruses were detected by polymerase chain reaction. According to the results of virus detection, formed groups of the patients, namely: patients with active CMV infection, active EBV, active CMV and EBV, without active CMV and EBV. All patients with SLE included in the study were subsequently stratified by age according to the classification of the World Health Organization (2015), according to which the following age limits were determined: young age, middle-aged, elderly, senile. Statistical analysis was performed on a personal computer in MS Excel and Statistica 6.0 using descriptive statistics. The frequency of cases of active CMV and EBV infection was calculated mathematically by the binomial coefficient of I. Newton. Research results and their discussion. We found in the vast majority of patients with SLE (117 patients, 97.50%) increase in the titer of specific antibodies to CMV. Only in 3 patients (2.50%) the titer of antibodies to this virus was within normal limits. Analyzing the frequency of EBV infection in patients with SLE, we recorded an increase in the titer of specific antibodies to the virus in 119 patients (99.17%). Among the examined patients with SLE in all (100.00%) found an increase in the titer of antibodies to CMV and / or EBV, of which 97.50% - infected with CMV and 97.17% - infected with EBV. The active phase of CMV and / or EBV infection was detected in 54.17%, of which 23.33% - active CMV infection, 17.50% - active EBV infection and 12.50% - a combination of active CMV and EBV infection simultaneously, which indicates a high frequency of CMV and EBV infection in patients with SLE and reflects the urgency of the problem of diagnosing herpesvirus infection in them. We found that activeCMV, EBV infections and their combinations are present only in women (64 patients, which is 60.96% of the total number of women with SLE), of which 28 patients (26.67%) there was only active CMV infection, in 21 patients (20.00%) - only active EBV infection and in 15 patients (14.29%) – combination of active CMV and EBV infection. 41 women (39.05%) and all (100.00%) men were not found to have active CMV and EBV infection, which indicates that men at the time of the survey were significantly more likely to have this infection in the integration phase. The most frequently active EBV infection was detected in patients with SLE of young age (17 cases, 24.64%), and in middle-aged patients 3 cases (6.52%) were recorded, which indicates a significant (p <0.05) difference in the frequency of cases of active EBV infection in patients of both groups. Only 1 case (20.00%) of active EBV infection was detected in elderly patients. Conclusions. All patients with systemic lupus erythematosus are infected - 97.50% with cytomegalovirus and 97.17% with Epstein-Barr virus infection, that was confirmed by the increased titer of antibodies to them. Among the mentioned patients 53.33% of them had the active phase of infection (23.33% - cytomegalovirus infection in the replication phase, 17.50% - the Epstein- Barr virus infection in the replication phase and 12.50% - their combination). The prevalence of active viral infection in patients with systemic lupus erythematosus depends on gender (active cytomegalovirus, active Epstein-Barr virus infection and their combination are significantly more common in women) and age - they are probably more common in young patients. &nbsp

Clinical Markers of the Syntropic Comorbid Lesions of the Circulatory System in Patients with Liver Cirrhosis

