UDC 616.36-004-06:612.015.11:616.24-008.4]-092

Background. Hepatopulmonary syndrome is one of the most dangerous syntropies in case of liver cirrhosis. Consequently, it is important to determine the role of oxidative stress, acid-base balance and ventila-tion-perfusion disorders as factors of hepatopulmonary syndrome development in cirrhotic patients.

Materials and methods. We included 44 cirrhotic patients with hepatopulmonary syndrome verified according to the patented. Method for diagnosing degrees of hepatopulmonary syndrome severity in patients with liver cirrhosis. In addition tothe traditional examinations, we determined the gas composition parameters in venous blood, acid-base balance parameters, catalase activity and malondialdehyde level in all the patients. The received material was processed on a personal computer using Excel 2010, Statistica 6.0, RStudio v. 1.1.442 and R Commander v. 2.4-4.

Results. Analysis of blood gas parameters revealed the reliability of the difference for PCO2(р = 0.03) depending on the class of liver cirrhosis severity. Also, with the liver cirrhosis severity increase, the malondialdehyde level increased,and catalase decreased. Moreover, significant inverse relationships between malondialdehyde content and PCO2(p = 0.039), HCO3(p = 0.039), TCO2(p = 0.036), Beb (p = 0.049), BEecf (p = 0.043) were found resulting in hypo-capnia and partiallycompensated metabolicacidosis.The found direct correlation between malondialdehyde level and AaDO2(p = 0.044) indicates the arteriovenous pulmonary shunts, ventilation-perfusion disorders. The absenceof catalase content changes can obviously be explained by the fact that its activity can be partially compensatory maintained.

Conclusions. In patients with hepatopulmonary syndrome, the peroxidation activity enhances with anincrease in the liver cirrhosis severity, resulting in the redox homeostasis imbalance, leading to the ventilation-per-fusion disorders and partially compensated metabolic acidosis.

Keywords: liver cirrhosis; hepatopulmonary syndrome; intrapulmonary vasodilatation; oxidative stress; metabolic acidosis

Introduction. Celiac disease (CD) is a global public health problem. Recent studies have revealed the global prevalence of approximately 1.4% in adults. It is known to manifest usually in childhood and have different symptoms similar to other diseases. In the presented case reports the case of CD in adult, manifested by various atypical symptoms, that became the obstacle to diagnosis the CD in time was described.

Methods. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a comprehensive literature search using such databases as Web of Science, Embase, PubMed. The search strategy included the following terms: "celiac disease", "gluten sensitivity", "pathophysiology", "diagnosis and treatment", "case report". Case description was described according to Case Report (CARE) guidelines.

Results. Recent advances in CD research have significantly enhanced our understanding of its epidemiology, pathophysiology, diagnosis, and management in adults. Advances in genetic and immunological research have deepened our understanding of disease mechanisms, paving the way for novel diagnostic and therapeutic approaches.

А female patient had the complaints of constant pain in the periumbilical and left hypochondriac areas, irregular defecation, diarrhea; legs swelling up to the level of knees. During the ultrasonography of the internal organs, free fluid in the abdominal cavity (approximately 2.0l) was detected. During the gastroscopy it was found pyloritis, gastroptosis, gastroduodenal reflux, CD was suspected, biopsy was taken. The results of the duodenal descending part biopsy: chronic enteritis with significant atrophic-inflammatory changes. To confirm the CD the serological testing also was conducted: IgA to deamidated gliadin > 9.0 (N-<1.0), IgG to deamidated gliadin 0.22 (N-<1.0), IgA to tissue transglutaminase 2 – 2.88 (N-<1.0), IgG to tissue transglutaminase 2 – 0.06 (N<1.0). After the mentioned examination the diagnosis of CD was set. The patient received symptomatic treatment followed by the gluten-free diet (GFD). After 10 days in the hospital the patient was discharged with improved condition and the main recommendation to maintain the GFD.

Discussion. CD is “getting older” and can be very similar to or accompanied by chronic pancreatitis, gastritis, irritable bowel syndrome etc. As could be seen from the clinical case description, the combination of the characteristic symptoms such as abdominal pain, bloating, continuous or frequently repeated diarrhea should lead to the thorough examination of a patient including endoscopy with biopsy and if any suspicion exists, subsequent serological testing. GFD remains the cornerstone of treatment, ongoing research into enzyme supplements, immunomodulators, and even genetic modification of wheat offers hope for additional management options.

Conclusions. Only the multifaceted approach, combining serological tests, instrumental examinations and qualified histopathological assessment, offers a comprehensive means of identifying CD and enabling the timely treatment.

