Medical perspectives (Medicni perspektivi)

10-15

Authors: Alexenko A.A., Medvedieva L.Ye., Medvediev M.V.

Uterine leiomyoma is a common benign tumor of the female genital organs. Very often cases of necessary invasive treatment in women planning pregnancy appear. At the same time, clear criteria for assessing potential impact of intramural leyomioma nodes, in contrast to submucous, do not exist. It is believed, that the most likely mechanism of leiomyoma effect on fertility non-deforming uterine cavity is disorder of uterine contractility. A promising method of investigation is ultrasonic evaluation of uterine peristalsis with its further computer-based analysis. The information obtained would help to predict possible negative impact of intramural fibroids on fertility, in future, thus avoiding unnecessary surgical interventions with high risk of postoperative complications and recurrences or, vice versa; would allow to normalize the motility of the uterus with the help of timely surgical removal of uterine leiomyoma.

23-29

Authors: Rokutova М.К.

The purpose of research is to assess the impact of diet therapy, physical activity and an ACE inhibitor (lisinopril) on renal dysfunction in patients with abdominal obesity and hypertension. The study involved 14 patients with abdominal obesity, 2-3 degrees in BMI, hypertension, I-II stage, 1 degree, and severe insulin resistance. Men were 9 (64.3%) patients, women - 5 (35.7%) persons. The average age of the patients was 37,0r1,7 years, mean BMI - 44.7 [35.5; 46.5] kg/m2. BP was between 140-158/90-98 mm Hg. Diroton (lisinopril, Richter Gedeon Ltd, Hungary) was administered 1 time per day in the morning at a dose of 10 mg. The effect of diet therapy, exercise and lisinopril on parameteres of renal function (glomerular filtration rate, urine protein, urine albumin, urine ȕ2 microglobulin, urine albumin / creatinine ratio, ȕ2- microglobulin / urine creatinine ratio). After 6 months of treatment there was a significant decrease in body weight (p<0.001) from 123.5 [110.0; 154.0] to 120.0 [105.0; 142.0] kg, with a BMI from 44.7 [35.5; 46.5] to 42.7 [33.9; 45.2] kg/m2 (p <0.001) and waist from 118.0 [105.0; 142.0] to 116.0 [105.0; 135.0] cm (p<0.05). Normalization of blood pressure was achieved in 71,4% (n=10) patients and a significant decrease in blood pressure - in 28,7% (n=4) persons in the 6th week of treatment. The level of GFR was significantly (p<0.01) decreased from 202.2 [156.1; 254.6] to 200.3 [148.8; 220.6] ml/min, the level of ȕ2-mg decreased from 3.4 [1.1, 4.8] to 2.8 [1.4; 3.6] mg/24 h, the ȕ2-mg / Cr urine ratio - from 2.3 [0.9, 4.0] to 1.9 [1.0, 2.7] mg/g, which is a positive point prognosis of obesity-associated nephropathy in these patients. GFR normalized in 2 (14.3%) patients, ȕ2-mg and ȕ2-mg / ɋr ratio - only in 1 (7.1%) patients. GFR decreased in 10 (71.4%) patients, ȕ2-mg and ȕ2-mg / Cr ratio – in 12 (85.7%) patients. It is the result of complex treatment of diet, exercises and lisinopril. A significant reduction (p<0.01) of leptin from 95.6 [58.1; 141.9] to 87.0 [56.5; 132.6] ng/ml was observed in 13 (92.9%) patients. Patients in this group showed a significant decrease in lipid, carbohydrate metabolism and the level of insulin resistance. ACE inhibitors in combination with diet and exercises considering metabolic disorders are the complex treatment early manifestations of kidney damage in patients with abdominal obesity and hypertension.

34-39

Authors: Kondratiev V.А., Reznik А.V., Yegoreynko А.V.

A comparative assessment of cardiac performance by the data of clinical-instrumental examination of 50 patients aged 5-15 years with persisting form of partially-controlled atopic bronchial asthma in the period between the attacks of the disease was made. Children were divided into two groups depending on presence of concomitant chronic tonsillitis (18 patients) or absence of the latter (32 patients). In all cases by the data of spirography in children against chronic tonsillitis in the period between the attacks of the disease there were revealed ventillation disorders in the lungs by obstruction type, this promoted elevation of pressure in the pulmonary artery. Only in this group of patients in 27,8% of cases pulmonary arterial hypertension of moderate severity was revealed. By echocardiography data in children with asthma against chronic tonsillitis reliably more often (ɪ<0,01) there was revealed decrease of contractile function of myocardium of the left cardiac ventricle; this was caused by the presence of metabolic disturbances in the myocardium in the majority of cases (83,3%). These changes were registered on the electrocardiogram in the form of repolarisation changes of the ventricular complex. Presence of concomitant chronic tonsillitis in children with bronchial asthma favored formation of pulmonary hypertension on the one side and worsening of contractile ability of myocardium of the left cardiac ventricle on the other side; this required performing therapeutic-preventive measures for sanation of chronic infectious focus in the nasopharynx to prevent formation of chronic cardiac insufficiency during asthma course.

50-56

Authors: Sorokina O.Y., Buryak T.O.

The article discusses the burn encephalopathy as a manifestation of organ dysfunction. Purpose: to determine the impact of the systemic inflammatory response to the development of encephalopathy in thermal injury. The study involved 104 patients, who were divided into two groups depending on the severity of the burn injury. The development of SIRS in patients was confirmed by high levels of IL-6 during the whole period of observation. The level of IL-6 did not affect the development, timing and duration of sleep disorders in both groups. The level of LII on the day 1 affects the development of sleep disorders in group 1 (R=0.499, p=0.041). Development of insomnia correlated with the shift of leukocyte formula to the left in group 2 on the day 5 (R=0.349, p=0.020). We found a relationship between the development of delirium, its duration and the level of young forms of neutrophils in patients of 1 (R=0.563, p=0.001) and 2 (R=0.3488, p=0.003) groups. Development of delirium, its timing and duration correlated with the level of IL-6 on day 3 (R=0.812, p=0,049, R=0.5903, p=0.079 and R=0.615, p=0.059, respectively) in the group 2. The extent of the inflammatory reaction determined the disorders of thought (R=-0.545, p=0.036), memory (R=-0.547, p=0.023) and the dynamic of the recovery of cognitive functions in patients of group 1. Cognitive deficit correlated with the level of IL-6 (R=0.760, p=0.079) and the level of young forms of neutrophils (R=-0.603, p=0,013) in group 2. Thus, SIRS is a defining moment in the development of nervous system dysfunction in severe thermal injury.

