CC BY
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GNIDENKO J., BOBRO V.
Kharkiv National Medical University, Kharkiv, Ukraine
Some Problems оf Early Diagnostics оf Diabetic Arthropathy
Introduction. With such complication of diabetes mel-litus (DM), as diabetic osteoartropathy (DOA or Charcot foot), there are doctors of different specialties, but far not always it in time is recognized. Prevalence of this complication among patients on (DM) folds less than 1 %, although in literature there are data about the defeat of bone fabric feet in 0.1—55 % of patients. Such large divergence of data, probably, related to the differences in methodology of inspection and different criteria of diagnostics of DOA. Consider now, that DOA causes any not form of neuropathy, its «subspecieses» are but only certain. In this connection to foresee development of DOA difficult, and late diagnostics and inadequate treatment of patient result in invalidi-sation.
Aim of work: to investigate frequency and character of clinico-instrumental signs of defeat of bones' tissue for patients on DFS.
Materials and methods. The analysis of results of inspection is conducted 62 patients on DM 2 to the type, complicated SFS. Men it was 36 (58.1 %), women 26 (41.9 %). Middle age of patients presented 56.90 ± 1.02. Experience of DM laid down 12.90 ± 1.02. A questionnaire was used by means of minute test of estimation of risk of osteoporosis, method of ultrasonic densitometry and radiography.
Results and their discussions. Distribution of the investigated patients depending on the clinico-pathoge-netic form of DFS was such: 14 patients (22.6 %) had neuropathic form, 18 (29.0 %) — ischemic and 30 patients (48.4 %) — mixed. From data of anamnesis, from 62 patients on DM the diagnosis of DOA was first set
KINASH M.I., LOBODA V.F., DZYUBAN L.V.
Ternopil State Medical University
named after. I.Ya. Horbachevsky, Ternopil, Ukraine
Diagnostic Criteria of the Bone Mineral Density Reduction in Children with Hepatobiliary Pathology
Introduction. Preclinical diagnostics of metabolic bone pathology in children is of great importance for the prevention of osteoporosis (OP), its timely correction and formation groups of high risk for osteopenic syndrome.
Aim: To develop methods of predicting the osteopenic syndrome in children with disorders of hepatobiliary system with the following development of forecasting algorithm.
Materials and methods. Comparative analysis of risk factors for OP development based on the history of life, results of clinical and laboratory investigation and den-sitometrical examination allowed to select 9 signs which were considered as informative diagnostic criteria of pre-clinical OP development.
Results. Results of a consecutive detection procedure, based on the review of ordered series of signs in the com-
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to 47 (75.8 %) patients, from them 92.2 % — at presence of III—IV of the stage of DOA. A questionnaire by means of minute test and analysis of anthropometric data of patients allowed to distinguish patients (35 persons — 56.4 %) with the high risk of presence of osteoporosis. From data of anamnesis, 34 (54.8 %) patients had an episode of manifestation of DOA as an one-sided sharp edema of foot. Mostly (in 37.5 % cases) patients saw a doctor of general practice or surgeon of policlinic, but manifestation of the sharp stage of Charcot foot was not diagnosed. At radiography research of bones' of foot of sign of osteoporosis educed in 9 (14.5 %) patients from the number of inspected (mainly with the neuropathy form of DFS); in 27 (43.5 %) patients from all cases the educed phenomena of ossifluence, presence of bone sequestra, osteomyelitis (mainly at the ischemic and mixed forms of DFS). Conducted inspection of patients with the high risk of osteoporosis educed the presence of os-teopenia the method of ultrasonic densitometry in 30 patients (48.3 %), from them in 12 (19.3 %) is an osteoporosis, that folded 34.3 % from the group of high risk.
Conclusions. The presence of sharp phase of DOA is necessary to be assumed for all patients with the one-sided edema of foot, taking into account duration of motion of DM, expressed of diabetic neuropathy, trauma or surgical interference on a foot, that preceded to the edema. A radiography inspection of patients is the late method of diagnostics of defeat of bone fabric, that does not allow effectively to conduct the prophylaxis of osteopenia and timely treatment of osteoporosis. For stratification of risk of os-teopenia for patients from DFS it is necessary to use a minute test with verification of degree of defeats of bone fabric by means of densitometry. Patients with suspicion on DOA most rationally to send in the specialized podiatric separations (centers).
parison groups and the sequential analysis of selected pairs of distribution, are presented in the table 1.
The process of forecasting is as follows: in every patient we have determined the value of each risk factor, which corresponds to a specific diagnostic factor, in the order they are presented in the table. Then diagnostic factors were added until one of the thresholds has not been reached. If the threshold A2 = +13 was achieved or exceeded, then with a probability of 95 % the risk of reduced bone mineralization in a child can be predicted. If the threshold is A1 = —13, with the same probability the risk of pathology can be denied. If the threshold of ±13 was not reached the next decision was made: there was not enough diagnostic information for resolving the issue with the planned reliability level and it is necessary to continue to study risk factors (undefined response).
