Medical perspectives (Medicni perspektivi)

4-11

Authors: Diachuk D.D., Hidzynska I.M., Moroz G.Z., Tkachuk I.M.

Scientific interest to the problem of multimorbidity is increasing due to the increase of the number of such patients. The aim of this work was to analyze and summarize current approaches to optimizing care for patients with multimorbidity and the results of their implementation in clinical practice. Since the beginning of this century, a number of documents have been created by WHO, government agencies and professional medical societies to improve medical care to patients with multimorbidity. The evidential basis of the effectiveness of the majority of the proposed measures based primarily on expert consensus. In 2016 NICE has published a clinical guideline NG56 «Multimorbidity: clinical assessment and management», WHO – a monograph «Multimorbidity: Technical Series on Safer Primary Care». In 2017 NICE has published a quality standard – Quality Standard №153 «Multimorbidity». The strategy of improvement of medical care for patients with multimorbidity is directly related to the patient-centered approach formation, which includes comprehensive assessment of the patient's condition. The main component of medical care is the definition of a realistic goal of medical intervention according to patient`s preferences, and making the choice of the optimal amount of diagnostic, treatment, and preventive measures, which can lead to the desired goal. A number of studies (the 3D randomized controlled trial, the MultiCare AGENDA, the SPPiRE study, the WestGem study etc.) have being conducted to evaluate the effectiveness of implementing proposed approaches in clinical practice. The results of the studies and meta-analysis do not provide conclusive evidence of the medical and economic effectiveness of their implementation at the presentstage. Improving the outcomes of medical care to patients with multimorbidity involves conducting further clinical trials that can provide evidence to determine the list of most effective interventions for clinical practice.

22-31

Authors: Ivanov V.P., Shushkovska Yu.Yu., Afanasiuk O.I., Pentiuk L.O.

The main morphological structural lesion substrate is myocardial fibrosis. The processes of fibrosis in a certain way are associated with the severity of a variety of cardiac arrhythmias. Myocardial fibrosis may be manifested by prolongation of the QRS complex, frequent ventricular arrhythmias and ventricular tachycardia on the electrocardiogram. Echocardiography is the main tool used to assess the structure and function of the heart, it reveals an increase in the left ventricle, and decrease in ejection fraction and diastolic dysfunction of the left ventricle and an increase in filling pressure. Biological markers are quantitatively defined biological parameters that, as indicators, determine the norm, pathology and result of medecinal correction of the disease (definition of experts from the Biomarkers Definitions Working Group, USA). Changes of biomarkers can be controlled to determine the individual risk of cardiovascular diseases development and measures to normalize them. Among the main causes of fibrosis activation, hyperactivation of the renin-angiotensin-aldosterone system and, as a consequence, the excessive formation of angiotensinogen and aldosterone are considered; increased levels of galectin-3, which contributes to the migration of macrophages, proliferation of fibroblasts and collagen synthesis in cardiomyocytes. Recently, much attention is paid to the study of biochemical markers such as aldosterone, galectin-3 and transforming growth factor- beta-1.Thus, these markers were determined in hypertension, metabolic syndrome, congestive heart failure, hypertrophic cardiomyopathy, myocardial infarction, atrial fibrillation. However, to date studies considering association between frequent ventricular premature beats, as a marker of electrical instability and plasma levels of biomarkers of fibrosis, such as aldosterone, galectin-3and transforming growth factor beta-1, in patients with essential hypertension without / or in combination with coronary heart disease are absent. Based on the aforesaid material,, further thorough study of this problem is promising.

39-47

Authors: Volotovska N.V.

The organism’s reaction to pathogenic impacts such as blood loss and ischemia can appear either on systemic or on ultrastructural level. The tourniquet inflation pressure on the extremity triggers local lipid peroxidation. However, the systemic influence of tourniquet is not completely studied. This experiment was dedicated to study of the changes that occur in the liver on the background of ischemic-reperfusion syndrome of the limb. In our experiment the animals were divided into 5 groups, in which the effect of ischemia-limb reperfusion, blood loss, mechanical injury of the thigh bone and their combination on the concentration of malonic dialdehyde and glutatoin peroxidase activity was studied. Biochemical investigation of the liver has shown that each of these experimental interventions had caused activation of lipid peroxidation in the liver and proper increase of the activity of the antioxidant protection enzyme in the blood. The peculiarities of the reaction were an increase of the first index, which was the highest among all experimental groups – on the background of blood loss combined with the use of a tourniquet; at the same time the critical suppression of antioxidation was noted as well. Besides 2 periods of exhaustion of the wounded organism were established – on the 3rd and 14th day. At the same time, the content of malonic dialdehyde was higher in the group where the imposition of the tourniquet was combined with mechanical trauma, comparatively to isolated mechanical trauma of the thigh, this indicated the role of the tourniquet as a factor complicating the course of posttraumatic period due to ischemic reperfusion syndrome. Understanding the pathogenesis of traumatic disease will allow to find a new way of valuing of the effects of limb decompression, to cope with oxidative stress and more successfully treat multiple organ failure.

59-65

Authors: Pertseva T.A., Konopkina L.I., Koval D.S., Guba Yu.V.

The aim of the study was to determine the categories of COPD patients with a predominance of fibrotic or inflammatory processes. The study included 37 stable COPD patients (men – 33 (89.2%), women – 4 (10.8%), mean age – 63.5±1.18 years, the level of forced expiratory volume for the first second after the test with bronchodilators (FEV1post) – 46.7±5.81% of the proper value). To determine the categories of COPD patients with a predominance of inflammation or fibrosis, a cluster analysis was performed. For this purpose the most important indicators from a clinical point of view were selected: the number of exacerbations over the past year, dyspnea severity according to the mMRC scale, the level of FEV1 post and reversibility level in absolute values, systemic inflammation markers levels (CAA, C-RP) and profibrotic cytokine TGF-β1. Thus, according to the results of cluster analysis, two categories of patients were identified. The first category – COPD patients with a predominance of the inflammatory process with low dyspnea severity, high functional indicators (FEV1 >50% of the proper value), high airway reversibility level, low level of profibrotic cytokine TGF-β1, high levels of systematic inflammation markers (C-RP and CAA). The second category – COPD patients with a predominance of the fibrosis process, with a high dyspnea severity, low functional indicators (FEV1 ≤50% of the proper value), low airway reversibility level, low levels of systematic inflammation markers (C-RP and CAA), and high profibrotic cytokine TGF-β1 levels. The prevalence of inflammatory processes was observed mainly in COPD patients, who belong to clinical group C; the prevalence of fibrotic processes – mainly in patients of clinical group B.

73-80

Authors: Poniatovskyi V.A., Bondarchuk O.L., Prystupiuk M.O., Smikodub O.O., Shyrobokov V.P.

Staphylococcus aureus is one of the most common opportunistic pathogens that causes a variety of diseases, from minor skin infections to life-threatening sepsis, meningitis, pneumonia and a number of other diseases. Particular attention was paid to methicillin-resistant Staphylococcus aureus (MRSA) strains with multiple drug resistance. The purpose of this study is investigation of the sensitivity of clinical isolates of Staphylococcus aureus, including methicillin-resistant strains, to bacteriophage drugs and determination of possibility of using this agent for the treatment of staphylococcal infections. A number of classical and modern microbiological methods for the isolation and identification of Staphylococcus aureus: an indication of genes, responsible for antibiotic resistance (PCR analysis), determination of sensitivity to antibiotics (disc diffusion method) and bacteriophages (spot test, Gracia method, Appelman method) were used in the study. The susceptibility analysis of Staphylococcus aureus with presence and absence of mecA gene to the commercial bacteriophage product – “PYOFAG® BACTERIOPHAGE POLYVALENT” was performed. The results of the study showed that the total number of susceptible strains of bacteria was 95±0,2%. The use of investigational Bacteriophage drug for the treatment of furunculosis caused by MRSA has shown positive results. After one week of using the bacteriophage as monotherapy, the patient experienced regression of the clinical symptoms. For the period of use no adverse effects have been detected. Thus, the phage drugs using can become an important tool in the control of antibiotic-resistant strains, which cause a variety of infections in humans.

87-93

Authors: Kovalyova O.M., Chukhrienko N.D., Pasiieshvili T.M., Pasiyeshvili L.M., Zhelezniakova N.M.

Aim of research was assessment of the levels of antioxidant biomarkers associated with mitochondrial function in young patients with gastroesophageal reflux disease (GERD) and autoimmune thyroiditis (AIT). This study included 165 patients of them 120 patients with GERD and AIT - the main group, 45 patients with isolated GERD - the comparison group. The examined contingent was presented by students aged 18 to 25 years. The control group consisted of 20 healthy individuals of corresponding gender, age and social status (students). Total antioxidant activity (TAS-TAC) was determined in blood serum of study persons with enzyme immunoassays (ELISA, Elabscience, USA), levels of manganese superoxide dismutase (MnSOD) – with enzyme immunoassays (ELISA, Elabscience, USA) and Klotho protein - with enzyme immunoassays (ELISA, Elabscience, USA). Statistical data processing by the Statistica Basic Academic 13 for Windows En local was made. In examined patients with esophageal and thyroid pathologies the decline of total antioxidant activity has been revealed. The MnSOD level in patients with comorbidity of GERD and AIT and isolated GERD was significantly higher as compare to control group. Significant increasing of Klotho protein in serum of young patients was observed. We assessed imbalance between decline of extracellular antioxidants and activation of mitochondrial antioxidants which is more pronounced in combination of diseases. The increase of biomarkers of mitohondrial antioxidant defense system with non-specific citoprotection mechanism in patients with GERD provides the basis to consider MnSOD and Klotho protein as prognostic indicator of clinical outcome of disease in young age. Under combination of GERD and AIT the tendency to overexpression of MnSOD and depression of total antioxidant activity has been revealed, this may cause the deterioration of mitochondrial function.

99-106

Authors: Gamian A., Zubchenko S.O., Havrylyuk A.M., Kril I.Y., Chopyak V.V.

Advanced glycation end-products (AGEs) are created during the process of glycation of cells from various tissues and fluids and are a heterogeneous group of molecules formed from the nonenzymatic reaction of reducing sugars with the amino group of proteins, lipids, and nucleic acid. In normal conditions, they play the immunoregulatory role. In pathologic conditions AGEs activate the receptors for advanced glycation end products (RAGE) and cause long-lasting inflammation. RAGE participates actively in various disorders such as rheumatoid arthritis, diabetes, etc. However, there is relatively small number of scientific studies on the possibility of using the role of AGE in the pathogenesis of allergic diseases. RAGE transcript and protein are expressed in the lung by pulmonary type I alveolar epithelial cells, suggesting that RAGE has an important role in lung pathophysiology. They repress some endogenous autoregulatory functions leading to many diseases, including allergy. Oxidative stress increases the inflammatory reaction in asthma and allergies. Long-lasting inflammation followed by free radicals production are important factors involved in allergic reactions, they negatively influence the incidence and prognosis of allergy. RAGEs are expressed on circulating immune cells, they activate NF kappaB and intracellular oxidative stress also increases the inflammatory reaction in asthma and allergies. The membrane RAGE (mRAGE) signaling is proinflammatory, whereas soluble RAGE (sRAGE), a secreted form of RAGE, is generally anti-inflammatory. The study of AGEs, soluble RAGE, ligands of RAGE HMGB1, and S100A8/A913 and IL-33 is useful in the context of their considering as biomarkers to the differentiation diagnostic between eosinophils-derived and neutrophil-derived asthma/AAD. The mean serum levels of RAGE may be the target of new therapeutic interventions.

114-121

Authors: Makarchuk O.M., Ostrovska O.M., Okolokh Onieka Gibson, Orishchak I.K., Cheredarchuk A.R.

In recent years, the number of cases of uterine factors infertility is constantly growing. Unfortunately, the analysis of scientific works is characterized by the lack of data on the improvement of the diagnostic algorithm and the expediency of accentuating the significance of the preconceptional stage. The purpose of this study was to develop sonographic criteria for endometrial readiness for implantation at the stage of preconceptional care in women with uterine factor infertility. The first group included 80 women with uterine factor infertility, the second group (40 women) consisted of patients who entered the IVF program for the first time. The control group consisted of 30 women with normal fertility. Studies of the structure of the endometrium, myometrium and ovarian tissue were performed on a Voluson 760, on the 4th-6th days of the menstrual cycle (according to the International Endometrial Tumor Analysis (IETA) – consensus of ultrasound description of endometrial changes) and on the 20th-24th days of the cycle. To assess the indirect signs of chronic endometritis the echographic criteria developed by V.N. Demidov et al. were used. The sonographic diagnosis was verified during morphological and immunohistochemical examination. The most common menstrual disorders in women with uterine factor infertility were algodysmenorrhea – 33.3%, algohypomenorrhea –22.2%, hypoopsomenorrhea – 64.4%. Thinning of the endometrium was significantly more often observed in the group with uterine factor of reproductive disorders; one third of patients (33.8%) had dyschronosis of the endometrial echotexture; heterogeneity of M-echo with a predominance of hyperechoic areas was diagnosed in 41.3% of cases. Hyperechogenic inclusions in the basal layer, multiple structures of a linear nature and increased echogenicity were revealed in every fifth patients and hypoechoic uterine contour – in 47.5% of cases. The most significant odds ratio associated with IVF failures and early reproductive loss was found in patients with endometriosis (OR – 5.85; 95% CI: 1.32-13.32), synechiae (OR – 2.27; 95% CI: 0.96-10.16) and polyps (OR – 2.48; 95% CI: 0.84-11.36). It was possible to distinguish the following criteria of functional readiness of the endometrium for implantation: endometrial thickness was more than 8 mm, compliance with the echostructure phase of the menstrual cycle, homogeneity of M-echo, absence of hyper-and hypoechoic inclusions, and full hemodynamics in the vascular pool of the pelvis.