61-65

Authors: Stepanskyi D.О.

One of the promising methods of prevention and treatment of intestinal infections is the use of probiotics. A series of experiments was carried out to study the protective effect of A. viridans vibrio in experimental vibroinfection and the introduction of staphylococcus toxin. In the intestine of animals receiving aerococcus competitive colonization takes place. Results of experiments on colonization in experimental animals which survived without signs of NAG infection showed that vibrios in the intestinal wall were almost absent, but a large number of aerococcus was found (2,5r0,2) *105. In cases of infectious process development, but in a mild form, aerococci prevailed over vibrios: (2,7r0,6) *104, and (2,0r0.2) *103 respectively. Aerococci injected subcutaneously can maintain livelihoods for several hours, destroying totally or partially introduced staphylococcus exotoxin, reducing the strength of its lethal activity.

72-79

Authors: Shvartsnau E.G., Kucherenko O.M.

The violation of microecology plays the important role in the pathogenesis of oral diseases. The question of correction of microecological violations in diseases of hard dental tissues and inflammatory periodontal diseases of young patients is still not enough studied. The aim. This study aims to examine changes of oral microbiocenosis of students with major dental diseases during the treatment. The change in state of oral microbiocenosis has been evaluated in medical students of two age groups: 14-17 years and 18–22 years, in the dynamics of treatment of major dental diseases by developed methods using monotherapy of applications of mucosal gel and combination of mucosal gel and ultraphonophoresis with galaskorbin according to the data which were obtained from the main habitat of the oral cavity: the content of the periodontal groove (gingival fluid), plaque from the vestibular surface of the lower molars, oral fluid. The usage of applications of mucosal gel Kvertgial in students aged 14-22 years removes disbiotic violations and restores normal biocenosis in the oral cavity. Identification of certain microorganisms, estimation of their amount and localization will allow to predict the course of lesions in the oral cavity in terms of causative agent nature and to take preventive measures beforehand with the use of mucosal gel Kvertgial.

91-97

Authors: Petrosian A.A.

Nearly 20-30% of all respiratory disorders and 40 % of asthma cases are the outcomes of intensive ambient air pollution. This study analyzes asthmatic morbidity among children exposed to high levels of SO2 from industrial emissions. The results of the study showed that ambient SO2 levels were at ɋmean=107±38 mkg/m3. It was revealed that 29176 children, which is 98% of the mapped child population within the city, were exposed to very high SO2 levels and lived in the zone of high health risk (HQ=1,6÷4,5). The prevalence of the disease was estimated at 100 cases per 10,000 of the population (95% CI; 87.5-111.5). It was revealed that children living in the zones of increased health risks attributed to SO2 are more likely to develop bronchial asthma than unexposed ones (1,99 OR; 95% CI (1,95-2,60), p<0,01). Over the city, SO2 exposure is responsible for 30.5% of asthma cases among the exposed children population.

10-15

Authors: Dzyak G.V., Nekhanevich O.B.

The purpose of our research was studying of cardiovascular system overexertion symptoms by dynamic of diastolic function of left ventricle during exercises of different power in athletes with small abnormalities of heart development. We surveyed 70 athletes aged 12-27 years. The diastolic function dynamics of left ventricular is showed in the work. The main indexes of myocardium relaxation disorders during diastole are defined. It is proved that in athletes with small abnormalities of heart development (mitral valve prolapse, open oval window) during submaximal physical loadings, signs of left ventricular diastolic dysfunction developed.

21-26

Authors: Stepanov Yu.M., Kovalenko A.N., Salenko А.V.

Among the diseases of the gastroduodenal zone chronic gastritis (CG) occupies one of the leading positions. One of the main forms of CG is reflux gastritis (RG) based on long-term location of duodenal content in the gastric antrum, so-called duodenal reflux (DR). It is well known that stable inflammatory response of the gastric mucosa (GM) appears under the influence of bile acid and gastric juice, leading to chronic antral gastritis followed by gradual development of atrophy, metaplasia and dysplasia appearance. Therefore the aim of our work was to investigate the influence of the DR on the course of chronic hepatitis and morphological changes in the gastric mucosa. We observed 70 patients with chronic RG, aged from 22 to 59 years, average age – 43,5±1,2 years. The control group consisted of 25 healthy individuals of both sexes aged from 19 to 39 years. As a result it was found out that pain and dyspeptic syndromes caused problems most of all. While studying the content of bile acids in gastric juice of all patients examined it was higher (1,42±0,05 g/L) in comparison with the control group (0,65±0,04 g/L). Content of bile acids in groups of RG patients with atrophy and without it was analyzed. The role of DR as an independent factor of recomposing changes in GM in chronic RG was proved.

32-37

Authors: Sebov D.M.

. The article analyzes data of 3234 coronary angiographies with established coronary X syndrome (CXS) in 217 cases, herewith expressed tortuosity of coronary arteries (ETCA) was found out in 148 (more than 2/3) of cases. A 5-years’ analysis of cardio-vascular events (CVE) in patients with CXS in comparison with the group of IHD patients and initial atherosclerosis of coronary arteries was made. Absence of reliable difference of developing severe cardio-vascular events (SCVE) bet¬ween patients with initial atherosclerosis and CXS was proved. Risk of CVE development was significantey higher in patients with ETCA, OR=4,93; 95% (0,62; 3929). Patients with CXS had higher risk of severe arrhythmias development as compared with IHD patients with initial atherosclerosis: OR=2,36 (1,01; 5,56). There was no reliable difference between lethality of any causes and number of coronary interventions in all groups.

42-48

Authors: Voronin K,V., Alale A.M., Alale I.I., Chervonyi S.I.