Introduction. Syntropic comorbid disorders of the circulatory system in patients with liver cirrhosis are among the most common ones and include two separate diseases: cardiomyopathy with characteristic changes of the heart structure and function; and stable arterial hypotension with its characteristic features of daily blood pressure rhythm and variability, diagnostics of which requires special investigations: echocardiography using doppler, 24-hour blood pressure monitoring, etc. Aim: to distinguish the clinical markers of cardiomyopathy and stable arterial hypotension according to the results of the primary examination of patients with liver cirrhosis. Methods and materials. Complex clinical laboratory and instrumental examination of 603 patients with liver cirrhosis (445 men and 158 women, average age 49.2 ± 10.6 years) was conducted. We distinguished 490 (81.3 %) patients with extrahepatic lesions of the blood circulation system (experimental group that was divided into three subgroups: with syntropic cardiomyopathy separately (103 patients), with syntropic arterial hypotension (89 patients), other (306 patients)), as well as 113 patients (18.7 %) without blood circulation system lesions (comparison group (CG)). The study is dedicated to the statistical analysis with calculation of the chances to put the correct diagnosis of syntropic damages of the blood circulation system using separate indicator: a marker. The research was carried out in four consecutive steps, which included assessment of demographic information, patient complaints, anamnesis and ob­jective review findings. The actual material was processed in the MS Excel and SPSS based on the conjugation tables. The relationships between cardiomyopathy (or arterial hypotension) and the investigated marker were considered to be confirmed, if the modulus of the association coefficient exceeded 0.5 (or 0.3 for the contiguous factor). Results and discussion. According to the first step consisting in the analysis of information from the passport, it was found that gender does not indicate the presence of a syntropic damages of the blood circulation system, unlike the age which can reliably indicate cardiomyopathy (middle and old age) or arterial hypotension (young and mature age). Among the complaints of patients with liver cirrhosis (second task), the pain on the left reliably denies the diagnosis of cardiomyopathy and indicates the presence of arterial hypotension, nausea clearly indicates that the patient does not have stable arterial hypotension. Due to the analysis of the anamnesis of patients with liver cirrhosis (third task),it was revealed that the presence of C-viral cirrhosis (viral etiology) or combined B- and C-viral cirrho­sis (viral etiology) in patients can reliably deny the diagnosis of cardiomyopathy, and the presence of cirrhosis lasting for more than three years, bleedings from varicose veins of the esophagus and/or the presence of virus B-cirrhosis of viral etiology independently of each other can reliably indicate that the patient has stable arterial hypotension. According to the results we received from the fourth step of the research, normal or lower normal body mass index, icteric skin and sclera, weakened heart sounds are associated with cardiomyopathy, and edema on the lower extremities and “caput medusae” – with its absence. Telangiectasias, ascites, “caput medusae”, edema on the lower extremities, hepato- and splenomegaly indicate a stable arterial hypotension. Conclusions. The analysis allows us to confirm that middle and old aged patients have complaints on pain and/or heaviness in the left hypochondrium, if C- or C- and B-viral etiologies of the cirrhosis are absent, body mass index is normal or lower than norm, icteric skin and sclera, weakened heart sounds and “caput medusae” as well as edema on the lower extremities are absent, the presence of cardiomyopathy may be presumed; and in young or middle aged patients there are complaints on pain in the left hypochondrium, nausea, if liver cirrhosis lasts longer than three years, there is information of esophageal varicose veins’ bleedings in anamnesis of the patient, B- viral cirrhosis, telangiectasias, ascites, “caput medusae”, edema on the lower extremities, hepato- and splenomegaly, the presence of the stable arterial hypotension may be presumed. Taking into account clinical markers during examina­tion of the patients with liver cirrhosis makes it possible to form risk groups concerning presence of the correspond­ing syntropic comorbid blood circulation system damages, examine the patient correctly and determine the correct treatment strategy

Treatment of the Liver Cirrhosis: Modern Principles, Considering Syntropic Co- and Multimorbid Lesions of other Organs and Systems of Organs