127-137

Authors: Gresko I.V., Kolesnichenko V.A.

The study included 80 patients aged 22-44 (31.7±4.4) years with lumbar osteochondrosis with impaired motor stereotype and myotonic reaction of the lumbar-pelvic region muscles. The patients were randomized into two homogeneous groups depending on the physical rehabilitation program: in the main group a combination of shock wave therapy (SWT) with the Masterplus MP200 extracorporeal shock wave therapy device (5 procedures with a frequency of 11 Hz, an impact force of 3.8-4.0 bar, intervals of 5-7 days) with a program of relaxing exercises according to the method of K. Levit was used; in the control group – only exercises program. The developed program of physical rehabilitation proved its effectiveness by a significant decrease in pain intensity indicators (p<0.001) by VAS scale, ODI disability level (p<0.001) and SKT kinesiophobia level (p<0.01), a significant increase in the spine mobility (p<0.05) and the lumbar spine mobility (p<0.05), flexion in the hip joints (p<0.05). The range of movements during extension, adduction and abduction of the hip joints also increased but not significantly. Normalization of the extensor muscle tone of the lumbar spine was observed in 87.5% of cases, the gluteus muscle tone – in 30.0%, and the piriformis muscle tone – in 27.5%. The frequency of registration of error patterns in the active combined movement of the lumbar segments and the pelvis decreased to 37.5% of cases as a whole. The developed program of physical rehabilitation proved to be effective compared with the results of the isolated application of relaxing exercises with a significant improvement by VAS scale (p<0.05), ODI (p<0.05) and SKT (p<0.05); normalization of the tone of the lumbar extensor muscles and the restoration of control of active movements in the lumbar-pelvic region are more often noted in more than a third of patients.

146-158

Authors: Fastovets O.O., Sapalov S.O., Shtepa V.O.

Complete dentures remain still popular due to the economic component of such prosthetic treatment. However, additional fixation on intraosseous implants provides a greater clinical and functional effectiveness and a greater level of satisfaction with the results of prosthetics in edentulous patients. At the moment, the biomechanical aspects of complete denture prosthetics and prosthetics with fixation on implants, taking into account the degree of atrophy of the edentulous jaws, are not complete understood. Such studies make it possible to create recommendations on the choice of prosthetic tactics for edentulous patients. The aim of the research was to study the distribution of stress-strain states in prosthetics of the edentulous mandible with complete dentures and with designs supported on intraosseous implants, taking into account the type of atrophy. It was carried out computer simulation of 8 virtual finite element models of mandible with different types of atrophy. According to Keller they were 4 models: of the biomechanical system simulation "complete denture – mandible" and 4 ones – "denture – intraosseous implants – mandible". In each of the models, a chewing load of 100 N was simulated (symmetrically and asymmetrically). The ANSIS 12.1 finite element analysis was used to calculate the stress-strain states in the described calculation systems. It was estimated the distribution of stresses in cortical bone and displacements of the dentures on the prosthetic bed. Under using complete dentures, the maximum stresses in the bone tissue of the prosthetic bed were observed for the third type of mandible atrophy with all types of power load, the smallest ones – for the fourth type. Additional fixation of removable dentures in simulation models of biomechanical systems “denture – intraosseous implants – mandible” lead to a significant increase in stresses in the alveolar bone. The maximum stresses were observed in the area of the marginal bone, while their greatest values were in the well-expressed alveolar part of the mandible for first and third types by Keller. The movements of bases of complete dentures were insignificant and fluctuated within hundredths of a millimeter for all types of atrophy. The use of intraosseous implants for fixation of dentures caused increase in movements by several times. Besides, displacement fields were characteristic: they were uniform for complete dentures but in the use of implants – not. The expressed alveolar process in the first and third types of atrophy of the edentulous mandible caused an increase in the displacements of the distal sections of the dentures on both sides with a symmetrical force load and on one side – with an asymmetric one. It can be assumed that such a distribution of stress-strain states accelerates atrophy of prosthetic bed tissues. As a result of prosthetics of complete defects of lower dentitions, both with traditional complete dentures and with additional support on implants, different distribution of stress-strain states occurs in different phases of the chewing act in the bone of the prosthetic bed, the character of which is determined by the shape of the alveolar part described by Keller's classification. The results allow us to develop an algorithm for determining the kind of prosthetics for edentulous patients, depending on the type of mandible atrophy.

166-173

Authors: Vavrinevych O.P., Shpak B.I., Antonenko A.M., Omelchuk S.T., Zinchenko T.I.

This work is the second part of our study to develop alternative experimental mathematic models for predecting toxicity of insecticides, where we carried out a statistical analysis and comparative estimation of the toxicometric parameters obtained experimentally and calculated according to the proposed equations. In the first stage calculations were carried out and the most reliable models were proposed. The purpose of the research is the scientific substantiation and statistical analysis of the calculation models for predicting the toxicity of insecticides of different classes. For research we took the insecticides of the following chemical classes: neonicotinoids, pyrethroids, organophosphorus compounds. Statistical analysis of the linear and nonlinear regression equations obtained for insecticides was conducted. The equations described the dependence of subthreshold doses in the chronic experiment of all insecticides, the median lethal doses at oral admission of pyrithoids and neonicotinoids from molecular weight; and toxicometry parameters of all insecticides and their individual groups (pyrithoids, neonicotinoids, organophosphorus compounds) on melting temperature and the octanol-water partition coefficient. On the basis of a comparison of the toxicometry parameters obtained experimentally (actual parameters) and calculated according to the proposed equations checking of possibility of using of the calculating models for predicting the danger of the investigated groups of insecticides was performed. For substantiated pairs of resultant and factorial variables for pyrethroids, neonicotinoids, and organophosphorus pesticides a reliable correlation was established (ractucal> rtable at p = 0.05) or trend (ractucal> rtable at p = 0.1). A good and very good consistency of the features selected for the calculations according to the Cronbach’s alpha (index ranged from 0.8 and above) was indicated. The developed algorithm makes it possible to significantly simplify the conduction of toxicological studies of the studied classes of insecticides.

181-188

Authors: Ipatov A.V., Khaniukova I.Y., Moroz О.М., Sanina N.A.

A full study was conducted using the statistical method of research in order to analyze the status and structure of primary disability of the adult population of the regions of Ukraine due to tumors in the period ща 2010–2019 and identify the causes that affect the indicators of primary disability and regional characteristics. We have performed the analysis of expanded statistical information regarding disability in Ukraine with the help of the "Report on the causes of disability, indications for medical, professional and social rehabilitation" (form № 14, approved by order of the Ministry of Health of Ukraine in coordination with State Statistics Committee of Ukraine dated 10.07.2007 № 378) within 24 regions of Ukraine and Kyiv over the last ten years. In addition, the correlation analysis was performed using Microsoft Excel© to find the connection between primary disability due to neoplasms and a number of medical and social factors using Pearson-Brave correlation coefficient (r). Over the last ten years, the rates of primary disability due to neoplasms and malignant tumors of both adults and able-bodied population have been increasing steadily. They have always been among the top three causes of disability in Ukraine. However, cardiovascular diseases occupied the first place over the last 27 years. In 2019, tumors took the first place. Fluctuations in primary disability due to neoplasms are connected with a number of medical and non-medical causes. The main ones are morbidity, prevalence of neoplasms, number of beds in cancer dispensaries and availability of specialized oncology medical expert commissions in the region, changes in legislation regarding criteria for assessing disability groups. In the structure of primary disability due to neoplasms people of working age (40-60 years) dominate, their number varies by year, but the tendency to predominance persists Among the disability groups a severe second disability group dominates, which indicates a late diagnosis due to untimely treatment of these people and the predominance of the so-called "neglected" forms of the disease. This trend takes place during the observation period of all ten years. The highest rates of primary disability due to neoplasms are also stable throughout the ten-year observation period and are observed in the regions that are considered the most affected by Chornobyl disaster: Kyiv region, Kyiv, Zhytomyr, Chernihiv, Volyn, Rivne. However, the increase in this indicator in Poltava region over the last three years is not entirely motivated. The obtained results will be the basis for the development of national and regional measures for the rehabilitation of people with disabilities caused by tumors and contribute to public funds saving due to their targeted distribution in regions and keeping labor resources.

198-206

Authors: Gorbunova G.D.

In order to define the quality of life of labor migrants’ children, there were researched different aspects of their lives, such as physical functioning (PF), emotional functioning (EF); social functioning (SF) and school functioning (SF). The given research involved 150 children from Republic of Moldova. They were of different age groups (5-7, 8-12, 13-18), of whom 75 children were of the labor migrants and their parents/guardians who remain in the country and 75 children of labor migrants and their parents without labor migration experience. As the instrument for given research there was used the Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire. In the course of the research there was distinguished Quality of Life (QL) of children on high level, score from 100 to 91, the middle level – from 90 to 81, the low level – from 80 to 71 and the lowest level, less than 70 scores. According to the results of the investigation it was established that the migrants’ children of various age groups, from all the examined aspects had a very low level of QL (less than 70 scores). In all age groups presented by the migrants’ children, the QL in terms of physical functioning, has a considerably lower level of scores (р<0.001) in comparison to the children from the control group. The highest level of QL was observed in the group of children aged 5-7 and the lowest in 13-18 aged group. There was also evidentiated a very low level of QL of the migrants’ children in emotional aspect (from 42.0±25.32 to 43.7±25.94 scores), that considerably differs (р<0.001) from the middle level of QL of the children from the examined group (from 85.0±19.83 to 89.0±20.82 scores). The lowest data of QL in the emotional aspect of the migrants’ children aged 13-18 years old (42.0±25.32), demonstrate a very specific emotionally stressed state of these children. Migrants’ children demonstrate a very low level of QL in terms of social functioning and it certainly differs from the middle level of QL of the children from the examined group. That definitely demonstrates a low ability to social adaptation of children after their parents’ migration. The lowest indicators of the total score of QL were revealed at the age of 13-18, both in groups of migrants’ children (46.8±24.19 scores) and in the examined group of children (82.7±19.57 scores). At the same time the highest indicators of the total score of QL were revealed at the age of 5-7, both in groups of migrants’ children (55.9±30.85 points), and children of the examined group (85.9±23.70 scores). The presented results perform a very convincing fact that labor migrants’ children in comparison to their peers from the families without labor migration experience had considerably low indices by all scales and integral characteristics of quality of life.

214-220

Authors: Poiasnyk I.M.

Lyme borreliosis is a tick-borne transmitted infectious disease caused by the spirochete Borrelia burgdorferi sensu lato and spread by the bite of ticks of the genus Ixodes. Lyme neuroborreliosis is a clinical manifestation of Lyme borreliosis, which affects the central nervous system and peripheral nervous system in up to 15% of the affected patients. Nerve structures are affected by spirochetes both in acute and late phase of the disease. The clinical course of neuroborreliosis is highly variable. Although at least 80% of European patients present with facial nerve palsy and radiculitis, symptoms of neuroborreliosis may be quite unspecific or even mimic other neurological diseases. Idiopathic peripheral facial palsy has long been considered as the most common cause of prosopoparesis, but modern diagnosis significantly narrow the range of cases of unknown genesis. Neuroborreliosis is difficult to diagnose, especially when prosopoparesis is the only clinical manifestation, so practitioners should be mindful of possible etiology to avoid misdiagnosis. The article presents a clinical case of early neuroborreliosis in a woman of 57 years who manifested with peripheral facial palsy. The author describes in detail the course of the disease (the appearance of new symptoms on the background of standard medical therapy (poor response), the presence of additional criteria (erythema migrans, lymphocytoma (rarely), arthralgia), diagnosis (specific immunological examination of blood to Borrelia burgdorferi sensu lato). Antibiotic therapy made it possible to achieve complete recovery of facial nerve function and avoid future complications.

4-8

Authors: Pelo I.M., Reva T.D., Nizenkovska I.V., Kozak N.D., Konovalova L.V.

The article identifies and characterizes the leading trends in the development of the pharmaceutical industry in Ukraine, namely: observance of ethical principles of work of the expert of pharmaceutical industry; a focus on European standards for the quality of pharmaceutical services; development of a national system for the production of medicines. Emphasis is placed on the fact that the teachers of the University have a goal to convey to students ideas that are important for forming the humanistic foundations of a pharmacist’s work. The initial instruction, according to the authors, is to provide each participant of the educational process with the conditions for self-realization in learning and future professional activity. At the same time, in the formation of the content of pharmaceutical education a deep understanding of the value of a person’s health is the highest personal and social value. It is noted that an integral characteristic of the modern development of pharmacy in Ukraine is its dependence on imported medicines. During the educational process at the Faculty of Pharmacy of O.O. Bogomolets National Medical University, students and teachers believe that in Ukraine there are a number of prerequisites for overcoming the dependence of the domestic pharmaceutical market on imported medicines, namely: Ukraine has joined the International System of Cooperation of Pharmaceutical Inspections; the country has created a system of registration of medicines and adopted an international format of registration dossier; the State Pharmacopoeia of Ukraine was developed and put into operation; mandatory requirements for compliance with the rules of Good Manufacturing Practice and Good Distribution Practice were introduced; to the licensing conditions for the production and sale of medicines in Ukraine European recommendations regulating the development and research of medicines have been adapted and updated.

