Medical perspectives (Medicni perspektivi)

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.

4-11

Authors: Pertseva T.O., Shponka I.S., Tverdokhlib I.V., Pototskaya O.Yu.

One of the important tasks in modernization of Ukrainian medical education is to bring it in line with international assessment criteria, which has become especially relevant after the introduction of the International Basic Medicine Examination in 2018. The aim of this work was to identify the most significant differences between international medical exams (for example, The United States Medical Licensing Examination, USMLE) and the national system of licensed exams KROK, and based on this, determine the direction of modernization of Ukrainian medical education for its adequate adaptation to new systems of assessment. The most significant differences between the two exams are: format (on computers / on paper); presence / absence of digital files with images and audio data in tasks; thematic focus of tests within one / several subjects; different list of items by which tasks are distributed; in the case of USMLE, there is a much higher motivation to pass the exam with the highest possible result. To adapt the medical education system to such features, it is necessary: to provide students with high-quality illustrated textbooks and meaningful digital data bases for each specialized subject; to actively use images (audio, video files) from these sources during the analysis of the material and all types of control (including test ones); to establish cooperation between the fundamental and clinical departments in the process of creating test tasks, as well as the exchange of digital materials for practical classes. Of particular importance is the synchronization of methodological approaches to conducting practical classes and assessment criteria not only in theoretical but also in clinical departments, which will make the learning process more transparent and understandable. Such a set of measures will help not only to adapt students to exams at the international level, but also will increase their interest and improve the effectiveness of the educational process. The employment of digital images, audio, video files will also contribute to the adequate preparation of students for new directions in medicine, such as telemedicine and telepathology.

19-24

Authors: Savchuk R.V., Kostyev F.I., Shmatkova N.V.

The aim of this work was to study the possibility of pharmacological correction of the neobladder contractile activity of mini-pigs under the influence of new chemical compounds, m-anticholinergic (solifenacin), selective beta-2 sympathomimetic (ginipral (hexoprenaline)) in vivo. Neobladder, formed from the distal section of ileum, pre-denervated along the anti-mesenteric margin, retains peristalsis, and given the sharp thickening of the muscle layer, capable to contractile reactions and tone support. New chemical compounds pyrrole-2-carbaldehyde 2- hydroxybenzoylhydrazone (PChBh) and isatin benzoylhydrazone (IBh) demonstrated spasmodic properties directed at smooth muscle in vivo. Compound PChBh (I) showed more pronounced relaxing properties compared to compound IBh (II), reducing basal pressure against KCl by 40.91%, contraction amplitude by 30.63%, contraction rate by 25.49%. Solifenacin, being an m-anticholinergic antagonist, most clearly demonstrated antispasmodic properties in vivo, reducing hypertonicity by 55.23%, amplitude – by 49.31%, frequency of contractions in 10 minutes – by 57.40%, duration of contractions – by 18.18%. Selective beta-2-sympathomimetic hexoprenaline, previously used to relieve hypertonicity of a pregnant uterus actively affects intestinal motility. Hexoprenaline inhibited bladder overactivity with KCl, decreasing basal pressure by 58.75%, the amplitude of the contractions – by 39.62%, frequency rate – by 57.49%, reductions in the duration – by 54.55%. Preparations from the group of m-anticholinergics and selective beta-2-sympathomimetics showed a pronounced antispasmodic effect in experiment in vivo and can be used to correct incontinence in patients after orthotopic bladder repair. The new chemical compounds pyrrole-2-carbaldehyde 2-hydroxybenzoylhydrazone (PChBh) and isatin benzoylhydrazone (IBh) demonstrated antispasmodic properties in the experiment in vitro, and confirmed an antispasmodic effect in the experiment in vivo, promising further research, determining safety and efficacy.

30-35

Authors: Feshchenko Y.I., Gavrisyuk V.K., Dziublyk I.V., Dziublyk O.Ya., Gumeniuk G.L., Gumeniuk M.I., Kapitan G.B., Yachnik V.A.

To determine the prevalence and spectrum of viral pathogens in patients with infectious exacerbation (IE) of chronic obstructive pulmonary disease (COPD), 106 patients were examined, who underwent a virological examination using fast immunochromatographic tests (IC-tests), as well as real-time multiplex polymerase chain reaction (PCR) with the simultaneous identification of 12 respiratory viruses. Respiratory viruses, as the etiological factor of IE COPD were identified in (65.9 ± 4.7)% of patients. Among viral pathogens adenovirus and rhinovirus - in (24.5±6.1)% of cases each and parainfluenza virus - in (18.4±4.6)% were of greatest etiological significance for the entire observation period. The influenza A and B virus was detected much less frequently - in (8.2±3.9)% and in (4.1±2.8)% of cases, respectively; respiratory syncytial virus and bocavirus – in (6.1±3.4)% and metapneumovirus – in (8.2±3.9)% of cases. The last two types of viruses were detected in Ukraine for the first time. The spectrum of viral pathogens of IE COPD depended on the seasonal circulation of a particular type of virus, the epidemiological situation in the region, and the characteristics of the examined population. The use of modern virological diagnostic technologies testifies to the leading role of respiratory viruses in the etiology of IE COPD аnd also allows the etiological diagnosis to be established in a short period of time – from 10-15 minutes when using fast IC-tests and up to 6-8 hours – when using real-time multiplex PCR, which contributes to the timely administration of adequate etiotropic treatment.

43-50

Authors: Abaturov A.E., Babуch V.L.

