Medical perspectives (Medicni perspektivi)

15-20

Authors: Кhaniukov O., Kozlov S., Yehudina Y., Sapozhnychenko L., Kozlova Yu., Somilo O.

Introduction and purpose of the study: high require­ments for graduates of higher medical establishments facilitate the search, implementation and improvement of modern teaching methods in order to optimize the development of clinical thinking in medical students. In the the course of the work, a big volume of information was used, which was worked out using such methods as historical and literary synthesis, structural and logical analysis, abstract thinking and personal experience taking into account the principles of systemic approach and analysis. To improve the quality of medical students' training it is necessary to use the innovative teaching methods. Presence of the personal clinical archive, with allow to use archival material in the training process (for example, to use case-method), in the analysis of a clinical case and the use of data in the scientific work. The article presents an example of a clinical problem and emphasizes the importance of the case-method in teaching students in higher educational institutions. Formation of clinical thinking takes place over the course of direct work with the patient, with an independent attempt to resolve a specific clinical situation in real conditions. Case method allows to reveal and form the necessary personal qualities and abilities of medical students, necessary for the further work. Modern methods and means of information technology must be purposefully implemented into clinical practice and educational process for the development of professional skills, formation of clinical thinking, ac­cumulation of clinical experience.

31-34

Authors: Semyonova L.S., Klimenko I.N.

This article shows the importance of studying history of medicine and importance of language training as an essential component of broadening of universal cultural and medical outlook of prospective doctors, upbringing of high moral ethical qualities inherent to a contemporary doctor. The authors of the article propose measure on improving teaching of these disciplines.

40-45

Authors: Poslavska О.V.

Merkel cell carcinoma (MCC) is a rare malignant primary skin neoplasia with epithelial and neuroectodermal differentiation. The problem of MCC, which determines the relevance of its research, is often a high frequency of local recurrence, regional lymph node metastasis and further hematogenous and/or distant lymphogenous dissemination. Materials and methods. A retrospective analysis of the biopsy material of 6 patients with isolated MCC metastasis aged from 29 to 82 years (average 63.11 ± 16.24; median 62.5) was carried out. For the control group, 9 cases of postoperative material of primary skin tumors with MCC of patients aged from 27 to 76 years (average 52.17 ± 12.72; median 53.5) were selected to determine the differential diagnostic criteria. The results of the study. Carcinomas without primary localization may be interpreted as MCC if they demonstrate phenotype Cytokeratin, Pan AE1/AE3 (paranuclearly +) / CK20 (paranuclearly +) / Vimentin (-) / CD45 (-) / S100 (-) / Chromogranin A (+) / Synaptophysin (+), with morphometric parameters of the area and perimeter, which is 2 times the size of ordinary lymphocytes, (all p>0.05). Findings. Metastatic CMC without primary localization, in comparison with locally spreading, often exhibit low-differentiated small-cell and transitional forms, which require additional immunohistochemical study to exclude carcinomas of other origin.

50-61

Authors: Idashkina N.G.

Objective – to evaluate the etiological significance of local and general factors in the occurrence of delayed union of bone tissue in patients with mandibular fractures. a personalized questionnaire was developed and filled by 74 patients with fragments mobility that persisted 1 month after reposition and fixation of the mandibular fractures for determination the role of local and general factors in the occurrence of delayed union. Thus, local and general factors that most closely correlate with the development of this complication were identified. The obtained data were compared with the results of a retrospective analysis of case histories of patients with mandibular fractures over a five-year period. The presence of a general somatic pathology, head injury and polytrauma, as well as such aggravating factors as alcohol and drug abuse should be considered as the general risk factors for the development of the delayed union of mandibular fractures. Among local factors, inflammation in the area of mandibular fractures takes the first place, the development of which is provoked by untimely treatment of patients, comminuted fractures, traumatic surgical interventions, etc. Among patients with delayed union of mandibular fractures, 86.5% received antibiotics for more than ten days. The risk group should also include patients with mandibular fractures of a young age (from 18 to 25 years) and those over 45 years. The problem areas for consolidation are mental section (31.1%) and the angle of the jaw (25.7%).