In the structure of inflammatory di¬seases postpartum endometritis (PE) retains its leading position. The likelihood of postpartum endometritis deve¬lopment after cesarean section increases by 5-10 times compared with spontaneous labor and its frequency has no tendency to decrease. The urgency of PE problem is determined not only by its high prevalence, economic losses, but its possible complications (uterine suture failure and generalization of infection as well). Clinical picture of PE currently is characterized by late manifastation, presence of atypical and asymptomatic forms with mismatched general reaction of the organism and severity of the local pathological process. The leading role in the etiology of PE belongs to conditionaly pathogenic microflora, in the most cases (90%) presence of strict anaerobic nonsporeforming mic¬roorganisms, composing part of the normal flora of the genital tract in women. The aim of the study was the development of the principles of active prevention of postpartum endometritis in women with severe vaginal anaerobic dysbiosis while planning cesarean section.

56-60

Authors: Yakovlieva V.H.

The violation of blood coagulation properties is observed in many diseases of the respiratory system, including chronic obstructive pulmonary disease (COPD). It is known that in a stable COPD phase release of proinflammatory cytokines in blood is observed, it leads to disturbance of hemostasis parameters toward hypercoagulation. The aim of our study was to determine possibility of coagulation disorders formation in patients with COPD in a stable phase of pathological process at different stages of disease course and identify relationship between coagulation parameters levels and degree of violation of ventilation lung function. Materials and methods. We examined 30 patients with COPD in a stable disease phase, included in the main group (FEV1 =49,5±15,5% of the due, there were 27 men (90.0%), 3 (30.0%) women, mean age was 61,8±7,9 years, level of pack /years index - 34,2±15,3). The control group consisted of 10 healthy subjects matched with the patients of the main group by age and sex. All patients were divided into 2 subgroups. Subgroup 1 included 16 patients with moderate COPD, that is the level of FEV1>50% (61,8±7,4% of predicted), and subgroup 2 - 14 COPD patients with severe COPD, that is the level of FEV1 <50% (35,3±8,2% of predicted). Patients received standard treatment according to the disease stage. Main indicators of coagulation levels: prothrombin index (PI), prothrombin ratio (PR), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT) and antithrombin III (AT III) were identified in all patients. Results. The levels of PI, PR and INR in the subgroup 1 differed significantly from those of in the subgroup 2, control group (p<0,05) and pointed at hypercoagulation, whereas in the subgroup 2 all indicators were absolutely identical with control group. Correlation link between the level of INR levels and FEV1 (r=-0,73; p<0.01) in patients of the main group was determined. Levels of APTT, TT and AT III in the main group and in subgroups 1 and 2 were identical to those of the control group. There were no significant differences of these parameters between subgroups 1 and 2. Conclusions. In patients with COPD already at early stage of the disease abnormalities of coagulation hemostasis link mainly on external coagulation pathway toward hypercoagulation develop.

67-73

Authors: Kotlyarchuk K.B., Maslyak Z.V., Lukianova A.C., Tsyapka O.M., Selina I.O., Usenko H.V.

Aim of this study was to analyze molecular genetic and cytogenetic reasons for disease resistance to tyrosine kinase inhibitors (TKI) imatinib (IM) and nilotinib (NI) in patients with chronic myeloid leukemia (CML). Material and methods. A group of 32 CML patients with primary or acquired resistance to TKI treatment was investigated. Cytogenetic response was determined by conventional karyotyping with differential banding. Presence of BCR-ABL kinase domain mutations was investigated by direct sequencing. Results and discussion. The frequency of mutations was 37% (12 patients) with prevailing occurrence of mutations with low sensitivity to nilotinib – E255K/V; Т315I; F359V; Y253H. In 47% of the cases (15 patients) additional chromosome aberrations (ACA) were revealed which could also be the reason for TKI resistance in patients without BCR/ABL mutations. Patients with detected mutations of BCR/ABL gene were either switched to nilotinib or treated with increased dose of IM. Cytogenetic response was achieved in only 2 patients with mutations and in 12 patients without them. Frequency of blast crisis development did not differ significantly in both groups. Conclusions. Among the investigated patients with CML resistant to IM BCR/ABL gene mutations were detected in more than third of the cases whereas ACA were found in almost half of the group. Taking into account revealed prevalence of mutations not sensitive to the 2nd generation TKI nilotinib, investigation of mutational status has to be obligatory in all patients for whom treatment correction is considered. Presence of ACA should also be taken into account in patients requiring administration of the second line TKI since they can adversely influence expected treatment response as well.

80-84

Authors: Kutovoy A.B., Petrashenko I.I.

With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001) of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%), Michelson(55,7%), Ivanov(59,6%) symptoms was higher than that of Kocher – Volkovich (36,5%), Rovsing (28,8%), Sitkovsky (51,9%), Bartomje – Michelson (55,7%) symptoms, their value was diminishing together with increase of pregnancy terms.

95-100

Authors: Grizodub D.V.

To improve prevention and treatment of intolerance to fixed denture materials by studying the impact of status of microbial contamination of the oral cavity on the pathogenesis of its development. The clinical study was performed in 62 patients, 22 of them came to the clinic for prosthetics and with clinical symptoms of intolerance to fixed dentures. The comparison group consisted of patients without clinical manifestations of intolerance. Healthy individuals without prosthesis were used as a control group. The results of clinical studies convincingly demonstrate that in the oral mucosa of patients of the main group level of Gram-negative bacteria was higher and that of Gram-positive was lower than in the comparison groups. Indicators in the study group testify to the increase in the total number of microorganisms, especially Gram-negative bacteria and decrease of gram-positive ones. Con¬ta¬mination with fungi of the genus Candida of the oral mucosa of patients with intolerance to materials of fixed dentures was higher by 67,3% in the main group than in the comparison group.

106-112

Authors: Besedin O.M.

Vacuum Therapy (Vacuum-assisted closure, VAC) - a method of complex therapy which is used to improve the healing of both acute chronic wounds in patients with diabetic foot syndrome. Due to widespread introduction of this technique, unique cell, extracellular and general effects of its use in the treatment of patients with purulent-necrotic complications of diabetic foot syndrome, a technique of vacuum wound therapy has been successfully used in many surgical departments of Ukraine. Despite the diversity of the clinical effects of VAC-therapy and appearance of number of publications, in the domestic and foreign literature physiological basis of this method have not been studied completely. The effectiveness of vacuum therapy explain: the reduction of the size of the wound, the stabilization of the wound environment (due to the removal of inflammatory mediators and cytokines), microdeformation and remodeling of cell, rows reduction of edema, reduction of bacterial contamination, etc. At the same time, mechanisms of blood flow enhancement at different duration of VAC-therapy use, remain unclear its effect on the third phase of wound healing process as well.