The high prevalence and possibility of transformation of functional disorders into organic pathology determine the relevance of the study of the cluster of functional disorders of the gallbladder and Oddi's sphincter (FD GB and OS) in children. Studies on the properties of ursodeoxycholic acid (UDCA) to alter the activity of generation of some microRNAs in various diseases of the hepatobiliary system have become important in view of the evidential impact on this process. The alm: to determine the effect of choleretic therapy with UDCA drugs addition on the microRNA-4714-3p expression level in functional disorders of the gallbladder and Oddi's sphincter in children. 70 children with FD GB and OS aged 4 to 14 years were examined. Main group included 50 children. They received standard therapy with UDCA combination. The comparison group included 20 patients receiving standard therapy without UDCA. A molecular genetic study was conducted to determine the microRNA-4714-3p expression level in serum before and after treatment by real-time polymerase chain reaction with reverse transcription according to TaqMan Gene Expression Assays. The correlation was established between the main anamnestic data, causative factors of development, clinical and paraclinical parameters of the FD GB and OS and the microRNA-4714-3p expression level in blood serum of children before therapy. The positive relationship of the microRNA-4714-3p expression profile with decrease in gallbladder contractility was determined (r=+0.36; p<0.05). It has been determined that in children with FD GB and OS after the combined therapy with UDCA, the mean value of the microRNA-4714-3p expression level in serum is significantly lower than before therapy (1.93±0.58 SU and 5.56±1.50 SU, respectively). A positive correlation was found between the microRNA-4714-3p expression level and the alkaline phosphatase activity level in the blood of children with FD GB and OS after therapy with UDCA addition (r=+0.33; p<0.05). There was no correlation between the microRNA-4714-3p expression level and the anamnestic, clinical-paraclinical parameters in children with FD GB and OS after treatment without UDCA. The effect of UDCA on the treatment of functional disorders of the gallbladder and Oddi's sphincter in children results in a decrease in the microRNA-4714-3p expression profile and is accompanied by the emergence of a direct correlation between low level of a microRNA-4714-3p expression and reduced alkaline phosphatase activity in serum.

59-68

Authors: Burtniak T.Z., Potabasniy V.A., Fesenko V.I.

The aim of the study was to establish the relationship between tolerance to exercise, oxygen saturation, and structural and functional cardiac status in patients with hypertension in combination with COPD. This study included 120 patients with primary arterial hypertension of stage I-II, grade 1, 2, and 3 in combination with COPD of grades 2 and 3 and clinical groups A, B, C, D, consisting group 1; group 2 – 30 patients with primary hypertension, and group 3 – 30 patients with COPD; group 4 – 30 practically healthy people representative by age and sex. Research methods included general clinical examination (collection of complaints, anamnestic data) and instrumental research methods: electrocardiography (ECG), echocardiography, measurement of ambulatory blood pressure (BP) profile (ABPM), spirometry, pulsoxymetry (SpO2), 6-minutes walking test (6MWT). On examination of 120 patients with stage I-II, grade 1 hypertension was established in 19 (15.8%), grade 2 was in 83 (69.2%) and grade 3 was in 18 (15%) patients, respectively. COPD in clinical group A was diagnosed in 10 (8.3%), B – in 51 (42.5%), C – in 18 (15%) and D - in 41 (34.2%) patients, respectively. The most common was AH stage 2 with COPD in clinical group B – 35 (29.2%) cases and D – 31 (25.8%) cases. The 24-hour average systolic BP (SBP) in patients of the main group was 165 [144;178] mmHg, and the diastolic BP (DBP) was 103 [94;111] mmHg. The daytime average SBP was 160 [140;180] mmHg, and the DBP was 105 [93;117] mmHg accordingly. The night-time average SBP was 165 [155;175] mmHg, DBP – 100 [95;105] mmHg, heart rate (HR) – 83 [76;88] minutes, respiration rate (RR) – 21 [19;24] minutes. Decreases in index of chronotropic reserve (ICR) and the index of inotropic reserve (IIR) and load index indicate an increase in myocardial oxygen demand during exercise. There was an inverse correlation of IIR with SBP at rest (r= –0.42; p˂0.05) and a direct correlation with age (r=0.28; p˂0.05), which is significantly different from the control group. A direct correlation was found between the double product (DP) before and after exercise (r=0.43; p˂0.05), which indicated an increase in consumption of oxygen by the myocardium. We found a direct correlation between left atrium (LA) and the ratio of expiratory volume per 1 sec (FEV1) to the forced lung capacity (FEV) – FEV1/FVC (r=0.32; p˂0.05), which indicates the effect of the severity of bronchial obstruction on the level of left ventricular (LV) overload in patients with hypertension combined with COPD. The inverse correlation between thickness of the posterior wall of the LV (RVWT) and FEV1/FVC (r= -0.32; p˂0.05) indicates the contribution of disorders of bronchial patency and intrathoracic pressure with the level of BP to the development of concentric remodeling and LV hypertrophy. The inverse correlation between SV and COPD Assessment Test (CAT) (r= -0.32; p˂0.05) indicates an additional effect of COPD clinical severity on central hemodynamics in patients with hypertension. This relationship between the ventilatory and hemodynamic parameters is confirmed by the inverse correlation of HR and FVC (r= –0.33; p˂0.05)), left ventricular internal dimension (LVEDD) of LV and CAT (r= –0.24; p˂0.05)), stroke volume (SV) and Modified British Medical Research Questionnaire (mMRC) (r= –0.42; p.00.05), CAT and pack years (r=0.33; p˂0.05), inverse correlation between CAT and mMRC and FEV1, FVC and FEV1/FVC (r= -0.40;p˂0.05 and r= -0.45; p˂0.05), respectively. Linear regression analysis showed that changes in SV LV, LVEDD and SpO2 were dependent predictors of patient’s worsening state according to CAT (p˂0.05). The direct correlation was established between the desaturation (ΔSpO2) and ΔDP (r=0.48) and the inverse of ΔSBP (r= -0.29), 6MWT (r= -0.45), ICR (r= -0.34) and IIR (r= -0.29), which indicates a pronounced effect of hypoxemia on hemo­dynamics in patients with hypertension in combination with COPD. Comprehensive determination of cardiorespiratory reserve by 6-minute walk test, pulse oximetry and ambulatory blood pressure monitoring in patients with hypertension in combination with COPD makes it possible to establish disadaptation of the body to physical activity due to hypoxemia, decrease in the index of chrono- and inotropic reserves, which is an indication for administering appro­priate therapy. In patients with hypertension combined with COPD, the degree of desaturation, stroke volume, end-diastolic parameters of the left ventricle, maximal size and volume of the left atrium, as well as remodeling of the left heart sections in the concentric direction can be considered as independent predictors of prognosis. The 6-minute walk test with desaturation can be used as an additional method of personalizing rehabilitation measures in patients with hypertension in combination with COPD.

