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

16-24

Authors: Oksana Zagorodnieva, Liliya Ponomaryova

Introduction. HIV infection is a very dangerous disease and due to the lack of specific prevention methods and effective treatment methods leads to early disability or death. Now this problem is actual for every state, especially for ours, because Ukraine has the highest rate of the epidemic in Europe, therefore, humanity is alarmed by what is happening to the country, which is located in the center of Europe. If this disease is not stopped, the threat of a demographic, economic and social crisis will also increase for other states. Aim – the study of epidemiological features and reasons for the further spread of HIV infection in Ukraine according to open sources of medical statistics in Ukraine and other countries of the world. Results. The article provides data on the study of the problem of the global spread of HIV infection, which has not lost its relevance over the past 40 years. Detailed official statistical information on the social significance of the prevalence of HIV infection in our country and in the world has been provided. The main measures for the prevention of this disease, which is the most dangerous for adolescents, are given. A characteristic feature of the current stage of the spread of infection is that transmission and infection are associated with populations including children of HIV-infected people, members of their families and victims of violations of safety standards in certain medical institutions. Numerous "secondary risk groups" are formed, the emergence of which has a completely social nature. Conclusions. Nowadays, it is understood that diseases that are dangerous to society, such as HIV infection, are phenomena in the fight against which exclusively medical measures are ineffective. Solution to the problem of HIV infection should be a priority of state policy; it should be aimed, first of all, at preventive and elucidating work with young people, who are, without exaggeration, the main risk group. The authors substantiated the need to strengthen control by state institutions and to develop and implement a system of special measures to protect the rights and legitimate interests of citizens and society to preserve the national security of Ukraine.

33-41

Authors: Volodymyr Bubalo

Introduction. Today in the world there is a tendency towards an increase in the incidence of salmonellosis. As well as an increase in the proportion of antibiotic-resistant and various temperature regimes of the pathogen strains. This justifies the urgency of studying this problem, because bacteria of the genus Salmonella are the causative agents of acute infectious intestinal disease – salmonellosis. The aim of the study. To give a comparative characteristic of the sensitivity of a number of Salmonella strains to the action of high temperatures of Salmonella strains. To study the degree of thermal resistance of Salmonella strains at different temperature conditions and exposure periods. One of the components of observations of the circulation of zoonotic Salmonella is the study of changes in their biological properties. One of such properties is the ability to evolve in the environment and the ability to adapt to its adverse conditions by changing the sensitivity of bacteria to temperature and the ability to acquire heat-resistant signs. One of these properties is high stability in the external environment and the ability to adapt to its unfavorable conditions and the sensitivity of bacteria to the action of high temperature conditions, and the ability to acquire thermoresistant signs. Research objectives. Objectives of the study. To determine the ability of current and archival strains of salmonella to the action of the temperature factor and to compare their thermal sensitivity spectra. Materials and methods. Materials and methods. The object of the study were 136 strains of salmonella obtained from the Museum of Pathogenic Microorganisms of the Laboratory of Medical Microbiology of the Institute of Epidemiology and Infectious Diseases LV Gromashevsky NAMS of Ukraine". Research methods: microbiological research methods, as well as statistical analysis of the results. Results. The research results were processed using the licensed program «GraphPad Prism 6» and statistical methods 2-way ANOVA. The data were presented graphically. The significance of the changes was denoted by the symbol ″ * ″ – the probable difference at p ≤ 0.05. It was found that the control strain of Escherichia coli ATCC 25922 was sensitive to all temperature conditions. The results of the study of susceptibility of S. typhimurium strains to the action of temperature in 70ºC showed that on average 75 % of archival strains survived at one-minute exposure, 33,00 % – at 3 minutes of exposure 70ºC, and up to 8,00 % at exposure of 10 minutes. The obtained results indicate an increase in heat resistance among S. Тyphimurium strains isolated in 2006–2012 compared to those isolated in 1996–2005 due to increased adaptive potential of microorganisms and increased chances of survival of bacteria in adverse conditions. The change of sensitivity to the action of high temperatures of Salmonella due to the accumulation of a significant number of heat-resistant strains in the population has been established. An increase in the percentage of moderately sensitive to high temperature actual strains of S. Тyphimurium and S. Еnteritidis in comparison with archival strains is shown. Increased adaptability to high temperatures was found in both S. Еnteritidis strains isolated from sick people and in salmonella strains of rare groups isolated from the environment. Topical strains of S. Еnteritidis and salmonella strains of rare groups were the most heat-resistant. In the course of the study, the author showed an increase in the percentage of moderately sensitive to high temperature actual strains of S. Тyphimurium and S. Еnteritidis in comparison with archival strains. Current strains of S. Еnteritidis and salmonella strains of rare groups were the most heat-resistant. Conclusions. The change of the biological properties of salmonella due to the accumulation of a significant number of heat-resistant strains in the circulating population has been established. An increase in the proportion of moderately sensitive to high temperature actual strains of S. Тyphymurium and S. Еnteritidis in comparison with archival strains is shown. Increased adaptability to the action of high temperatures was found in both S. Enteritidis strains isolated from sick people and in Salmonella strains of rare groups isolated from the environment. Topical strains of S. Еnteritidis and salmonella strains of rare groups turned out to be the most heat-resistant. The results of studies to assess the sensitivity of Salmonella to high temperatures indicate changes in the genotype of bacteria and as the result of evolutionary changes aimed at preserving the genus.