120-127

Authors: Shydlovska T.A., Basanets A.V., Gvozdetskiy V.A., Shevtsova T.V.

Noise influence takes one of the leading roles in the development of sensorineural hearing loss (SHL). At the same time professional deafness steadily occupies the 5th place in the structure of occupational diseases in Ukraine over the past few years. Of special importance is the problem of pre-clinical and early diagnosis of occupational hearing deterioration, in sense of timely prophylactic and rehabilitation measures in “risk group” workers. The objective research methods play an important role in the diagnosis of auditory analyzer state. Many scientific studies have shown the diagnostic effectiveness of method of otoacoustic emissions recording in the early diagnosis of lesions of receptor part of auditory analyzer. It is known that SHL of noise genesis largely affects the receptor part of the auditory analyzer, for which the OAE method has great practical diagnostic significance. Objective: to study informativity indicators of otoacoustic emission for the diagnosis of sensorineural hearing loss in various occupational groups of coal workers in Ukrainian mines. Materials and Methods: Auditory function of 87 workers of the coal industry (drifters, miners and longwall miners) with different levels of industrial noise and hygienic conditions in their workplaces was: 28 studied drifters (group 1), 25 miners (group 2) and 34 longwall miners (group 3). Work experience in noise in these groups was 17,9±1,0; 23,1±1,0 and 22,2±2,0 accordingly. Noise ratio in drifters was 93,6±4,9 dBA, in miners – 92,9±5,5 dBA and in longwall miners – 86,5±6,04 dBA accordingly, while the maximum permitted level is 80 dBA. The research was conducted on the analyzing system "Eclipse" "Interacoustics" (Denmark). All patients underwent registratiov of the caused OAE at frequency distortion product (DPOAE) at frequencies 1-6 kHz. The results were rated using variation statistics Student's test. Results: The most prominent violation of the receptor part of the auditory analyzer according to the OAE among all the examined workers of different professional groups of the coal industry was found in drifters, miners had less pronounced violations and the least significant ones were in longwall miners. At the same time in 42,9% drifters caused OAE at frequency distortion products was not recorded on any of the investigated frequencies. Received averages of OAE amplitude in the studied frequencies differed significantly in drifters not only from the norm, but also from that in the group of longwall miners in the 4-6 kHz region. The most prominent disorders according to the speech and above-threshold audiometry were found in drifters and miners, testifying to violations in the receptor part of the auditory analyzer. Conclusions: In all occupational groups of coal industry workers according to OAE data, more pronounced violations were found in the frequency distortion products in the 4-6 kHz. This is evidenced by significant decrease of OAE amplitudes averages, especially pronounced in 4 and 6 kHz, where they significantly differ from the norm and from the indicators in the group of longwall miners; and OAE registration was absent in the drifters. The identified differences in OAE indicators and dysfunction severity in the receptor structures of the auditory analyzer, obviously, could be explained by the nature of industrial noise and hygienic working conditions in the workplaces of the studied workers of coal industry.

133-138

Authors: Vіtovska O.P., Savіna O.M.

The purpose of the work is to estimate sickness rate and patterns of eye and adnexa diseases. The data of departmental statistical reports of Ministry of Health of Ukraine (form 12) for 2005-2014 years, period were used. The specific weight, prevalence and sickness rate were determined for the following diseases: conjunctivitis and other diseases of the conjunctiva, cataract, myopia - among children aged 0-17 years; strabismus - among children aged 0-14 years; glaucoma and optic nerve atrophy - among adolescents aged 15-17 years. Results. Among children's eye and adnexa diseases the following diseases were identified the most often: myopia (28,26 ± 0,02)%, conjunctivitis (20,12±0,01)% and strabismus (7,87±0,01)%; particularly among new cases of eye diseases their proportions were 13,89±0,02%, 44,06±0,03% and 2,24±0,01% correspondingly. The prevalence of eye and adnexa diseases among children in Ukraine was 102,05±0,03%, and 45,90±0,02% especially for newly diagnosed diseases.

144-147

Authors: Nikolayenko-Kamyshova T.P.

Disturbances in the system of he¬mostasis and vascular complications is the topical clinical problem, requiring profound study with the development of treatment and prophylaxis algorithm. Thrombus-hemorrhagic complications in patients with chronic myeloproliferative (CMPN) neoplasias are caused by the presence of plethoric and myeloproliferative syndromes, findings of hemogram (level of erythrocytes, thrombocytes, leukocytes, hematocrit index) and hemostasiogram testify to this. A case of thrombus-hemorrhagic complication in a female patient with chronic myeloproliferative neoplasia was considered. Carrying out differential diagnostics requires performing additional investigations: USI, CT with defining of hemostasiogram, hemogram findings, their thorough monitoring when surgical intervention is needed. This diagnosis for the first time was made in conditions of surgical in – patient unit. In pre- and postoperative periods as well as for prevention of vascular complicatients in the patient with CMPN it is necessary to mandarory administer agents which correct hematologic status and rheologic indices. This clinical case was analyzed with the aim to draw doctors’ aftention to complexities in diagnostics and defining treatment tactics for patients with thrombus-hemorrhagic complications: necessity to establish all possible risk factors of vascular events development and to carry out constant hemostasiologic menitoring for preventing lethal outcomes.

11-16

Authors: Fedorenko Yu.V.

The aim of the work was to study dynamics of changes of summation-threshold index under the combined impact of cadmium and immobilization of animals depending on the typological characteristics of animal behavior. The studies were conducted on white rats, previously divided into groups of active and passive ones by terms of "horizontal activity" in the test "open field". In each group the experiments were planned according to the scheme of orthogonal design 22. Summation-threshold index was studied by Speransky S.V. method. It was found that the summation-threshold index increases on the day 10 of experiments under the action of a cadmium only in groups of "active" and "passive" animals; this testifies to inhibition processes in the CNS. The effect of cadmium, immobilization and their combined action on day 30 of experiments leads to the reduction in the of studying parameter in both groups of animals; this testifies to excitation of the CNS. The active animals are more susceptible to immobilization stress, the passive ones  to the action of cadmium. The combined action of stress factors on day 10 is characterized by desensitization, on day 30 – by unidirectional interdependent action and less than by additive effect. The processes of inhibition and excitation in the central nervous system depend on type of animal behavior, type and duration of exposure to the stress factor. The results may be taken into account when assessing adaptation process, correction, and adaptation depending on the type of behavior.

