The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

5-13

Authors: Viacheslav Chernuskyi, Mykola Popov, Olha Hovalenkova, Hanna Letiaho, Tetyana Evdokymova, Svitlana Tolmachova, Alisa Popova

Introduction. At the present stage of development of the problem in the etiopathogenesis of bronchial asthma (BA) in children, regardless of form, one of the leading places belongs to the microbial factor. Aim. The aim of the work was to study the development of autoimmune reactions to the cellular tissue structures of the trachea, bronchi and lung tissue, stimulated by heterophilic antigens of the microbiota of the bronchopulmonary system of children with BA. Materials and methods. A total of 97 children with BA aged 7 to 15 years were examined. The diagnosis of the disease was established according to GINA (2017) and the order of the Ministry of Health of Ukraine dated 08.10.2013 No. 868. Heterophilic antigens of bronchopulmonary structures in microbiota were determined using hyperimmune organ-specific rabbit sera to antigens of the trachea, bronchi and lung tissue. Lipopolysaccharide antigens from homologous cell-tissue structures of the trachea, pulmonary bronchi were determined, water-salt antigens from the structures of the trachea, bronchi, and lung tissue were obtained from accidentally dead children with I (0) blood group. The level of autoantibodies to antigens of the bronchopulmonary system with the quantitative calculation of the indicator Qφ was determined in the nephelometric reaction. Results. In the work it was shown experimentally that microorganisms, isolated from sputum of children, patients with asthma in the period of exacerbation, varying their antigenic potential, are able to include in their structure heterophilic antigens of cell-tissue structures of the bronchopulmonary system. Microorganisms including in their structure heterophilic antigens of the trachea, bronchi and lung tissue not only determine the induction of the pathological process in the bronchopulmonary system, but also translate it into an autoimmune basis, exacerbating the severity of the course of the disease. Conclusions. The study showed that the proposed methods are important for clarifying the etiopathogenesis of BA in children and disclosing the mechanism for switching the pathological process in the bronchopulmonary system to an autoimmune basis and can be used to develop new approaches for the etiopathogenetic treatment of the disease.

26-32

Authors: Yevgen Khvorostov, Olexii Tsivenko, Sergii Bychkov, Roman Hrynov, Yuriy Zakharchenko

Aim of the study was the assasement of surgical treatment results of patients with cholelithiasis, who had external or internal bile leakage (BL), for the optimization and improvement of diagnostic programme and surgical tactic of minimally invasive techniques usage. Materials and methods. Results of surgical treatment during the early postoperative period of patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC) were analysed. Results. In early post-operative period 67 (0,6%) patients, mean aged 56,9 ± 7,4 had BL. 54 (81,0%) of them were women, 13 (19,0%) were men. 21 (31,3%) patients underwent LC due to chronic cholecystitis, 46 (68,7%) patients had acute cholecystitis. In 54 (81,0%) cases there was drainage bile leakage, in 13 (19,0%) cases bile collection in abdominal cavity was identified several days after drains ejection, due to clinical manifestation and ultrasonography data. 23 (34,3%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 35 (52,2%) patients, 9 (13,4%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi’s syndrome type I. 6 (9,0%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (1,5%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,0%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy. Conclusion. Installation of drainage into the hepatic space and the right flank provide early diagnosis of postoperative complications, one of which is bile flow syndrome. Ultrasound examination of abdominal organs and endoscopic retrograde cholangiopancretography are performed to determine the cause and localization of the syndrome of the BL syndrome, depending on the volume of the BL. Repeated laparoscopy is indicated for the phenomena of bile peritonitis, significant accumulation of bile in the abdominal cavity. The complex usage of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomy operations to correct complications.

39-48

Authors: Tetiana Liadova, Olga Volobueva, Kseniia Pavlikova, Olga Sorokina, Olesya Gololobova, Oleksandr Kozlov

