Medical perspectives (Medicni perspektivi)

5-7

Authors: SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine"

GEORGIY VICTOROVYCH DZYAK – GREATNESS OF PERSONALITY AND LIFE

15-18

Authors: Breydak O.A.

Evaluation of gonadotoxic effect of diazolin was conducted according to the methodical recommendations. "Methods of experimental studies to establish thresholds of action of industrial poisons on the generative function for the purpose of hygienic regulation". Experiments were carried out on nonlinear white male rats. The preparation was introduced intragastrically within 72 days in a dose of 100 mg / kg (experimental group 1) and 20 mg / kg (2 experimental group), which made up 1/100DL50 and 1/500 DL50. For the assessment of sexual glands microscopic studies of the testes (external examination, weight, size), functional and morphological parameters were used. The parameters obtained during experiments were compared with the results of the control group and values of standards in laboratory animals. Influence of diazolin in the dose of 100 mg/kg (1/100 DL50) resulted in the increase in the total number of sperm cells with simultaneous decrease of their mobility, redox processes, osmotic and acid resistance. However, these changes did not reach statistical significance. Number of dead sperm cells and their pathological forms and indicators of semen-forming epithelium were within the control. Diazolin in the dose of 20 mg/kg (1/500 DL50) and 100 mg/kg (1/100 DL50) shows no gonadotoxical action.

23-27

Authors: Kulbashna Ya.A., Gudaryan O.O., Nikonov V.V., Idashkina N.G.

The article deals with the problem of identifying specific com­petencies of Master in dentistry. The results of the analysis of domestic and foreign scientific literature, legal documents regulating the implementation of competence-based approach in higher medical education is presented, international experience in the modernization of higher education, including medical, on the basis of changes in the educational paradigm on competence approach is studied. In the process of identifying set of special competences of Master of dentistry, the main ideas of the existing professional Standards in Dentistry were used. A worked out set of special competences reflects peculiarities of the profession in accordance with the algorithm, aimed to help dental patient in a vicious circle from disease prevention to rehabilitation after diseases, the latter includes legal, methodical, social and managerial aspects of the professional activities of a dentist.

33-38

Authors: Andryushkova N.G., Turchin N.S., Dolinchuk L.V., Ponyatovskyy V.A., Melnik V.V., Shyrobokov V.P., Trepet L.N.

Objective of the study was determination of enterovirus genom presence in the blood serum of patients with acute stroke by polymerase chain reaction (PCR). The blood serum of 72 patients with acute stroke and control group of 30 patients with another vascular disease was studied to reveal genom of enteroviruses. Detection of enterovirus RNA was performed by PCR using the reverse transcription. Viruses were isolated on HeLa and HEp-2 cell lines. The enterovirus genom detected by PCR was in 17 of 72 samples of the tested serum in the research group (23,6±5,0%). In the control group only one serum was PCR-positive for enteroviruses (3,3±3,2%). Cytopathogenic agents were isolated in HEp-2 and HeLa cell lines from 11 PCR-positive samples of blood serum from the experimental group of patients. No viruses were isolated from the remaining PCR-positive and PCR-negative sera. The presence of enteroviruses in the blood of patients with acute stroke suggests etiopathogenetical link between them. The introduction of PCR to detect enteroviral agents in patients with acute stroke can complement existing methods of diagnosis.

45-49

Authors: Yur’yeva L.N., Shusterman T.Y., Leonov S.F., Varshavskij Ya.S.

The article describes a one-year follow-up study of the clinical case of organic hallucinosis that we have described in the previous article in the patient with pituitary macroadenoma. At primary admission to the hospital (one year earlier) the likelihood of permanent or recurrent nature of hallucinosis and absolutely poor prognosis for recovery and life without removal of the tumor was pointed out to the patient and his family. However, the patient and his relatives flatly refused to undergo neurosurgical intervention. The article describes the dynamics of psychopathological and somatic statuses of the patient during his readmission to a psychiatric hospital. The exciting cause of death on the 25th day of hospital stay was phenomenon of cerebral edema. By results of post-mortem studies the underlying cause of death was small cell chromophobe pituitary adenoma. There was a complete accuracy between clinical and post-mortem diagnosis. Absolutely unfavorable prognosis made before has been confirmed. The conclusion about the need of psychoeducational interventions with this contingent of patients and their relatives for prevention of an adverse disease outcome is made.

54-62

Authors: Filippova A.Yu.

Aim - to study charac­teristics of indicators of lipid peroxidation (LPO) and antioxidant system (AOS), depending on the body mass index (BMI) in patients with non-alcoholic steatosis (NASP) in combination with obesity (OB) and pathology of the biliary tract (BT). The study involved 100 patients with NASP in combination with OB and BT pathology, who at the time of sonographic and morphological study of liver biopsy presented signs of hepatic steatosis. Among the patients there were 19 men and 81 women. The average age of patients - (53,67 ± 1,11) years. The control group consisted of 20 practically healthy persons (PHP). BMI is determined by the formula Quetelet. Depending on the degree of BMI increase all patients with NASH and obe­sity were divided into three groups: 1 group – with BМI 25-29,9 kg/m2– ex­cessive body mass; 2 group – with BMI 30-34,9 kg/m2– obesity of I degree; 3 group – with BMI 35–39,9 kg/m2– obesity of ІІ degree. Status of LPO system was assessed by the concentration of malondialdehyde in plasma and red blood cells and the content of lipid peroxidation intermediates in the two phases of the lipid extract – isolated double bonds, diene conjugates, oksidien conjugates and the final LPO products – schiff bases. Factors of antioxidant defense activity were assessed by ceruloplasmin (CP), superoxide dismutase (SOD) and catalase in erythrocyte hemolysate. All LPO indicators have been activated in the two phases of lipid extract (from p<0,05 to p<0,001 when compared with a group of PHP and p<0,05 as compared to other groups of patients) and depended on increasing BMI. Indicators of AOS – SOD and catalase in all NASP groups practically did not differ from PHP parameters and did not depend on the increase of BMI. From the CP side a compensatory increase in its activity in response to the intensification of LPO was revealed. In NASP patients in combination with OB and comorbid disorders of BT the course of the disease was associated with significant violations of the oxidant-antioxidant balance, which depended on increasing BMI parameters.