74-83

Authors: Dzyak L.А., Rosytska О.А.

Aim to evaluate the comorbidity profile in patients with chronic cerebral ischemia on the background of multifocal atherosclerosis. The study included 137 patients aged 40 to 84 years with chronic cerebral ischemia (CСI) on the background of multifocal atherosclerosis, which were divided into three clinical groups depending on the localization of vascular lesions by stenosing atherosclerosis. The co-morbidity profile and severity were evaluated using the Charlson’s index in modification of R.A. Deyo (1992). In CCI patients, regardless of the combination of vascular basins affected by atherosclerosis, a severe degree of comorbidity prevailed - the Charlson’s comorbidity index (IC) was predominantly > 5 points (84.7% of cases). In the analysis of IC in age categories, depending on the combination of atherosclerotic lesions of the vascular basins, it was found that comorbidity of severe degree (IC> 5) was predominantly represented by patients of the older age group (60-74 years), and comorbidity of moderate severity (IC≤5) – patients of middle age group (45-59 years). A median difference of 3 points in assessing the mean value of age-matched comorbidity index showed that age, as a non-modifiable risk factor, in 1/3 cases determines the comorbidity index, which depends on the number of vascular basins affected by atherosclerosis. In 2/3 of the cases it is a modified comorbid pathology. Assessment of IC in clinical groups, taking into account the nature of the disease course (p <0.05), showed a correlation between the number of atherosclerosis affected by vascular basins, the severity of the clinical course of CCI and the severity of comorbidity. The severity of comorbidity, as measured by the Charlson’s index modified by R.A. Deyo, depends on age and determines the nature of the atherosclerotic lesion, as well as the severity of the clinical course of CCI. Assessing the profile and severity of comorbidity makes it possible to influence the nature of the development and course of brain ischemia, which is caused by systemic atherosclerotic lesions of the vascular system.

89-93

Authors: Dytyatkovska E.M., Bendetska Yu.V., Rodkina I.A., Nedogibchenko N.А.

The article presents summarized materials on etiology, pathogenesis, classification, clinical manifestations and treatment of chronic urticuria, The management of patients with this pathology at Dniprovsky Allergological Center was analyzed. For assessment of quality of life SKINDEX-29 questionnaire was used. The questionnaire includes three sections: symptoms, emotions and functions. Physical symptoms include six points: tenderness, heartburn or tingling, itching unpleasant sensations when cotacting with water, skin irritation, sensitivity. The emotional sphere is characterized by such ten points as: concern about the condition of the skin; deppression; feeling of shame; concern that scars can remain after skin disease; feelings about worsening of the skin; anxious mood; embarrassment, feeling of humiliation; skin irritation; rejection of oneself. “Features” section has twelve items: sleep quality; work and hobbies; social activity; sex life; solitude; fatigue; unwillingness to leave home; limiting intimacy with others; complexity in carrying out daily activities; difficulty in expressing feelings; obstruction to create relationships with others; limiting close communication with relatives. Gastrointestinal system was also examined: fibrogastroduodenoscopy with determination of Helicobacter Pylori, ultrasound diagnosis of abdominal organs, the intensity of clinical symptoms was determined on a UAS7 scale. Fifteen patients (including eight women and seven men) were successfully treated with omalizumab. The mean age was 39.1 ± 3.6 years. The average duration of the disease in patients was 5.1 ± 0.9 years. The intensity of symptoms was determined before treatment after the first and second injection of Omalizumab. After the first injection, there was a positive trend. The clinical effect occurred in seventy-two hours. Statistical processing of the study results was performed using Statistica v.6.1® software. (StatSoft, USA). The inclusion of omalizumab is an effective treatment for chronic urticaria in the absence of an effect from antihistamines.

101-111

Authors: Hnenna O.M.

The coexistence of psychopathological symptoms with HIV / AIDS is associated with aggravation of their condition due to the likelihood of deviant behavior. The aim of the study – assessment of the likelihood of deviant behavior in HIV-positive patients with non-psychotic psychiatric disorders. A comprehensive clinical and psychodiagnostic examination of 114 HIV-infected patients with non-psychotic psychiatric disorders was conducted including clinical-diagnostic interviews, pathopsychological and experimental-psychological methods of investigation, including the method of Ch.D. Spielberger in modification of Yu.L. Hanin (STAI - State-Trait Anxiety Inventory) for assessing anxiety level, Beck Depression Inventory (BDI-II) for assessing depression, SCL-90-R (Symptom Checklist 90-Revised) for assessing psychiatric symptoms. Statistical processing of the results was performed using descriptive and analytical methods implemented in the software STATISTICA 6.1 (StatSoftInc., Serial No. AGAR909E415822FA). Frequency and severity of depression and anxiety in HIV-infected persons is significant and by 3.4-4 times exceeds the corresponding in­dicators of a healthy Ukrainian population. Anxiety, depression, and other psychopathological symptoms according to SCL90-R scales (except for the obsessive-compulsive scale) are more pronounced in HIV-infected patients with destructive behavior than in patients without it. The chances of developing deviant behavior in HIV-infected persons with non-psychotic psychiatric disorders are increased at GSI>1 by 20.0 times (95% CI 5.63 - 71.07), in the presence of depressive symptoms – by 6.76 times (95% CI 2.16 – 21.18) and at a high level of personal anxiety – by 4.61 times (95% CI 2.05 - 10.40). Psychopathological symptoms of people with HIV status are characterized by high rates of depression and anxiety, somatization, paranoid ideas, interpersonal sensitivity. In patients with signs of deviant behavior, the severity of these disorders and the severity index of psychopathological symptoms was significantly higher (p<0.001) compared with patients who do not have such characteristics. According to the logistic prognostic model, the chance of developing deviant behavior significantly increases with an increase in the index of overall severity of psychopathological symptomatology, with an increase in the level of depression, and a level of personal anxiety. Considering this, when providing medical assistance to HIV-infected people, their needs for psycho-correction should be taken into account in order to prevent deviant behavior.

121-133

Authors: Krasnoselskyi M.V., Hladkykh F.V., Kulinich H.V., Sevastianova V.S.