17-21

Authors: Kolomiets L.V., Orobey V.F., Lymarenko O.M., Ovcharov Y.V., Tsilvik O.V.

The paper presents modeling of denture specimens with different surface reliefs under the action of static loading using modern numerical methods - finite and boundary elements. Based on the analysis of literature, it is shown that the most effective approaches for calculating the stress-strain state (SSS) of dentures is the finite element method (FEM), which allows you to create 3D models with any complexity of geometry and surface, as well as the boundary element method (BEM), which allows in some cases to obtain more accurate calculation results than finite element method. The algorithm and procedure for exact integration of differential equations of hollow shells according to the algorithm of Kantorovich-Vlasov variational method are presented for the formation of the calculated finite element method ratios. The analytical expressions for the parameters of the hollow shells used for calculations of the state of dentures are given. Finite element method is represented in the work by the universal package SolidWorks. Different stages of solid-state modeling of prototypes of dentures with different surface reliefs are shown in detail. Dental stress-strain state calculations were performed by two methods. The results of the calculations are in good agreement with each other, which proves the reliability of both models developed and the results of the stress-strain state received. It is shown that the smallest values of stresses occur in dentures with a rhombic lattice; they are 5.9% less than prosthesis with a smooth surface, and 18.78% less than in prosthesis with a square lattice. Equivalent displacement of a rhombic lath prosthesis is less by 3.864% than that of a smooth surface prosthesis and 8 52% less than a square lattice prosthesis.

30-39

Authors: Lievykh А.E., Bondarenko N.S., Dronov S.N., Mamchur V.I., Tverdokhlib I.V., Zhyliuk V.I.

Chronic hyperglycemia, insulin resistance, endothelial dysfunction, and disturbance of the integrity of the blood-brain barrier are considered as strategically important links in the development of cognitive deficits in diabetic encephalopathy. Taking this into account, one of the modern trends in the optimization of the treatment of cognitive impairments induced by prolonged hyperglycemia is the co-administration of agents with antihyperglycemic and nootropic activity, in particular, metformin with piracetam. It has been shown that under conditions of experimental alloxan-induced hyperglycemia, piracetam has insufficient nootropic potential for eliminating cognitive deficits. Metformin has a weak nootropic effect in short-term use in low doses, without exhibiting these properties in prolonged administration. When combined with piracetam, metformin potentiates its antiamnesic properties, which helps to restore cognitive functions impaired by hyperglycemia. It is assumed that the mechanisms of such synergism are mediated by a decrease in the content of early and late markers of the destruction of protein molecules, the level of stable nitric oxide metabolites in the cerebral cortex, as well as a significant limitation of the manifestations of ultrastructural destructive changes in hippocampal neurons with a simultaneous improvement in the state of its microvasculature. The obtained results indicate the expediency of the combined use of metformin with nootropic agents for the prevention or treatment of cognitive impairments that occur as a result of diabetes mellitus.

50-61

Authors: Pertseva T.A., Bielosludtseva K.O., Kirieieva T.V., Konopkina L.I., Krykhtina M.A., Basina B.A., Matykina N.N., Turchin N.A.

The diagnosis of community-acquired pneumonia (CAP) on the background of COVID-19 is especially actual due to the prevalence of this pathology and the possible aggravation of the pathological process. The aim of our study was to improve the principles of CAP diagnostics on the background of COVID-19 and to determine risk factors for aggravating of the pathological process. Patients with respiratory symptoms who were hospitalized with suspected COVID-19 were examined. General clinical research methods were carried out, determination of SARS-CoV-2 virus RNA by PCR method, computer tomography (CT) to identify the features of lung tissue damage was performed. The main observation group consisted of 37 patients (men – 19 (51.4%), average age – 61 (57; 69) years) with pneumonia on the background of confirmed COVID-19. According to the severity of coronavirus disease, all patients of the main group were divided into 3 subgroups: subgroup 1 included 17 people with moderate COVID-19, subgroup 2 – 13 people with severe COVID-19, subgroup 3 – 7 people with critical COVID- 19 course. The levels of markers of systemic inflammation (C-reactive protein (C-RP) and fibrinogen) were also determined. Since patients with COVID-19 of moderate severity (which is characterized by the presence of community-acquired viral pneumonia) belong to the risk group of severe and critical course, it is suggested to consider the following risk factors for aggravating the pathological process as: temperature over 38.5°C, heart rate over 90 per minute, respiratory rate over 20 per minute, SpO2 ≤ 93%; absolute lymphopenia (less than 0.9 G/L) and an increase in serum levels of C-RP more than 50 mg/L and fibrinogen more than 5 g/L.

71-76

Authors: Bosdriesz J.R., Semenov V.V., Kuryata O.V.

Chronic kidney disease puts an individual at a higher risk of all-cause and cardiovascular death. Coronary artery calcium score reflects the accumulation of calcium in the walls of the coronary arteries and a higher coronary artery calcium score is associated with lower survival rates. It is unclear if control of conventional risk factors is enough to reduce cardiovascular risk in patients with chronic kidney disease. The aim of this study was to investigate if the association between estimated glomerular filtration rate and coronary artery calcium score in the Ukrainian population differs by sex, age, blood pressure, and total cholesterol. This cross-sectional study was conducted on a sample of patients who underwent measurement of coronary artery calcium score at Dnipropetrovsk Mechnikov Regional Hospital, Dnipro, Ukraine. Inclusion criteria: age >40 years old, available data about coronary artery calcium score and estimated glomerular filtration rate. Exclusion criteria: the presence of known cardiovascular disease, diagnosis of diabetes mellitus, estimated glomerular filtration rate <30 ml/min and extreme coronary artery calcification (coronary artery calcium score >1500 Agatston units). 137 patients (54 males and 83 females), median age 59.0 [54.0;67.0] years were enrolled in the study. In the patients with lower eGFR there was non-significantly higher coronary artery calcium score (p=0.07). In males with eGFR ≥90 ml/min, 60-89 ml/min, and 30-59 ml/min coronary artery calcium score didn’t differ significantly, while in females a lower estimated glomerular filtration rate was associated with a higher coronary artery calcium score. A lower estimated glomerular filtration rate was significantly associated with a higher coronary artery calcium score in the patients with systolic blood pressure ≥140 mmHg (p=0.04), but not in patients with diastolic blood pressure ≥90 mmHg. In the patients with total cholesterol <5.0 mmol/l and ≥5.0 mmol/l coronary artery calcium score tended to be higher in the patients with lower estimated glomerular filtration rate. A lower estimated glomerular filtration rate in our study was associated with a higher coronary artery calcium score in females, patients aged ≥55 years old and in patients with systolic blood pressure ≥140 mmHg.

87-95

Authors: Zabolotny D.I., Sambur M.B., Savchenko T.D., Krіvokhatskaуа L.D., Zayets T.A., Tymchenko M.D.

The aim of the study is to determine di­sorders of immune homeostasis in patients with laryngeal papillomatosis at different periods after complex treatment with the inclusion of the “Gardasil” quadrivalent vaccine in the adjuvant therapy. Studies of the immunity state were conducted in 26 patients with laryngeal papillomatosis (LP) before, 2-12 and 13-29 months after complex treatment, consisting of surgical removal of papillomas and anti-relapse therapy, including inhalation of Laferobion, taking a vitamin-mineral complex and a course of vaccination with antiviral “Gardasil” quadrivalent vaccine according to which the second and third injections were administered in 2 and 6 months after the first. Significant disorders of cellular and humoral immunity indices in patients with LP were revealed in the form of multidirectional changes in the functional activity of natural killer cells, a decrease in the total number of T lymphocytes, mainly due to CD4 + subpopulation, increase in circulating immune complexes level in blood serum and concentration of secretory IgA in the secretion of the oropharynx. Disbalance in the patient’s cytokine system resulted in increased γ-IFN and TNF-α serum levels, an increase in spontaneous production of interferon and inhibition of stimulated production of λ - and γ-interferon by blood cells in vitro. Complex treatment with the use of the “Gardasil” quadrivalent antiviral vaccine in the postoperative period contributed to the normalization of most immunological reactivity indices that were altered in patients. The results indicate the prospects of using the antiviral vaccine as part of adjuvant antirelapse therapy after surgical treatment of LP patients and indicate the advisability of long-term clinical and immunological monitoring at different periods after vaccination.

104-110

Authors: Gashynova K.Yu., Suska K.S., Dmytrychenko V.V.

Chronic respiratory tract infection and relapsing exacerbations worsen the quality and reduce the life expectancy of patients with bronchiectasis. This work aimed to identify the spectrum of pathogens and to determine their profile of antibiotic resistance in the sputum of patients with bronchiectasis in the Dnipro region. Sputum of 60 patients in a stable phase with confirmed bronchiectasis was a subject to microbiological examination and determination of antibiotic sensitivity according to generally accepted CLSI recommendations. According to the results of the study, it was found that 70% of patients have sputum colonization by pathogens in the stable phase of the disease, and the most common pathogens are Pseudomonas aeruginosa and Haemophilus influenzae, which is in line with the global trend. Haemophilus influenzae was sensitive to ampicillin, amoxicillin, amoxicillin/clavulanate, piperacillin/tazobactam, cefuroxime, ceftriaxone, cefotaxime, cefepime, cipro­floxacin, levofloxacin and moxifloxacin in a hundred percent of cases. However, more than half of the strains of Pseudomonas aeruginosa were resistant to one or more drugs with anti-Pseudomonas activity. In particular, the highest level of resistance was identified to such drugs as imipenem, aztreonam, ceftazidime. The problem of antibiotic resistance is alarming and once again indicates the need for the regular microbiological examination of the sputum of patients with bronchiectasis even in a stable phase for subsequent rational administration of antibacterial therapy.

117-124

Authors: Revenko H.O., Mavrutenkov V.V., Chykarenko Z.O.

Antiretroviral therapy has made HIV infection a chronic controlled disease, where aspects of the immunoprophylaxis of infectious diseases have acquired important clinical significance. The goal of the study was to determine the clinical and laboratory predictors of antitoxic immunity against diphtheria and tetanus in HIV-infected adults. The study included 90 HIV-infected patients aged 22 to 60 years (main group). The control group consisted of 49 immunocompetent volunteers of the corresponding age. The levels of anti-diphtheria and anti-tetanus antibodies were determined by ELISA using the diagnostic test systems RIDASCREEN Diphtheria IgG and RIDASCREEN Tetanus IgG (R-Biopharm AG, Germany). Statistical processing was performed using the licensed software product STATISTICA v.6.1. Significant differences were found between the titers of antitoxic antibodies in HIV-infected and immunocompetent adults. According to the correlation analysis, the decrease in the titers of antidiphtheria antibodies was revealed with an increase in the age of the HIV-infected patient (rs=-0.21; p=0.05). The fact of smoking (rs=-0.31; p=0.003), lowered body weight (BMI<18.5 kg/m2) (rs=-0.29; p=0.006), the presence of arterial hypertension (rs=-0.38; p<0.001), a history of bone fractures over the past 5 years (rs=-0.38; p<0.001), anemia (rs=-0.21; p=0.049), thrombocytopenia (rs=-0.44; p<0.001), accelerated ESR (rs=-0.61; p<0.001), the presence of hairy leukoplakia of the tongue (rs=-0.23; p=0.027), frequent infections caused by herpes simplex (rs=-0.52; p=0.003) and varicella zoster virus (rs=-0.34; p=0.013) are associated with low levels of antidiphtheria antibodies. A direct relationship was found between the intensity of anti-diphtheria immunity and patients receiving OST (rs=+0.54; p=0.003) and with a history of injuries with impaired skin integrity (rs=+0.31; p=0.003). Decreased anti-tetanus immunity in HIV-infected patients was also associated with smoking (rs=-0.48; p<0.001), decreased BMI (rs=-0.71; p<0.001), anemia (rs=-0.33; p=0.002), thrombocytopenia (rs=-0.75; p<0.001), a history of bone fractures over the past 5 years (rs=-0.67; p<0.001); the total number of HIV-associated opportunistic diseases (rs=-0.42; p<0.001), including the presence of oropharyngeal candidiasis (rs=-0.23; p=0.032) and hairy leukoplakia of the tongue (rs=-0.57; p<0.001), history of Herpes Zoster in the past (rs=-0.48; p<0.001), with frequent relapses of diseases caused by herpes simplex viruses (rs=-0.78; p<0.001) and repeated episodes of herpes zoster (rs=-0.74; p<0.001), as well as with pathology of the skin (rs=-0.55; p<0.001). Protective predictors of anti-tetanus antitoxic immunity strength were established: male gender (rs=+0.22; p=0.039), parenterally acquired HIV infection (rs=+0.21; p=0.05), HIV-infected patients receiving OST (rs=+0.40; p=0.041). A direct relationship was found with the decreased level of hemoglobin (rs=+0.41; p<0.001), the increase of relative number of lymphocytes in the blood (rs=+0.21; p=0.05), as well as with living in rural areas (rs=+0.40; p<0.001) and the presence of injuries with impairment of skin integrity (rs=+0.84; p<0.001). Clinical and laboratory predictors of strength of antitoxic immunity against diphtheria and tetanus in HIV-infected adults were identified, which allows us to create an individual “vaccination roadmap” for patients in this category.