67-71

Authors: Stepansky D.A., Kremenchutsky G.N., Koshevaya I.P., Velychko Ye.A.

Adhesion is the major stage of interaction of microorganisms with macroorganism, important factor with the help of which microflora colonizes different biotypes of macroorganism, thus providing colonization resistance, preventing adhesion and pathogenic invasion. In our study data about adhesive features of Aerococcus viridans autophytes of rats, mice and human are presented. Aerococcus viridans autosymbionts have higher performances of adhesion in the condition of heteroadhesion. Among performance of homoadhesion the highest microorganisms adhesive index (MAI) was in human autosymbionts – 5,78±0,04, in rats – 4,49±0,06 and mice – 4,29±0,04. On the account of greater adhesive features, using of autosymbionts of Aerococcus viridans theoretically can be justified for correction of disbiotic conditions of a human and animals, this requires further study.

78-84

Authors: Mashchenko I.S., Kuznyak N.B., Shostenko AA.

The paper presents the results of a comparative study of features of gingival tissues microbiocenosis and local immunity in 60 patients with chronic and exacerbated chronic generalized catarrhal gingivitis. We found that in patients with exacerbated generalized catarrhal gingivitis there exist more significant differences in terms of local humoral immunity as compared with a group of patients with chronic manifestation of the disease, characterized by a large decrease in levels of sIgA and IgM and to a lesser extent, an increase in IgG. It was established that conditionally-pathogenic streptococcal microflora leads in the etiology of chronic generalized catarrhal gingivitis and staphylococcus and fungi of the genus Candida play the dominant role in formation of exacerbations of inflammation in the gingival tissue.

91-97

Authors: Mashchenko I.S., Struk V.I., Vatamanyuk N.V.

The article presents the results of a comparative study of the microbial landscape and violations of local immunity in patients with generalized periodontitis at preclinical-radiological stage of development in 60 patients. It was revealed that appearance of representatives of the major periodontal bacteria in the gum tissue is a precursor of development of initial stage of generalized periodontitis in them. It has been established that the early objective indicators of bone resorptive process in periodontal tissues in patients with generalized catarrhal gingivitis is an overproduction of proinflammatory cytokines IL-1.beta and TNF-alpha and the lack of anti-inflammatory IL-4, which persists for a long time during the observation period.

106-115

Authors: Yakovenko L.N., Iefymenko V.P., Makarevich A.Yu., Kovtun T.A.

A retrospective analysis of 1147 patients’ records from the clinic of the department of surgical dentistry and maxillofacial surgery of childhood of NMU Bogomolets and 944 case histories of patients with traumatic injuries of maxillofacial region in the clinic of the department of pediatric dentistry of SE «Dnepropetrovsk medical academy of Health Ministry of Ukraine» has shown that traumatic damages to teeth make up 18.8% of all injuries in maxillofacial region. It was found that in most cases the cause of injury is fall of a child - 60%, punching on the face - 19%, other causes – 21%. Most often maxillary central incisors are affected - about 70-80%, lateral - 10-20% both in temporary and in shift bite. Lower incisors are injured only in 1-6% of cases. Injuries of the temporary teeth were observed in 30-45% of cases. The aim of the study was to determine the major diagnostic methods and therapeutic measures that have been used in trauma of permanent and temporary teeth in children of different ages. Diagnostic measures included clinical and instrumental studies. Of the additional survey methods of dental trauma in 90% of cases back-side X-ray, in 7-8% – orthopanto­mography, in 1-2% - CT were performed. In dislocations of temporary teeth X-ray examination was carried out only in impacted dislocation. Algorithm of treatment tactics for almost all kinds of temporary teeth dislocations was to remove it, not taking into account the degree of formation of the tooth root and functional ability of the tooth, that involves the development of the indications for their preservation. Most often, for the immobilization of the injured permanent teeth a smooth splin-clamp (85%) was used, it is cheap, easy to manufacture, reliable for fixing, individual as for adaptation, but when applied it leads to injury of periodontal tissues, the development of inflammatory processes in them. Alternative methods of fixation were splint systems, splint-caps and tooth-gum splints. There remains the question of development of non-invasive fixing systems, which would be less traumatized for the tooth and periodontal tissue.

123-129

Authors: Biletska E.M., Onul N.M., Kalinichevа V.V.

Chemical aggression of technogenic pollution of the environment, according to experts, is the leading risk factor for population health. A systematic entry of contaminants in the related life-supporting environments – air, water, plant and animal food products by direct and indirect migration chains creates both integrated and combined effect on the body. It should be noted that a chemical factor, on the one hand, is the least studied in this respect, on the other hand it represents the most significant and rapidly growing environmental threat to human health. In the human body bone tissue has the highest cumulative properties against many xenobiotics, in particular to heavy metals, among which lead is the leader in relationship to the bone tissue. In this regard, the goal is to study peculiarities of different forms of zinc on calcium content in bone tissue in lead intoxication. As a result of researches it is established that low dosed effect of lead during subacute experience causes a significant decrease of calcium content in the bone tissue by 28% in comparison with those of control group of animals, this reduces its density and becomes a risk factor for the development of osteopenic and osteoporotic state of the organism. Combined effect of lead and organic and inorganic forms of zinc zeliably increases calcium content by 16.43% and 22,04% respectively, as compared with lead group, suggesting protective properties of zinc in lead intoxication due to the effect of bioantagonism. In the isolated introduction of organic and inorganic forms of zinc, calcium content in the bone tissue increases by 1.4 and 2.04 times respectively, as compared with the control group. The obtained results confirm osteoprotective action of zinc, particularly of organic forms in lead intoxication and give reason to believe that in the system "lead – zinc" effect of biological antagonism is formed.

136-145

Authors: Korshun M.M., Ruda T.V., Blagaia А.V, Antonenko A.M.