66-72

Authors: Rubtsov R.V.

The aim of the research is to study the peculiarities of changes in the chest on survey radiograph at pneumoconiosis associated with COPD in workers of mine and metallurgical industry. The data of clinical examination of 635 workers with lung pathology of occupational genesis are presented in the article. Group I consisted of 99 workers with pneumoconiosis associated with COPD, II group – of 21 workers with pneumoconiosis, and III group – of 515 workers with COPD of occupational etiology. A comparative analysis of radiographic changes in the chest X-ray has established that the most informative radiologic changes for pneumoconiosis associated with COPD are: linear reticular obscuration up to 1.5 mm in size, cord obscuration from 1.5 to 3.0 mm in size, and less significant changes in the form of nodules size up to 1.5 mm, from 1.5 to 3.0 mm, the thickening of pleura more than 10.0 mm wide. The most sensitive radiographic signs typical for PC associated with COPD are the indicated obscurations and nodules, their etiological share in diagnosis of this disease is 100%, determining the greatest absolute risk of development of this occupational pathology in this category of patients. The revealed X-ray diagnostic criteria allow to conduct timely diagnostics, define the tactics of treatment and prevention of PC associated with COPD in workers of mining and metallurgical industry.

80-86

Authors: Khomenko I.M., Zakladna N.V.

The relevance of the work is determined by the absence of documents on the problems of observation zones of nuclear power plants, including the organization and monitoring of environmental objects in Ukraine. The purpose of the study was to assess the state of radioactive contamination of the environmental objects of the observation zone of the Zaporizhzhia nuclear power plant. To accomplish the tasks, we analyzed the data of the laboratory control performed by the external radiation monitoring laboratory of the Zaporizhzhia nuclear power plant and the data of the State Institution «Zaporizhzhia Regional Laboratory Center of the Ministry of Health of Ukraine». The obtained results allow us to draw the conclusions that in the environmental objects (water of the Kakhovsky reservoir, atmospheric air, soil, drinking water) of the observation zone of the Zaporizhzhia nuclear power plant, the main dose-forming radionuclides were identified. It is established that their levels are not uniform, and the identified instability indicates the need for continuous laboratory monitoring of the content of cesium and strontium and the need to monitor the impact on health of the residents of the observation area. It is necessary to improve radiation monitoring through the development and implementation of new methodological documents and regulations on the organization of laboratory control, justification of its frequency and the required amount of laboratory research, which will allow to establish the true impact on public health in these areas.

94-100

Authors: Yeroshkina T.V., Derevyanko D.V.

The purpose of the study is to analyze the activity of the laboratory service of the Dnepropetrovsk region, to develop and substantiate the concept of optimizing its work. We have carried out in dynamics the analysis of the laboratory service of the Dnepropetrovsk region: its structure; staffing level of doctor-laboratory assistants, biologists and laboratory assistants; carrying out laboratory researches, their structure and quality, as well as the state of laboratory equipment and reagent base. The methods of research used: bibliosemantic – systematic and historical analysis of domestic and world literary sources on the organization of laboratory service; reports and legislative documents on the activities of the laboratory service of the region; systematic analysis – to identify the existing shortcomings and positive experience in the training system, the formation of an effective team of employees, quality of the provided laboratory services, ways to optimize the work of the clinical-diagnostic laboratories (CDL); medical statistics for the analysis and interpretation of research results, logical mode­ling – for the development of the concept. The article covers the state of the laboratory service of the region: changes of its structure due to restructuring of the treatment-prophylactic institutions (TPI), the reforming of primary medical-sanitary care; development of family medicine – the number of hospital decreased by 39,8% in 2017 as compared to 1995, the number of hospital – by 38% beds per 10 thousand population; At the same time, the number of outpatient cl­inics increased by 70,1% during this period, which is in line with the WHO recommendations for provision of out­patient care to 80% of patients. Coefficient of provision of population of the region with doctor-laboratory assistants per 10 thousand of population is 0,68; staffing level of doctor-laboratory assistants with of medical doctors by natural persons is 25,9% with tendencies to decrease. The staffing level of specialists with higher non-medical education is 63.6%. Clinical and diagnostic laboratories in most cases have a minimum of equipment that is often outdated, without means for automatization equipment. Problems of the laboratory service of the region consist in the presence of a large number of low-power CDLs, performing the minimum set of diagnostic tests, lack of programs of research in the framework of separate nosological forms of diseases at different stages of medical care provision, acute shortage of high-tech equipment; lack of a systematic approach; the high turnover of personnel due to unsatisfactory material and technical and economic condition of the service and low wages. The main ways of optimization of laboratory services are offered.