132-139

Authors: Shevchuk I.M., Snizhko S.S.

The goal of the work is to improve the results of treatment of patients with esophageal perforations complicated by purulent mediastinitis. Examination and treatment of 30 patients with esophageal perforation (EP) complicated by purulent mediastinitis were performed. The causes of EP were foreign body damages in 12 (40%) of 30 patients, spontaneous rupture of the esophagus – in 11 (36.6%), iatrogenic damage to the esophagus – in 7 (23.4%) patients. The main method of surgical treatment of esophageal perforations complicated by acute purulent mediastinitis is thoracotomy with suturing of the perforated wall of the esophagus and sanation of mediastinal tissue. In case of purulent melting of the esophageal wall and total mediastinitis with severe endogenous intoxication, surgical interventions should be aimed at minimizing surgical trauma and elimination of the purulent process in the mediastinum using video-assisted thoracoscopy. The use of developed surgical tactics for the treatment of esophageal perforations complicated by acute purulent mediastinitis with intramediastinal administration of antibacterial drugs and the method of irrigation of the esophageal sutures contributes to a significant rapid reduction in endogenous intoxication, namely leukocytosis units up to 2.103±0.182 d. units (p<0,001) with normalization of the indicator on the 5th day from the beginning of treatment, the severity of the condition on the APACHE II scale in the modification of Radzikhovsky AP from 14.91±1.80 points at the time of hospitalization to 9.4±0.3 points on the second day after surgery (p<0.001), the severity of patients’ condition on the SOFA scale on the 3rd day to 3.221±0.445 points, on the 5th day – 1.832±0.219 points (p<0.001), the level of C-reactive protein on the 2nd day after surgery decreased from 236.2±21.4 mg/l to 144.3±9.3 mg/l, and on the 3rd day was 112.1±7.2 mg/l (in both cases p<0.001), reducing the content of procaltcytonin from 8.7±0.9 ng/ml to 3.828±0.251 ng/ml on the 2nd day after surgery. The use of this surgical tactic allows you to quickly eliminate the purulent process in the mediastinum, reduce the healing time of the perforation of the esophagus and reduce mortality from 28.5 to 6.2%.

144-152

Authors: Gudaryan O.O., Mashchenko I.S., Kucherenko T.O.

The modern treatment strategy for various forms of generalized periodontitis includes the use of a wide arsenal of drugs, which in turn leads to an excessive drug load on the body, this actualizes the search and use of drugs that have a systemic effect. The aim of the study is to develop and study the effectiveness of the use of systemic enzyme therapy in the treatment of aggressive (rapidly progressing) generalized periodontitis. The work is based on the results of comprehensive clinical and laboratory studies of 61 patients with an aggressive form of generalized periodontitis, without concomitant pathologies (30 main groups and 31 comparison groups). A control group consisted of 20 healthy donor volunteers. We used standard clinical, paraclinical, laboratory diagnostic methods, supplemented by dental volumetric tomography. In patients of both observation groups, standard protocol therapy was used, in the comparison group supplemented pathogenic therapy, and in the main group – multienzyme drug (Wobenzym) and rhBMP-2 injections. A comparative analysis of clinical, paraclinical, and laboratory studies has shown that the use of systemic enzyme therapy supplemented with recombinant morphogenetic protein (rhBMP-2) in patients with aggressive (rapidly progressing) generalized periodontitis is comparable to that of standard polymedicine therapy supplemented with pathogenic therapy, and leads to a faster control (average 13.7±0.7 days) of an active inflammatory and destructive process, normalization of indices of local humoral immunity, cytokine profile, free radical oxidation and antioxidant defense system, achievement of clinical and radiological remission in more than 90% of patients.

161-168

Authors: Savushina I.V., Pavlenko O.I., Zos'ka Y.V.

The number of people in need of phoniatric help is constantly increasing. People with voice problems are of working age. The object of researche: lowering risk of progression of vocal pathology based on a comprehensive system of management of teachers’ occupational risks. Hygienic, epidemiological, sanitary-statistical, in-depth medical examination method and mathematical-statistical methods were applied. Working conditions of teachers are characterized by complex effects of harmful production factors, which can reach 3d degree of 3d class of harmful work by intensity (according to the calculated points 3,63), 2nd degree of 3d class of harmful pressure on vocal apparatus (27,52±3,54 hours), 1st degree of 3d class of harmful by equivalent noise level and unfavorable microclimate. The most widespread pathologies of the vocal apparatus are chronic hypertrophic laryngitis (190,20±22,61) and chronic catarrhal laryngitis (131,00±15,07 cases). Almost 70% of occupational laryngitis cases are in the age group of 46-60 years. The critical length of service influenced by voice load is 10-19 years. The length of service more than 20 years in conditions of voice load increases the etiological percent of occupational pathology causes to 81,8%. Therefore, an age of 45,8±0,5 and older is dangerous for the occupational laryngitis progression and requires a special approach of development and imple­mentation of preventive measures aimed at maintaining of occupational health. Suggested complex of measures increase the healthy life by 7,3 years and reduce the loss of healthy life years determined by the impact of voice activity by 7,1 years. At the same time for physical health component (PH) by 4,5 and 4,3, and the psychological health component (MH) by 10,3 and 10,1 years QALY respectively.

176-183

Authors: Kuznetsova О.M., Ostanina N.V.

This article shows a study of different aspects of dietary supplement (DS) consumption by the population of Ukraine, the probability of using poor-quality DS is determined. As a part of this project, a questionnaire-based survey on the issue of DS consumption was conducted among residents of the following Ukrainian cities: Kyiv, Poltava, Kharkiv and Vyshneve (Kyiv region). The following data were analyzed: statistical data of the Ukrainian population, presence of pharmaceutical facilities in regions of Ukraine, DS sales volumes and laboratory data concerning correspondence of DS with the claimed content of active ingredients. Statistical analysis was carried out with use of the standard software Microsoft Excel 2007 and STATISTICA 8.0 portable The survey allowed to evaluate health level of respondents who take DS, obtain information concerning purposes or recommendations for DS taking, detect channels of purchase of such products, identify the risks of taking poor-quality DS. According to the survey results, about 72% of respondents are taking DS. The survey results indicate that 39% of respondents that take DS consider themselves healthy, almost half of respondents have insignificant health problems and about 12% of respondents have serious health problems. 79% of respondents purchase DS in pharmacies, which allows to conclude that about 59.7 million packaging of DS were consumed in Ukraine in 2019. It was confirmed that the presence of pharmaceutical facilities is even in all regions of Ukraine and, therefore, residents have access to necessary DS through pharmacies. Taking into account the results of laboratory tests of DS quality, the risks of poor-quality DS consumption in Ukraine in 2019 may be estimated as 9.5%. The research results of test purchases demonstrate that the aforementioned risks may increase significantly.

192-197

Authors: Bilynska М.М., Suray I.G., Vasiuk N.O., Savina T.V.

Purpose of the article is to determine the training needs of healthcare managers in Ukraine in the specialty "Public administration and management". As the main method, we used a written survey (questionnaire survey) of experts in the field of healthcare, using modern computer technologies. Participation of experts in this study is entirely voluntary. Confidentiality of information is guaranteed by anonymity of the questionnaire. Expert poll of healthcare leaders was conducted in March-April 2020 in order to determine training needs of the specialty "Public administration and management." A total of 54 respondents took part in the expert poll. Majority (96.3%) of respondents need to undergo training in the specialty "Public administration and management" (specialization "Management in the field of healthcare"). The overwhelming majority of them would like to undergo training on the topics: "personnel management in healthcare organizations (leadership, communication management, time management, stress management, self-management, psychological foundations of management in healthcare, etc.)" (64.8%) and "healthcare management "(59.3%). Summarizing results of the study, it has been proved that in order to improve the professional competencies of leaders in the health sector, it is desirable to introduce the training program "Leadership and Management in Health Care", which is aimed at solving problematic issues of management in the field of health protection; application of strategic management in the field of health care, quality management of medical care; obtaining communication skills and building an effective team; effective application of the knowledge gained in the environment is changing rapidly, etc. We believe that improving the mechanisms of training, retraining and raising their qualifications should be an important issue in the development of human resources in health care, especially managers. In particular, this applies to innovative forms of education, including trainings, online training, etc.

204-210

Authors: Kotelevska T.M., Pryimenko N.O., Dubynska H.M., Koval T.I., Iziumska O.M., Zviagolska I.M.

West Nile Fever (WNF) is the most common arbovirus infection with a transmission mechanism caused by West Nile Virus (WNV), present on all continents, except for Antarctica. WNV has a high epidemic potential and is dangerous for health of the population all over the world, due to rapid global spread, the formation of new natural foci and the ability to cause epidemics in endemic areas. Over the past 20 years, there have been numerous epidemic outbreaks of the disease among people, birds and horses, associated with WNV. On the territory of Ukraine WNV was first detected in the 70s of the XX century, but at present clinical and epidemiological aspects have been understudied. This study analyzed the epidemic situation regarding WNF in Poltava Region in 2011-2018, and clarified the epidemiological and clinical manifestations of serologically confirmed cases of acute WNF. This is the first actual survey of WNF cases in Poltava Region, its results indicate the prevalence of WNV in the central part of Ukraine. The aim of the study was to study the epidemiological and clinical characteristics of West Nile Fever in Poltava Region. The cases of WNF in Poltava Region in 2011-2018 have been analyzed, according to the annual reporting forms of the Ministry of Health of Ukraine. A serological study of pair blood sera for specific IgG-class antibodies to WNV of 232 patients with febrile conditions, requiring screening for WNF, was conducted. The clinical course was studied in a retrospective analysis of 14 case histories of patients with WNF under treatment in the Poltava Regional Clinical Infectious Diseases Hospital. The analysis demonstrated that in Poltava Region in 2011-2018 35 serologically confirmed cases of acute WNF were registered, with the largest number (14) in 2012. Serologic examination of the specific markers of WNV in 232 patients with febrile conditions allowed to detect 57 (24.6%) seropositive patients. Acute WNF was diagnosed in 35 (15,1%) patients, past WNF – in 22 (9,5%) persons. Analysis of case histories of patients with acute WNF showed that the most susceptible ones were females (64.1%), and the average age of the persons was 46.28±0.30 years old. According to the epidemiological history, the city residents dominated among the patients (71.4%), all of them (100%) marked mosquito bites, and the disease was of a seasonal nature, with the largest (78.6%) number of cases in July-August. The clinical course of WNF in all (100%) patients was moderate-severe and characterized by polymorphism of clinical manifestations. The leading clinical syndromes were: intoxication (100.0%), fever (100.0%), catarrhal (50.0%), allergic (42.8%), dyspeptic (35.7%) syndromes and lymphadenopathy (28.5 %). Thus, the conducted researches have shown that there are all conditions for formation of a natural center of WNF on the territory of Poltava Region. WNF was characterized by a typical course of the disease.

4-12

Authors: Zavizion V.F., Bondarenko I.M., Avierin D.I., Hojouj M.I., Davlietova N.O., Cherednychenlo N.O., Prokhach A.V., Mashtaler V.E., Dmytrenko K.O., Lohvynenko V.V., Kyslytsyna V.S., Sukhoversha O.A., Khvorostenko Y.M., Elhajj M.H., Suzdalev P.L., Myroniuk T.F., Kichtenko I.N., Hrabovskyi Y.V., Smolina K.V., Baranov I.V.

The urgent introduction of distance education into the learning process due to the COVID-19 pandemic has become a spontaneous experiment, requiring urgent decisions, effective mechanisms to implement into the educational process and analysis of ongoing educational process. The possibilities of modern digital technologies made it possible to quickly set up the information component of education and to controle student’s knowledge. A detailed analysis of the communication between the faculty members of the department among themselves and analysis of the features of teaching and self-education of students in the field of medical radiology and oncology based on answers and comments with using Google classroom, Socrative, Messenger Telegram, etc. was made. Issues of communicative interaction between faculty members and students, psychological aspects of distance communication, language of instruction, logistics of distance education and methodological problems are described in details. It has been suggested that distance education may be equally effective for theoretical subjects in full-time study form, but when studying clinical disciplines, the priority should be given to traditional methods of teaching, involving student's bedside training. Taking into account technical possibilities and high risk of development of extreme and emergency situations, it is suggested to introduce permanent readiness for distance education, to create all – Ukrainian distance imitation service of patients’ follow-up. The importance of using the state language in training as the basis for mastering the professional Ukrainian and English language as the basis for mastering international medical experience is indicated.

19-25

Authors: Reva T.D., Nizhenkovska I.V., Stuchynska N.V., Chkhalo O.M.

The paper considers the materials of the Pharmacists Summit and International Pharmaceutical Congresses, in particular, the issue of achieving quality pharmaceutical education. It shows cause of the proper training process of pharmacy sector specialists in accordance with current state and requirements of the society and suggests a model of professional pharmaceutical education. According to the authors of the paper, the implementation of education quality in Ukraine calls for, first, professionally educated personnel in the pharmacy sector of healthcare; second, proper academic and university infrastructure for training future specialists within the system of higher pharmaceutical education; third, ensuring the high quality of higher pharmaceutical education on the basis of implementing the competence approach and taking into account international experience on pharmacy development. Increasing significance of the pharmacy branch in Ukraine is directly linked to the quality of training of pharmacy specialists, continuous improvement of the content of their education, implementation of new educational technologies, adapting higher pharmaceutical education to European standards. According to the authors, an important condition of ensuring effective professional training of future pharmacy specialists within the national system of higher pharmaceutical education is the following: firstly, considering public demand to the level of healthcare services, disease prevention; secondly, implementing the productive global experience on introducing customer service standards. The established prospects of the development of national higher pharmaceutical education include: 1) the adoption of ethical principles of training Masters of Pharmacy within the system of higher pharmaceutical education; 2) focus on European pharmacy standards which are based on high customer service standards; 3) improvement of the content of pharmacy specialist education taking into account the development of national pharmaceutical production; 4) ensuring the development of the clinical direction within the system of general pharmacist training.