Objective. The article is devoted to the study of the content of the main immune parameters in patients with infectious mononucleosis (IM) in the dynamics of the disease. Materials and methods. A clinical examination of IM patients (n = 60) and patients of the control group (n = 20) included the study of complaints, epidemiological history, history of disease and life, objective examination, standard instrumental and laboratory studies in dynamics, detection of EBV DNA in saliva and blood serum, and a comprehensive analysis of immune parameters. The main subpopulations of peripheral blood lymphocytes (CD3 +; CD4 +; CD8 +; CD16 +; CD8 + CD28 +; CD8 + CD28-; CD20 +; CD25 +) were determined by flow laser cytometry on a FACS-Calibur apparatus (USA) using monoclonal antibodies. For identification of INF-γ (Th1-cells), IL-4 (Th2-cells) in the cytoplasm of T-lymphocytes, monoclonal antibodies INF-γ-PC-5, IL-4-PE (eBioscience, Beckman Caulter, R & D System) were used. Results. A comprehensive study of the state of the subpopulations of reacting immune cells revealed significant violations of cellular parts of the immune response compared to the control group. It was established that the immune response in patients with IM during the height of the disease is characterized by an imbalance in the cell link (as evidenced by an increase in the content of CD3+, CD4+, and a simultaneous increase in the content of CD16+, CD25+). In the period of convalescence, violations have been identified that will persist without reaching the levels of the control group in a larger number of IM patients. Conclusion. The results obtained indicate significant changes in the structural characteristics of the cellular immunity system and the multidirectional immune response in IM. The progressive character of changes in immune parameters in IM indicates the formation of a secondary cellular immune imbalance, a change in the balance of immunoregulatory mediators towards the Th2 link during the formation of protracted and chronic forms of EBV-infection.

56-62

Authors: Natalia Shevchenko, Kostiantyn Voloshyn, Tetiana Zimnytska, Liudmyla Rakovska, Tetiana Holovko, Nataliya Panko

Objective was to study the level of tumor necrosis factor α (TNF-α) and interleukin 1α (IL-1α) in the blood of children with various forms of functional dyspepsia in accordance with various endoscopic changes of the gastric mucosa. Materials and methods. 79 school age children with functional dyspepsia were examined. The diagnosis was made in accordance with the recommendations of the Rome Criteria IV (2016). All patients underwent endoscopic examination of the esophagus, stomach and duodenum to exclude destructive changes of the mucous membrane. The level of TNF-α and IL-1α in the blood serum was determined by enzyme immunoassay. Statistical processing of the results obtained was performed using Microsoft Excel 2010. Results. The average level of TNF-α in the total group was 463.22±27.4 pg/ml, which statistically significantly exceeded this indicator in the control group (26.76±1.10 pg/ml; p<0.01). The IL-1α value in the total group was 148.6±6.06 pg/ml and was significantly higher in comparison with the control group (53.29±3.28 pg/ml; p<0.01). The level of proinflammatory cytokines in the group of children with epigastric pain syndrome was significantly higher than in the group of children with postprandial distress syndrome. Endoscopic examination showed the presence of unchanged mucous membrane in only 25.3% of children. Erythematous gastroduodenopathy was observed in 74.7% of children and was typical mainly for patients with epigastric pain syndrome (97.7%; p<0.05). Conclusions. The level of pro-inflammatory cytokines in children with functional dyspepsia is increased. When comparing the clinical variants of the disease, a significant increase in the level of TNFα, and IL-1α in children with epigastric pain syndrome was found. In the same group of children, endoscopic changes in the gastric mucosa were more pronounced. Further study of changes in the level of pro-inflammatory cytokines in children with functional dyspepsia may allow this to be used as one of the methods for the differential diagnosis of functional dyspepsia and chronic gastritis

72-78

Authors: Andrii Volyanskiy, Alyona Klisa, Maxim Kuchma, Tetiana Karlova, Natalia Zvereva

Objectives. The purpose of this article was to determine the intensity of immunity against measles among health workers in Kharkov to identify and vaccinate susceptible individuals. Materials and methods. ELISA levels of specific measles IgG in blood serum of health workers were studied. Results. It was shown that the largest number of measles-susceptible individuals is observed in the age group of 18 to 27 years (9 % do not have a protective level of antibodies (AT); 7.7 % have a dubious level of protection). In the age groups from 28 to 37 years old and from 38 to 47 years old, a rather large number of measles-sensitive health workers was also detected (6.9 % and 6.1 % - with the absence of a protective level of AT and 6.9 % and 5.1 % - with a dubious level of protection, respectively). The minimum number of measles unprotected health workers was determined in the group aged 48 to 57 years (0.9 % of negative and doubtful results), and among physicians older than 57 years, there were no individuals with a lack of protective levels of antibodies to measles virus. Conclusions. Possible reasons for the prevalence of measles-unprotected health workers in the age groups from 18 to 47 years and the absence of unprotected people in the group of people over 57 are discussed. Doctors are a professional risk group for contracting infections (including measles). The article argues that there is no need for vaccination against measles for medical workers over 57 years old and vaccination of representatives of other age groups is recommended only after determining the strength of measles immunity, since more than 90 % of medical workers have protective levels of IgG.