Introduction. Cirrhosis of the liver is a frequent chronic polyethyologic disease of the internal organs with polymorphous syntropic lesions, which often causes early disability and death of patients – that is why it is necessary to improve the principles of complex differentiated treatment taking into account extrahepatic manifestations of the disease. Aim. To improve the algorithm and to improve the efficiency of treatment of patients with cirrhosis of the liver by taking into account detected extrahepatic co- and polymorbid syntropic lesions of other organs and systems. Materials and methods. The study included 1713 patients with cirrhosis (75.7% of men, 24.3% of women, age 18-86), who performed a comprehensive examination of all organs and systems in accordance with the requirements of modern medicine. Subsequently, patients were divided according to the criteria for classification of C. G. Child – R. N. Pugh by severity at A (38.1%), B (52.3%) and C (9.6%) classes, and a comprehensive differential treatment was performed for 4-6 weeks. The control group consisted of 302 patients, representative of gender, age and severity of liver cirrhosis, which were treated according to the generally accepted method. Results. Among patients with cirrhosis of the liver, 74.3% had varicose veins of the esophagus, 61.3% had gastropathy, 48.2% had varicose hemorrhoidal veins, 19.2% had arterial hypertension, 56.4% arterial hypotension, 57,3% – secondary cardiomyopathy, 27.5% – rhythm disorders, 65,3% – disorders of conduction, 82,9% – signs of hepatopulmonary syndrome, 8,9% – portopulmonal hypertension, 0.8% – signs of hepatolateral syndrome type І, and 3.3% – type II, 56.0% – secondary encephalopathy, 73.1% – signs of the disorders of the autonomic nervous system, 60.5% – osteopenia and 39.5% – osteoporosis, 42.3% – anemia, 29.8% – coagulopathy and 94.2% – signs of skin lesions. In 64.2% of the patients treated using the system we had modified, good results were obtained, in 28.7% the results were satisfactory and 7.1% – were not satisfactory. 73.1% had a good result in patients with class A of liver cirrhosis, 63.9% – class B and 61.8% – class C. The number of patients with satisfactory results was roughly the same in all groups (26.5% -30.4%). In group A, there were no patients with poor treatment outcomes, in group B – 5.7%, and in group C they were 11.7%. The presented actual material allows us to assert that the complex treatment we have modified is effective in 92.9% of the patients with liver cirrhosis. In the significantly lower number of patients treated using the usual method compared to the experimental group (47.4%), good results were obtained, and this was due to a significant increase in the number of patients with only a satisfactory result of treatment (46.7%). In 5.6% of the patients, the results of treatment were not satisfactory, and 0.3% the results were poor. 51.3% of the patients with a good result were patients of class A of liver cirrhosis, 49.4% – class B and 20.7% – class C. The number of patients with satisfactory results, as in the experimental group, was approximately identical in quantity in groups A, B and C (from 46.2% to 48.3%). In group A, 1.7% of the patients had a poor outcome, in group B they were 4.4%, and in group C – 27.6%. Consequently, the generally accepted comprehensive treatment is effective in 94.1% of patients with liver cirrhosis, but for qualitative indices, it is significantly lower than the medical complex we have modified. Conclusions. Modified by the authors, the complex differential treatment of patients with liver cirrhosis, taking into account the presence of polymorbid syntropic lesions, as well as the traditional one gives a positive result, but the effectiveness of conventional treatment is lower compared to the complex we modified

Characteristics and Features of the Circulatory System Status in Patients with Liver Cirrhosis as a Disease of Multiple Organ Lesions: Pathogenesis; Diagnostics; Principles of their Treatment (Literature Review and Clinical Case Description)