According to the National Cancer Registry of Ukraine, cervical cancer ranks second among cancer morbidity, in women of reproductive age and the first place (14.1% of all cases) in the mortality from malignant neoplasms in women aged 18-29, and in aggregate almost 1.7 thousand women die from this pathology in Ukraine annually. Radiation therapy plays a leading role in the treatment of this pathology. In turn, an increase in the survival rate after the course of combined treatment leads to an increase in the absolute number of patients with adverse effects of treatment, in particular, late radiation toxicity (LRT). A retrospective analysis of 254 case histories of patients with malignant cervical neoplasms (127 patients with late radiation toxicity and 127 patients without late radiation toxicity) was conducted. Depending on the nature of the genesis of the late radiation toxicity, it has been found that inflammatory changes occurr in 95.3% of patients (atrophic cystitis, radiation recticite, radial enterocolitis, radiation retropsychoiditis, etc.); in 32,3% – late radiation toxicity of fibrotic genesis (intrapulmonary radiation, ureter stenosis, fibrosis of the skin and subcutaneous tissue of the irradiation fields, etc.); in 25.2% – degenerative late radiation toxicity (radial ulcers, fistulas, etc.) and 30.7% – hematologic late radiation toxicity. The comparative analysis of clinical and laboratory parameters of patients before and after radiotherapy with regard to cervical cancer has shown that prognostic factors of late radiation toxicity such as increase in hematocrit and fibrinogen indices deserve attention. It has also been established that the presence of laboratory signs of a cytolytic syndrome (increased levels of aspartate aminotransferase, urea and total protein) in patients with cervical cancer prior to radiation therapy can be a prerequisite for the formation of late radiation toxicity. In addition, it has been shown that the presence of concomitant aggravating diseases of the endocrine system, blood system, musculoskeletal system, nervous system and digestive system is statistically significantly (p<0,05) increases the risk of LRT in patients with cervical cancer by 20,2; 7.0; 2.3; 1.8 and 1.6 times respectively.

145-153

Authors: Khotimska Yu., Kovach I., Buniatian Kh., Kravchenko L., Varzhapetian S.

The purpose of the study was to determine the effect of tricalcium silicate cement on the protective process of pulp in the treatment of reversible pulpitis. There was carried out an experiment on 3-month-old male rabbits to study morphofunctional changes in the pulp tissue with modeling of reversible pulpitis followed by vital amputation with coating of the pulp with tricalcium silicate (8 animals, study group) and mineral trioxide aggregate (MTA) (8 animals, comparison group). In 2 and 6 weeks dental tissues were fixed by 10% formalin solution and after decalcification and done routine procedures, histological sections were made, stained with hematoxylin and eosin. After the application of tricalcium silicate cement in 2 weeks, the odontoblast density changed to 3.92±1.03×103/mm2 from 8.3±1.02×103/mm2 of cell density in the intact group. The number of neutrophils also plays a big role in the regeneration of inflamed pulp. Thus, in 2 weeks the number of neutrophils made up 6.39±2.61x102 per 1 mm2, which is 3 times less than after mineral trioxide aggregate usage – 19.49±2.85x102 per 1 mm2. It was established that the processes of rheological disorders with impaired lymph circulation are replaced by the restoration of the cellular component. In such a way the proposed vital amputation was examined for reversible pulpitis and it revealed similar clinical and pathological effectiveness with a positive regenerative process with formation of a sufficient number of odontoblasts (7.98±1.51×103/mm2) for the subsequent formation of a hard tissue bridge, which consists of collagen fibers in the form of a frame. The main goal of vital amputation procedure is regeneration (proliferation) of the pulp with a short-term signs of alteration and exudation, which is provided by the choice of material for the pulp covering. Thus, after the vital amputation of the pulp, followed by the use of tricalcium silicate cement 6 weeks after, the number of neutrophils was 1.39±0.72x102 per 1 mm2, which is 5 times less than after using mineral trioxide aggregate.

160-176

Authors: Hryhorenko L.V., Baibakov V.M.

Purpose of the research performed by the cohort method is to study the levels of public health among children and adults living in the rural industrial area of the Zaporizhzhia region. In order to estimate primary and overall disease incidence by the separate nosological forms in children and adult population: (C00-C97), (E10-E14), (I10-I15), (I20-I25), (J95- J99), (K20-K31) retrospective research was carried out according to the ICD-10. Scientific substantiation of the research in the rural district was based on the following categories: choosing category of the adult population and children aged 0-14 years to 15-17 years, social-hygienic parameters, types of water supply systems. Investigation of the incidence was carried out according to the report of Information Health Department Centre for the period of 2008-2016 years. The main factors which influence the formation of public health are demographic indicators of different age groups, as well as indicators of dispensary supervision (the composition of health groups, the proportion of frequently ill children) on the territory of experimental observation area. In our research we tried to study these two groups of medical and social factors to understand the conditions under which health of the rural population in this industrially developed region of Ukraine is being formed. The percent of organized groups of frequently ill childrenl in the Kamensko-Dniprovskyi rural district during 2008-2016 observation period increased from 53.3% in 2008 to 68.2% in 2016, which also testifies to a negative tendency to increase in the rate of children falling ill more than 4 times during 1 year, and the low resistance of the body to acute viral infections.

182-190

Authors: Kolesnik N.S., Marchenko N.A., Stadnik A.I., Ielisieiev V.V., Stepanova T.A.