It is well known that despite an actual efficiency pesticides can have a negative impact on humans, animals and the environment. So, new pesticides must be regulated at the stage of their registration in order to prevent such a harmful effect of chemical crop protection agents (CCPA). In this context, the aim of our study was to assess the danger by using toxicological criteria and substantiate acceptable daily intake (ADI) of pymetrozine for humans. It was performed the expert-analytical study of the primary and secondary sources of information during study of its toxicity on laboratory animals. It was established that pymetrozine is related to 2 class of hazard (limiting indication is inhalation toxicity). In chronic study the lowest NOAEL on rats was set at 10 ppm (0,337 mg/kg) for systemic toxicity, which made it possible to substantiate ADI of pymetrozine for a human at 0,003 mg/kg. The definition of this criterion will allow to set a series of hygienic standards to be followed, without any harmful effect on a human.

150-156

Authors: Kramarenko N.N., Ivanus S.H.

36 children with cystic fibrosis are inspected. Certain modern problems of children’s cystic fibrosis and questions related with warning and slowing down unfavorable consequences of illness in the future are determined. Data of cystic fibrosis prevalence and morbidity in Dnepr for the last 5 years are analyzed. Epidemiology of disease, clinic-anamnesis data, laboratory instrumental indexes of our patients are analyzed. Anthropometric measuring of body mass, height, chest circumference, somatoscopic research, calculation of trophic index is conducted. Features of physical development and nutritional state of children with cystic fibrosis, which consist in the substantial decline of body weight in disharmonized development are found. Certain degrees of protein-power insufficiency are determined. The relationship of these features with the function of the external breathing, duration and severity of disease is analyzed.

164-168

Authors: Chekan M.K., Loskutova T.A., Fomicheva Ye.V.

Gastric or duodenal ulcer with perforation - a heavy, death threa­tening, complication of peptic ulcer disease, especially in pregnant or postpartum. The occurrence of this complication in the postpartum period is a common cause of late diagnosis, delayed surgical treatment and poor outcome for the patient. There are several problems that contribute to the late diagnosis of perforated ulcer: rare incidence, difficulty in identifying common signs, stiff muscles of the anterior abdominal wall and localization of pain in the stomach due to abdominal extension by a pregnant uterus, pain due to caesarean section, absence of ulcer history, the young age of patients, an unusual course of the disease. Complaints and clinical presentation are often regarded by physicians as complications of carried out obstetric surgery, which leads to late diagnosis. The paper describes a clinical case of duodenal ulcer with perforation, which occurred on the second day after a planned caesarean section, as a rare but life threatening complications. The patient underwent laparotomy with suturing of the perforation and drainage of the abdominal cavity. It should be noted that, despite the fact that complications of peptic ulcer disease is a rare phenomenon among women in labor, it should be in anamnesis taking to pay special attention to information that may indicate the presence of disorders of the diseases of gastrointestinal tract. In case of unfavorable postoperative course after abdominal labor an acute surgical pathology should not be excluded.

172-173

Authors: SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine"

Mokiya-Serbina Svitlana Oleksiivna

177-179

Authors: Savyna R.V.

From the history of preventive medicine

183-184

Authors: SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine"

Syahailo Petro Trokhymovych. To commemoration of a talented scientist is devoted.

4-14

Authors: DZYAK G.V.

THE WAY TO GLORY AND RESPECT

20-25

Authors: Pototskaya O.Yu., Lievykh A.E., Mamchur V.I.

Some orders of Ministry of Education and Science of Ukraine encourage scientific authors to publish their articles abroad but do not detail selection criteria of the journals recommended. As a result, authors choose the easiest way and publish their papers in low-quality foreign journals. Moreover, some false journals have been created since the Orders entered into force. In this article we emphasize the importance of journal registration in scientometric databases for the international and regional rating of universities. Also attention is paid to the need of verification of journal quality and its reliability by the authors before sending manuscripts for publication. To resolve these problems we propose to indicate URL link of the article in the annual scientific report of scientists, departments and organizations. It will help to verify the quality of the journal and concentrate attention of the authors on checking the existence of journal’s web site before sending their manuscripts. It is important to emphasize that journals without web sites do not influence on the rating of scientific organizations in any scientometric databases. If such link is absent, article should not be scored up for the rating. Additional way is to create adequate system of scientific ratings. For example, articles published in major scientometric databases, such as Scopus and Web of Science, should be scored two (or more) times higher than any other articles. Papers published in other scientometric databases (such as RISC) also should be scored higher than onother articles. Information about principal scientometric databases should be clarified for scientists to help them in choosing optimal journal for manuscripts publishing.

29-33

Authors: Kamenshchyk А.V., Kamyshny A.М., Ivanko О.G.

The genes of nuclear factor of activated T-cells (NFATC) play a key role both in heart valves formation and immune response. The genes belong to transcriptional factors and lead to myocardial hypertrophy in postnatal period that is confirmed by experimental models on animals. The purpose of this study was to reveale NFATC1 and NFATC4 genes expression level in the blood of 30 children with congenital heart diseases (CHD), 15 of them had bicuspid aortic valve, 15 had CHD without valve anomalies and 15 healthy children of the control group. No patients had signs of heart failure. At the first sage of Doppler heart ultrasound study a significant increase of the left ventricle posterior wall and ventricular septum thickness in comparison with CHD and control was revealed in BAV group. At the second stage a significant rise of relative normalized expression of NFATC1 in BAV children compared to CHD and control without differences in the expression of NFATC4 gene were established. Thus, in children with bicuspid aortic valve, formation of early myocardial hypertrophy with changes in nuclear factor of activated T-cells genes expression with prevailing of NFATC1 expression takes place. The detection of NFATC1 expression level in the blood of children could be considered as an early marker of progressive myocardial hypertrophy.

41-46

Authors: Kosul'nikov S.O., Besedin A.M., Tarnapol'skiy S.A., Karpenko S.I., Kravchenko K.V., Simonova E.V.

Recently, in Ukraine a trend to increased incidence of suppurative osteomyelitis of the spine is defined. The main factors contributing to incidence increase is the growth of proportion of population with immunodeficiency and implementation of computer and magnetic resonance tomography in clinical practice. Treatment of suppurative osteomyelitis of the spine should include antibiotic therapy, adequate sanitation of the infectious focus, strict bed rest with exercise therapy. Tactics of surgical treatment combined with antibiotic deescalation therapy with glycopeptide antibiotic – teicoplanin and rehabilitation program which helped to achieve recovery in 23 (37.8%) of patients treated conservatively and in 55 (91%) of the operated patients was proposed.