Introduction. Liver cirrhosis has a significant place among the diseases of internal organs and its comorbid syntropic lesions of the circulatory system are a common cause of disability, and often death of patients, determining the actuality, health, socio-economic importance and need for improvement of the principles of its integrated differential treatment, taking into account the state of the cardiovascular system. Aim. To analyze the studies on frequency, pathogenesis, clinics, diagnostics and treatment of polymorbid syntropic extrahepatic lesions of the cardiovascular system in patients with liver cirrhosis published until now. Materials and methods. We have worked on clinical research data for previous years and have analyzed a case of the disease of a particular patient who was under our observation. Results. Diseases of a liver as a key organ of the interorgan and intersystem relationships, lead to the circulatory system disorders. It appears, first of all, by the hemodynamics disorders with the formation of stable arterial hypotension and, consequently, microcirculatory disorders, functional failure of almost all organs and also myocardial damage resulting into cirrhotic cardiomiopathy with systolic and diastolic heart failure and changes of the heart’s parameters. The study of this problem started in Cappadocien Aretacus and Claudius Galenus, but there were only isolated reports. Detailed study of this problem began in the twentieth century. However, despite the lengthy study, today there is no there is no final answer to the questions of pathogenesis of the circulatory system lesions in patients with cirrhosis. At this moment, it is well known that cardiovascular homeostasis in patients with liver cirrhosis is associated with the presence and severity of portal hypertension and hepatocellular insufficiency, and among the molecular mechanisms the leading role is given to endothelial dysfunction with an imbalance in the system of vasoconstrictors (endothelin-1) and vasodilators (nitric oxide, carbon monoxide, hydrogen sulfide, prostacyclin, kanabioids, endogenous opioids and others), disorders in the renin-angiotensin-aldosterone system and in the autonomic nervous system. An imbalance in the mentioned system leads to the systemic vasodilation, which is the most pronounced in splanhnic vessels, causing arterial hypotension and subsequent changes in the bloodstream and in the end, leads to polyorganic failure. These vasoactive substances are able to make the cardiodepressive effect and potentially participate in the pathogenesis of cardiomyopathy in the cirrhotic patients. Clinical signs of liver cirrhosis with the involvement into the process organs of the cardiovascularsystem is poor and, most importantly, non-specific. Most often there are no complaints or regarded as a manifestation of liver disease and the results of physical, laboratory and instrumental examination are of low information. The most specific is a high heart rate, presence of «chronotropic insufficiency», the level and daily fluctuations of blood pressure. Specific treatment of the cardiovascular system lesions in case of liver cirrhosis have been not developed till now. Treatment of such patients should be individualized, aiming at the support of myocardial function and prevention of circulatory decompensation. Conclusions. According to a literature review the injury of a liver as a key organ of interorgan and intersystem relationships, leads to the disorders of the circulatory system and manifests with the hemodynamics violation resulting into the formation of stable arterial hypotension and myocardial damage known as cirrhotic cardiomiopathy with systolic and diastolic heart failure and changes of the parameters of the heart. However, disorders of blood flow in patients with liver cirrhosis require further elucidation of features of the pathogenetical mechanisms of its appearance, which will justify the new principles of the effective treatment of this category of critically ill patients

The content of some vasoactive humoral-metabolic factors in patients with cirrhosis and their participation in pathogenesis of comorbid syntropical damages of cardiovascular system