In the practical activities of a modern doctor, significant difficulties are noted in the diagnostics and proper management of patients with hereditary diseases due to the limited coverage of the population by genetic researches. For a long time, the patients with a variety of complaints are observed by doctors of various specialties, and the therapy often has little effect due to a lack of understanding of the true causes of pathological changes. The situation is complicated by case of a combined course of a hereditarily caused disease and some other disease of an infectious, non-infectious or tumor nature. The aim of the research was to study the characteristics of clinical manifestations, course of tuberculosis with resistance to anti-TB drugs in a patient with a rare hereditary disease from the group of phacomotoses - Bourneville-Pringle disease or tuberous sclerosis. This disease has a wide range of clinical manifestations, accompanied with the development of benign neoplasms in various organs and systems, damages to the skin, brain, organs of vision, lungs, kidneys, heart, as well as the musculoskeletal and endocrine system. It leads to development of various infectious and non-infectious pathologies in these organs. The article covers a 4-year period of observation of a young patient with late diagnosed tuberous sclerosis, suffering from pulmonary tuberculosis and tuberculosis of urinary system, includes the initial diagnosis of a specific disease, the course, the dynamics against received treatment and the development of relapse with the formation of resistance to anti-TB drugs. The difficulties in the management of tuberculosis in this patient were in the detection of numerous neoplasms and changes in the internal organs, in particular in the kidneys and lungs, which characterized tuberous sclerosis, on the one hand this contributed to untimely diagnosis of tuberculosis, and on the other hand – worsening the course and the progression of a specific process, as well as an unfavourable prognosis for recovery.

4-9

Authors: Usenko L.V., Krishtafor A.A., Tiutiunnyk A.H., Petrashenok Ye.V., Oleniuk D.V., Machuzhak H.A., Skulinets O.B.

The article describes an important component of the medical process which should be paid a special attention: the preparation of a young doctor – the communication between the physician and the patient and his relatives. Distinctive features of a modern patient: the tendency to control the state of his own health with simultaneous irresponsible attitude towards it; when revealing a disease, he/she is looking for the worst in himself/herself; the reduction of the moral character against the background of a decline in the morals of society, which affects the culture of the patient's behavior, makes him/her more aggressive; a modern patient is more lenient to himself/herself with an extremely demanding attitude to the doctor. Several interrelated functions of communication are distinguished: informational, interactive, perceptual, emotive (affective-commutative). The levels of communication are distinguished: social-role (ritual); business; intimate-personal. There are three types of communication: imperative; manipulative; dialogical (based on equal partnership). In the process of communication of the physician with patients, depending on the circumstances, two systems of communication can be used: verbal and nonverbal. In the relationship "patient-physician" R. Witch identifies 4 models: paternalistic, technocratic, collegian, and contractual. Each patient needs an individual approach, individual forms of communication and measures of physician’s psychotherapeutic influence, especially in the communication of the doctor with so-called “difficult” patients, as well as at the risk of conflict situations. Causes of conflict situations are: insufficient attention to the patient; characteriological features of a doctor and a patient; unreliable information about the state of health of the patient from the part of junior and middle medical personnel; lack of patient’s information consent for treatment; lack of coordination of the actions of different medical specialists; defects in the maintenance of medical records; professional incompetence.

15-21

Authors: Kuryata O., Semenov V.

Patients with chronic kidney disease (CKD) have higher than in general population all-cause and cardiovascular mortality. Arterial hypertension (HTN) is a powerful potentially modifiable risk factor that affects the majority of patients with chronic kidney disease and one of the main causes of end stage renal disease worldwide. Existing tools for assessment of risk of CKD progression do not take into account arterial hypertension. The aim – to investigate the association between cardiovascular and nephrological risk factors in patients with CKD in ambulatory practice. The study was carried out in the Center of Nephrology Care in Mechnikov Dnipropetrovsk Regional Hospital, Dnipro, Ukraine. 278 patients (114 males and 164 women, aged 41 [31;61] years) with CKD (stages 1-3) who were followed-up in ambulatory care, but required diagnosis or treatment revision were enrolled to the study. All patients were examined and followed-up according to local and European standards. Females slightly prevailed in our study, gender distribution varied insufficiently in groups by CKD progression risk. Elevation of risk of CKD progression was accompanied by rise of prevalence of diabetes mellitus, left ventricle hypertrophy, proteinuria and HTN. Risk of CKD progression correlated with age, systolic and diastolic blood pressure, erythrocyte sedimentation rate, total cholesterol, glomerular filtration rate, albumin excretion rate, duration of HTN and body mass index. Rise of cardiovascular risk was accompanied by rise of proportion of patients with high risk of CKD progression. Increase in risk of CKD progression is associated with rise of burden of cardiovascular risk factors. HTN and blood pressure values should be accounted for assessment of risk of CKD progression.

33-39

Authors: Khalimonchyk V., Klygunenko O.

Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immulogic, and metabolic alterations. Objective: to evaluate the effect of combined intraoperative use of ketamine in low subnarcotic doses and dexketoprofen on intensity of the pain syndrome and dynamics of the stress response in gynecological laparoscopic surgery. A total of 45 patients scheduled for laparoscopic gynecological surgery under total intravenous anesthesia (TIA) were examined randomly and divided into 2 groups. Demographic characteristics, anthropometric data, functional status, duration of surgery and anesthesia were similar in all groups. Group 1 (n=25) patients received total intravenous anesthesia (TIVA) with propofol and fentanyl. Group 2 (n=20) patients received TIVA with additional administration of subanesthetic doses of ketamine and a single administration of 50 mg of dexketoprofen 30 minutes before the end of the surgery. Cortisol and blood glucose levels were evaluated before induction into anesthesia, after the main stage of operation, 2 and 24 hours after surgery. The intensity of postoperative pain was evaluated by VAS in 2 and 24 hours after surgery. The intensity of postoperative pain, concentration of serum cortisol 2 hours after surgery were significantly lower (p <0.05) in patients of group 2, compared to control (p<0,05). Differences of blood glucose levels between groups at the stages of the study were not identified. Combined intraoperative use of subanesthetic doses of ketamine and dexketoprofen at the end of the surgery provides a stress-protective effect. This is confirmed by the rapid normalization of serum cortisol levels and stable blood glucose levels after surgery and is manifested by a low level of postoperative pain syndrome.

45-52

Authors: Filippova A.Yu.