30-36

Authors: Sirko A.H., Dzyak L.A., Chekha E.V.

Concurrent development of primary brain tumors and multiple sclerosis is quite rare. Only a few dozens of such comorbidity have been reported. Nevertheless, given the fact that such pathologies are characterized by similar clinical picture and neuroimaging findings, issues about diagnosis and differential diagnosis of such conditions often arise, which makes the problem relevant. A literature review was conducted using PubMed, by selecting articles on concurrent multiple sclerosis and brain tumors, particularly glial origin tumors, over the past 20 years (1989 to 2019). The search was performed in English, Russian, and Ukrainian using the following key words and terms: comorbidity, concomitance, multiple sclerosis, brain tumor, glioma, astrocytoma, glioblastoma. The analysis included all articles on etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, neuroimaging, and pathomorphological assessment. After identifying all the articles that met the inclusion criteria and removing duplicate data, 35 literature sources on concurrent primary brain tumors and multiple sclerosis were selected. The conclusion on whether concurrent primary brain tumors and multiple sclerosis develop randomly or have common pathophysiological mechanisms is still under discussion. Potential causes of pathogenesis of both diseases include viral infection, chronic inflammation, neoplastic transformation, and involvement of neurotropic growth factors. The likelihood that two processes, demyelinating and neoplastic, can develop in parallel will never be underestimated. In such cases, strong clinical suspicion arises due to atypical clinical picture characterized by aggressive and rapidly growing neurological symptoms such as aphasia, spastic hemiparesis, epileptic seizures, or signs of intracranial hypertension. In MRI diagnosis, pathological findings such as single lesion of more than 2 cm; mass effect, edema, signal amplification in the form of ring-shaped shadow are the reasons for a more thorough examination and applying additional diagnostic methods: CT, MR spectroscopy, PET, CSF tests to determine oligoclonal antibodies and other markers content, cerebral biopsy. According to the literature, cases of concurrent primary brain tumors and multiple sclerosis are rare though described. Atypical clinical signs, neuroimaging data, and cerebral biopsy which is currently considered as the only method for making accurate diagnosis are helpful in the diagnostic process.

43-47

Authors: Svirgun I.S., Mohammed Adab, Koshelev O.S., Drozdov O.L.

In our time the study of the influence of soya and especially sunflower lecithin as one of the natural monopolies in Ukraine, on the state of cognitive functions is relevant. Specified neurotropic activity of lecithin is characterized by the obstacle to the development of behavioral manifestations of neurotoxic action of carbon tetrachloride, prevention of inhibition of mobility, research, unconditional reflex activity. In this article the determination of the effects of soy lecithin (L), and sunflower lecithin on a state of cognitive processes in rats showed that there is no significant differences between them. Changes in memory were judged by conventional passive-defensive reactions. Conditional reaction of passive avoidance (passive avoidance reaction) was produced on the basis of a single electric-skin support. We proposed modified method of assessing the presence of individually obtained memory trace and a group of genetically fixed form of memory. The establishment of this fact allows to make a comparative analysis of changes caused by the two lecithins in reproduction of individually obtainjed memory trace. Lecithin, derived from both plants in the conditions of intoxication by carbon tetrachloride prevents and improves reproduction of conditional reaction of passive avoidance. Soy lecithin and sunflower lecithin prevent the development of behavioral manifestations of neurotoxic action of carbon tetrachloride, preventing inhibition of mobility, research, unconditional reflex activity, cause expressive anti-amnesic effect contributing to the course of protective instinctive behavior in recognition of new circumstances as a safe. Both lecithins of plant origin exhibit the improving effect on the course of cognitive processes and their neuro-hormonal mechanisms in conditions of poisoning with carbon tetrachloride. Sunflower lecithin has more antidepressive, nootropic effect whereas soy lecithin has been demonstrated to have significant anti-amnestic effect.

55-59

Authors: Czubaj-Kowal M., Friediger T., Hudáková Z., Sokołowski M., Walczak-Kapołka E., Aštaryová I., Lesňáková A.

Nowadays, there are a number of respiratory illnesses that directly affect children. Exhaled nitric oxide measurement (FeNO) is one of the modern methods of investigation used for diagnosing and controlling allergic eosinophilic airway inflammation. It is a simple, painless and time-saving method for the patient. Because of its non-invasiveness and simplicity, it is a valuable diagnostic method, especially in younger children. Measurement of FeNO is a recognized biomarker and an accurate quantitative indicator in the detection, assessment and monitoring of airway inflammation, including asthma. However, only a few studies assess the relationship between FeNO and level of air pollution. The aim of our study is to determine the relationship between FeNO in third-grade students of primary schools and the level of air pollution in Ruzomberok. 146 children aged 8-10 years were included in the research. This is the first stage of a wider research project involving FeNO measurements in children at different times of the year. The goal of the research is to determine the concentration of FeNO in the studied group of children in the autumn when air pollution is lower than in second stage which is observed in winter. The study showed elevated values of FeNO>20 ppb in 11% of the tested children and correct values <20 ppb in 89% of them. Level of average air pollution in survey days for PM10 ranged from 23 to 40 μg/m3 and for NO2 – from 28 to 44 μg/m3. The study shows that the significant majority of children have normal levels of nitric oxide in the exhaled air when air pollution is low. Analysis of the second phase of FeNO measurements in winter, when air pollution was higher, will allow to compare the results and assess the correlation between the FeNO value and air pollution.

66-71

Authors: Loskutova T.O., Demchenko T.V., Kryachkova N.V.

The aim of our study was to find out the influence of gene polymorphisms of coagulation factors, endothelial dysfunction and regulators of blood pressure in early (EPE) and late preeclampsia (LPE). The study of genetic polymorphisms of blood coagulation factors and fibrinolysis (1691 G/A factor V Leiden (FVL), 20210 G/A prothrombin, -675 5G/4G PAI-1, 455 G/A fibrinogen β), endothelial dysfunction (192 Q → R paraoxonase 1, 677 C/T MTHFR, arterial pressure regulator (235 M/T angio­tensinogen II (AGT II)) using an PCR was performed. A prospective cohort study of 39 women with EPE, 93 with LPE and 44 pregnant women with a physiological pregnancy (C group) was conducted. The average gestational age at the time of delivery in EPE group was lower than in LPE and control group (p<0.001). In group with EPE new-borns had low weight-growth characteristics, low grade by the Apgar scale and foetal distress (38.5% vs. 9.7%, p<0.05). Caesarean section in EPE group was performed by 2.25 times more often than in control group and by 2,13 times than in LPE group (p<0,05). It was detected that the number of 1691 GA FVL heterozygote carriers in the group with EPE was significantly higher than in LPE group (p<0.05, OR=3.65, 95% CI 1.5-8.9) and control group (6.04, 1.7-21.6). The number of 20210 GG homozygotes and 20210 GA heterozygotes in prothrombin gene was probably lower in EPE group compared with the LPE and control group (0.03, 0.002-0.49, and 0.18, 0.06-0.53, respectively). It was established increase in frequency of 677 TT MTHFR genotype in EPE compared with control group (17.27; 0.9-317). Also, the carriers of 235T allele AGT II gene have an increased risk of EPE and PPE development (2.25, 1.2-4.2), (1.9, 1.1-3.3) respectively. The allele -455A of fibrinogen β gene increases the chances of developing EPE by 4.4 times (2.0-9.5), and LPE by 3.5 times (1.7-7.1). Risk factors that significantly increase the chances of developing early preeclampsia were identified: allele 1691 A of FV Leiden (5.96, 1.5-8.9), allele 20210 A of prothrombin (39.8, 2,3-679), 677T MTHFR (2.5, 1.18-5.3). In was detected that other researched polymorphisms between groups with PE were not significantly different and did not affect on time of preeclampsia development.

78-85

Authors: Khaniukov O.O., Yalovenko M.I., Kalashnykova O.S., Kravchenko O.I.

The purpose of the study was to establish clinical features of permanent atrial fibrillation (AF) in patients with heart failure mid-range ejection fraction (HFmrEF) and to develop a mathematical model for predicting arrhythmia development. The study included 42 patients with IHD, arterial hypertension (AH), permanent AF and HFmrEF (1 group), mean age – 68.0±1.2 years (21 men and 21 women) and 36 patients with CAD / АH and HFmrEF without AF, mean age- 67.5±0.7 years (22 men and 14 women). The results of the study show, that patients with permanent AF and HFmrEF are characterized by the higher diastolic arterial pressure, higher values of the LDLP, iESV LV, index of end-systolic volume of LV septal thickness and lower EF of the LV in comparison with patients without AF. Patients with permanent AF and HFmrEF also have increased plasma levels of hsCRP, IL-1β, IL-6 and IL-10 in comparison with patients without AF. A mathematical model with scoring system of hsCRP, IL-1β, LV mass index, HDLP, LDLP was developed to assess the risk of AF development in patients with HFmrEF with accuracy of 85.9%, sensitivity of 85.7% and specificity of 86.1%.

92-97

Authors: Kryvoviaz O.V., Tomashevska Yu.O., Makarenko O.V., Kudria V.V.

The purpose of the study is to substantiate the personalized selection of substitution therapy medications with the consideration of the pathogenesis of dry eye syndrome development in each patient. In order to achieve the set goal, we conducted a content-analysis of the information from nomenclature on active ingredient as well as on the mechanisms of action of substitution therapy medications provided in the prescribing information and labeling of the medications. After that, we performed a pathogenetic ranging of substitution therapy medications depending on the way they influence a certain aspect of disorder of the tear film renewal process in dry eye syndrome. The information received in the course of the conducted research makes it possible for an ophthalmologist – basing on information on the disorder in the quantitative and qualitative correlation between the tear film layers received with the help of modern diagnostic tools to prescribe targeted dry eye syndrome treatment taking into account the necessary point of application of the substitution therapy medications, considering their composition and action mechanism of the active ingredients which they contain.

103-108

Authors: Maslova G.S., Skrypnyk I.M.

The aim of study was to investigate the changes in the arginine / citrulline cycle in patients with acute myeloid leukemia (AML) with concomitant obesity in dynamics of chemotherapy (CT). The study included 20 patients with newly diagnosed AML who had a body mass index (BMI) above 25. The average BMI was 29.35±0.93 kg/m2. Patients have undergone a course of remission induction CT "7+3" or "5+2". All patients were examined twice: before CT and on the 28th day. Complete blood test was assessed. Arginine and citrulline content, arginase and ornithine decarboxylase (ODC) activity were measured in the blood serum. The study results showed a 3-fold decrease in arginine content in the blood serum of patients with AML, as well as a 3.9-fold increase in arginase activity, 1.9-fold – ODC, 7.6-fold higher citrulline concentration compared with control (p<0.05). After CT, against the background of complete blood count normalization in AML patients with concomitant obesity, a 1.3-fold decrease in arginine concentration was noted, while the arginase activity increased by 2.2 times, ODC activity – by 1.8 times and citrulline content – by 2.4 times (р<0.05). After CT a high direct correlation between BMI and arginine concentration in AML patients with concomitant obesity (r=+0.63; p<0.05), as well as between the activity of ODC and arginine content (r=+0,55; p<0.05) was revealed. Thus, in AML patients with obesity prior to CT the disorders in the arginine / citrulline cycle were present, which are caused by oncohematological disease. Excess weight and obesity affect serum arginine levels, which may contribute to chemotherapy resistance.

118-124

Authors: Kutovyi O.B., Klishyn O.A., Kosulnikov S.O., Kravchenko K.V., Tarnopolskiy S.O., Lohvynenko M.V.

The purpose of the study is to clarify the causes, features of clinical manifestations, to evaluate the results of diagnosis and surgical treatment of patients with sepleen abscesses. The article presents data on the results of diagnosis and treatment of 19 patients with spleen abscesses who were treated at the Surgery Department of the Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, from 2006 to 2018. A comparative analysis of the etiological factors of spleen abscesses among a selected group of patients was carried out. It was established that among the causes of spleen abscesses according to our data were: bacterial endocarditis, purulent diseases of the pancreas, trauma, simple cysts, portal vein thrombosis. When analyzing the results of inoculation of the contents of abscesses, it was determined that E.Coli (26.3%), St. Epidermalis (21.1%), Ac.Baumani (10.5%) and P. Aeruginosa 21.1%) occur the most often. For the diagnosis of spleen abscesses, general clinical, biochemical, and hardware methods of investigation (computed tomography, ultrasound examination of the abdominal organs) were used. The treatment of spleen abscesses was complex and included conservative therapy and surgical methods. As a surgical treatment minimally invasive, laparoscopic, as well as open techniques were used. The main surgical method was percutaneous drainage with ultrasound monitoring (42.1%). Relapse of abscess with this treatment option in the remote period was detected in 1 (5.6%) patient. In 5 (26.3%) cases patients with spleen abscesses underwent laparotomy and splenectomy. Laparoscopy was performed in 2 (10.5%) patients with spleen abscesses, operations were completed by opening, debridement and drainage of the abscess cavity and abdominal cavity. Fatal cases were not observed in the treatment of spleen abscesses. The combination of conservative therapy (using etiotropic antibacterial therapy) and surgical treatment (a combination of minimally invasive and laparoscopic techniques) allowed to achieve good treatment results. The number of complications was 15.8%

130-137

Authors: Shostakovych-Koretskaya L.R., Shevchenko-Makarenko O.P., Lapikova-Bryhinska T.Yu.