51-55

Authors: Maryukhnich N.V., Klapchuk V.V.

Secondary school age is a critical period in the development of a person. For the purpose to evaluate and compare the level of exercise performance and aerobic performance in 90 girls at the age of 11-14 with impaired vision in the form of weak and moderate myopia, as well as myopic astigmatism, veloergometric test PWC170 was used. Power of performed load was estimated and indices of maximum oxygen consumption were calculated. It is established that absolute levels of physical per­formance and maximal oxygen consumption in girls significantly increased with age: 8.7%, 17,9% and 19% test PWC170 and 8.4%, 6.4% and 13.4% – aerobic performance by GMT. Relatively to body mass they decreased by 8.4%, 6.4% and 13.4% – test PWC170 , and 12.8%, 14.8% and 21.8 per cent – aerobic performance by GMT. Relative indicators of MSCS girls at the age of 11, 12 and 13 with impaired vision are of the average level of aerobic capacity and girls at the age of 14 – below average.

61-64

Authors: Moshkovskiy V.E.

Asbestos and artificial mineral fibers were used actively at thermal power plants (TPP) as heat insulation of pipes, seal plates, electrical insulation, etc. But content of asbestos fibers in the air of working zone at TPP was not registered to date. Therefore, aim of the work was to assess asbestos containing dust in the air of working zone at steam turbine and gas turbine TPP in the east region of the country. It was found that old insulation at TPP is mixture of asbestoses that contains chrysotile asbestos and traces of amphibole asbestoses – crocidolite and anthophyllite. In the majority of investigated workplaces at the steam turbine TPP significant dust generation with exceed of maximum one-time exposure limits (2 mg/m3) was observed. Concentration of respirable fibers in the air of working zone in all workplaces did not exceed actual hygienic standard (1 fiber/cm3).

70-76

Authors: Andreyeva І.А., Lugova О.V., Nashyvanko О.V., Chernyak Yu.S., Shevchenko О.А.

In the review, the evolution of Public Health and global development tendencies of Public Health system have been discussed. Stages of formation of the updated concept, principles of Public Health organization and the role of various organizations have been shown in the connection with development of the global concept of "Health for All". A well-functioning public health system is primarily the result of multisectoral cooperation. The aim of modern Public Health is to provide conditions of access to appropriate and cost-effective health care for all population groups, including health promotion and disease prevention.

81-86

Authors: Vezhnovets T.A.

The purpose of the research was to determine the features of the socio-psychological climate of health care institutions (HCI) and the factors that cause them. The psychological testing of the socio-psychological climate has been accomplished by the method of A. Nemov “The socio-psychological self-esteem of a collective”, The study involved 152 health care workers of two hospitals in Kherson region (institution N 1 and institution N 2), providing multidisciplinary patient care. It was found that the group of health care workers in the institution N 1 had significantly lower average age and average length of joint work than personnel of the institution N 2 (P<0.007). It was determined that all indicators of climate (responsibility, openness, teamwork, contact, cohesion, orderliness and awareness) had significantly lower levels of the values in the institution N 1, than in the institution N 2 (P<0.007). The worst state of the socio-psychological climate was indicated by the personnel of the institution N 1. In two institutions indicator of team cohesion had the lowest value among all. The direct correlation between the average age and the length of experience of joint work in the collective and the value of indicators of the socio-psychological climate in the team has been established. The status of the socio-psychological climate in HCI collectives is affected by the age of health care workers and the experience of joint work. It was found, that the lower average age and experience of joint work of health care workers, the lower indicators of the socio-psychological climate in the collective are. The feature of the socio-psychological climate of HCI collectives is low evaluation of indicator of cohesion by health care personnel. This testifies to the expressed individuality in actions. The peculiarities of the socio-psychological climate in collectives of health care workers should be considered when evaluating the effectiveness of personnel management in HCI.

92-93

Authors: Korobchansky V.A.

Prescription of healthy ecology. Review on the monograph of Beletskaya E.N., Onul N.M. «Ecological-hygienic assessment of technogenic load caused by the environment as a risk factor for health of population of Pridneprovye»

4-8

Authors: Rodynskiy A.G., Kondratieva O.J. Demchenko O.M.

In experiments on rats of three age groups the role of thyroid hormones in the regulation of fatty acid spectrum of cortical and hippocampus lipids was studied. It was found that on the background of decreased thyroid status content of polyunsaturated fractions of free fatty acids, significantly changed depending on the age of the animals. In particular, in juvenile rats hypothyroidism was accompanied by a decrease almost twice the number of pentacodan acid decreased lipids viscosity in neurocortex. In old rats reduce of pentacodan acid in the cortex (38%) was supplemented by significant (77%) decrease in linoleic and linolenic acids. Unlike the two age groups deficiency of thyroid hormones in young animals caused accumulation of free polyunsatarated fatty acids (C18: 2.3) in the cerebral cortex by 74%, which may be associated with a decrease of this fraction in fatty acid spectrum of lipids and increase of viscosity properties of the membranes. These restruc­turing may be associated with modulation of synaptic transmission of specific neurotransmitter systems in the brain.

13-19

Authors: Fedorenko Yu.V.

The aim was to study dynamics of changes of certain biochemical indices and the development of adaptation in white rats with active and passive type of behavior under the influence of immobilization stress. Experiments were conducted on white rats, previously divided into groups of active and passive ones, on the basis of indicators of activity in the test “open field”. Modeling of immobilization stress was carried out by placing the animals in plastic boxes for 6 hours daily within 30 days. It was found that the immobilization caused changes of carbohydrate, lipid, calcium metabolism, activity of alkaline phosphatase, alanine- and aspartataminotransferase in blood serum of both experimental groups. However, the intensity, direction of the biochemical parameters, development in time depends on the type of animal behavior. To a greater degree active animals reacted to immobilization by changing of concentration of glucose and calcium in the blood on the 3rd and 5th day of the experiment, changes of all investigated parameters were observed on the 10th and 30th day of the experiment. Animals with active type of behavior appeared to be more susceptible to stress mobilization, but the intensity of their metabolic processes was higher than in animals with a passive type of behavior. This is testified by the highest level of blood glucose and lower levels of total cholesterol and triglycerides, as well as more active processes of calcium metabolism in the active animals than passive ones. Thus, dynamics of changes of biochemical parameters and the proceeding of the adaptation process in the conditions of immobilization stress depends on individually-typological features of animal behavior. This indicates to the necessity of differentiated approach to correction of adaptation disorders due to the action of immobilization stress on the organism with different typology of behavior.