Introduction. Liver cirrhosis is an inveterate polyetiological disease that regards to the 6 main reasons of patients’ mortality at the age of 35-60. The management of treatment and prediction for patients with cirrhosis particularly are defined by syntropic polymorbidal damages of other organs and systems among which are circulatory system diseases – cardiomyopathy and arterial hypotension – the most frequent ones. Firts of all, the improvement of diagnostics and treatment of those patients supposes the studying their pathogenesis. For the time being, the most probable pathogenetic chains are endothelial dysfunction, imbalance in renin-angiotensin-aldosterone system, and also overproduction of brain natriuretic peptide. Aim. To examine the content of vasoactive humoral-metabolic factors, i.e. endothelium-dependent (cyclic guanosine monophosphate, endothelin-1), indexes of renin-aldosterone system (renin, aldosterone) and brain natriuretic hormone in blood plasma in patients with cirrhosis and discover their participation in pathogenesis of comorbid syntropical damages of cardiovascular system. Materials and methods. Randomly with the previous stratification due to the presence of cirrhosis there were 603 patients (445 men (73.8 %) and 158 women (26.2 %) at the age of 19-80 (average age 49.2 ± 10.6) who were treated in the Lviv Regional Hepatological Centre, they had the complex clinical-laboratorial and instrumental research of all organs and systems before treatment due to the orders of the Ministry of Healthcare of Ukraine. Using these results we have seperate 490 (81.3 %) cirrhosis patients with extrahepatic damages of cardiovascular system (investigational group which is stratified into 3 subgroups, i.e. those who have only syntropic cardiomyopathy (103 patients) – group A, only syntropic hypotension (89 patients) – group B and others (306 patients)), and also those who don’t have the damages of cardiovascular system (113 patients; 18.7 %) – the comparison group). Randomly, to achieve the aim the part of the patients from every subgroup (30 patients from A-group, 27 – from B-group and 25 from group of comparison) were screened for the content of the vasoactive humoral-metabolic factorsm. There were 17 almost healthy volunteers of the same gender and age in the control group. Results and discussion. The patients of both investigational groups have reasonably higher number of vasoactive humoral-metabolic factors. In particular, patients with cirrhosis and syntopetic cardiomyopathy dominate the effects of endothelin-1, renin and brain natriuretic peptide, and in patients with cirrhosis and syntropic arterial hypotension – cyclic guanosine monophosphate and aldosterone are the main factors. Additionally we recorded the pathological interaction among vasoactive material. Unlike of the results in comparison group, in patients with liver cirrhosis and syntropic cardiomyopathy, the local vasoactive compounds are in such interactions with each other that result in hyperactivity of the renin-angiotensin-aldosterone system and endothelial dysfunction with a significant increase in both vasoconstrictor endothelin-1 and vasodilator NO, and in patients with liver cirrhosis and arterial hypotension – to severe endothelial dysfunction with overproduction of NO. Conclusions. Cyclic guanosine monophosphate, endothelin-1, renin, aldosterone, and brain natriuretic peptide, have a pathological effect on each other and are involved in the pathogenesis of syntropic damages of the circulatory system in patients with liver cirrhosis. In patients with cirrhosis and syntropic cardiomyopathy, heart damage occurs through toxic myocardial damage due to excessive effects of renin, endothelin-1, and brain natriuretic peptide with the onset of systolic and diastolic dysfunction and overload of the heart with blood volume. And in patients with cirrhosis and syntropic arterial hypotension, the damage occurs due to the endothelial dysfunction with excessive cyclic guanosine monophosphate and hyperaldosteronism, which leads to the expansion of peripheral vessels, the depositing of excess blood in the organs and, consequently, the decrease in the effective volume of circulation blood

Peculiarities of Calcium-Phosphorus Metabolism and Bone State in Patients with Liver Cirrhosis: Diagnosis and Principles of Differential Treatment (Literature Rewiev and Clinical Case Description)

Introduction. The disorders of calcium-phosphorus metabolism and bone tissue state, which are the main cause of spontaneous fractures and motor activity disorders in patients with liver cirrhosis, they require deeper understanding of etiology and pathogenesis, the use of laboratory-instrumental methods of diagnosis, taking into account risk factors and prescribing of the effective treatment to improve the quality of life. Conducting the additional studies will give impetus to the search for new methods of treatment of not only individual nosolenias, but also co- and polymorbid diseases and will help to reduce the effect of radiation from the use of medications. Aim. To make the literature review devoted to the peculiarities of calcium-phosphorus metabolism and the state of bones in patients with liver cirrhosis, methods of diagnostics and the principles of differentiated treatment, to describe the clinical case. Materials and Methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of studying the actual scientific studies of the peculiarities of calcium-phosphorus metabolism and the state of bones in patients with liver cirrhosis, methods of diagnostics and the principles of differentiated treatment are described. Results. The review of the literature shows the importance and urgency of the problem of studying calcium-phosphorus metabolism and the state of bone tissue in patients with cirrhosis of the liver. Mechanisms leading to pathological changes in bone tissue in such patients has been insufficiently studied. Nevertheless, there are number of common factors affecting bone metabolism: malformation of calcium and vitamin D, vitamin K deficiency, hormonal disregulation, cytokine release, insulin-like growth factor 1 (IFR-1) deficiency, etc. All efforts in the treatment are aimed at minimizing the loss of bone mass, preventing the fractures and kneading bone pain. First of all, it’s important to persuade the patient to stop smoking and drink alcohol, exercise regularly, and maintain a balanced diet with high levels of calcium and vitamin D. In the described clinical case, the patient with cirrhosis of the liver is diagnosed with osteoporosis confirmed by ultrasound densitometry and examination of calcium-phosphorus metabolism and bone tissue state by measuring the content of total calcium, ionized calcium, phosphorus, vitamin D, parathyroid hormone and markers of bone metabolism (b- crossLaps, P1NP, osteocalcin). Conclusions. The study of the state of calcium-phosphorus metabolism and the state of bone tissue in patients with liver cirrhosis requires the use of safe and informative diadynamic methods that will be used at any stage of the disease and will help in choosing the therapeutic tactics