11-15

Authors: Koldunov V.V., Klopotskyi G.A., Kozlova Ju.V., Kaniuka G.S., Starushkevych G.F.

The article presents the results of the individual psychophysiological features analysis of the 3-d course students of the Dentistry Faculty, who have completed studying pathological physiology. The obtained data were compared with the results of the complex exam and the results of the licensing exam STEP-1. As a result, it was found that the psychophysiological indicators of students affect on learning performance. The main psychological differences between successful and unsuccessful students are in the intellectual and emotional-will spheres. Therefore, conducting psychophysiological testing among students and familiarizing them with the results obtained makes it possible for future doctors to take into account their personal and psychophysiological characteristics not only during the training period, but also in their professional activities. Such information, on the one hand, may induce many students to work on themselves, and on the other - not to fall into illusions. Further research in this direction and carrying out correlations of the obtained results will allow to find and eliminate the causes of unsatisfactory students’ studying. Work in this direction will contribute to the development of fundamentally new teaching methods in accordance with the requirements of time and scientific-technical progress.

20-30

Authors: Shapovalenko I.S.

The purpose of the work is to determine the characteristics of prescription, adherence to treatment and the effect of certain classes of drugs used for the treatment of cardiovascular diseases on the life expectancy of elderly patients with ischemic heart disease (IHD). 517 case histories of patients aged 60-87 (–91) years old, born in 1925-1957 with IHD were analyzed. All the examined were first hospitalized in the hospital and later were observed with the main diagnosis of coronary artery disease: stable exertional angina I-IV FC. Further observation of the patients lasted from 3 to 25 years (average observation period 10 years), until reaching the endpoint or until the last observation in 2017. The patient’s death was chosen as the endpoint, on the basis of which the life expectancy index (determined by the year / age of death) was studied. It has been shown, that therapeutic regimens for the elderly patients with coronary artery disease meet current standards for the treatment of coronary artery disease at the stages of 1990, 2010 and 2017. Patients' adherence to therapy was 82.4%. According to the data obtained, the association of taking certain classes of drugs with the life expectancy of patients was: ACE inhibitors increase life expectancy by 7 years, acetylsalicylic acid (ASA) - by 4 years, statins and β-blockers - by 2 years. The most effective combinations for treating people with IHD that affect life expectancy are: combinations of ASC, statins and ACE inhibitors - survival up to 80.14±3.16 years, ASA, statins and Ca-channel blockers - survival up to 80±1.71 years, ASC, statins and β-blockers - survival to 79.3±4.24 years, ASA and ACE inhibitors - survival to 79.59±3.83 years.

40-51

Authors: Khaniukov O.O., Yehudina Ye.D., Kalashnykova O.S.

Pulmonary arterial hypertension (PAH) is a serious condi­tion caused by the damage of the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic sclerodermia (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy are observed in these groups, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials.

59-63

Authors: Kutovoy A., Klishyn A., Kosulnikov S., Kravchenko K., Tarnopolskiy S.