31-38

Authors: Amosova K.M. Rudenko Iu.V.

The aim of our work was the assessment of effectiveness of standardized algorithmic treatment based on fixed-dose combination of perin­dopril/amlodipine and gender and age-related differences for office and home blood pressure control in real clinical practice. Our study included 421 patients with uncomplicated arterial hypertension 204 (48.5%) patients aged 60 years and older, 78 (18.5%) men (group 1), 126 (29,9%) women (group 2) and 217 (51,5%) patients younger than 60 years, 115 (27,3%) men (group 3) and 102 (24,2%) women (group 4). Home and office blood pressure measurements were performed with the standardized oscillometric automatic device with individually selected cuff. At visit 1, patients were given training and written instructions for home blood pressure measuring and recording (twice per day for 7 consecutive days before each of 5 next visit) and were prescribed a fixed-dose combination of perindopril/amlodipine, which, if needed, was followed by consecutive addition of indapamide SR, spironolactone, and moxonidine or doxazosin for target office blood pressure achievement (<140/90 mm Hg). We have identified gender and age-related differences in home blood pressure control, including lower incidence of achievement of recommended level (<135/85 mm Hg) in men younger of 60 years compared to women of the same age and persons over 60 years of both genders, which resulted in a greater incidence of masked uncontrolled hypertension in this group of patients at comparable level of adherence to treatment.

47-52

Authors: Krotova V.Yu.

According to the survey of 68 patients with arterial hypertension stage II, 1-2 degrees, controlled on the background of antihypertensive therapy, cardiovascular risk, severity of cognitive impairment were analyzed. Instrumental examination of ambulatory blood pressure monitoring; electrocardiography, ultrasound investigation of the main arteries of the head and neck was performed. Neuropsychological examination: an integrated assessment of cognitive functions by MMSE scale; memory evaluation using the procedure of memorizing "Saving 10 words" by Luria; rating of attention and speed of sensorimotor reactions by Schulte and Rybakov procedure was made. Total cardiovascular risk was defined on a scale «SCORE». Typical cognitive disorders in patients with hypertension of working age, even in the controlled blood pressure level were found. Presence of verbal memory disorders associated with hypertension was revealed. The importance of determining the overall cardiovascular risk, diagnosis of cognitive impairment and measuring thickness of the intima-media of the arterial wall as factors of brain lesion which is the target organ in arterial hypertension of 1-2 degrees, was proved.

57-62

Authors: Kondratiev V.А., Reznyk А.V.

By dopplerechocardiography method there was studied functional state of cardiac ventricles and character of hemodynamic disorders in 48 patients aged 5-17 years in attack period of moderately-severe and severe bronchial asthma. Group of comparison included 40 healthy peers. Disorders of central and peripheral hemodynamic in attack period of bronchial asthma in children were accompanied both by systolic and diastolic dysfunction of the left and right heart ventricles, herewith right ventricle was functioning in the mode of hyperdynamic, and left one – in the mode of hypodynamic. Combined systolic-diastolic variant of dysfunction both of right and left ventricles was developing in 58,3% of patients with moderately-severe and in 91,6% of patients with severe bronchial asthma. In the attack period of bronchial asthma in children equal directionality of systolic and diastolic dysfunction of heart ventricles was developing; this was characterized by synchronization of their function. Assessment of functional interaction of the ventricles under conditions of severe asthma attack showed direct and high (r=0,67) correlative interaction between finding of Tei index of the left and right ventricles, which characterize their systolic function; this, under conditions of increased hemodynamic pre-loading testified to compensatory increase of systolic interaction of ventricles. Direct and high (r=0,69) correlative interaction between time indices of isovolumic relaxation of the left and right ventricles, characterizing their diastolic function, testified to compensatory increase of diastolic interaction of ventricles under conditions of increase of hemodynamic post-loading. Imbalance of central and peripheral link of hemodynamic in attack period of bronchial asthma in children testified to development of cardiac insufficiency, which was compensated predominantly at the expense of increase of heart contractions rate.

69-73

Authors: Poslavskaya O.V.

Up to 40% of squamous cell carcinoma of the oropharynx (SCCO) are associated with human papillomavirus of a high oncogenic risk, which shows the greatest affinity to the epithelium of the tonsils. One of the indicators of malignant transformation of the multilayered epithelium cells with evidence of HPV lesions is the accumulation of oncoprotein p16INK4a, tumor suppressor from Ink4 family. Presence of excessive amount of p16INK4a in a free state shows its reduced suppressor function and is an indication of the active expression of viral oncogene E7. For multivariate analysis of molecular mechanisms of oncogenic transformation, the obtained data of p16INK4a expression options were distributed according to the clinical and morphological characteristics of squamous cancers. Mixed nuclear-cytoplasmic expression of p16INK4a more than 5% of tumor cells was observed in 73.6% of cases, which confirms the relations of path of carcinogenesis of cancers of this localization with HPV. Statistically significant association between a positive p16INK4a status and decrease of the degree of of SCCO differentiation (p=0,002, r=-0,365) was determined. But with respect to other clinical and morphological characteristics of SCCO and marker p16INK4a statistically significant differences between groups were not found (p>0.05), this denies its prognostic and predictive value in the diagnosis of SCCO.

77-81

Authors: Khvorostenko M.I., Bondarenko I.N., Barannikov K.V., Khvorostenko Y.M., Phokhach A.V.