25-29

Authors: Iermolenko T.I.

Herbal medicines provide their versatile complex influence on the course of the pathological process in the kidneys due to biologically active compounds. Specifically, they cause the direct impact on the concrements formation. The search of drugs which would contain high biological compounds of plant origin is an actual issue of modern pharmacology. The aim of investigation was to study the anti-inflammatory activity of the new combined drug of urolytolytic action, which includes the total plant extract and succinate buffer complex. Materials and methods: aseptic exudative inflammation was caused by subplantar introduction of 0,1 ml of 1% solution of λ-karahenin in the right hind paw of rats, the investigated drug was administered at doses 1, 2 and 4 ml/kg. The influence of the studied drug was evaluated in terms of swelling limbs volume. It is shown that the severity of antiexudative action of flarosukcine had dose-dependent nature, increasing from dose of 1,0 ml/kg to 2,0 ml/kg (by 5,5%). Further dose increase to 4,0 ml/kg, was not defined by significant increase of activity. Anti-inflammatory activity of the drug ranged from 25 to 33%, which can be regarded as quite distinct, since in pharmacological study of anti-inflammatory drugs pharmacological activity level of at least 20% is significant.

36-42

Authors: Gashynova K.Y.

The aim of the study was to compare the clinical and anthropometric characteristics of patients with COPD, which differ in the degree of airways obstruction and belong to groups A, B, C, D in accordance with GOLD, 2011 classification. A total of 112 ambulatory COPD patients in remission made the study sample. Anthropometric data, body mass index, medical history, dyspnea by mMRC scale, and spirometry was performed for all patients. There was confirmed that outpatients with COPD is a heterogeneous group, in which the majority are those with moderate (48.22 %) and severe (30.36 %), airway obstruction. Despite the vast majority of men among outpatients, the percentage of women among patients with mild to moderate obstruction (22.58±5.31 %) was significantly higher (p=0.002) as compared with those with severe or very severe limitation of airflow (6.00±3.36 %). Patients with severe and very severe obstruction were of significantly older age (p = 0.024). At the same time, the distribution of patients according to the GOLD, 2011 classification, demonstrate that all groups did not differ on any of the anthropometric indicators, including gender and age (p > 0.050). Distribution of patients by groups with different risk for future exacerbations is not a mirror image of gradation in accordance with the degree of airway obstruction. Every second (50.00±4.43 % of cases) patient is included in group C and every tenth (10.20±4.32 %) belongs to the group D not due to degree of bronchial obstruction, but due to the number of exa¬cerbations in the past year. Therefore, in future studies it is advisable to use both principles of patients’ classification.

47-53

Authors: Avramenko I.V.

Based on data from a prospective analysis for the year of observation, the article presents information about the features of severe community acquired pneumonia in patients who were hospitalized at the department of pulmonology (or therapy), as well as department of the intensive care from three teaching hospitals in Dnepropetrovsk, namely "Dnipropetrovsk City Hospital №6», "Dnipropetrovsk City Hospital №2», "Dnipropetrovsk City Hospital №16», which are the clinical ones of "Dnepropetrovsk Medical Academy of the Ministry of Health Ukraine". Dependence of the severity of the condition shown on duration of illness before admission, features of season character of disease. The effect of breathing exercises on the course of the disease. The results can be the basis for a more personal approach to the development of diagnostic and therapeutic programs for patients with severe community-acquired pneumonia.

62-69

Authors: Dudukina S.O.

In 260 patients with intracranial aneurism hemorrhages long-term results were estimated according to Rankin scale 2,5 years after operation. Long-term results by Rankin 0-2 were considered to be “good”, 3-5 were considered to be “bad” ones. Two years after operation 53% of all patients had “good” long-term outcome. Factors negatively influencing long-term outcomes are to be the following: intra-operational aneurism rupture, temporary arterial clipping in the process of operation, complications in the post-operational period, angiospasm according to the transcranial Doppler sonography, angiospasm prevalence, clinicopathologic hemorrhage characteristics “subarachnoid hemorrhage+others”, critical condition according to H-H>1, feminine sex, aneurism location in the forebrain arteria, subarachnoid hemorrhage lesion according to Fisher> II, ischemic heart disease, pathological comorbitidy, ABO blood group – III or IV. “Good” treatment results 2,5 years after treatment are prognosticated in patients with severe invalidity by Glasgo scale (GOS=3) on hospital discharge, in those who didn’t experience ischemic stroke after operation and with severity of condition I or II according to H-H on admission. In patients with GOS-3 on hospital discharge the best long-term results according to Rankin were observed in those treated under hypothermia conditions. Hypertensive disease worsens long-term results according to Rankin even in patients with GOS-5 on hospital discharge. With positive renovation results by Rankin 0 or 1 in the post-operation period (GOS = 5) excellent long-term results are prognosticated, but the best results could be obtained in patients without hypertensive disease under prophylactic hypothermia.

78-84

Authors: Volkov O.O.

General anaesthesia may be the cause of different damages of the nervous system after surgery. Anaesthesia technique may be preventive factor of developing or worsening postoperative cognitive disfunctions. A research aim was to study an influence of inhalation anaesthesia during the caesarean section on the parturients’ cognitive functions. Having agreed with local ethics committee and obtained informed consent, 30 pregnants (at 37-42 weeks of gestation (38,9 (0,76), those who underwent caesarian section) were examined. Inhalation anaesthesia: induction - thiopental sodium (5 mgs/kg), maintenance - sevofluran 1,3 vol.%, in fresh gas flow 1,5 L/min. Relaxation – suxcinilcholinum (1-1,5 mgs/ kg). Phentanyl (0,05 mgs/of ml - 4 mls) and diazepamum (10 mgs) after newborn extraction were introduced. Mainte¬nance of analgesia is phentanyl in the dose of 0,05 mg/ml – 1 ml in approaching of BIS to 60 (BISX Module, BIS™ Co¬vidient, the USA). We used Montreal Cognitive Assessment (MoCA) test – for cognitive functions investigation, “Matching digits and letters” test for control functions, Luria’s test for memory, perception was studied by test “recognition of time”. Speech was studied by test "name of fingers", praxis by “drawing of clock” test. Control points: 1 - upon admission to the obstetrical department (P1), 24hours after the surgery (P2), on the day 3 after the surgery (P3), on the day 5-7 after the surgery (P4). The study showed that in 24 hours after caesarean section under inhalation anaesthesia the meanings of cognitive functions did not change in general, and were kept on predelivery values. Under inhalation anaesthesia cognitive functions are normalized on day 3 of postoperative period. Perception level does not depend on the time after surgery. Initially decreased memory level in expectant mothers was regressed after operative delivery and recovers by the day 3 after surgery. Speech normalizes by days 5-7 after inhalation anaesthesia in caesarean section, and praxis remains decreased.