The paper presents the results of diagnosis and treatment of patients with liver abscesses. In the surgery of Dnipropetrovsk Regional Hospital named after І.І. Mechnikov 183 patients diagnosed with liver abscess aged 18 to 81 years were treated. In 118 (64.5%) patients the period from the first complaints to the diagnosis was up to 1 month, in 48 (26,2%) from 1 to 3 months, in 15 (8,2%) from 3 to 6 months, in 2 (1.1%) from 6 to 12. To diagnose abscesses of the liver ultrasound of abdominal cavity, computer tomography, laparoscopy were used. Treatment of liver abscesses included both conservative therapy and surgical intervention. Only 14 (7.6%) patients received conservative treatment. Surgical treatment included minimally invasive interventions under U.S. control, laparoscopic, open drainage and resection techniques. The method of choice of surgical treatment for patients with uncomplicated liver abscesses with a diameter of 3 cm or more was echocontrolled peritoneal pelvic drainage, performed in 146 (79.8%) patients. Complications of surgical treatment were found in 15 (8.2%) cases: drainage dislocation – in 12 (6.6%) patients, purulent fistula – in 1 (0.5%), intestinal obstruction – in 1 (0.5%), peritonitis – in 1 (0.5%).

68-74

Authors: Grek L.Р.

The aim of our study was to create a pathogenetically determined systemic approach to improve the treatment and the psycho-emotional state of a woman with chronic pelvic pain and inflammatory diseases of the pelvic organs through the individualization of therapeutic and rehabilitation tactics on the basis of the study of immune-hormonal relations, and psychopersonal characteristics of thematic patients. A comparative evaluation of the cytokine (IL-10, IL-6, TNF-α) and hormonal profile (luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, progesterone, prolactin, cortisol) was carried out as well as; monitoring of pain and psycho-emotional disorders of the dynamics of observation. In the dynamics of observation after the treatment for 6 months it was noted: a decrease in the pro-inflammatory activity of the cytokine profile: IL-6 by 43.28%, TNF-α by 63.27%; recovery of hormonal ratios – in 76% of women; 88% of patients identified a significant improvement in general and psychoemotional state; reduction of reactive anxiety and depressive disorders to normal values was determined in 84% of patients; regression of pain syndrome to the minimum indices according to the VAS scale was determined in 96% of patients. This demonstrates the effectiveness of personalized therapy and the possibility of expanding the therapeutic - diagnostic algorithm in patients with chronic pelvic pain.

81-87

Authors: Yalovenko M.I., Khaniukov O.O.

More than 30% of the world's population suffer from arterial hypertension (AH). AH is one of the important cardiovascular risk factors. AH is associated with a 1.5-fold increase in the risk of atrial fibrillation (AF). AF is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, in consideration of the broad range of its negative consequences not only due to significant deterioration in the quality of the patients’ life but also due to related significant increase in the incidence of serious complications and death. Objective: to study the features of the AH clinical course, the nature of the target organs lesion in patients with ischemic heart disease with and without permanent form of atrial fibrillation. The study included 78 patients, average age was 66,3±1,0, men – 43 (55,1%). Patients were divided into 2 groups: group 1 (n=42) consisted of patients with AH, IHD and permanent AF; group 2 (n=36) included patients with AH and IHD without heart rhythm disturbances. The analysis of the frequency of lesions of target organs in groups 1 and 2 showed that the III degree of hypertension was detected in 25 (59,5%) patients in group 1 and in 8 (22,2%) patients in group 2. Degree III was diagnosed in 17 (40,5%) and 24 (66,6%) patients of 1-st and 2-nd groups, respectively. Absence of targets organ damage in group 2 was documented in 4 (11,1%) patients. AF presence is associated with a severe course of hypertension and more frequent lesion of target organs. Based on the research results, it was established a direct relation between the duration of AH and the duration of the permanent form of AF. It is expedient for patients with AF arisen against the background of AH to achieve target levels of BP for prevention disease progression and improving the prognosis.

95-100

Authors: Bogachova O.S., Korobchanskiy V.O.