The analysis of the effectiveness of different methods of treatment of patients with gastric cancer have been conducted. In additional to surgery methods of antitumor action – preoperative radiation therapy (combination therapy), adjuvant chemotherapy allowed to improve survival in patients with locally advanced gastric cancer as compared with surgical method only. On the early stages of gastric cancer surgery may be the only and final treatment. Indicators of long-term survival in usage of routine treatment options (surgery and irradiation) or adjuvant chemotherapy improved by 1.5-2 times, and were the highest in the group with combined radiotherapy (5-year survival rate - 25%). Improvement of resection procedures in gastric cancer in combination with appearing of targeted, immunomodulatory drugs, increasing possibility of high-precision equipment improve long-term results as well. Thus, improvement of treatment methods of gastric cancer requires search for and application of new advanced modes of systemic and combined treatment.

87-93

Authors: Stepanskyi D.O., Kremenchutskyi G.M., Koshova I.P.

The paper presents data of preclinical study of autocamiones A. viridans properties. Acute toxicity and harmlessness of strains was tested. Strains of bacteria of Aerococcus genus were checked for absence of contamination by morphological, cultural, biochemical and tinctorial properties. Aerococci accumulate weight well on standard nutrient media, morphology, tinctorial and biochemical properties meet the standards. All indicators of activity of glutathione peroxidase, superoxide radical, superoxide, SOD, protein content comply with the standards. Antagonistic activity of the studied strains of aurococcus was investigated by the method of deferred antagonism to test cultures. Data show a high antagonistic activity of aurococcus strains to conditionally pathogenic microorganisms. During determination of acute toxicity of aurococcus in the observation period, edema and tissue necrosis at the injection site of aurococcus, death of mice was not marked were not revealed. A complete harmlessness of microbial suspension of aurococcus when administered to white mice per os was revealed.

99-102

Authors: Belitskaya E.N., Antonova E.V.

Total daily load and the contribution of the different ways of the lead entry in children’s organism in industrial and control area were calculated. The study of a complex metal intake in the children's organism with air, water and food has shown that in industrial areas its intake is increased and intake of micronutrients - copper and zinc is reduced as compared to the control area. This work made it possible to draw a conclusion on justified evidence that chemical loading of the environment makes a significant contribution into worsening of children’s population. Lead occupies a leading place in this process. This necessitates the development of measures on prevention of ecologically-dependent pathology.

106-111

Authors: Stavnichenko P.V., Antonenko A.M., Korshun M.M., Bardov V.G.

Toxicodynamic peculiarities of the new fun­gicide – cyflufenamid were studied. It was found that in accordance with hygienic classification of pesticides, cyflufe­namid is referred to the 3rd class of hazard (moderately hazardous). It was shown that liver is the primary target organ of cyflufenamid action, thyroid gland, heart, kidneys, brain are secondary. It was established that cyflufenamid is mic­rosomal enzyme inducer. Acceptable daily dose of cyflufenamid for humans was substantiated on level of 0,01 mg/kg.

117-120

Authors: Hryhorenko L.V., Zaitsev V.V., Kondratiev A.Yu.

In the all rural tacsons of Dnepro­petrovsk region a common tendency – high salt composition of potable water from centralized water sources is observed: general rigidity, dry residue, chlorides, sulfates, calcium, magnesium, iron. The highest content of general rigidity was shown in the water of 1st tacson: from 143 to 21.2 of MAC for 2008 – 2014 years’ period (p<0.001). Thus, in water samples the of 1st tacson high dry residue content (from 1.38 to 1.04) of MAC, chlorides (from 1.64 to 1.14) of MAC, sulfates (1.06 of MAC) (p<0.001) were determined.

127-132

Authors: Vezhnovets T.A., Pariy V.D.

The article presents the results of researches of peculiarities of burnout syndrome formation in healthcare workers with different types of work motivation. It is discovered that the syndrome is formed for each motivational type as mechanism of psychological protection against the action of certain stressful factors, namely: for instrumental type – an excessive concentration on obtaining material rewards; for professional type – an excessive control of emotions in substantial professional communications and high psycho-emotional overload; for patriotic type – high level of dependence on social approval, a high level of communicative activity, a high level of psycho-emotional overload, for economical type – distrust, for lumpenized – any labor. Prevention of burnout syndrome in healthcare workers has to be realized taking into account peculiarities of psycho-traumatic factors depending on the type of work motivation.

141-144

Authors: Trofimov M.V., Barannyk S.I., Muntian S.O., Kryshen V.P.

Professor Vincent Tsesarevych Tomashevch – the founder of general surgery department (to his 140-th birthday)

4-9

Authors: Rodinsky A.G., Tkachenko S.S., Guz L.V.

The aim of our work was analysis of the bioelectrical activity of efferent fibers of the sciatic nerve in experimental menopause condition. Experiments were performed on 25 female white rats, divided into experimental and control groups. Menopause was modeled by total ovariohysterectomy. In 120 days after modeling we had recorded evoked action potentials of fibers of isolated ventral root L5 induced by stimulation of sciatic nerve with rectangular pulses. Threshold, chronaxia, latency, amplitude and duration of the action potential (AP) were analysed. Refractory phenomenon was investigated by applying paired stimuli at intervals of 2 to 20 ms. In the context of long-term hypoestrogenemy threshold of AP appearance was 55,32±7,69%, chronaxy – 115,09±2,67%, latent period – 112,62±1,74% as compared with the control animals (p<0.01). In conditions of paired stimuli applying the amplitude of response to the testing stimulus in animals with ovariohysterectomy at intervals 3 and 4 ms was 61,25±36,45% and 53,48±18,64% (p<0.05) respectively.

19-23

Authors: Pertseva T.O., Konopkina L.I., Huba Iu.V.

Chronic obstructive pulmonary disease (COPD) has a significant impact on various aspects of life of patients due to of daily symptoms, frequent exacerbations, comorbid conditions, including anxiety and depression. In the scientific literature there are different data on the relationship between the frequency of occurrence and severity of exacerbations of COPD on the one hand and concomitant depression and increased anxiety on the other hand. The aim of our study – to examine frequency and se­verity of depression and anxiety in patients with COPD exacerbation and in stable phase of the disease in patients with varying terms of remission. We examined 108 patients with COPD, which were divided into two groups. The main group – 16 patients with COPD were examined in two visits: in exacerbation and after two months of its completion. A comparison group – 92 patients with COPD in stable phase of the disease for at least three months. Examination of pa­tients included general clinical methods, evaluation of clinical symptoms of COPD, evaluation of mental status using Hospital Anxiety and Depression Scale. It was found that symptoms of depression and anxiety are more expressied in pa­tients with COPD exacerbation than in the stable phase. It was determined that the frequency of depression and anxiety in patients with COPD tends to decrease in two months after the exacerbation. It was also shown that mild depression and anxiety prevail in COPD patients with impaired mental state. In addition, there was found correlation between severity of dyspnea and depression severity in COPD patients with concomitant depression in the stable phase of the disease.