Background: The patients with liver cirrhosis (LC) have autonomic nervous system (ANS) imbalance that can be evaluated by the heart rate variability (HRV) study. ANS imbalance results into cirrhotic cardiomyopathy (CCMP) and the most easily diagnosed feature of CCMP is the prolonged QT interval. Usually, in the literature not all HRV parameters are characterized, or their assessment period is short, not allowing covering all the important moments and therefore needing further study.

Material and Methods: In a randomized way with the preliminary stratification by the presence of LC 33 patients after signing the informed consent were examined. In addition to routine screening methods, all patients underwent 24-hour ECG monitoring.

Results: Patients with LC and syntropic CCMP have the ANS disorders with a HRV decrease, predominance of the sympathetic over the parasympathetic system, heart rate regulation at the humoral-metabolic level. The ANS disorders severity depend on the LC severity according to C. G. Child - R. N. Pugh criteria. During the analysis of the received results the significant positive correlation between the SDNN index and maxQT, avg QT, positive correlation between HF and max QTc, avg QTc were found. The diagnostic sensitivity of SDNN index and HF was high in the patients with LC and CCMP.

Conclusions: The ANS imbalance can be regarded as syntropic comorbid disorder in the cirrhotic patients. The diagnostic sensitivity of SDNN index and HF was found to be high in the patients with LC and CCMP, serving as diagnostic markers of CCMP.

Introduction: Information about calcium-phosphorus metabolism (CPM) and bone turnover in patients with liver cirrhosis (LC), as well as clarifying their diagnostic value for assessing bone structure disorder, will help doctors to detect their lesions in timely manner and, based on the information received, to choose well-founded comprehensive treatment strategy.

Aim: To characterize the indicators of calcium-phosphorus metabolism and bone turnover in patients with liver cirrhosis, and to find out their diagnostic value for detecting bone structure disorder.

Materials and methods: In randomized manner 90 patients with LC (27 women and 63 men of age from 18 to 66), who were treated at the Lviv Regional Hepatological Center (Communal Non-Commercial Enterprise of Lviv Regional Council “Lviv Regional Clinical Hospital”) between 2016 and 2020, were included in the research. The research was carried out in two stages. The purpose of the first stage was to obtain information that would allow characterizing indicators of CPM (total calcium, ionized calcium, phosphorus, total vitamin D (25-hydroxyvitamin D), and parathyroid hormone) and bone turnover (osteocalcin, P1NP, alkaline phosphatase (bone formation markers), and β-Cross Laps (bone resorption marker)) in patients with LC, and the purpose of the second stage was to find out their diagnostic value for assessing bone structure disorder of them. To perform research, an experimental group (EG) (72 patients with impaired bone mineral density (BMD)), which was divided into EG A (46 patients with osteopenia) and EG B (26 patients with osteoporosis), and a comparison group (18 patients with normal BMD) were formed. The control group consisted of 20 relatively healthy people.

Results: At the first stage, it was established that the frequency of cases of increased alkaline phosphatase content was statistically significantly different in LC patients with osteopenia and osteoporosis (p = 0.002), as well as with osteoporosis and normal BMD (p = 0.049). Impaired BMD in general had significant direct stochastic relationship with vitamin D deficiency, decrease in osteocalcin content and increase in P1NP content in serum (Yule's Coefficient of Association (YCA)) >0.50); osteopenia – with decrease in phosphorus content, vitamin D deficiency and increase in P1NP content (YCA >0.50); and osteoporosis – with vitamin D deficiency, decrease in osteocalcin content, increase in P1NP content, and increase in alkaline phosphatase content in serum (YCA >0.50). Significant inverse stochastic relationship was recorded between vitamin D insufficiency and each of the impaired BMD manifestations (YCA <-0.50), which most likely indicates that it is characteristic of normal BMD. At the second stage, it was found that among indicators of CPM and bone turnover, only increase in alkaline phosphatase content in serum can be diagnostically valuable marker of osteoporosis in patients with LC (р <0.050; YCA >0.50; coefficient contingency = 0.32), which has medium sensitive (80.77 %) and positive predictive value (70.00 %) for it. Although other indicators of CPM and bone turover did not confirm their diagnostic value in our research, they may be useful for monitoring pathogenetic changes in bone structure disorder and evaluating the effectiveness of their treatment in patients with LC.

Conclusion: Indicators of calcium-phosphorus metabolism and bone turnover, which are characteristic of bone structure disorder and its absence in patients with liver cirrhosis, were revealed. Among them, an increase in alkaline phosphatase content in serum, which is a moderately sensitive marker of osteoporosis, is diagnostically valuable.