88-94

Authors: Abaturov A.E., Rusakova E.A.

The article discusses the clinical and immunological features and mechanisms of recurrent acute obstructive bronchitis in infants. We have examined 102 children aged from 6 months to 3 years with acute obstructive bronchitis and signs of respiratory insufficiency of the I-II degree. There were 28 children with recurrent acute obstructive bronchitis and 74 patients with acute obstructive bronchitis, developed for the first time. We determined the concentration of total IgE, content of IFN-γ, IL-4, IL-12 and IL-13 in serum by ELISA and the expression of the transcription factor NF-κB in lymphocytes of peripheral blood by flow cytometry in all the children. High level of IL-12 as compared to physiological norms in the dynamics of the disease was the characteristic feature of the children of both groups. And it was the factor, which detected a voltage of cell-mediated immune response and inflammation. The second specific feature was the high concentration of IgE. It was shown that the transcription factor NF-κB determined the cytokine status at the beginning of the disease, and in the period of convalescence. That fact did not depend on the number of previous acute obstructive bronchitis. However, there were violations of the mechanisms of NF-κB-associated signaling pathways activation, which manifested itself in an advantageous enhancement of the chains, determining the production of Th2-associated cytokines in children with recurrent acute obstructive bronchitis.

100-108

Authors: Biletska E.M., Bezub O.V., Okolova V.V.

Today the problem of diseases of support-motor system, especially in middle-aged and elderly persons is extremely important, caused also by worsening of demographic situation in many countries of the world. Purpose - basing on generalized analytical scientific data to define the role of eco-dependent risk factors in the development of bone pathology in humans. It is found that recently there appeared a number of compelling evidence for the list of known factors of bone pathology, including chemical pollution of the environment with lead. This toxicant even in low doses selectively accumulates in the bone tissue, replacing calcium from its matrix; this on the background of widespread calcium deficiency in nutrition, potentiates the development of osteopathy and increases incidence of musculoskeletal system diseases, particularly in the inhabitants of ecologically crisis areas.

117-123

Authors: Schudro S.А.

The primary purpose – to give estimation of nutrition status indexes of teenagers and define their role in donosologic health diagnostics. In the work it is proved that in 17,1% of girls anaemia was diagnosed, in 53,9% – latent deficit of iron. Clinically, symptoms of ascorbic acid deficiency were educed in 50,0%, and its maintenance in the blood serum was reduced in 70,0% of inspected. It is shown that anaemias and latent deficit of iron in teenagers are associated with their activity, anxiety and physical capacity; deficit of ascorbic acid − with the changes of amino acid composition of blood and activity; violations of proteometabolism − with general state, anxiety and physical capacity; increase of both lipids and blood glucose − with their activity; violation of cellular immunity − with activity and general state, and humoral immunity − with the mental capacity of teenagers. It is necessary to take into account all these violations in donosologic diagnostics of health of the rising generation.

131-136

Authors: Manin M.V., Abramov V.V., Nekhanevich O.B., Khaitov P.A., Kaptelov N.I., Sysenko I.V.

The analysis of structure of lumbar spine dorsopathy morbidity among able-bodied population of the Dnepropetrovsk area for substantiation of differentiated approach to the choice of exercise therapy methods was a research objective. The structure of dorsopathy morbidity in 371 patients in 2009-2013 period is analysed in the work. The paper presents analysis of the most frequent morphological changes in the structures of the spine, their localization and clinical course. Link of clinical manifestations of dorsopathy with structural changes of the backbone, the disease experience is revealed, efficiency of rehabilitation by means of physiotherapy exercises depending on qualitative and quantitative signs of disease is defined. Results of the research specify that more than 40% of patients were on repeated treatment, clinical manifestation in 62% of patients was observed at the most able-bodied age (from 30 to 50 years), according to the disease experience number of aggravations per a year increased, in 57,5% of cases administration of medical physical culture was limited due to development of an accompanying pathology, in 40% of cases against positive dynamics of painful syndrome insufficient changes in volume of movements of the spine segments throughout treatment were marked. It testifies to necessity of working out algorithm of differentiated approach to the choice of means medical physical culture in treatment of lumbar spine dorsopathy.

10-14

Authors: Popadyuk O.Ya.

Surgical infection is a difficult problem in modern medical practice. Prevalence of surgical infection, new strains of microorganisms and their resistance to antibiotics, poor outcomes of wound treatment, lack of sensitivity of microorganisms to commonly used antiseptics necessitate the search for the new methods and means of treatment in wound surgery. This article provides an overview of domestic and foreign literature on the possibility of solving the problem of effective local treatment of purulent wounds through the study and implementation of nanotechnology in modern medicine. Researchers around the world are beginning to use nanoparticles and developments of nanotechnology in various fields of science and medicine to synthesize new drugs and vaccines, including zinc nano oxide usage as a highly effective local antiseptic that is non-toxic to the cells of the human body at very low, concentrations but with sufficient antibacterial action. Small sizes and large surface area relatively to volume increases efficiency of interaction of nanoparticles with germs and makes it probable a wide range of antimicrobial activity. Nanoparticles on metals base due to their biological and physical-chemical properties are perspective antibacterial agents and may be used to solve many problems in nanomedicine and surgery in particular. Study and application of zinc nano oxide in preparations of multidirectional local action will ensure high effective defense against pathogenic microorganisms in the wound.

21-26

Authors: Melnik A.V.