27-34

Authors: Pysarevska K.О.

Atrial fibrillation (AF) - one of the most common cardiac arrhythmia, which leads to increased mortality, increased risk of stroke, heart failure, worsening of quality of life. The aim of the study was to examine the clinical condition and hemodynamic performance of the heart in patients with non-valvular persistent AF before and 6 months after the restoration of sinus rhythm by electrical cardioversion (ECV). According to the study, it was found that the major diseases against which persistent AF is diagnosed: hypertension (87.7%), obesity (60.5%) and a combination of these diseases (33%). Hold of sinus rhythm within 6 months after ECV is accompanied by a significant improvement in clinical condition: the number of patients with significant dyspnea (scale MRC=3) has decreased (12% of patients versus 34% at the time of the ECV) (p <0.01), dyspnea (scale MRC=1) - 22% of the patients (p <0.05). Heart failure III FC remained only in 10% of patients versus 28% t the time of the ECV (p <0.05). Long-term preservation of sinus rhythm improved atrial function: ejection fraction LA increased by 25.8% (p <0.01), RA by 18% (p <0.05), decreased volume of indexed parameters in systole (LA - 21.3 %, RA - 26.4%) and diastolic (LA - 12.4%, RA - 21.6%) (p <0.001). Contractile function of the left ventricle improved: ejection fraction increased by 14.3%, SV - 13.7% (p <0.001), diastolic volume decreased by 20.7% (p <0.01). Despite optimal medical therapy, clinical status and cardiac hemodynamic parameters in patients with recurrent AF have not improved.

40-46

Authors: Kytovyi A.B., Pymakhov V.V.

Results of treatment of 71 victims with combined blunt thoracic and brain trauma were analysed. In the main group (n=35) there was used algorithm, envisaging videothoracoscopic interventions and widening indications for chest stabilization. Mentioned above technique enabled to increase efficiency of diagnostic and treatment in patients with mild and moderately severe brain trauma; this was reflected both in acceleration of restoration of respiratory index by 5,8 days, consciousness – by 4,3-4,9 days depending on trauma severity and decrease of postoperative complications and lethality number.

52-63

Authors: Cherednichenko Yu.V.

Objective — to evaluate the efficacy of endovascular techniques in the treatment of occlusion and stenotic lesions of the brachiocephalic and cerebral arteries, to define the ways of complications prevention. Materials and methods. 594 patients with occlusion and stenotic lesions of the brachiocephalic and cerebral arteries were operated by endovascular methods in endovascular center of Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. 688 endovascular operations were carried out. Most part of the operations are carotid stenting (423 operations). All of these operations were carried out with the usage of different types of antiembolic protection systems: distal, proximal or their combination. Intracranial segments of cerebral arteries were operated in 43 cases. 169 operations of stenting of vertebral arteries in extracranial segments were performed. Subclavian arteries and brachiocephal truncus were operated in 53 cases. Results. Total removal of stenosis was achieved in 588 cases (98.99%). 509 patients (85.69% of cases) had improvement in neurological status (on a scale NIHHS, Mrs., MoCA). 77 (12.96%) patients had no deterioration of neurological status. Postoperative mortality was 1.01%. Common level of other complications was 4.3 %: cerebral complications - 2.7%. Discussion. The results of the endovascular treatment of occlusion and stenotic lesions of the cerebral arteries show high efficacy and low complication level. The ways of reduction complications level are identified. They are in a differentiated selection of antiembolic protection method, endovascular treatment planning, based on monitoring of changes in the brain hemoperfusion, the emphasis is on the use of the special neurologic deviсes. Conclusions. Endovascular treatment of occlusion and stenotic lesions of the cerebral arteries is effective with a small risk of complications. Risk can be reduced further by the differential choice of antiembolic protection methods, with the help of wide use of special cerebral balloon-catheters and stents for the treatment of stenotic pathology of intracranial arteries, by planning stages of endovascular treatment, based on the clinical data, data of cerebral hemoperfusion in various areas of the brain, and cerebral angiography.

70-79

Authors: Filippova A.Yu.

Nonalcoholic fatty liver disease is now considered as a part of comorbidity pathology. About third part of general population suffers from hepatic steatosis and non-alcoholic steatohepatitis (NASH), which is a serious problem of the XXI century, considering the growth of prevalence of obesity, which leads to fat accumulation in the liver. The aim of our study was to investigate the clinical and functional manifestations of hepatic steatosis and NASH in patients with obesity and disorders of the biliary tract (BT), depending on the body mass index. The study involved 200 patients with nonalcoholic fatty liver disease (NAFLD) (100 patients with hepatic steatosis and 100 NASH) in combination with obesity and BT disorders. Middle age of those examined was 42,1±2,02 years (range from 24 to 73 years). The control group consisted of 30 healthy persons. Each group was divided into subgroups according to body mass index (BMI): overweight (BMI 25-29.9 kg/m2), first degree of obesity (BMI 30-34,9 kg/m2), second degree of obesity (BMI 35-39,9 kg/m2). We evaluated the main clinical and biochemical syndromes (pain, dyspeptic, asthenia, cholestatic, cytolytic, mesenchymal-inflammatory, liver-cell deficiency). It is found, that the most reliable clinical and functional parameters were observed already at the first stage of NAFLD, at the stage of steatosis with fat deposition in the liver. It indicates that the majority of clinical parameters could be considered as early markers of hepatic steatosis formation and its further progression up to the level of steatohepatitis in patients with NAFLD in combination with obesity and BT disorders. Thus, in patients with NAFLD in combination with obesity and BT pathology an active clinical picture of the disease was observed, the severity of which was increasing together with BMI increasing.

86-90

Authors: Kondratiev V.A., Reznik A.V.