Conclusion. Retrospective analysis of risk factors for the osteoporosis development in examined children has demonstrated a relatively high accuracy (87.9 %) of osteoporosis prediction using the presented table, so that allows to recommend it for revealing the probability of bone mineral density reduction in certain patients with hepatobiliary disorders.
№ 2 (18), 2015
Brnb. CyMo6u. Xpe6eT, ISSN 2224-1507
Table 1. The distribution of risk factors for osteopenic syndrome development by diagnostic coefficient and informative signs
The risk factor The presence of factor CCC CC BD CVH
DF IX1 DF IX1 DF IX1 DF IX1
Body Mass Index < 18.45 kg/m2 6 1.53 3 0.34 4 01.02 4 1.00
> 18.45 kg/m2 -8 2.44 -5 0.4 -7 1.79 -6 1.50
Level of rumalon antibodies in the blood < 24.0 cu. -7 1.82 -3 0.54 -3 0.47 -3 0.45
> 24.0 cu. 6 1.06 6 0.72 3 0.47 2 0.3
The pathology of bone system Absent -2 0.27 -1 0.19 -1 0.32 -2 0.37
Incorrect posture -1 0.21 -1 0.18 -1 0.12 -3 0.56
Scoliosis 6 1.35 2 0.62 1 0.12 9 2.76
Caries 5 1.23 2 0.56 1 0.18 7 0.8
Hypocalcemia Present 1 0.08 5 1.83 7 1.79 9 02.05
Absent -1 0.12 -2 0.33 -4 1.22 -4 01.11
Pain in the spine and legs Present 7 1.63 3 0.33 2 0.24 9 1.76
Absent -1 0.19 -1 0.16 -1 0.13 -3 0.68
Oxyproline level in the blood < 35.24 mkmol/l -3 0.48 -2 0.76 -2 0.36 -3 0.23
> 35.24 mkmol/l 3 0.48 3 0.57 5 0.88 1 0.08
The body weight of the child at birth < 2900 g 4 0.46 3 0.38 7 01.09 3 0.36
> 2900 g -1 0.19 -1 0.19 -2 0.31 -1 0.23
Mitral valve prolapse Present 4 0.54 1 0.37 5 0.9 3 0.54
Absent -2 0.27 -1 0.26 -2 0.54 -4 0.72
The level of bilirubi-nemia Raised 3 0.42 2 0.29 3 0.38 1 0.14
Normal -2 0.32 -1 0.18 -2 0.25 -1 0.08
Notes: CCC — chronic cholecystocholangitis, CC — chronic cholangitis, BD — biliary dyskinesia, CVH — chronic viral hepatitis, DF—
diagnostic factor, IX1 — indicator informativity.
KOVALCHUKT., BOYARCHUK O., HARIYAN T. Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine
Joint Pain Perception Features in Children with Juvenile Rheumatoid Arthritis and Their Parents
Introduction. Juvenile rheumatoid arthritis (JRA) is a chronic disease that requires a doctor's constant assessment of the patient's condition for timely decision about important changes in therapeutic tactics. In the clinical picture of the disease the center place pain is belongs.
The aim of the research was to determine peculiarities of pain perception by suffering from juvenile rheumatoid arthritis children and their parents.
Materials and methods. The 99 children were examined — 60 sick by JRA patients and 39 healthy children. Selected groups were matched by the sex, age, and nationality. The intensity of joint pain was assessed by the using of visual analogue scale (VAS) in children and their parents. Children aged 6—10 years were interviewed by VAS with pictures that reflect the grimaces of pain. Patients above 10 years and their parents were interviewed by simple VAS.
Results. Established that patients with JRA and their parents had given the same assessment of articular pain
intensity (3.5 ± 0.3 cm, 4.5 ± 0.6 cm; p > 0.05). In the group of healthy children the average body pain during the last week was 0.5 ± 0.2 cm by children assessment, and 0.6 ± 0.2 cm by parents assessment (p > 0.05). The level of pain intensity determined in accordance with the VAS gradation revealed the following features. 7.1 % of patients with JRA didn't feel joint pain during last week (0 cm). 41.1 % of children had mild pain (0.1-3.9 cm), 33.9 % had moderate pain (4.0-5.9 cm), 17.9 % had severe pain (6.07.9 cm). Their parents indicated absence of joint pain in 6.8 % of children, mild pain in 42.4 %, moderate pain in 33.9 %, severe pain in 10.1 %, very severe pain in 6.8 % (8.0-10.0 cm).
Depending on the therapy all patients were divided into two groups. Children of the first group (n = 24) received basic therapy with a low-dose of methotrexate (7.5 mg/m2 of body surface per week). Kids of the second group (n = 29) received nonsteroidal anti-inflammatory drugs monotherapy. The monitoring of pain syndrome during treatment showed significant reduction of pain intensity in the first group only. Children felt decrease joint pain 2 years after the date of initiation a low-dose of methotrexate (4.1 ± 0.4 cm, 1.6 ± 0.3 cm; p < 0.05). However parents indicated that the level of pain decreased already one year after conducted basic treatment (4.3 ± 0.4 cm, 3.3 ± 0.3 cm; p < 0.05).
№ 2 (18), 2015
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