High priority in the pathogenesis and treatment of non-alcoholic steatohepatitis (NASH) is given to disorders of lipid-phospholipid fractions, which are directly related to the functioning of hepatocytes. The aim of the study was to evaluate the effect of various complex treatment regimens on lipid-phospholipid fractions in patients with NASH in combination with obesity (OB) and pathology of the biliary tract (BT) according to a 6-month follow-up. 52 patients with NASH in combination with OB and BT pathology were examined. The control group consisted of 20 practically healthy individuals. The effect of complex treatment (preventive and therapeutic measures) on the indicators of lipid-phospholipid fractions in patients with NASH in combination with obesity and pathology of the biliary tract was studied. Changes in the indicators of serum lipid-phospholipid fractions were detected before treatment in all observation groups, which were accompanied by decrease in phospholipids (PL), phosphatidylcholine and sphingomyelin content and a significant increase in PL lysoforms – lysophosphatidylcholine and phosphatidylethanolamine, triglycerides, cholesterol esters (from p<0.05 to p<0.001). Combination therapy with the inclusion in the standard treatment of ursodeoxycholic acid and arginine glutamate in the comorbid course of NASH can be considered as a promising direction in the treatment of this category of patients, this allows to improve indicators of lipid-phospholipid fractions and stabilize the hepatocytes’ membrane (from p<0.05 to p<0.001).

58-66

Authors: Sirko A.G., Dzyak L.A., Pylypenko G.S., Yovenko I.O. , Skrypnik A.A.

Purpose – to ana­lyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of exa­mination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001).

74-79

Authors: Ilchenko S.I., Fialkovska A.А.

Chronic bronchitis (СB) remains one of the most pressing problems of pediatric pulmonology. This is due to the high prevalence of this disease and the possible transformation into chronic obstructive pulmonary disease (COPD) in adults. Today, there is a large number of exogenous and endogenous risk factors for developing CB in children and adolescents. However, the effect of smoking on the development, clinical course of СB and the molecular genetic basis of its formation is insufficiently studied in adolescence. The purpose of the study is to investigate the clinical features of the course and genetic risk factors for the development of CB in adolescent smokers. A comprehensive survey of 107 adolescents was performed. All patients were divided into three groups. The group 1 included 40 adolescent smokers with СВ, the group 2 – 30 adolescents with СВ who never smoked, the control group included 37 conditionally healthy adolescent smokers. The study included the collection of anamnesis, an objective examination of adolescents, and a molecular genetic investigations. For statistical processing of the results obtained, the program “Statistica 6.1” was used. The results of the study showed that smoking leads to the development of СВ in adolescence and affects its course, increasing the frequency and duration of exacerbations. An association of the 2G/2G genotype of the MMP-1 (rs1799750) gene with the risk of developing СВ in adolescent smokers was detected. At the same time, it was found that the presence of the TT genotype of the CYP1A1 (T3801C) gene can be considered as a possible factor of resistance to the development of CB in adolescent smokers. The data obtained in the course of the research will help develop measures of primary prevention and individual approaches to the rehabilitation of adolescents with СВ, which will prevent the development of COPD in the future.

87-96

Authors: Nikolenko O.O., Shulga O.D., Kozliuk V.V., Zheshko O.M., Yurko O.A., Dubinets M.I.

Exact causes of contradictions in the understanding of relapsing course as characteristic phenomenon of multiple sclerosis (MS) and primarily relapsing-remitting type are still considered to be “sub rosa”. We tried to determine connection and correlation between seasonal dynamic factors, chronometric parameters of disease progression (age, disease duration) and frequency of relapses and the role of gender differences as well. A four-year prospective study included complete registration of all cases of MS exacerbations in resident patients with a relapsing-remmiting course of the disease according to McDonald criteria in Volyn region of Ukraine in 2010. Each patient had neurological score based on EDSS scale to ensure compliance with inclusion criteria. 128 patients (44 males and 84 females) with a remitting-recurring course of the disease were involved in this study. Statistical analysis was performed using SPSS 18, MedCalc and Microsoft Excel software using standard descriptive statistics, correlation and regression analysis. In total, 197 cases of MS relapses were registered. Episodes of relapses prevailed in winter-spring period. Multiple regression model including suggested climate factors showed multiple correlation coefficient – 0.55 (p<0.01). The prevalence of MS was higher in females, while general incidence of recurrences was similar to males. However, relapse rate in different age groups differs: the rate of recurrence increases in women aged after 50 years (mean annualized relapse rate (ARR)=0.66), while it slowly decreases in men with aging. The duration of the disease did not have significant effect on the course of MS in women, whereas weak negative relationship (0.24, p<0.001) between the duration of the disease and the frequency of MS in men was showed. Correspondingly, the average negative correlation (-0.37, p<0.001) was detected between the age of disease onset and the incidence of MS recurrence in males, while this connection was not observed in females. We established that the recurrence of MS is a result of multifactorial influence of external and internal factors. Individual seasonal climate variability did not have sufficient force of influence. Therefore, combined effect of corresponding climate changes played a significant role. Furthermore, it is quite probable that interactions of MS with external factors influencing the human body can be mutually integrated.

101-105

Authors: Raznatovska O.M., Fedorec A.V., Shalmina M.O., Grekova T.A.

Objective – to update the literature data with the clinical features of pregnancy in multidrug-resistant tuberculosis (MRD-TB) and type 1 diabetes mellitus (T1DM) comorbidities based on an example from own clinical experience. A clinical case of pregnancy course in MRD-TB and T1DM comorbidities was described based on our own clinical experience. We report the clinical case of newly diagnosed MRD-TB in a 38-year-old woman suffering from T1DM. Her general condition was unstable from satisfactory to moderately severe despite an adequate treatment of MRD-TB and T1DM with manifestations of intoxication syndrome and nephropathy. Adenomyosis with periodic bloody vaginal discharge was diagnosed. There was no clinical-radiological dynamics and sputum culture conversion. After an intensive phase of antimycobacterial therapy within 3 months, the patient got pregnant. Based on the medical indications (MRD-TB, absence of sputum culture conversion and clinical-radiological dynamics, moderate severity of T1DM, nephropathy) and adenomyosis with bloody vaginal discharge, the patient was requested to induce the pregnancy termination, and she consented. On month 7 of antimycobacterial therapy, an extensive drug-resistance of Mycobacterium tuberculosis to antimycobacterial agents and negative dynamics by follow-up chest X-ray were diagnosed. The feature of pregnancy course in MRD-TB and T1DM comorbidities was an unfavorable coexistence of both these diseases simultaneously resulting in an induced abortion. In this case, doctors to working with patients suffering from both MRD-TB and T1DM are recommended to advise patients the use of contraception in order to prevent pregnancy during treatment of active MRD-TB.