5-11

Authors: Marina Ivanenko, Olena Klimova, Serhii Sherstiuk, Svitlana Nakonechna

Introduction. The protection of the body against external and internal antigenic factors is executed with the help of the primary cellular and secondary resistance links. Excessive activation of adaptation reactions leads to the formation of various pathologies of inflammatory nature. Changes in the immune responses occur at all ontogenesis stages. In the present study, we conduct the experiment of induced peritonitis in animals of different ages in order to investigate more accurately adaptive responses of the immune system during inflammation.Objectives. The aim of our research was to study changes in the indicators of adaptive humoral immunity, levels of immunoglobulin A and circulating immune complexes, phagocytic activity of neutrophils and the disruption of enzymes activity, which provide the phagocyte function in the NST test on the model of induced peritonitis in animals of different ages.Materials and methods. The studies were performed on 200 white male rats. They were divided into a control group and the experimental rats, 3-and 22-month-old ones. Acute inflammation and dysbiosis in the small intestine were caused by intraperitoneal injection of lipopolysaccharide obtained from Escherichia coli strain. The material for the study was serum and blood elements of experimental animals. Results.The levels of immunoglobulin A in the blood serum of 3 and 22-month-old rats with the inflammation model were reduced in comparison with this index in control group animals. The content of the CIC in the rats blood serum of both age groups was significantly higher in comparison with the control group. All the studied indices of neutrophils phagocytic activity in the 22-month-old animals with the inflammation model were lower than in the control rats of this age. In the 3-month-old rats with the inflammation model, the index of phagocytosis completeness was significantly lower in comparison with the control group. The reduction in the reserve capacity of phagocytic cells was higher in the 22-month-old animals. An increase in the neutrophils metabolic activity and a decrease in their metabolic reserve in 3 and 22-month-old rats with the inflammation model were revealed in comparison with the parameters of the control groups.Conclusions.The results of the study indicate presence of violation of the primary cellular and secondary humoral immunity during the aging of the body and decrease in the adaptive responses of the immune system during inflammation due to an increase in antigenic effects

22-35

Authors: Zolochevsky O. O., Martynenko O. V.

Introduction.Bone repair after periprosthetic fracture is a critical issue in orthopedics.Objectives.So there isa need for research to provide new medical solutions, especially in the context of population ageing in the Ukraine.The importance of biomechanics which is concerned with the application of principles, concepts and methods ofmechanics of solid and fluid to the human body in motion and at rest is well recognized as a foundation for furtherexperimental and theoretical research in the skeletal tissues.Materials and methods.Different aspects ofbiomechanics require different concepts and methods of mechanics of solid and fluid to be used. Remodelingoccurs significantly throughout lifetime of bone that is why it can be regarded as a primary determinant of themechanical properties of bone and implant. Biomechanical analysis given in this review has been concernedwith understanding on how mechanical signals and molecular mechanisms affect the healing of Vancouverperiprosthetic femoral fracture of B1 and C-type with the useof internal fixation through a less invasive stabilizationsystem (LISS)-plate, which is screwed into the artificial hip joint.Results.Identification of such parameters asmechanical properties of bone, titanium alloys (hip prosthesis, coating, LISS-plate, screws) and implant/biomaterialinterface with bone under mechanical and biochemical loading that are very essential for predicting arthroplastyoutcomes were investigated experimentally considering elastoplastic deformation, creep, fatigue and ratcheting, aswell as, damage development in materials under discussion. Among the basic deformation features were tension-compression asymmetry, anisotropy and heterogeneity of mechanical properties. We used the three-dimensional finiteelement model derived from the reconstruction of treatment and magnetic resonance (tomographic) images.Conclusions.As a result of this model analysis, it was found that treatment rate of periprosthetic femoral fracturesafter total hip arthroplasty with the use of LISS-plates and screws for internal fixation may be controlled by meansof ABAQUS (or ANSYS) software package to reproduce the characteristic features of bone and implant in bonereconstruction in order to improve the fracture healing rate and shorten treatment duration.