Hydrogen sulfide is signalling molecule that regulates vascular tone and myocardial contractility. Role of estradiol in hydrogen sulfide production in cardiovascular system of rats remains unclear and this becames research objective. Effect of estradiol on hydrogen sulfide level, cystathionine-γ -lyase activity and its kinetic parameters - Michaelis constant (Km) and maximum rate (Vmax) in rats’ heart was estimated. Experiments were conducted on 45 white nonlinear female rats. Deficit of sex hormones level in females was modulated by castration - ovariectomy and hormone replacement therapy with estradiol. It is shown that the production of hydrogen sulfide in the myocardium is determined by the level of estradiol: castration of females causes a significant decrease in myocardial hydrogen sulfide content, cystathionine-γ-lyase activity, maximum rate of hydrogen sulfide formation from cysteine in participation of cystathionine-γ-lyase, as well as increase in Michaelis constant of this enzyme in comparison with the controls. Hormone replacement therapy with estradiol brings nearer hydrogen sulfide level, cystathionine-γ-lyase activity and kinetic parameters of cysteine desulfuration reaction in the rats’ myocardium to the levels of the control group. Thus, estradiol is involved in regulation of hydrogen sulfide production in cardiovascular system of rats, namely it increases cystathionine-γ-lyase activity and its affinity to cysteine.

35-41

Authors: Kolesnyk M.Yu.

Purpose: to estimate diagnostic accuracy of C-terminal fragment of type I procollagen (PICP) in hypertensive males with hidden chronic heart failure (CHF). The study included 220 men with uncomplicated arterial hypertension (mean age 52 (46-58) years). The control group consisted of 40 healthy men of similar age. Ambulatory blood pressure monitoring, transthoracic echocardiography and speckle tracking echocardiography was performed to all participants. All patients underwent treadmill test with post-exercise evaluation of left ventricular (LV) filling pressure by tissue Doppler Е/е' ratio to reveal hidden CHF. The post-exercise Е/е'≥13 was considered to be pathological. PICP levels in plasma were determined by ELISA. The PICP concentration was significantly higher in men with hypertension (132,3 (81,3-216,8) ng/ml) as compared with healthy subjects (93.2 (64,7-133) ng/ml) (p=0,0068). The presence of LV hypertrophy did not affect the level of PICP (p=0,58). 16 patients presented pathological result of diastolic stress test revealing signs of hidden heart failure. PICP concentration was 2-fold higher in these individuals as compared with other patients (p=0.01). The ROC-analysis revealed, that optimal cut-off point is 170.2 ng/ml for PICP to detect hidden CHF (area under curve – 0,68±0,08; 95% confidence interval – 0,61-0,74; sensitivity – 68,7%, specificity – 69,6%). The PICP level exceeding 170,2 ng/mL testifies to hidden CHF in hypertensive males.

49-55

Authors: Molchanov R.N. , Blyuss O.B.

Objectives. To investigate the possibility of predicting recurrence of bladder tumors based on the clinical and morphological features of the disease and preoperative intravesical instillation of probiotic Aerococcus viridans 167. 190 patients operated for bladder tumors have been observed for a period from 1 to 73 months (mean 35.2 months). In 51 patients one single preoperative intravesical instillation of probiotic Aerococcus viridans 167 was added to a standard treatment. Reported cases of recurrence of tumors were used as a basis for the development of mathematical rules for predicting recurrences. These rules have been used to create a logistic regression and support vector machines. Of 190 patients, in 132 (69,5%) transitional cell carcinoma (TCC) in the stage Ta-T1, in 58 (30,5%) - transitional cell papilloma of the bladder (TCP) was identified. Recurrences were detected in 52 (27.4%) patients, mean time of observation was 14.7 (1-50 months). In patients with TCC recurrence was observed in 36 (37%) of 96 patients not treated with probiotic instillation vs 7 (19%) of 36 after probiotic use (p> 0,05). In TCP group no significant signs of the instillation influence of probiotics on the number of relapses were revealed. Classification rules that can predict the risk of recurrence of bladder tumors based on histological characteristics and application of probiotic were obtained. Preoperative instillation of probiotic Aerococcus viridans 167 in TCC TaT1 patients reduces the recurrence rate from 37% to 19% (p <0,05). Variables "Number of tumors" and "Maximum tumor size," and their relationship are informative prognostic parameters. The rules obtained may be recommended to follow up patients after surgery for timely distinguishing group of patients with increased risk of bladder tumor recurrence.

62-69

Authors: Loskutova T.O.

Hypertensive disorders in pregnancy remain important problem of modern obstetrics, their frequency being 2-8% with no tendency of decreasing. To identify pregnant women with high risk and to conduct preventive treatment is very important for the practitioner. The aim of the study was to develop and justify differential management of pregnants depending on the risk of preeclampsia. 131 pregnant women in I trimester were tested to determine the risk of hypertensive disorders. Prediction model allows to identify pregnant women with risk of hypertensive disorders according to the results of testing thrombophilia genes (presence of 455G → A polymorphism in the gene for fibrinogen β and 4G/5G in gene of plasminogen activator inhibitor - type 1), the level of antibodies to β2 glycoprotein-1, the level of D-dimer and the value of atherogenicity coefficient. Pregnant women with high risk of hypertensive disorders, received prophylactic treatment complex. This complex included antiplatelet therapy, correction of hyperho¬mo¬cysteinemia and hypercholesterolemia levels. Etio-pathogenic concept of prediction and prevention of pre-eclampsia associated with thrombophilia was proposed. The proposed scheme of preventive treatment allowed to normalize blood clotting parameters, lipid metabolism, to reduce the number of thrombophilia markers. The necessity of early and long-term administration of prophylactic complex was proved. This management prevents endothelial damage and deve¬lopment of pathological range of pre-eclampsia. The results of prophylactic treatment were the reduction of preeclampsia cases by 6,5 times (p < 0.05), number of complicated deliveries by 3 times (p <0.05), number of preterm birth by 6,57 times (p <0.05), cases of growth retardation by 9,8 times (p = 0.003), increase of newborns’ weight by 1,24 times (p = 0.02).

75-81

Authors: Gashynova K.Yu.