113-122

Authors: Lekhan V.M., Kriachkova L.V.

In the modern world, the use of the global burden of diseases and the quantitative assessment of the factors leading to the loss of a healthy life provides fundamental evidence for the development of an adequate public health policy. The purpose of the study is to substantiate the system of measures on improvement of the health of the population of Ukraine on the basis of an in-depth analysis of the global burden of diseases and injuries and associated risks. The study used materials from the Institute of Health Metrics and Evaluation of the University of Washington, Human Development Network of the World Bank and the «Disease Burden Unit» of the World Health Organization, collected during 1990-2017 years. The bibliosemantic, historical, epidemiological, conceptual modeling methods and benchmarking were used in the course of study. The loss rate of age-standardized disability-adjusted life year (DALY) in Ukraine in the period between 1990-2017 practically unchanged and in 2017 it was 34 975.04 DALYs per 100 000, which is almost a quarter more than in the countries of Eastern Europe and twice as much as in the countries of Western Europe. In the structure of Global diseases burden in Ukraine, 3/4 falls on non-communicable diseases, about 15 % depend on external causes and less than 1/10 – on infectious and other diseases and conditions. Shares of the disease burden associated with specific risk factors and diseases related to the relevant factor were identified. The evidence-based system of measures is aimed at achieving goals to reduce the global burden of disease and the risk factors affecting it, being based on an inter-sectoral approach and combines population and individual risk strategies. The subjects of the system are parliament, central and local governments / communities, private campaigns, the media, public health structures and primary health care.

4-9

Authors: Pyatchanyna T., Ogorodnyk A., Melnik-Melnikov P.

Patent research in the field of biomedical sciences (BMS) allows to give an objective assessment of the novelty and technical and economic level of the developed object of economic activity, to identify the most promising objects of economic activity, to identify competitive trends in the analyzed industry, to use the best achievements of world science, in the course of scientific research (SR), timely protect own technological and technological solutions with patents in Ukraine and abroad. The purpose of the article is to optimize methodological approaches to conducting patent research in the field of biomedical sciences on the basis of analysis of patent and scientific and technical databases. The fulfillment of the patent researches requires the use of compulsory methodological approaches, which are developed on the basis of DSTU 3575-97 "Patent Research: Key Provisions and Procedure". At each stage of the implementation of the SR, the algorithm for the patent researches, which must be followed in order to ensure the perspective of the development of object of economic activity, its legal protection, and competitiveness has been developed. The methodical approaches to conducting the patent researches in the field of BMS are determined on the basis of analysis of patent and scientific and technical databases, which allow to reveal competitive directions in the field of BMS, identify the most promising ones, give an objective assessment of novelty and technical and economic efficiency of SR; to use the most outstanding achievements of the world science during SR; timely protect own technical and technological decisions by patents in Ukraine and abroad.

13-19

Authors: Poslavska О.V., Shponka I.S., Babiy H.S.

Carcinomas with an unknown primary site are a heterogeneous group of metastatic tumors, numbering from 3% to 5% of all malignant carcinoma phenotypes. An isolated lesion of the inguinal lymph nodes is relevantly associated with primary localization of tumors in the pelvis, anal canal, lower abdomen, lower limbs, and more towards in the reproductive system (vulva, vagina and cervix for women, penis for men). But in the absence of clinical signs of cancer after careful research, the histological biopsy of the lymph node with additional immunohistochemical staining with organ-specific markers becomes the diagnostic method of choice. A retrospective analysis of the histological, morphometric and immunohistological characteristics of the biopsy material of 59 patients with isolated lesions of the inguinal lymph nodes (35 women and 24 men) aged from 20 to 87 years (mean 59.26±15.86; median 62 years) was conducted. The distribution of variants of an isolated lesion of the inguinal lymph nodes in women showed 14 of 35 (40.00%) metastatic tumors (the other 21 are lymphoproliferative conditions that require phenotyping, but not finding the primary localization). Of 14 metastatic lesions in women, 6 cases demonstrated a p16ink (+) phenotype. For comparison, of 24 cases in men, only 6 (25.00%) were of metastatic origin, of which p16ink (+/-) was partially 1 metastasis of melanoma (16.67%). After a thorough immunohistochemical study with a panel of organo-specific markers among isolated metastatic lesions of the inguinal lymph nodes of tumors in women, half of the revealed localized sites (7 out of 14) were in reproductive organs, namely: 4 p16ink (+) to squamous cervical cancers, 2 p16ink (+) to serous ovarian adenocarcinoma, 1 p16ink (-) to leiomyosarcoma of the uterus. Other localizations did not have a clear location, as they related to metastases of carcinoma from Merkel cells and melanomas, as a result of frequent reduction of the primary tumor lesion in the skin.

24-33

Authors: Surkov D.

The negative impacts of standard pharmacologic sedative agents suggest that alternative agents should be investigated. Dexmedetomidine could be the new option for sedation in newborns with hypoxic-ischemic encephalopathy requiring mechanical ventilation. The aim – to determine the impact of dexmedetomidine and other sedatives on the cerebral blood flow and outcomes of hypoxic-ischemic encephalopathy in term neonates. Data of 205 term infants with hypoxic-ischemic encephalopathy by Sarnat scale stage II-III were collected during ≤72 hours of life. The infants were divided using a simple open randomization by pharmacological sedative agents during mechanical ventilation into dexmedetomidine group (n=46) and the control group (n=159), which included morphine, sodium oxybutyrate, and diazepam in standard recommended doses. A comparative analysis of the effect of dexmedetomidine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. A significant difference between groups in days of trachea extubation (p=0.022) was found; the chance for babies to be extubated before the 7th day of treatment was significantly higher in the dexmedetomidine group 68% versus 33% in the control group (p=0.018) with HR 0.48 (95% CI 0.27-0.86, p=0.011). Also, the NIRS index rScO2 differed significantly between the studied and control groups on the 1st day of treatment (65% versus 79%, p=0.012) and on the 2nd day of treatment (74% versus 81%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group – (58 [51-65] mm Hg versus 53 [46-60] mm Hg, p<0.001), with a lower dose of dobutamine (EV -1.87, 95% CI from -3.25 to -0.48, p=0.009). In the dexmedetomidine group, the rate of seizures was significantly lower on the 1st day of obser­vation (4.3% versus 48.3%, p <0.001); the incidence of unfavorable outcome sueh as cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared to the control group (2.2% versus 15.1%, p=0.018). Dexme­detomidine is a safe sedative agent with a stable hemodynamic profile, without adverse influence on cerebral perfusion and possible neuroprotective effects in term infants with HIE, as addition to standard therapeutic hypothermia.