51-63

Authors: Dmytriiev Dmytro, Nazarchuk Oleksandr, Babina Yuliana, Oleksandr Stoliarchuk

Summary. The problem of treatment and prevention of postoperative purulent complications in abdominal surgery in our time remains extremely urgent. This is due to an increase in the number of complex operations using modern technologies, an increase in the volume and duration of surgical interventions, as well as current antibiotic resistance problems. Objective: to study the structure of the leading causative agents of perioperative infectious complications in patients with surgical pathology and study their antibiotic sensitivity. Materials and methods - 576 patients, the average age of 45 ± 10.5 years, took part in the investigation, who were treated in the departments of surgery and intensive care unit of medical institutions of Vinnitsa region. A microbiological study of materials collected from patients was carried out (selection of secretions, fluid during drainage of superficial and deep surgical wounds). From the obtained biological material, a pure culture of the pathogen was isolated with its identification by morphological, tinctorial, cultural and biochemical properties according to generally accepted microbiological methods and using the Vitec automatic bacteriological analyzer (France). And a comparison was made of the profile of the sensitivity of the most significant pathogens to modern antibiotics. Results. According to the results of the study, it was revealed that the most common pathogens of surgical wound infections include opportunistic bacteria E.coli (22.0 %), S.aureus (19.0 %), S.epidermidis (13.0 %), E .faecalis (15 %), P.aeruginosa (10.0 %), A.baumanii (11.3 %). An analysis of the sensitivity to antibiotics of various classes of studied strains of the dominant causative agents of perioperative infectious complications showed that β-lactam antibiotics (meropenem (75–100 %), cefepime (65–100 %) and fluoroquinolones chemotherapeutic agents had the greatest antimicrobial activity. A slightly lower antimicrobial activity was found for third generation cephalosporins (70–85 %), amoxicillin-clavulanate (40–75%), aminoglycosides (tobramycin – 80 %, amikacin – 40 %). A high level of resistance of most grams of (-) microorganisms to ampicillin-sulbactam, cephalosporins of I–II generations in different ratios was determined. S.aureus resistance to azithromycin, clarithromycin is shown. Conclusions: the high prevalence of multiresistant isolates of pathogens (gram-positive (Staphylococcus aureus, enterococci), gram-negative pathogens (Escherichia, Klebsiella, enterobacteria, acinetobacteria, pseudomonads) emphasizes the need for dynamic microbiological monitoring in the surgical departments and the use of alternative antimicrobial drugs only.

74-83

Authors: Oksana Matsyura

Introduction. Food allergy is an urgent problem in modern pediatrics. Cow’s milk is the main food allergen in young children. By the age of one year, from 0.5 % to 3 % of children suffer from cow’s milk protein allergy. Aim. To analyze the existing standards of conducting oral provocation tests with milk in young children and suggest own algorithm of diagnostics. Materials and methods. Algorithm of diagnosing cow’s milk allergy was probated in 107 children aged from one to three years in Communal Municipal Children’s Clinical Hospital. To diagnose cow’s milk allergy, compilation of allergological anamnesis, examination, assessment of physical development, and determination of specific IgE to cow’s milk are performed. Then, different oral provocation tests are conducted based on the obtained results: at the allergist’s office on an outpatient basis, in a specialized inpatient department, in an intensive care unit. Results. Among 107 children, who were subjected to oral provocation test with milk, cow’s milk protein allergy was diagnosed in 67 (62.62 %). In children, who were diagnosed cow’s milk protein allergy (n = 67), skin (41.79 %) and gastrointestinal (28.36 %) symptoms prevailed. In the group of children with predictable low risk of allergy, diameter of a papule equaled 3.86 ± 0.62 mm2, the level of specific IgE to milk in blood serum was 0.58 [0.37–0.68], and in the group with medium risk – 5.51 ± 1.38 mm2 and 3.62 [0.86–9.66] kU/L, respectively. All 40 children, in whom cow’s milk protein allergy was not confirmed, constituted the group with predictable low risk of reaction development. Diameter of a papule during prick-test equaled 3.13 ± 0.24 mm2, the level of specific IgE to milk in blood serum was 0.36 [0.35–0.67] kU/L. In this group of children, complaints of gastrointestinal symptoms (82.5 %) prevailed. Conclusions. A complex diagnostic approach, in particular, study of anamnesis, examination, assessment of physical development, record of food diary, determination of specific IgE to milk, oral provocation tests enable to optimize diagnostics of food allergy and choose further therapeutic tactics. Algorithm of diagnosing cow’s milk protein allergy in 1–3-year-old children has been elaborated, which can be recommended for common application in clinical practice.