By the data of clinical-instrumental examination there was performed comparative assessment of gender differences in cardiac performance of 54 patients aged 5-15 years with persisting form of partially controlled atopic bronchial asthma in inter-attack period of disease. Children were divided in two groups depending on gender - 28 boys and 26 girls. Group of comparison included 52 healthy children - 26 girls and 26 boys. In the girls in the inter-attack period of asthma reliably more often than in the boys there were revealed ventilation disturbance in the lungs by obstructive type; this promoted rise of pressure in the pulmonary artery. Herewith only in girls in 15,4% of cases there was revealed arterial pulmonary hypertension of a mild form. By the data of echocardiography in girls with bronchial asthma as compared with boys more expressed dilatation both of the right and left ventricles of the heart was observed. Average means of left ventricle contractility both in girls and boys in the inter-attack period of bronchial asthma were reliably decreased (р<0,01) as compared with healthy children, but in girl-patients as compared with boys these deviations were more significant. In the majority of such cases (in girls – 73,9%, in boys – 53,8%) decrease of contractile myocardium function was caused by presence of metabolic disorders in the form of repolarization changes of ventricular complex ob electrocardiogram. Investigations performed showed presence of some gender differences in cardiac performance in bronchial asthma children which should be considered in the course of treatment.

96-103

Authors: Drogomiretskaya M.S., Ahmad Saleh Khalyaf Salama

Anomalies and deformation of dental system in children and adolescents contribute not only to the deterioration of dental health, bat quite often this is the cause of a wide range of somatic pathology. The aim of our study was to determine risk factors of dental system myofunctional disorders in children with impaired course of the antenatal period using morphological and morphometric studies. The changes that have been defined in the organs examined were dystrophic and dyscirculatory and differed in degrees of severity in all parts of the oral cavity. Dystrophic changes were detected in the gums and tongue epithelium. Dyscirculatory disorders were characterized by formation of submucosal edema, development of the vascular bed hyperemia and presence of hemorrhage under the basement membrane of the epithelium and salivary gland stroma. Pronounced changes were recorded in the nerve cells of the oral cavity.

109-116

Authors: Serdyuk A.M., Beletskaya E.N., Stus V.P., Onul N.M.

Deterioration of the environment in the XX-XXI century under the influence of chemical, physical, radiological and other factors is not only and not just an ecological catastrophe of modern times, but a direct threat to the health and life of human society as a whole. Among the most important factors influencing people's health occupy chemical the leading place, because since 1957 more than 50 million chemical substances were synthesized, but only 15% of them have a toxicological evaluation, and 30% of the diseases in Europe are associated with chemical factor (ECHA-EXA). Chemical "pressing" determines a significant reduction in the reproduction of the population of Europe, and for Ukraine it means a large-scale depopulation, among possible reasons of which a significant role belongs to the deterioration of the reproductive capacity of population, men in particular, and this work is devoted to this problem. On the basis of profound analysis of literature data, complex ecologic-hygienic researches we identified markers of exposure, prognosticaly significant markers of impact for the early diagnostics of disorders of male generative system in conditions of low-dose impact of xenobiotics. We achieved convincing evidence of ecologically determined character of unogenital diseases and fertility decrease, we developed scientifically-justified principles of management of risk of development of ecologically-determined reproductive pathology in men.

123-129

Authors: Berdnyk O.V., Rudnytska O.P., Dobrianska O.V.

Spatial-temporal characteristics of the population’s morbidity and prognosis of the situation are the main conditions for substantiation of the management decisions directed at the optimization of public health formation. Determination of the tendencies of morbidity 6-years children of during 1972 – 2014 years and their prognosis levels was the aim of the study. The analysis of morbidity based on the preschool institution’s health documents involved both temporal (42-years period of time) and spatial (different ecological districts) assessments. The negative changes in older preschool age children’s health have been revealed: growth of total morbidity, prevalence of respiratory diseases, inflammatory diseases of the eye. The higher levels of morbidity are registered in the districts located near the highways of the city. It testifies to the negative influence of transport-related air pollution on the children’s health formation. The estimation of prognostic levels (till 2020 year) showed future growth of diseases prevalence etiologically linked with air pollution.

134-139

Authors: Duzhiy I.D., Muntyan S.O., Dubnitskiy V.Yu., Kharchenko S.V., Smianov V.A.

Until 2030 the ulcer mortality will have a growing trend as estimated by the World Health Organization. Detection of countries and population groups with high risks for the ulcer mortality is possible using forecast method. The authors made a forecast of mortality rate from complicated ulcer disease in males and females and their age groups (15-24, 25-34, 35-54, 55-74, over 75, 15 - over 75) in our country. The study included data of the World Health Organization Database from 1991 to 2012. The work analyzed absolute all-Ukrainian numbers of persons of both genders died from the ulcer causes (К25-К27 coded by the 10th International Diseases Classification). The relative mortality per 100 000 of alive persons of the same age was calculated de novo. The analysis of distribution laws and their estimation presents a trend of growth of the relative mortality. A remarkable increase of deaths from the ulcer disease is observed in males and females of the age after 55 years old. After the age of 75 years this trend is more expressed.

144-148

Authors: Karpenko S.I., Shponka I.S., Zavizion V.F., Zavizion E.M., Skoryk V.R., Snisar A.V.

Solid pseudopapillary tumor of the pancreas (Frantz's tumor) is a very rare disease with uncertain malignant potential. This tumor occurs in young women at the age before 35 years. Asymptomatic disease course leads to growth of tumor up to the huge size. Surgery is the only treatment method applied. Histological diagnostic is complicated with similarity of tumor with neuroendocrine tumor of the pancreas. Disease is characterized with favorable prognosis. Paper shows our own clinical observation of Frantz’s tumor. During control ultrasound examination of woman aged 34 years, echo-signs of mass lesion in extraperitoneal area near the lower pole of the left kidney were diagnosed. During physical examination in the left hypochondrium a soft, atropic mass lesion 5.5x5 cm in size was diagnosed. Lesion presence is confirmed by CT assessment. Distal resection of the pancreas and splenectomy was performed. Diagnosis was verified histologically and immunohistochemically. Postoperative period is complications free. The results of CT assessment, detailed description of gross specimen and the results of histological and immunohistochemical examination are presented.