40-45

Authors: Arkhipkina O.L.

Nowadays, the problem of comorbid chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) is considered from the point of view of the presence of common risk factors and pathogenetic mechanisms. The aim of the study was to investigate cardiorespiratory system function in patients with COPD and AH and to analyze the main cardiovascular risk factors. 284 patients with COPD were divided into 2 groups: the main group - 167 patients with COPD and concomitant hypertension, the comparison group - 117 patients with COPD and normal blood pressure values. An analysis of the clinical picture of COPD revealed that patients with AH more often had exacerbation of underlying disease, more expressed clinical manifestations of the disease, differed in phenotypic distribution of patients. All patients with COPD showed a tendency to increase in arterial pressure, blood glucose level and total cholesterol compared with the control group with enhanced tendency in hypertensive patients. In addition, in hypertensive group the patients had a higher body mass index and smoked intensively. According to EGC data, the majority of patients with COPD experienced tachycardia, arrhythmia and conduction disturbances, hypertrophy of ventricules, which occurred more often in hypertensive patients. Pulmonary function was characterized both by obstructive and restrictive changes that were more expressed in the comorbidity. Thus, in the presence of AH the clinical manifestations of COPD varied, demonstrating the contribution of vascular pathology to the respiratory disorders in those patients. The combined course of COPD with AH is characterized by a modification of clinical manifestations of the disease and COPD was associated with increased cardiovascular risk in patients examined.

52-58

Authors: Zhabchenko I.A., Korniets N.G., Tertychna-Telyuk S.V.

Harmonious and stable psycho-emotional state of pregnant women is an important condition of successful pregnancy course, fetal development and physiological childbirth. People are facing various problems related to mental health that vary from psycho-emotional stress to the mental disorders. Important factors that determine the physiology of pregnancy are the psycho-emotional state of the pregnant and fetoplacental complex. Among the consequences of severe stress during pregnancy is dizziness, tachycardia, trembling of limbs, elevated arterial pressure, unmotivated increase in nervousness and anxiety, sleep disorder, depression that lead to worsening of general condition of a future mother. The purpose of the study was to determine changes in the production of placental hormones and stress-associated hormones in pregnant women - displaced persons. To carry out the study, a randomised dynamic prospective clinical-paraclinical examination of 96 pregnant women (the main group) - displaced persons and 39 pregnant women (control group), who lived permanently in the territory of Ukraine under control, with gestation period after 22 weeks was used. Concentration of stress-associated (cortisol and prolactin) and placental (estradiol, progesterone, placental lactogen) hormones in serum was determined by solid-phase immunoassay. Increased estradiol concentrations and relative reductions in progesterone and placental lactogen, displacement of estrogen-progesterone equilibrium toward relative hyperestrogeny, increase in the concentration of stress-associated hormones were observed. The revealed hormonal and metabolic disorders in pregnant women, internally displaced persons, are biochemical markers of placental dysfunction, which testifies to the expediency of a comprehensive preconceptional preparation with the involvement of a psychologist and inclusion of preventive measures in the form of long-term progesterone support during pregnancy in the program of antenatal observation of such women.

65-72

Authors: Krotova V.Yu.

By the WHO data, Ukraine is country number 1 in Europe and number 2 in the world according to the cardiovascular mortality rate. In the structure of the prevalence of cardiovascular diseases in Ukraine, the percentage of persons of working age with arterial hypertension is 36.7%. The improvement of the prognosis of patients with arterial hypertension depends not only on long-term effective control of blood pressure, but the diagnosis and initiation of therapy at the initial stage of the development of the disease, when the target organs have not yet undergone hypertensive damage is also an important condition. The article presents the results of neuropsychological examination of 509 outpatients with a controlled second stage arterial hypertension, with an integrated assessment of cognitive functions using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MCA) methods. It has been established that even in patients with controlled arterial hypertension stage II with a low cardiovascular risk, by SCORE scale cognitive disorders were revealed in 32,2%. The peculiarities of the development of cognitive disorders in arterial hypertension in connection with the history and course of the disease are analyzed. The majority of patients with hypertension have an increased level of anxiety, especially personality, and this is not due to the presence or absence of cognitive disorders. In patients with hypertension and cognitive disorders, on the basis of testing data by the SF-36 scale, there was a significant (p<0.001) decrease in quality of life on all scales as compared with healthy ones on average by 24.5-66.0 points.

83-86

Authors: Yuryeva L., Shusterman T., Varshavskyi Ya., Malyshko V.

The article des­cribes the clinical case of obsessive-compulsive disorder in an adult patient with Gilles de la Tourette syndrome and severe behavioral disorders. The authors demonstrated the comorbidity of Gilles de la Tourette syndrome and obsessive-compulsive disorder. Obsessive thoughts and compulsive actions were diagnosed as the most frequent behavioral disorders in Tourette syndrome. It was indicated on gender as an additional sanctioning factor for the early onset of mental disorders. Obsessive-compulsive disorder in the patient was characterized by mixed obsessive thoughts and actions, had a protracted nature, with prolonged decompensations requiring treatment in a psychiatric hospital. Emotional instability, impulsivity, obsessions and compulsions affecting the social functioning of not only the patient himself, but also those around him, as well as pronounced behavioral disturbances led to social malajustment. When treating the patient, the doctors had to resort to a combination of typical neuroleptics with second-generation antipsychotics, mood stabilizers and antidepressants due to the poor response to pharmacotherapy. Comorbidity of mental disorders determined the complexity of therapeutic measures with the use of psychotherapeutic interventions, which made it possible to achieve an improvement in the mental state and avoid disability of the patient.