92-97

Authors: Kyrylo Parkhomenko

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

107-114

Authors: Larysa Strilchuk

Introduction. The monocytes to high-density lipoproteins ratio (M/HDL) is known as an integral indicator of inflammation, oxidative stress and lipid accumulation, which allows its use in the assessment and prediction of a number of diseases. Purpose: to determine the clinical significance of M/HDL according to the literature and to establish its changes and correlations. Materials and methods. We made a literature search in the Pubmed database and domestic sources, and analyzed data of 1190 outpatients with various diagnoses and 116 inpatients with unstable angina (UA). Digital data were statistically processed with Statistica 6.0. Results and discussion. Elevated M/HDL is associated with the development of atrial fibrillation after coronary artery bypass grafting, hospital mortality, and all-cause mortality. M/HDL can be a criterion of inflammation and oxidative stress, as well as a predictor of the severity of coronary heart disease and the risk of cardiovascular events. According to own data, in 1190 outpatients the average level of M/HDL was 6.50 ± 0.21. The increase in the M/HDL ratio occurred in parallel with an increase in the number of blood basophils, the development of intrahepatic cholestasis, increased endogenous intoxication, decreased total cholesterol and fasting blood glucose, and diastolic left ventricular dysfunction. In patients with UA M/HDL averaged 5.41 ± 0.40. An increase in the M/HDL ratio was associated with male gender, a decrease in total cholesterol and fasting blood glucose, and lower integrative hematologic markers of immune reactivity. The M/HDL was maximal in patients with bent gallbladder body, which was accompanied by the elevated values of very low density lipoproteins cholesterol (0.80 ± 0.10 mmol/l), triglycerides (1.76 ± 0.21 mmol/l), both Castelli indices and lower high-density lipoprotein cholesterol. An inverse correlation of M/HDL with left ventricular ejection fraction was found in patients with intact gallbladder. Conclusions. 1. M/HDL is a valuable marker of atherosclerosis and inflammation. 2. M/HDL was maximal in patients with bent gallbladder body, which was accompanied by dyslipidemia. 3. The inverse correlation of M/HDL with left ventricle ejection fraction in case of intact gallbladder and direct correlation with the aorta diameter in patients with cholecystitis confirm the association of the increase of this ratio with the unfavorable course of cardiovascular diseases. 4. In patients with UA and intact gallbladder or cholelithiasis M/HDL correlated with the nuclear index of intoxication.

123-130

Authors: Viktor Slivka

The literature review summarizes the data on the classification and characteristics of the antioxidant defense system. This model combines a number of different substances. Each of the components of the antioxidant system acts in close connection with its other structural elements, harmoniously complements, and in many cases – enhances the action of each other. The functional basis of the system of antioxidant protection is formed by the glutathione system, the constituent elements of which are actually glutathione and enzymes that catalyze the reactions of its reverse transformation (oxidation ↔ reduction). Most researchers conventionally divide the system of antioxidant protection into enzymatic and non-enzymatic. The enzyme links of the antioxidant defense system include: catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase, glutathione transferase and other enzymes. The non-enzymatic system includes fat-soluble vitamins A, E and K, water-soluble vitamins C and PP, biogenic amines, glutathione, carotenoids, ubiquinone, sterols. Both enzymatic and non-enzymatic antioxidant defense systems are present in the bloodstream. The activity of the enzymatic antioxidant system is very well regulated and depends on age, physiological condition, hormone dynamics, intensity of antioxidant enzyme synthesis, pH, presence of coenzymes, inhibitors, activators and other factors. The non-enzymatic part of the antioxidant system does not require as many regulators as the chemical itself - the antioxidant - reacts chemically with the radical. Only the reaction rate can change. The lungs are directly exposed to oxygen and oxidants of polluted air, they are most sensitive to oxidative damage, so they have an increased possibility of free radical reactions. Protection against the damaging effects of reactive oxygen species and free radicals is provided by anti-radical protective systems, especially the glutathione system and its enzymes. Numerous papers have obtained clinical and experimental data on the important role of free radical oxidation of lipids (FROL) and antioxidant systems (AOS) protection in the development of many diseases, including pulmonary tuberculosis (TB). The review presents modern views on the state of the system of lipid peroxidation (LPO) and antioxidant protection in TB. The main topic of the review is information on the generation of free radical compounds by different populations of leukocytes with further enhancement of LPO and secondary deepening of functional disorders. The article substantiates the feasibility of identifying LPO products as non-specific markers of aseptic inflammation in TB and the need to develop new generations of antioxidants. One of the universal mechanisms of damage to cell membranes is LPO, the excessive activation of which is normally prevented by factors of the antioxidant defense system. Membrane-bound enzymes involved in the formation of LPO products include lipoxy and cyclooxygenases. Lipoperoxidation processes change the structure and phospholipid composition of cell membranes, which negatively affects the cellular immune response due to damage to the mechanisms of information transfer from extracellular regulators to intracellular effector systems.