44-50

Authors: Moskal O.M., Logay I.V., TurokYu.Yu., TurokY.Yu., Archiy E.Y.

ntroduction.Nonsteroidal anti-inflammatory drugs are the most commonly usedmedicines in medical practice. As literary sources show, they often cause unwantedside-effects.The purpose of our work was to evaluate the frequency, clinicalmanifestations andmorphological features of lesions of the gastroduodenal zone that arise in patients ofrheumatologic, neurological profiles and angiosurgery department during the courseof treatment with nonsteroidal anti-inflammatory drugs of different groups, to tracethe dependence of the frequency of manifestations of the pathology of the stomachand duodenum from simultaneous receiving two nonsteroidal anti-inflammatorydrugs and their combination with glucocorticosteroids and anticoagulants.Material and methods. 73 patients who had used NSAIDs for a long time and hadendoscopically confirmed medicated gastroduodenopathy. Patients were divided into3 groups depending on the profile of the department: Group I included -24 patientsof the departmentof vascular surgery; Group II -23 patients of the neurologicaldepartment; Group III -26 patients with rheumatological profile.Results.Asymptomatic clinical picture of NSAID-gastropathy was found, which didnot coincide with the available endoscopic changes in the gastroduodenal tube: in63% of cases, erosive changes in the mucous membrane were present, and stomachand duodenal ulcers were revealed in 11%. It was also found that in the group ofpatients receiving proton pump inhibitors, the incidence of gastroduodenopathy wasreliably lower (34.2%) than in patients who did not receive them (53.4%). During thisstudy, it was found that the use of selective non-steroidal anti-inflammatory drugs cansignificantly reduce the probability of developing the pathology of thegastroduodenal zone, compared with non-selective.Conclusions.The course of treatment with nonsteroidal anti-inflammatory drugsshould be as short as possible and should be carried out with minimal but effectivedoses. Parallel prophylacticadministration of proton pump inhibitors is appropriate inpatients at high risk of developing erosions and ulcers in the background of treatmentwith these drugs.

59-64

Authors: Safronov D.V.

ntroduction.Injuries are a large medical and social problem. It takes many lives and is often a cause of disability.Objectives.The work is devoted to the study of the motor-evacuation function (MEF) of the gastrointestinal tract (GIT) in patients with closed abdominal injury of varying severity.Materials and methods. 125 patients with isolated or combined blunt abdominal trauma were under observation. The main criterion for the inclusion of patients in the study was the presence of injury to the abdomen and / or retroperitoneal space, confirmed while surgery or using instrumental methods of examination. The structure of injuries was dominated by a combined trauma, which was observed in 104 (83.2%) victims; in 21 (16.8%) patients abdominal injury was isolated or multiple. Evaluation of the MEF of the gastrointestinal tract was carried out using a technique developed with the participation of the author on the basis of the available indicators widely used in practice. The severity of the injury was determined on an ISS scale.Results.The results showed that the predominant part of patients with abdominal trauma (62.4%) had a violation of gastrointestinal MEF upon admission; in 21% of patients, the state of function at the border of functional compensation was noted, and only in 16% of persons, the MEF of the gastrointestinal tract was rated as moderately and completely compensated. By severity of injury, a group of patients with moderate severity (47.2%) prevailed; a mild injury was observed in 35.2% of patients, severe injury was diagnosed in 16%, and a super-severe one was in 1.6% of injured people.Conclusions.The possibility of using the MEF indicators of the gastrointestinal tract as one of diagnostic criteria for the severity of a blunt abdominal injury is assumed

86-92

Authors: Babii O.H., Simonova I.V., Vasylenko O.O., Prylutcka K.Y., Meleshenko O.A.