The authors present the study of the level of expression of miR-196a in 74 patients with chronic viral hepatitis C with the 1st genotype of HCV, based on previous experience in patients with antiviral therapy regimens containing interferon. The patients were divided into two groups, depending on the previous experience of antiviral therapy with circuits containing interferon – 21 patients who failed after antiviral therapy regimens containing interferon (group 1) and the comparison group (group 2) – 53 naive patients. To study the level of expression of miR-196a (miR-196a), a two-stage study according to the manufacturer's protocol was used. First, total RNA was isolated from the plasma by the method of phenol-chloroform extraction. Futher reverse transcription was performed using a kit for reverse transcription of miR TaqMan® (Applied Biosystems, USA), specific loop primers to achieve mature miRNA, snRNA U6 (as an endogenous control gene), and 10 ng of total RNA. Real-time quantitative PCR was performed using TaqMan® miRNA analysis. In order to optimize the prediction of response to antiviral therapy and the use of optimal treatment regimens for problem patients with treatment failure regimens containing interferon, analysis using ROC curves was used. The average level of expression of miR-196a in patients with chronic hepatitis C was evaluated. In the 1st group of patients it was 0.011 (IQR: 0.002; 0.310) and in the comparison group – 0.346 (IQR: 0.054; 1.239) at p=0.012 by U criterion. The conducted ROC analysis showed that the studied miR-196a could differentiate patients with chronic viral hepatitis C with HCV genotype 1, depending on previous experience of antiviral therapy, namely, patients with treatment failure regimens containing interferons and naive. AUC=0.688 (95% CI 0.570-0.791; p=0.017), J=0.40, Se=57.14%, Sp=83.02%. It gives additional opportunities for correction of therapeutic tactics. Therefore, the level of expression of miR-196a (<-1,75) may be an additional biomarker in the pathogenesis of HCV-infection, which can then be used in the monitoring and treatment of patients. Low expression of miR-196a may be the basis for prescribing more effective direct-acting antiviral therapy to patients and will allow personalizing therapeutic tactics in patients with chronic viral hepatitis C.

145-148

Authors: Loskutov O.E., Biletska E.M., Kalinicheva V.V., Onul N.M., Sinegubov D.A.

Disorder of the relationship between biotic and abiotic elements against the background of anthropogenic stress on the human body affects the course of bone remodeling. It is bone tissue in the human body that has the greatest cumulative properties with respect to many xenobiotics, lead in particular. The accumulation of lead in the bone leads to the replacement of calcium ions by ions of the abiotic element and causes further changes in the bone structure: inhibition of growth processes, decreased density, the development of osteopenia and osteoporosis. In the article, a comparative hygienic analysis of bone mineral density levels (according to T-score) in industrial (n=68) and control (n=70) areas was conducted. The T-score, calculated at the LI-LIV level obtained by the method of dual-energy X-ray absorptiometry was used and was evaluated according to the recommendations of the WHO. The formation of a homogeneous sample of persons for the study was conducted according to the place of residence, age, sex, absence of diseases and regular intake of drugs leading to a decrease in bone mass. Summarizing the results, it should be noted that the population of Dniprо city has a more negative and significant decrease in the bone mineral density (according to the T-score) compared to the same values of the control areas – 2.15-4.6 times and Ukraine's – 1.39-4.21 times. According to WHO recommendations, T-score indices for residents of industrial territory indicate to the presence of osteopenia, while among residents of the control area, the norm for this indicator is noted. Consequently, there is an effect of man-made including lead, pollution of the environment on the level of bone mineral density in the industrial city this contributes to the development of osteoporotic changes in the population.

155-162

Authors: Serheta I. V., Mostovaya O. P., Panchuk O. Yu., Stoyan N. V.

The purpose of the work is to establish features of the processes of formation of indicators of emotional burnout of students in the dynamics of learning in modern institutions of higher medical education. Research was conducted on the basis of National Pirogov Memorial Medical University, 307 students of the 1st, 3d, and 6th courses were surveyed. To assess the level of development of the characteristics of emotional burnout Boyko’s personal questionnaire was used. It was established that a high level of severity of the leading manifestations of emotional burnout among students which determines their pronounced emotional instability and a tendency to develop various disorders in terms of the characteristics of psychophysiological adaptation and of the mental sphere was observed among young women, and, first of all, among third-year and first-year young women. Considering the structural distribution of the studied indicators, it should be noted that in all comparison groups the leading components of emotional burnout were either at the formation stage (young men, of the 1st and 3d courses, and young women of the 1st and 6th courses), or were already formed (young men of the 6th course, and young women of the 3rd course). During the analysis of the features of formation of the main phases of emotional burnout, it should be noted that the highest degree of their development during period of learning was inherent of the resistance phase, followed by indicators of individual manifestations of the exhaustion phase and, lastly, tension phase. In the structure of the characteristics of the phase of tension mostly pronounced both in young men and young women, it is necessary to consider indicators of anxiety, depression and experiences of traumatic circumstances, in the structure of the leading characteristics of the phase of resistance – indicators of inadequate selective emotional response and reduction of professionally-oriented educational duties, in the structure of the leading characteristics of the phase of exhaustion – indicators of the severity of psychosomatic and psychovegetative shifts, personal detachment and emotional deficit.

168-176

Authors: Berest I.R., Berest R.Ya., Pasichnyk M.S., Savchuk H.M., Oliynyk M.A.

Based on the principle of historicism, system analysis, structural functionalism, dialectics and synergetics, the paper analyzes the charter and activity the of the Lviv Society of Halician Physicians, the first trade union organization in the medical sphere. Contemporary codition as well as development of historiography of the issue including the history of the medical and trade union movement, the names of the Society founders is shown. The crucial problem among physicians of the second half of the nineteenth century which was in line with the problems of all population segments is proved. This organization played a prominent role in the development of medicine in Halychyna. The activity of the Society was regulated by the charter. Each member, when joining the Society, assumed the obligation to comply with all the provisions of the charter and had to care for its growth and the glory of the organization. Acting members had to be present at scientific meetings and provide observations on the status of the medical case. That is, to provide statistics on the diseases and patients they have been treated, as well as to share the experience gained in practice. The purpose of the organization and its activities were primarily socio-economic and cultural-educational ones. Under its control, the Society kept a record of the movement of patients in Lviv hospitals (kept statistics of all cured patients), analyzed new methods in the treatment of fever, various pathologies and other issues. The members of the Society promised to meet every first Saturday of the month to participate in scientific meetings. They discussed major events in the life of the organization, read correspondence and planned work for the next month. Once a year, in December, the Society of Galician physicions held an annual meeting, which provided a full annual financial report, discussed the issues of new members and those who left the organization, announced the names of new honorary and advisory members.

4-9

Authors: Khomazyuk T.A., Krotova V.Yu., Kosova Н.A., Kirichko M.G.

The article provides a practical example of the positive experience of the students of the medical academy in the international social project on combating arterial hypertension in order to improve the level of general competence and effective intellectual and professional socialization in getting higher medical education. The phenomenon of professional socialization should be considered along with the concepts of professional orientation, professional development, professional adaptation and professional becoming. Professional socialization is the ultimate link in the professional way of the individual. The algorithm of professional socialization of students in higher education consists of the following stages: professional orientation → professional development → professional adaptation → professional becoming → professional socialization. It should be noted that a personality who successfully socializes, has a well-defined social orientation, actively strives to self-determination and self-realization in society and is able of productive adaptation to the surrounding society on the basis of knowledge about social reality. In this case, the success of socialization is connected not only with the presence of specified qualities in the person, but, first of all, with the real actions in which these qualities are realized. By mastering the roles system, students acquire socially significant qualities, develop their worldview, their goals, motives, interests, feelings, personal and socially important needs, develop different types of competencies, including social competence, which will allow them to become what they want to become. Professional development of young talented individuals is possible only in open communication and interaction systems, it is in the international social projects of medical societies that constantly exchange energy and information with the environment, and at the same time, being a source of development and prospects for preserving the life of nation. Such a model of education supposes changing the role of teacher: the transition to joint actions with the student in new situations in an open, changing, modern world.

17-24

Authors: Knysh O.V., Martynov A.V.

The purpose of this study was to evaluate the effect of supplementing the culture medium with ascorbic acid on the antimicrobial properties of Lactobacillus reuteri cell-free extracts (CFEs). CFEs were prepared using commercial strain L. reuteri DSM 17938 by culturing lactobacilli in its own disintegrated cell suspension (DCS) supplemented with ascorbic acid in sub-inhibitory (5 mg/ml, CFE5) or minimal inhibitory concentration (20 mg/ml, CFE20) and without supplementation (CFE0). Staphylococcus aureus AТСС 25923, Escherichia coli AТСС 25922 reference strains and Pseudomonas aeruginosa extensively drug resistant (XDR) clinical isolate were used as indicator cultures. Screening of the inhibitory properties of the studied CFEs and elucidation of the nature of inhibitory products were done using modified Micro scale Optical Density Assay (MODA). The inhibition indices (InhI) were calculated for the studied CFEs and ascorbic acid of appropriate concentrations. CFEs were subjected to HPLC-analysis. CFE5 and CFE20 showed significantly higher antimicrobial activity toward to indicator cultures than CFE0. InhI calculated for extracts CFE5 and CFE20 mainly exceeded the sum of the corresponding indicators calculated for CFE0 and ascorbic acid (АА) of appropriate concentrations: InhI CFE5 ≥ InhI CFE0 + InhI AA5; InhI CFE20 > InhI CFE0 + InhI AA20. Acidic metabolic products have made the greatest contribution to the antimicrobial effect of the studied CFEs. HPLC-nalysis showed that the modified ascorbic acid was the substance found in CFE20 in the greatest quantity. The revealed effect of potentiation of antimicrobial activity of CFEs by ascorbic acid should be taken into account when developing new biotechnological products based on derivatives of L. reuteri DSM 17938.

32-44

Authors: Dzyak L.A., Shulga O.O.

Currently, the treatment of lumbosacral radiculopathy (LSR) is an urgent problem due to the frequent chronic pain syndrome, the lack of a unified methodological approach to the recommendations, taking into account the pathological characteristics of the compressed root. The purpose of the work is the development of the concept of a comprehensive etiopathogenetic treatment of acute lumbosacral radiculopathy. 100 patients, divided into two groups were examined (the main – 45 people, the control – 55 people). Each group was divided into subgroups depending on the treatment received (basic and complex). Basic therapy included treatment according to European and American recommendations. Complex treatment consisted of a combination of basic therapy and vibrotraction postisometric muscle relaxation (PIMR) with biomechanical stimulation of the paravertebral muscles. Treatment control was based on the analysis of the neurological and neuroorthopaedic status, severity of a pain syndrome using a 5-point verbal scale, PainDETECT questionnaire, the muscle syndrome index, as well as quantative sensory testing. The stages of the study were chosen taking into account the pathological stages of the disease: 1-7 days and 30 days. When analyzing the results of ELISA to IgG for urogenital infections in 46.7% of patients of the main group and 47.3% of the control, urogenital chronic infections were detected, while in the main group mycoplasmic and ureaplasmic infections were more common, and in the control group patients mostly had chlamydial infection. When antibacterial drugs were included in the treatment, the most pronounced regression of the pain syndrome was determined. Thus, it was found that the use of vibrotractional postisometric relaxation with biomechanical stimulation of the paravertebral muscles in combination with the use of NSAIDs is aimed at quickly removing the muscular-tonic and compression symtoms during 10-14 days (p<0.05), and the further use of neurotropic therapy led not only to a persistent analgesic effect, but also contributed to the improvement of the biomechanical indicators of the spine (p<0.05), positively affecting the motor activity.

51-58

Authors: Lesiv M.I.