Severity Degrees of Syntropic Stable Arterial Hypotension in the Cirrhotic Patients and Their Dependence on the Daily Blood Pressure Monitoring and Liver Damage Class by C.G. Child – R.N. Pugh

Introduction. Daily monitoring of the arterial blood pressure in the cirrhotic patients is used in the practical medicine, as well as in numerous scientific studies for the study of the pathogenesis, clinical and instrumental manifestations of the circulatory system injury. Daily monitoring of the arterial blood pressure should also be used for the syntropic arterial hypotension severity degrees gradation inthe cirrhotic patients. The aim of the study. To determine the syntropic arterial hypotension severity degrees in the cirrhotic patients, their dependence on the daily blood pressure monitoring and liver injury class according to C.G. Child – R. N. Pugh. Materials and methods. The study involved 603 patients with liver cirrhosis (445 men and 158 women, mean age – 48.4 ± 10.3 years), among which – 173 patients with syntropic arterial hypotension, 89 patients of which – with syntropic arterial hypotension without any other disorders of the circulatory system (experimental group). The control group included 26 practically healthy volunteers of the respective gender and age. The daily blood pressure monitoring using the ABPM-04 (Meditech, Hungary) device according to the standard procedure was conducted for all the patients, in addition to the usual examination procedure. Results. It was found that the average, maximum and minimum daily systolic, diastolic, mean and pulse blood pressure, as well as their derivative parameters in the patients of the experimental group, compared with their values in the practically healthy volunteers, are significantly lower, which confirms the presence of stable arterial hypotension in such category of patients. The disorders of the circadian rhythm and blood pressure variability were also found in the patients of the experimental group. The average daily blood pressure is advisable to use to determine the severity of hypotension. In case if the average daily blood pressure, determined by the method of daily monitoring, ranges from 80 mmHg to 76 mmHg, we diagnose mild (I) degree of hypotension, from 75 mmHg to 70 mmHg – the average (II), and in cases when the average daily blood pressure is less than 70 mm Hg -severe (III) degree of arterial hypotension. Among the examined patients (173 patients with arterial hypotension), 54 patients with I degree (31.21 %), 66 patients with II (38.15 %) and 53 patients with III (30.64 %) degree of arterial hypotension were found. The study of correlation between the indicators of daily blood pressure monitoring, depending on the arterial hypotension severity, showed that the average daily blood pressure is the most informative parameter, also the number of some other indicators are informative. After analyzing the distribution of degrees of arterial hypotension, depending on the severity of livercirrhosis by C.G. Child and R.N. Pugh, we found that with the increase of the class, the number of patients with mild (I degree) hypotension decreases and the number of patients with secondary (II degree) and severe (III degree) arterial hypotension increases. Conclusions. We characterized the arterial pressure, recorded by the method of daily blood pressure monitoring. It was found that in the cirrhotic patients there is a syntropic stable arterial hypotension with the disturbed circadian rhythms and arterial pressure variability. The average daily blood pressure is set as the most informative parameter, and the syntropic hypotension is classified into three degrees of severity. Correlative relationships between the pa­rameters of daily blood pressure monitoring and degrees of severity of stable arterial hypotension, among which the strongest has an average daily blood pressure, are revealed. It was stated that with the increase of the liver cirrhosisseverity class by C. G. Child and R. N. Pugh, the number of patients with mild degree syntropic hypotension decreases and the number of patients with syntropic arterial hypotension of moderate andsevere degrees increases