Studying the causes of hospitalization prolongation terms in COPD exacerbation may help optimize treatment, reduce expenditures on the patient and avoid episodes relapses. The aim of the work was to determine the factors affecting the length of hospitalization due to COPD exacerbation. A retrospective analysis of medical records of inpatients hospitalized with COPD exacerbation to therapeutic department of CI "Dnipropetrovsk municipal clinical hospital N 6" of “Dnipropetrovsk regional council" during three years was done. It was found that age, height, number of comorbidities, presence of any symptoms or changes in laboratory analyses do not affect the duration of hospitalizations due to COPD exacerbations. Regardless of the frequency of hospital admissions, length of hospitalization moderately positively and reliably correlates with the disease stage (R = 0,516, p <0,001). Decrease of respiratory function indices, especially FEV1, significantly increases the length of stay in the hospital both in case of one (R = -0,457, p <0.001) or multiple hospitalization during three years (R = -0,512, p <0.001). Reduced body weight and low body mass index during hospitalization are prognostically unfavorable factors, because these parameters, though weakly, but reliably negatively correlate with the number of days spent in the hospital (R = -0,195, p = 0,028 and R = -0,246, respectively, p = 0,005). In the population of patients hospitalized due to COPD exacerbation, moderately positive reliable correlation (R = 0,392, p <0,001) between the length of hospital stay and number of hospitalizations during three years was established. The dependence of hospitalization duration in COPD exacerbations on patient’s gender requires further investigation.

85-91

Authors: Shevchenko Y.M.

The aim of the study was to examine the quality of life and clinical features of non-psychotic mental disorders in patients with acute and chronic pancreatitis. Polymorphic mental disorders of different clinical content and severity in most cases not only comorbid diseases of the pancreas, but often are the first earliest clinical manifestations of the disease. The data on clinical and psychopathological features of non-psychotic mental disorders in patients with acute and chronic pancreatitis are given. The share of cardinal syndromes such as asthenic-neurotic and anxious-depressive was established and described. The study was conducted using the following methods: clinical psychiatric questionnaire of common type MOS Short Form-36 Health Survey (SF-36) and methods of mathematical processing. The sample included 131 patients with acute and chronic pancreatitis. Clinical variant of acute and chronic pancreatitis debut were the features of mental disorders and psychotic-pathologic structure of non-psychotic mental disorders. Various indicators of quality of life in acute and chronic pancreatitis in presence of psychotic disorders were revealed.

98-103

Authors: Dyudyun A.D., Reznichenko N.Yu.

The objective of the study was to determine the effect of frequent consumption of alcohol on the state of skin and general health state of males. 197 males aged 45-64 years have been examined. They have been divided into subgroups depending on the frequency of alcohol consumption. Questioning of the males, assessment of skin state, investigation of skin microflora, oropharynx, feces, levels of sexual and gonadotropic hormones, state of lipid metabolism has been performed. The negative impact of alcohol abuse on the skin and homeostasis of the organism has been proved. Worsening of skin state has been revealed in males who frequently drink alcohol as compared to individuals who do not abuse alcohol. The trends towards violations of skin microflora, that of oropharynx, feces, changes of testosterone levels, luteinizing hormone, accelerated formation of androgenic deficiency, changes of lipid metabolism, blood pressure increase have been identified in males who often drank alcohol. Alcohol abuse is considered as one of the risk factors of accelerated aging of the whole body and skin in particular.

111-116

Authors: Biletska E.M., Stus' V.P., Onul N.М., Polion N.Yu.

The article presents the results of studying features of heavy metals content - lead, cadmium, copper and zinc in the whole blood and ejaculate of fertile and infertile men. The concentration of metals in biosubstrates was determined by inverse voltamperometry method with the usage of АVА- 2. It is revealed, that maintenance of lead and cadmium practically in all biosubstrates of fertile men is 1,3-2,2 times higher as compared to the indices of infertile patients and in all investigated groups it exceeds normative levels by 1,2-6,4 times. Thus, sterile men have the expressed disbalance of copper in the organism, maintenance of which in the blood is 1,7-2,3 times higher against the analogous indices of fertile group and physiological level. Concentration of zinc in ejaculate of men with normal fertility is 9,3 times higher as compared to analogous indices of sterile men and by 30,9 times exceeds its level in blood of fertile group, this testifies to the exceptionally important role of zinc for the generative sphere of men. In biosubstrates of fertile men, living in conditions of technogenically polluted territories, concentration of zinc is by 1,2-1,5 times lower than physiological levels, this may testify to probability of forming zinc-deficient states in this contingent of population.

122-127

Authors: Kuzminov B.P., Skaletska N.M.

In this work we consider methods of solving urgent issues of prevention of violations of children’s health those who live in technologically contaminated areas. Content of pollutants in environmental objects of Sosnivka town as geochemical province was conducted. We made a comparative analysis of pre-pathological health indicators of children living on this territory, as well as "conditionally clean territory" by the elemental composition of children’s hair and blood content, intensity of lipid peroxidation and activity of antioxidant enzymes, parameters of physical development and condition of their actual nutrition. Correlations between exposure to toxicants of the environment and changes in the health of children was revealed. There was developed integrated scheme of measures for the prevention of technogenic microelementosis among children.

132-139

Authors: Kovalchuk L.J., Mokiyenko A.V.

The literature data and results of monitoring of the aqueous objects of Ukrainian Danube region on sanitary-microbiological, physical and chemical and sanitary-chemical indicators testify to adverse changes of their condition, especially in comparison with quality of the Danube water and the waters of the Danube lakes (Kagul, Kugurlyi, Yalpug, Katlabug, Kitay) and the lake Sasyk. High levels of inorganic nitrogen which strengthens eutrophication of reservoirs and degradation of the existing ecosystems are confirmation of antropogenicity of the pollutant sources. This may be considered as persistency of threat to sanitary-and-epidemiologic situation. It is necessary to carry out profound monitoring of water quality of the superficial reservoirs in the mentioned region to reveal anthropogenous pollution of chemical (pesticides, oil products, phenols, stable organic pollutants) and biological (conditional-pathogenic and pathogenic microflora) substances.

143-145

Authors: Semenova L.S., Koryagin U.A.

This article is about Nikolay Ivanovich Pirogov, a surgeon and anatomist, prominent scientist and educator, founder of field surgery. He was the first to learn field surgery and military administration in practice. He was the first to use famous triage (the wounded were sorted according to the severity of injuries). N.I.Pirogov considered that well organized triage at dressing stations and temporary military hospitals is the main tool to provide proper care and to prevent harmful consequences. He organized training of medical nurses to help the wounded. He also published the work on the problems of pedagogy in which he proposed reforms of education system. The authors of the article have analyzed N.I.Pirogov`s works and showed their significance for modern social medicine and organization of Public Health.