Medical perspectives (Medicni perspektivi)

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.