The aim of the study was to study the status of cognitive functions in hypertensive patients, patients with hypothyroidism, and in patients with combination of these diseases, taking into account the state of disease compensation. 67 patients (36 men and 31 women), average age – 49.84±2.83 years were examined. The control group (CG) consisted of 18 practically healthy individuals (8 men and 10 women). Patients who received appropriate nosology treatment were divided into 3 groups: Group I – 21 patients with hypertension, systolic blood pressure (SBP) – 134.26±5.23 mm Hg, diastolic blood pressure (DBP) – 84.37±4.51 mm Hg; Group II – 18 patients with hypothyroidism, thyrotropic hormone (TSH) – 3.16±0.79 mIU/L, stage of hypothy­roidism compensation was diagnosed in 83.3%, subcompensation – in 16.7%; Group III – 28 patients with hyper­ten­sion (SBP 145.52±5.45 mm Hg; DBP 82.41±3.86 mm Hg) with concomitant hypothyroidism (TSH – 2.92±0.78 mIU/L, stage of compensation for hypothyroidism was diagnosed in 85.7%, subcompensation – in 14.3% of cases. Information about visits to the therapist/cardiologist/family doctor and endocrinologist was used to analyze the therapeutic correction of the disease: ambulatory medical records of patients with measurement of blood pressure (BP) and TSH during the disease were processed. To assess cognitive functions, Mini Mental State Examination (MMSE) and the Addenbrooke’s cognitive examination (ACE-R) were used. The relationship of average blood pressure data in patients with hypertension and TSH in patients with hypothyroidism during the disease period and the level of cognitive function was investigated. The average level of office BP (SBP/DBP) in Groups I and III compared to CG during the examination was: SBP 134.26±5.23 mm Hg (p=0.047), DBP 84.37±4.51 mm Hg (p=0.041) in Group I; SBP 145.52±5.45 mm Hg (p=0.031), DBP 82.41±3.86 mm Hg (p=0.050) in Group III. Analyzing the TSH levels it was found that at the time of the physical examination of patients in Group II the TSH was 3.16±0.79 mIU/L (p=0.009), the stage of compensation was diagnosed in 83.3%, subcompensation – in 16.7%; in Group III the TSH was 2.92±0.78 mIU/L (p=0.027), the stage of hypothyroidism compensation was diagnosed in 85.7%, subcompensation – in 14.3%. When evaluating MMSE scores, the proportion of patients in Groups I-III who had cognitive impairment (CI) was 6.9%, 10.3% and 13.8% respectively. On individual assessment of ACE-R test scores, CI in Groups I-III was in 6.4%, 9.6% and 13.8% respectively. A detailed analysis of the patterns of the ACE-R scale revealed that patients in Group I had a significantly lower score in the memory domain (22.68±0.96, p=0.037); patients in Group II had a low score in the concentration domain (15.85±1.14, p=0.045) and executive functions domain (11.62±8.63, p=0.041). Taking into account the interaction of factors (hypertension and hypothyroidism), it was found that in 40% of patients in Group III the most affected cognitive domains were memory (21.12±0.98, p=0.012) and speech (22.41±2.32, p=0.038); 60% of patients had problems with executive functions (11.90±9.17, p=0.033) as well as with visual-spatial skills (14.40±8.15, p=0.045). MMSE test showed a significantly lower score in the memory domain (1.87±0.46, p=0.008) in Group I, patients of Group II had a significantly lower score in the concentration domain (2.53±0.54, p=0.018). Basing on the interaction of factors (hypertension and hypothyroidism), it was found that in 45% of patients the most affected cognitive domain was memory (2.3±0.38, p=0.028), and 55% suffer from impaired speech, praxis (7.48±0.59, p=0.018) and perception (2.45±0.67, p=0.028). A retrospective analysis of medical records regarding the control of patients’ diseases was conducted. It was found that the average level of SBP/DBP in Groups I and III was 154.38±5.11 (p=0.000) \ 96.47±3.49 (p=0.006) mm Hg; 158.26±5.64 (p=0.001) \ 98.42±4.93 (p=0.005) mmHg, respectively. The TSH level over the disease period in patients of Groups II and III was 7.14±2.37 mIU/L (p=0.002) and 8.03±3.77 mIU/L (p=0.000), respectively, which was different from the data obtained in the last study. Retrospective analysis of medical records made it possible to establish a real long-term control of blood pressure, TSH in patients with hypertension, in patients with hypothyroidism and in patients with combination of these diseases, which caused CI in 6.9% of patients with hypertension, in 10.3% of patients with hypothyroidism and in 13.8% of patients with combined pathology based on MMSE test results. The ACE-R test results show the same sequence. Individual assessment of ACE-R test scores revealed CI in Groups I-III: 6.4%; 9.6% and 13.8%, respectively. The MMSE scale evaluates the selective deficits of one or more cognitive domains; the ACE-R scale is a wide-ranging study tool but it should be noted that the implementation of this scale requires time outlays.

65-73

Authors: Filippova A.Yu.

The aim of the work is to investigate the diagnostic value of laboratory blood biomarkers – alanine aminotransferase, aspartate aminotransferase, oxyproline and prothrombin time in comparison with morphological indicators for diagnosis of the degree of liver fibrosis in patients with comorbid course of non-alcoholic steatohepatitis (NASH) combined with obesity and chronic calculous cholecystitis. The data of 22 patients with NASH combined with obesity and chronic calculous cholecystitis was analyzed by laboratory and morphological indicators. There were 6 (27.2%) men and 16 (72.8%) women among the patients. Liver biopsy was performed intra-operatively on performing surgical treatment of calculus cholecystitis. METAVIR and Е. Brunt criteria were used in the histological diagnosis of NASH, as well as for determination of the stage of liver fibrosis (LF). Hepatic tissue fibrogenesis was assessed by serum values of total (OPT), free (OPF) and protein-bound (OPB) oxyproline, activity of indirect fibrosis markers – alanine ami­notransferase (ALT), aspartate aminotransferase (AST), AST/ALT ratio and prothrombin time (РТТ). As a mathematical tool for modeling, stepwise discriminant analysis was used. Fibrosis of the first stage (F1) was observed in 5 (22.7%) patients, the second stage of fibrosis (F2) – in 7 (31.8%), F3 stage of fibrosis - in 10 (45.5%) patients. Analysis of the morphological study of liver biopsy samples in examined patients with NASH indicates that established histological changes combine the signs of fatty and protein degeneration of hepatocytes, inflammation and necrosis in the lobules. Among the indicators included in the mathematical model the highest diagnostic significance can be attributed to the AST / ALT ratio (F = 9.03; p = 0.003) and the level of OPF (F = 5.67; p = 0.016), whereas OPB level has the lowest value (F = 2.94; p = 0.086). Evaluation of the accuracy of the method for determining of the LF phase based on the proposed algorithm showed that the frequency of correct detecting of F1 and F2 stages of LF was 100%, for the F3 stage - 90% (1 case attributed to the F2 stage). In general, the accuracy of the method was 95.5% (95% CI 86.8-100%), sensitivity – 90.0% (95% CI 71.4-100%), specificity – 100% (95% CI 92,5 – 100%), validity - 90.0%. Evaluation of the stage of LF in patients with NASH combined with obesity and chronic calculous cholecystitis, which was determined using discriminant functions calculated from laboratory data (OPT, OPF, OPB, ALT, AST / ALT ratio and PTT), is very much in line with the corresponding results of histopathological studies of liver biopsy samples.

79-87

Authors: Shponka I.S., Poslavska О.V., Savchenko O.A.

Studies of the recent decades on serous pelvic adenocarcinomas in women have set the goal of distinguishing between two diagnostic units: "low-grade" and "high-grade" carcinomas. The predecessor of the "low-grade" variant (type I) is considered to be a borderline serous tumor / atypical proliferative serous tumor (8442/1), which according to the International Classification of Diseases for Oncology ICD-O 2013 of the female reproductive system refers to non-specific, borderline tumors and tumors with unpredictable clinical behavior. The predecessors of the “high-grade” variant (type II) are serous tubular intraepithelial carcinomas (in situ) or “high-grade” serous invasive tubal carcinomas, since they have the TP53 mutation identical to “high-grade” ovarian carcinoma, an aberrant p53 protein expression, high proliferative activity, and significant genomic instability. In addition, according to the carcinogenesis of "high-grade" serous ovarian carcinoma with metastases to the peritoneum, it can also be interpreted as "pelvic high-grade serous carcinoma". A retrospective analysis of the histological, morphometric and immunohistochemical characteristics of the biopsy material of 31 women aged from 28 to 76 years (mean 57.32±11.54; median 57), divided into 3 groups, was carried out. Group 1: 14 observations of the tubal epithelium (8 tubes without pathological changes (subgroup 1a) and 6 with signs of intraepithelial neoplasia (subgroup 1b); group 2: 12 cases of serous adenocarcinoma of the ovary of the “high-grade” variant; group 3: 6 metastatic peritoneal serous carcinoma without a known primary site. Results. Group immunophenotypes showed uniformity in the expression of markers CK7 (+, +/-), CK20 (-), WT-1 (+), CA125 (+, +/-), with an affinity to distal uterine tube fragments. The expression of p53 in all groups with signs of carcinomas (compared with the control subgroup 1a without atypia) was divided into two options - negative samples and samples with overexpression, where no statistically significant difference was found (p>0.05), which is possibly a single way of carcinogenesis. The morphometric study revealed a significant difference in the area of the nuclei between group 3 and the first three groups (1a, 1b, 2), which indicates the similarity of ovarian and tubal neoplasias and uterine tube epithelium. The number of intranuclear reactions with ER and PGR progressively decreased from group 1 to group 3, with an increase in cases with ER (+/-) / PGR (+/- or -) to 50% in group 3, which greatly complicated the diagnostic search for unknown carcinomas of primary localization. HER-2-new expression revealed a possible amplification (gradation 2 + / 3 +) only in group 2 at the level of 16.67% and in group 3 at the level of 33.33%.

96-104

Authors: Kalbus O.I., Makarov S.O., Shastun N.P., Somilo O.V., Bukreyeva Yu.V.

The relative risk of developing depression in myasthenia gravis is 2.14 times higher than in the general population. The features of depression in myasthenia patients remain poorly understood and need to be clarified. The purpose of this work was to study the features of the development of depression in patients with myasthenia gravis. From 2014 to 2017, 182 patients with myasthenia gravis were examined. 147 (80.8%) patients had a generalized form of the disease, 35 (19.2%) had an ocular form. The clinical examination included assessment of complaints, medical history, neurological examination, as well as MGFA (Myasthenia Gravis Foundation of America) disease class and subclass of the disease determination. The severity of myasthenia gravis has been quantified according to the QMG score (Quantitative Myasthenia Gravis Score). All the patients were examined for the titer of antibodies to acetylcholine receptors (AchR) and muscle-specific tyrosine kinase (MuSK) by enzyme-linked immunosorbent assay (ELISA). Patients were also tested for the presence of antibodies to titin and SOX1 by indirect immunofluorescence. To detect depression the Beck depression inventory (BDI) was used. The mean depression score in the total sample was 16.0 (10.0; 24.0), which corresponds to a moderate depression level. The mean depression score in patients with ocular form was 6.0 (3.0; 11.0) points (ie, depression is absent), whereas in patients with generalized myasthenia gravis – 19.0 (12.0; 29.0) points (corresponds to moderate depression) (p <0.001). The distribution of patients with mild depression was also uneven: significantly bigger part of the patients was recorded with myasthenia gravis of class I (ocular form) – 10 (28.6%), and with myasthenia gravis of class II – 23 (44.2%). Among the patients with myasthenia gravis of class III, only 13 (20.3%) patients were reported with mild depression and 1 (3.2%) with class IV, p<0.001. The distribution of patients with moderate depression was the opposite of others: most patients had myasthenia gravis of class II – 12 (18.8%), and there were no patients with myasthenia gravis of class I. A similar tendency is also observed in the case of severe depression: patients with myasthenia gravis of class II – 23 (35.6%) dominated, to a lesser extent - patients with myasthenia gravis of class IV – 6 (19.4%). Among patients with ocular myasthenia gravis, only 1 (2.9%) patient was found to have severe depression. Severe depression was mainly recorded in patients with myasthenia gravis of class IV – 22 (71%) patients. The number of patients with severe depression has been decreased in the class of myasthenia gravis: 13 patients (20.3%) patients with ІІІ class, 1 (1.9%) with II class, no patients with class I. The degree of depression correlates with the clinical form of myasthenia gravis (ρ= -0.52; p<0.001), class (ρ= -0.30; p<0.001) and the subclass of the disease according to MGFA (ρ= -0.36; p<0.001). A reliable correlation relationship was established between the quantitative evaluation of the severity of myasthenia gravis (according to the QMG score) and the results of the evaluation according to the BDI score in the total sample (ρ=0.73; p<0.001). The assessment indicators on the QMG score and the BDI score significantly correlated in patients with ocular (ρ=0.36; p<0.05) and generalized forms (ρ=0.67; p<0.05). In addition, the level of depression correlates with the presence (ρ=0.15; p=0.040) and the titer of antibodies to AchR (ρ=0.42; p<0.001), with the presence (ρ=0.18; p=0.016) and the titer of antibodies to MuSK-AB (ρ=0.19; p=0.011). No correlation was found between the presence of antibodies to titin and to SOX1 (ρ=0.14; p<0.05 and ρ=0.07; p<0.05, respectively). There are no relationships between the use of anticholinesterase drugs, prednisone, the combined use of prednisone with / without azathioprine with / without anticholinesterase drugs and the development of depression in patients with myasthenia gravis.

109-115

Authors: Budnik T.V., Kvashnina L.V.