Modern ideas about the role of psycho-physiological functions in the formation of personality indicate that the prognostic value of the main properties of the central nervous system (CNS) is the physiological basis of the formal-dynamic side of the behavior of each individual person. Against the background of inconsistencies of psycho-physiological functions with professionally significant requirements, pre-pathological conditions associated with impaired psycho-physiological adaptation of adolescents arise, which affects the functional state of their body, and, above all, has negative consequences in relation to the central nervous system. The purpose of the study is to identify and correct the development of donosological mental states in order to prevent possible disorders in students of professional agrarian lyceum (PAL) using a computer program on determining the leading professionally significant functions by the "Test program of professional suitability for agrarian professions "Agrotest"”. 100 students aged 15-18 studying agrarian specialties at the Odnorobovsky Professional Agrarian Lyceum were under supervision. We divided them into 3 groups. The study was conducted using our developed computer program "Test program of professional suitability for agrarian professions «Agrotest» and "psycho diagnostic questionnaire for high school pupils”. The students who mastered agrarian specialties at PAL suffered from the disturbance in the process of psychophysiological adaptation, this directly affects their functional state by the development of fatigue in the 2-nd year of study, resulting in a high percentage of donosological pathology in this group of students with significant increase in the 3-rd course of study (p <0.05). It has been established that the propagation of donosological mental states in students of professional agrarian lyceum (PAL) affects the background disorders of the functional state of the central nervous system, which requires immediate introduction of psychohygienic measures.

13-20

Authors: Abdulrahman Ali Hattan, Essa Ali Hattan, Abdulaziz Maree Alqahtani, Omar Saud Alqutaym, Refdan Obeid Alqahtani, Khaled Ghormallah Alzahrani, Abdulrahman Abdullah Al-Otaibi, Omar Mufi Aldwsari, Khalid Mansour Alkhathlan, Mohammed Abdullah Aldossari

Oral microbiota is a vital part of human microbiota, including bacterial, protozoa, viral and fungal species. Beneficial microbes form biofilms to form a first-line defense against harmful microorganisms. Tobacco smoking is considered a major environmental factor affecting the orodental microbiota. Smokers harbor more pathogenic microbes than non-smokers. In fact, cigarette smoking exposes the oral cavity to a large number of toxicants, perturbing the oral microbial ecology through various mechanisms. In Saudi Arabia, research on the impact of tobacco smoking on oral microbiota is still lacking. Therefore, this case-control study is an important addition to the literature in terms of tobacco use and its effects on oral microbiota and oral hygiene. 130 men were recruited for this study, including 65 smokers and 65 non-smokers. The following parameters were recorded for all 130 participants – age, weight, height and education. The aim of this study was to investigate and compare the effect of tobacco smoking on the oral microbiome of smokers and non-smokers. The majority of the smokers were young adults between the ages of 21 and 30 inclusive (n=27). The results show that excessive microorganism growth was seen in smokers to a greater degree than non-smokers (38.5% of smokers vs. 8.8% of non-smokers). Not surprisingly, a significant majority (85.3%) of non-smokers had moderate microorganism growth compared to only 53.8% of smokers. cigarette smoking facilitates excessive growth of oral microorganisms, predisposing smokers to various periodontal diseases. In fact, smoking perturbs the balance of oral microbiota, producing a viable environment for microbes to cause diseases. Further large scale prospective studies are required to determine the exact mechanism that causes tobacco to affect oral microbiota.