Familial combined hyperlipoproteinemia is considered one of the most common genetic hyperlipidemias in the general population with estimated prevalence 0.5%–2.0% of all inherited dyslipidemias. This disorder frequently coexists with other metabolic diseases such as obesity, insulin resistance, hypertension, non-alcoholic fatty liver disease. Association of hyperlipoproteinemia and type 2 diabetes mellitus can be explained due to the fact, that familial combined hyperlipoproteinemia is caused by genetic variability, including genes encoding the upstream transcription factor 1. The last regulates nearly 40 genes implicated in lipid, lipoprotein and carbohydrate metabolism, as well as immune response. Polymorphism in the upstream transcription factor1 is strongly associated with dyslipidemia, impaired glucose tolerance, insulin resistance, and type 2 diabetes mellitus. In this report on example of clinical case we want to pay attention ofpractitioners to the problem of familial causes of hyperlipidemias, which leads to early onset of atherosclerosis, cardiovascular disease, and, finally, to premature disability of the affected person. Because of the frequent overlapping with the features of metabolic syndrome, this serious disorder is often not recognized and treated timely.Our patient was a 43 year old male, who was referred to the clinic with complaints of angina pain and dyspnoea provoked by minimal physical exertion, palpitations, irregular heartbeats, lower extremities and face oedema. At the age of thirty in the patient have developed type 2 diabetes mellitus, during last 7 years it was insulin dependent, the course was severe, glycaemia was poorly controlled by the therapy. Also he had essential hypertension III grade. At the age of 37 years the patient suffered from ST-elevated myocardial infarction, one year later occurred recurrent myocardial infarction. His family history was strongly positive for atherosclerosis and cardiovascular disease, as well as type 2 diabetes mellitus. In laboratory testing the fasting blood sample revealed a grossly lipemic serum, with total cholesterol level 17.75 mmol/L, very low density lipoproteins3.41 mmol/L, low density lipoproteins 13.64 mmol/L, high density lipoproteins 0.7mmol/L. Diagnosis: «Familial combined hyperlipoproteinemia (Fredrickson type 2B). Acute coronary syndrome: Unstable angina IIB. Postinfarction (STEMI 2014, 2015) cardiosclerosis. Essential hypertension III degree III stage. Heart failure with left ventricular systolic and diastolic dysfunction, EF 36%. III functional class NYHA. Stage D AHA. Risk score 4 (very high).Type 2 diabetes mellitus, insulin dependent, severe course. Non-alcoholic fatty liver, 2 degree. Nodular goitre Idegree, euthyroid state»was established. Management of this patient includes lifestyle modification and combined lipid lowering therapy in high doses: rosuvastatin and choline fenofibrate. Unfortunately, in this case target levels of cholesterol and triglycerides were not achieved: minimal level of total cholesterol was 12.29 mmol/L, and level of triglycerides was 41.48mmol/L. Risk estimates based on risk charts, scores, or functions used in the general population, probably grossly underestimate the realrisk of this patient with familial combined hyperlipoproteinemia. Coexistence of extremely high level of cholesterol and type 2 diabetes mellitus significantly aggravates and advances each other's course, comparing with the isolated disorders

100-107

Authors: Golubkina E. O., Silenko I. Y., Brahmbhatt H.

Introduction.Systemic sclerosis (SSc) is a rare chronic systemic disease of theconnective tissue, presenting with high level of patient-to-patient clinical variabilityof features.Objectives.The aim of our research was to study a clinical case of the clinicalcourse and difficulties in timely diagnosis of SSc in middle-age female patient.Materials and methods. Patient is a 39-year-old woman unemployed due todisability of 3rd degree. The disease manifested with Raynaud phenomenon in 2008.During 2008-2013 condition of the patient progressively worsened, new symptomsappeared as difficulty in swallowing of solid food, ulcers. In 2013 she was consultedby a surgeon and treated with antibiotics without significant effect. In October 2013shewas admitted to the rheumatology department, where she was eventuallydiagnosed with SSc, stage II (generalized), subacute course, activity II stage, withdamage to the skin (edema, induration), blood vessels (Raynaud syndrome, stage IIIischemia), joints(polyarthritis with predominant lesions of the hands, wrists, elbow,knee, feet joints, radiographic changes of II grade, functional impairment I st.),esophagus (esophagitis). The last hospitalization was due to the worsening of thegeneral condition. Patient was treated with methylprednisolone 8 mg, amlodipine 2,5mg, naftidrofuryl 200 mg tid, aspirin 75 mg, pentoxifylline 600 mg, omeprazole 20mg.Results.Our study presents the results of different laboratory and instrumentaltests conducted in the clinic: full blood count, biochemical panel, serological tests(antibodies), ECG, EchoCG, chest X-ray, upper Gl tract radiography, ultrasound ofabdominal organs, kidneys, rheovasography of the vessels of the upper limbs, X-rayof hands. Patient was consultedby gastroenterologist, vascular surgeon andgynecologist.Conclusions.An important task for the practicing physician is the ability torecognize the first signs of systemic sclerosis -“red flags”, which will help todiagnose the disease at early stages,start timely treatment to prevent irreversiblepathological changes, early disability and mortality of patients with SSc