Factors Affecting Mortality Of Patients With Systemic Lupus Erythematosus (Prospective Study)

Introduction. Systemic lupus erythematosus is accompanied by lesions in vital organs and systems and significantly reduces the life expectancy of patients. Attempts have been made to identify the main factors that worsen the prognosis of patients and increase the risk of mortality. The obtained information has often been fragmentary, taking account of only a few factors, and sometimes contradictory.Objective. To identify factors that affect the mortality of patients with systemic lupus erythematosus.Materials and methods. 294 patients after stratification by the presence of systemic lupus erythematosus were randomly enrolled in a prospective study. The study was conducted in two phases. The first phase consisted of three consecutive steps. At the first step we analyzed passport data, at the second step – the presence of ACR criteria, and at the third step – the presence of pathogenetically associated with SLE organ lesions. In general, the first phase dealt with the analysis of factors that determine the survival of patients with SLE. The purpose of the second phase was to identify constellations of manifestations that most significantly determine the risk of death.Results. Factors that increase the mortality of patients with SLE are male sex, age (under 42.5 years), proteinuria and cylindruria, seizures, lymphopenia, lupus anticoagulant antibodies, as well as the presence of myocarditis, pneumonitis, autoimmune hepatitis, aseptic necrosis, chronic caries. However, the combination of male sex, overweight (over 92.5 kg) and autoimmune hepatitis plays the most important role

Cytomegalovirus And Virus Epstein- Barr Infection In Patients With Systemic Lupus Erythematosus And Its Dependence On Gender And Age Of Patients

Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by various manifestations and clinical course, many aspects of the etiology and pathogenesis of which remain unclear. Recently, the interest of researchers in studying the role of cytomegalovirus (CMV) and Epstein - Barr virus (EBV) has been growing in the occurrence and course of a number of human diseases due to their ability to affect almost all organs and systems of the body, causing the formation of latent, active or chronic infection, which can often cause temporary disability, disability or even death, however, for the patients with SLE, despite the possibility of approaching the difficult problem of diagnosis and treatment of this disease, this issue is given insufficient attention, as evidenced by isolated studies.The aim of the study. Detect cytomegalovirus and Epstein - Barr infection in patients with systemic lupus erythematosus and its dependence on gender and age of patients. Materials and methods of research. The study involved 120 patients (15 men (12.50%) and 105 women (87.50%) aged 18 to 69 years with SLE, who were in the rheumatology department of the Communal Non-Commercial Enterprise of the Lviv Regional Council "Lviv Regional Clinical Hospital" in 2014-2019. To diagnose CMV and EBV infection by enzyme-linked immunosorbent assay, antibodies of IgM and IgG to viruses were detected in blood serum, and viruses were detected by polymerase chain reaction. According to the results of virus detection, formed groups of the patients, namely: patients with active CMV infection, active EBV, active CMV and EBV, without active CMV and EBV. All patients with SLE included in the study were subsequently stratified by age according to the classification of the World Health Organization (2015), according to which the following age limits were determined: young age, middle-aged, elderly, senile. Statistical analysis was performed on a personal computer in MS Excel and Statistica 6.0 using descriptive statistics. The frequency of cases of active CMV and EBV infection was calculated mathematically by the binomial coefficient of I. Newton. Research results and their discussion. We found in the vast majority of patients with SLE (117 patients, 97.50%) increase in the titer of specific antibodies to CMV. Only in 3 patients (2.50%) the titer of antibodies to this virus was within normal limits. Analyzing the frequency of EBV infection in patients with SLE, we recorded an increase in the titer of specific antibodies to the virus in 119 patients (99.17%). Among the examined patients with SLE in all (100.00%) found an increase in the titer of antibodies to CMV and / or EBV, of which 97.50% - infected with CMV and 97.17% - infected with EBV. The active phase of CMV and / or EBV infection was detected in 54.17%, of which 23.33% - active CMV infection, 17.50% - active EBV infection and 12.50% - a combination of active CMV and EBV infection simultaneously, which indicates a high frequency of CMV and EBV infection in patients with SLE and reflects the urgency of the problem of diagnosing herpesvirus infection in them. We found that activeCMV, EBV infections and their combinations are present only in women (64 patients, which is 60.96% of the total number of women with SLE), of which 28 patients (26.67%) there was only active CMV infection, in 21 patients (20.00%) - only active EBV infection and in 15 patients (14.29%) – combination of active CMV and EBV infection. 41 women (39.05%) and all (100.00%) men were not found to have active CMV and EBV infection, which indicates that men at the time of the survey were significantly more likely to have this infection in the integration phase. The most frequently active EBV infection was detected in patients with SLE of young age (17 cases, 24.64%), and in middle-aged patients 3 cases (6.52%) were recorded, which indicates a significant (p <0.05) difference in the frequency of cases of active EBV infection in patients of both groups. Only 1 case (20.00%) of active EBV infection was detected in elderly patients. Conclusions. All patients with systemic lupus erythematosus are infected - 97.50% with cytomegalovirus and 97.17% with Epstein-Barr virus infection, that was confirmed by the increased titer of antibodies to them. Among the mentioned patients 53.33% of them had the active phase of infection (23.33% - cytomegalovirus infection in the replication phase, 17.50% - the Epstein- Barr virus infection in the replication phase and 12.50% - their combination). The prevalence of active viral infection in patients with systemic lupus erythematosus depends on gender (active cytomegalovirus, active Epstein-Barr virus infection and their combination are significantly more common in women) and age - they are probably more common in young patients. &nbsp