Recurrent urinary tract infection (UTI) remains a pressing issue in the era of large-scale antibiotic resistance (ABR). Modern discoveries testify to the paradigm's error regarding sterility of urine, pointing to the decisive role of the microbial symbiote in the persistence of infection. The purpose of the study was to study the clinical and laboratory efficacy of vaccine therapy in children with recurrent UTI. During the period 2018 - 2019, 21 children (girls) aged 7-18 years with recurrent UTI in the exacerbation phase were observed. By the nature of therapy, children were divided into groups: Ia - received vaccine therapy (VT) in the complex of therapy, Ib - a combination of VT and ABT, II – ABT. In addition to the generally accepted methods of assessing the clinical and laboratory status of a nephrologicals patient, modern non-routine diagnostic methods such as the identification of a microbial pathogen by MALDI TOF mass spectrometry and the determination of the susceptibility of microorganisms by the MIC 90 method were used. As vaccine therapy, the original multicomponent drug was used: Ecsherichia coli (CCM 7593), Enterococcus faecalis (CCM7591), Klebsiella pneumonia (CCM 7589), Proteus mirabilis (CCМ 7592), Pseudomonas aeruginosa (CCM 7590), Propionibacterium acnes (CCM 7083). The drug was prescribed according to the instructions, the duration of use was determined individually by clinical indicators, from 3 to 12 months. According to the study, it was determined that VT leads to the restoration of the sensitivity of resistant strains of pathogens. The probability of recovery of sensitivity after the 3rd cycle of treatment was OR=1,87±1,13 [0,2; 17,3] at CI 95% (p<0,05), after the 6th cycle of therapy – OR=4,5±1.32 [0.33; 60.1], which is 2.4 times higher than the previous one. The effect of restoring the sensitivity of the strains was significantly confirmed in patients after the 9th cycle of therapy (p=0.008). A high association strength according to the Spearman criterion indicated the dependence of bacterial efficacy of VT on its term of application – p= -0.97, (p<0.05). It is shown that the probability of reinfection after 3 cycles of vaccine therapy is 20.5 times lower than after the course of ABT.

122-127

Authors: Biesiedin O.M., Storubel L.N., Yevtushenko E.V., Biesiedina K.O.

Recently, there has been a steady tendency towards increase in the resistance of microorganisms to antibacterial drugs, which is due to the lack of development of new antibiotics, their uncontrolled administration, total use in animal husbandry, etc. leads to fatal outcomes, unsatisfactory results of treatment, rise in cost of treatment, formation of hospital pan-resistant strains. The increasing ability of microorganisms to cooperate in biofilms, production and improvement of resistance mechanisms in symbiosis are intractable issues in the treatment of patients with surgical infection of soft tissues. In patients with surgical infection of soft tissues, surgical treatment of a purulent focus and antibiotic therapy are fundamental doctrinal, determining the success of treatment.The choice of an antibacterial drug in most cases is based on the results of an antibioticogram. A study of wounds by smear technique and biopsy samples of wound tissues in 81 patients was performed. The quantitative and qualitative composition of wound microflora of patients was evaluated during the study of biopsy samples and standard culture from the wound surface. When examining the biopsy samples, 86 strains were isolated, and 110 – in the material from the wound surface. There was no growth on the wound surface in 11 cases (13.5%), against 20 (almost 25%) in biopsy samples. One species of flora was isolated from 37 wound surfaces (about 46%), biopsy samples of wounds with monoculture – in 61 samples (75%). Associations (two or more) are present in 33 (41%) wound samples, and only in 21 biopsy samples (26%). Thus, the conducted studies confirm the fact that wound surface is more contaminated by foreign microflora than biopsy samples. The data obtained allow us to recommend the method of wound biptates instead of a smear, as more specific and sensitive in patients with surgical infection of soft tissues.

134-141

Authors: Vovk I.B., Zadorozhnaya T.D., Gorban N.E., Kondratiuk V.K.

The article presents the analysis of clinical-morphological and immunohistochemical features of endometrial hyperplasia. 60 patients of reproductive age with non-atypical endometrial hyperplasia (EH) were examined. The following morphological distribution of its different types was established: glandular – 56.6%, glandular-cystic – 40.0%, stromal and cystic-atrophic forms – 1.7%, respectively. When carrying out immunohistochemical studies, the expression of CD-138, a modern reliable marker of the presence of an inflammatory process in endometrial tissue was determined. In the group with non-atypical glandular EH, signs of the inflammatory process in the endometrium were verified in 7 (20.59%) patients. In the group with signs of glandular-cystic change of EH – in 11 (45,83%) patients, as well as in the only patient with non-atypical stromal EH (100,0%). In almost one-third of patients with different morphological types of EH in 19 (31.7%) of 60 the presence of structural-morphological signs of chronic endometritis was revealed, which was manifested by signs of lymphoplasmacytic infiltration, indicating the presence of chronic inflammatory process. These data indicate the possible pathogenetic role of inflammation as one of the trigger factors for the hyperplastic transformation of endometrial structures, which allows to confirm the role of infectious factors in the occurrence of these processes in almost one third of patients with non-atypical ЕН. Thus, the conducted studies indicate that the development of EН is a process based on both the infectious factor and hormonal metabolic disorders, which dictates different personalized approaches to therapeutic tactics.

150-156

Authors: Kutovyi O.B., Balyk D.V., Kysilevskyi D.O.

The results of the examina­tion and treatment of 67 patients with a high level of obstructive jaundice were analyzed. Diagnosis of obstructive jaundice syndrome was based on the data of anamnesis, complaints, physical, laboratory and instrumental research methods. Among the latter we performed ultrasound investigation (USI) of abdominal organs and bile ducts as a screening method, fibrogastroduodenoscopy (FGDS), computed tomography(CT), magnetic resonance cholan­gio­pancreatography (MRCPG) was carried out if necessary. The cause of a high level of obstructive jaundice: pancreatic head cancer - 27 (40.3%); choledocholithiasis - 21 (31.3%); Klatskin tumour - 5 (7.5%); cancer of the large duodenal papilla – 4 (6.0%); chronic pseudotumor pancreatitis – 4 (6.0%); choledoch cancer – 3 (4.5%); choledochal stricture – 3 (4.5%). The first stage of treatment started from the implementation of percutaneous and hepatic external drainage of the bile ducts under ultrasound control. The functional state of the liver was evaluated according to the level of total bilirubin and its fractions, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). The researches were performed at the admission of patients to the clinic and on day 1, 3 and 7 after external drainage of the bile ducts. Patients were divided into 2 groups, depending on the bile flow rate on the first day after decompression of the biliary tract. It was concluded that the degree of hepatitis in the early period after the performed procedure is directly associated with the bile flow rate during the first day after external drainage of the bile ducts.

166-174

Authors: Shostakovych-Koretskaya L.R., Lytvyn K. Yu., Gubar I.O., Chukhalova I.V., Gudova M.G., Lopatenko A.A.

The epidemiological situation on HIV infection in Ukraine remains complicated due to high morbidity and mortality, which requires a comprehensive study of this problem. Purpose of work: to clarify the main patterns and characteristics of prevalence of HIV infection in Dnipropetrovsk region and develop a forecast for changes in the main epidemic indicators. The study was based on reports from the Public Health Center of the Ministry of Health of Ukraine and Dnipropetrovsk Regional Center for AIDS Prevention and Control. (2005-2017). To determine the main trends of development and forecasting the epidemiological situation, methods of analysis of time series with the calculation of chain growth rates and regression analysis were used. Analysis of the number of newly registered cases of HIV infection and AIDS over a 13-year period (2005-2017) showed an increase in figures for HIV by 1.5 times, for AIDS - by 2.4 times in Ukraine and in Dnipropetrovsk region – by 1.9 times and 3.0 times, respectively. A significant prevalence of HIV/AIDS incidence rate in Dnipropetrovsk region as compared with national indicators in some years of the study and on average over the entire observation period was determined – 92.8±4.2 cases of HIV infection per 100 thousand and 45.2±5.2 cases of AIDS per 100 thousand in the region versus 41.0±1.4 and 16.1±1.6 per 100 thousand of the population in Ukraine (p<0.001). According to prognostic algorithms, in Dnipropetrovsk region until 2020, the annual AIDS incidence rate is expected to increase to 80.7±2.56 cases per 100 thousand people; AIDS mortality to 33.7±0.99 per 100 thousand people, which also predicts an increase in the incidence and mortality associated with opportunistic infections. A calculated forecast of HIV incidence rates and newly registered AIDS cases in Ukraine and the region for the coming years may be useful for predicting the number of opportunistic infections and calculating the needs for hospitalization and treatment of HIV/AIDS patients.

185-192

Authors: Maruta N.O., Shevchenko-Bitensky K.V., Kalenska G.Yu.

The relevance of the study is determined by a high prevalence of dementia, significant economic costs of treatment, negative consequences in the form of disability and decrease in the quality of social functioning. The aim of the research was to study the clinical and psychopathological characteristics and specificity of the social functioning of patients with hallucinatory-paranoid disorders (НРD) in moderate vascular dementia (MVD). To achieve this goal, a comprehensive methodological approach was used, which was implemented using the clinical and psychopathological method, supplemented by the use of psychometric scales (neuropsychiatric inventory (NPI), global assessment functioning scale (GAF), disability assessment scale (WHO / DAS), Bristol daily activity scale (BADL)) and methods of mathematical data processing. In a study of clinical-psychopathological characteristics and social functioning of patients with HPD in MVD 75 patients took part. 41 patients with HPD (main group) and 34 patients without psychotic disorders (control group) were examined. In the structure of clinical-psychopathological mani­festations in patients with HPD in MVD the following symptoms were revealed: the prevalence of frequent delusional ideas of material damage, robbery and jealousy - in a moderate degree; a combination of HPD with frequent vagrancy; periodic moderate verbal aggression; frequent rhythm disturbances day / night, frequent low mood, manifested in the form of dysphoria; fear of being alone; frequent states of irritability. The expressed negative influence of HPD on communication function, quality and level of participation in fulfilling the parental role, the need and effectiveness of social contacts, the effectiveness of behavior in non-standard and difficult conditions was established. The influence of HPD on the formation of limitations of their vital functions in communication, ability to use the phone, make purchases, manage finances and use transport in patients of this group was defined. It was proved that the range of social functioning of patients corresponded to disorders ranging from a serious deterioration in functioning in the social and professional spheres - to the inability of functioning in certain areas of life.

204-214

Authors: Fastovets O.O., Shtepa V.O.

Dynamic occlusion is the main indicator of the harmonious functioning of the dental apparatus. At the same time, irrational reconstructive treatment can lead to its disorders and, as a result, increased tooth wear, periodontal diseases, dysfunction of masticatory muscles and temporomandibular joints. To date, the computer diagnostic methods allow studying occlusion in dynamics. The aim of the research was to study the prevalence and character of occlusal disorders in young people with intact dentitions, and those whose defects in teeth and dentitions were restored by direct and indirect restorations. 300 persons aged 25-44 years were examined, equally men and women: the first group – 100 persons with intact dentitions; the second one - 100 persons with direct composite restorations located on the occlusal surfaces of the molars; the third one - 100 persons, who had indirect restorations of the crowns of teeth and dentitions of small sizes. Intercuspidation were analyzed using methods of occlusiography, the study of diagnostic models in the articulator, and computer analysis of occlusion. According to the peculiarities of centric and eccentric occlusions, the sequence of formation of the maximum occlusal load vector, the balance of occlusion and the time of closing and opening of dentitions, occlusal disorders were diagnosed in 14.0% of the first group, 35.0% of the second one and 44.0% of the third one. In 100% of patients these disorders were compensated, asymptomatic. The presence of supracontacts in centric occlusion leads to a displacement of the mandible in a forced position in 17.7% of cases. In 83.0% of the examined persons, the occlusion balance was at the level of 50% - 50% and in 13.7% – 60% - 40%. The remaining 3.3% of patients had an occlusive imbalance in the range of 70% - 30%. In this case, significant deviations of the total trajectory vector of the occlusal load were not revealed. The most common occlusion disorders were centric contacts, which are formed as consecutive single, multiple, unilateral and bilateral overload areas, constantly being changed on sliding in dynamic occlusion. Occlusive disorders are characterized by an increase in the time of closure and opening of the dentitions, and the time to reach the maximum number of interdental contacts. The efficiency of occlusiography was only 29.7%, the efficiency of the study of diagnostic models in the articulator was 59.7%, compared to the computer method with 100% of the information value. The widespread use of direct and indirect restorations of teeth and dentitions leads to an increased prevalence of occlusal disorders in young people. Usually, small restorations are integrated into the dentition by grinding their occlusal surface, focusing on patient's comfort on closing the teeth and unhindered movements of the mandible to the sides and forwards. This simplified approach is conformative and incapable of providing optimal functional occlusion. The presence of occlusal imbalance requires appropriate measures for its diagnosis and correction.

221-229

Authors: Gulich M.P., Petrenko E.D., Lubarskaya L.S., Deputat Yu.M.

Nutrition of military personnel in the field or during combat operations is of great importance for maintaining force performance. An indispensable element in the provision of service personnel with food is individual “dry rations”, which are most often formed based on the nutrition of one soldier for one to three days. Of interest was the question of how the nutrition of the service personnel changed in combat operations meanwhile. Objective – to study the historical aspect of nutrition in battle conditions during the period from the Zaporizhzhia Sich to the present day. Materials and methods – literary sources, regulatory documents, research results. The information retrieval and the theoretical analysis method are used. The literature data, legislative and regulatory documents, the results of scientific research related to the nutrition of Ukrainian service personnel in the combat operations for the period from XVII-XXI centuries are analyzed. The evolution of “dry operational ration” over several centuries took place depending on the development of the food industry: from dry products that do not spoil with long-term keepeng (crackers, cereals, dry meat, dry fish), dry food concentrates and canned foods to ready-to-eat first and second courses. The caloric content of dry rations from the middle of the twentieth century ranged from 3100 kcal to 3350 kcal. In the Ukrainian army it is from 3,500 kcal to 3,800 kcal, and only for Joint Force Operation (JFO) – 4,100. Until recently, the energy value (calorific value) of dry rations was calculated without taking into account the actual energy consumption of service personnel in carrying out combat operations. Further studies on improving the nutritional standards of service personnel should be aimed, first of all, at establishing real energy costs when they perform their mission, including military ones.