Lesions Of Respiratory System In Patients With Systemic Lupus Erythematosus:

Introduction. The respiratory system lesions in patients with systemic lupus erythematosus have not been properly addressed by both clinicians and scientists yet, since the progression of these lesions is often asymptomatic. Objective. To identify and determine the nature and prevalence of respiratory system lesions in patients with systemic lupus erythematosus; to distinguish syntropic comorbid lesions, to determine their prevalence and their relationship with the age of patients, disease duration, and the severity of respiratory failure. Materials and methods. 370 patients (331 women and 39 men) with SLE were enrolled. They underwent comprehensive examinations and were stratified by age, duration, and the activity of SLE. The obtained data were processed in Microsoft Excel by means of descriptive statistics, χ2 test, and z-test for comparisons of two proportions; the relationships were considered to be statistically significant when p < 0.05. Results. 67.57% of patients with SLE had respiratory system lesions. Pneumosclerosis, pulmonary hypertension, pneumonitis, and pulmonary fibrosis were found to be syntropic comorbid lesions, i.e. pathogenetically associated with SLE. The prevalence of syntropic comorbid respiratory system lesions in patients with systemic lupus erythematosus depends on the age of patients, duration of the disease, and the severity of respiratory failure. Pneumosclerosis is more prevalent in elderly patients and patients with the SLE duration of more than 6 years. It was the cause of respiratory failure in 43.02% of patients; the condition was of the first degree of severity. Pulmonary hypertension is more prevalent in elderly patients and patients with the SLE duration of less than one year. It led to respiratory failure in 16.13% of patients; the respiratory failure was predominantly mild. Pneumonitis is more prevalent in young patients and patients with SLE duration of more than 10 years. It led to respiratory failure in 52.00% of patients, while 64.10% out of them had degree I respiratory failure. Pulmonary fibrosis is more prevalent in elderly patients and patients with the SLE duration of 1-5 years. It led to respiratory failure in 62.50% of patients, while 80.00% out of them had the first degree of this condition)