27-35

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

Patients with isolated abdominal carcinomatosis are traditionally treated similarly to patients with ovarian cancer stage III/IV. Despite histological, molecular and clinical similarities, this approach leaves no room for studying the individual biology of this phenotype of cancer of unknown primary localization. In addition, some metastases of gastrointestinal, pancreatic-biliary or endometrial adenocarcinomas simulate the histological and/or immunohistochemical (IHC) characteristics of primary ovarian adenocarcinomas. Over the past three decades, understanding the biology and pathways of intra-abdominal dissemination of tumors, taking into account the protective function of the peritoneal barrier against further tumor spreading, has led many researchers to consider the concept of peritoneal carcinomatosis as a locoregional disease. In the absence of other systemic metastases, new multimodal approaches combining aggressive cytoreductive surgery, intraperitoneal hyperthermia chemotherapy, and systemic chemotherapy are considered promising for improving disease control and increasing survival. Materials and methods. A retrospective analysis of clinical data, histological and IHC characteristics of biopsy material of 24 women with isolated abdominal carcinomatosis at the age of 28 to 81 years (mean 56.29±14.68, median 58.5) and 46 cases of primary ovarian tumors of women at the age of 27 to 76 years (mean 52.17±12.72, median 53.5), was performed to determine differential diagnostic criteria. IHC profile of primary ovarian tumors determined the most specific markers of cytokeratin C7 and CA125 (mucin 16), which in 43 out of 46 (93.48%) and 37 of 46 (80.43%) were respectively positive at least partially. It should be noted that 1 undifferentiated carcinoma was negative for both markers, only for SC7-2 mucinous adenocarcinomas and 1 low-grade, but only for CA125-2 endometrioid, 2 light-celled, 1 undifferentiated carcinoma and 4 low-grade adenocarcinomas (the latter were regarded as primary in exclusion of other localizations on the basis of a complete survey). Receptors to estrogens were determined in 14 of 46 (30.43%) of observations, which indicates their prognostic, and not diagnostic significance. In the group of women with isolated carcinomatosis of the abdominal cavity, SK7 was identified in 21 of 24 (87.5%) observations, CA125 in 16 of 24 (66.67%), all of whom had SC7 immunoreactivity, but only 9 of them demonstrated the presence of estrogen receptors, and 6 – serous phenotype (WT-1+), and 1 – mesothelioma (CK7 +, calretinin +). It should be noted that CA125-partially positive tumor patterns were often mixed with undifferentiated and nopapillary tumor deposits. These women were older than of the entire subgroup (mean 61.4 ± 10.08, median 61), but without significant difference (p>0.05). Conclusions. Only 2/3 of the investigated cases of carcinomatosis without primary localization in women after IHC research can be convincingly attributed to ovarian metastases for the application of appropriate therapy. Other 33.33% percent in our study were divided into 1 - neuroendocrine cancer (Chromogranin +, Synaptophysin +), 3 - colorectal (CK20 + CDX2 +), 2 - moderately and 1 - low-grade carcinomas with doubtful immunophenotypes (CK20+/-CDX2-/+CK7-/+Vimentin -/+), as well as 1 mesothelioma.

41-46

Authors: Kapustnyk V.A., Kostyuk I.F., Melenevych A.Ya.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease. The prevalence of COPD continues to increase steadily. 90% of patients with COPD have at least one comorbid pathology. Among concomitant COPD diseases pathologies of the cardiovascular system prevail. The variety of the disease course in patients is the basis for distinguishing COPD patients with similar pathophysiological mechanisms based on analysis of biomarkers. The aim of the study was to analyze the dependence of cytokinemia (interleukin-18 and interleukin-10) on the clinical course of the disease in patients with COPD in combination with hypertension (HT). In total, 100 occupational COPD (GOLD 2, group B) patients in remission were monitored. The main group included 69 patients with COPD in combination with HT stage II, the comparison group - 31 patients with isolated COPD, and the control group - 20 healthy volunteers. All groups were comparable by sex and age. Levels of interleukin-18 (IL-18) and interleukin-10 (IL-10) were significantly higher in COPD patients combined with HT compared to healthy volunteers and isolated COPD. Growth of IL-18/IL-10 ratio is associated with increase in the degree of dyspnea, decrease in exercise tolerance, increase in desaturation during the 6-min walk test, decrease in body mass index, waist and mid-upper arm circumferences, and also more frequent detection of emphysematous changes in chest X-ray. Thus, the IL-18/IL-10 ratio reflects the state of the immune-inflammatory process and has the potential to predict the future risk of developing irreversible pathological changes in the respiratory tract, alveoli and lung vessels with the formation of emphysematous and fibrotic changes.

53-58

Authors: Bilenkyi G.Z., Makarenko O.V.

Acute pancreatitis refers to the most severe urgent diseases of the abdominal cavity. It occupies the third place after acute appendicitis and cholecystitis. The share of acute pancreatitis makes up 5-10% in the urgent pathology of the abdominal cavity organs. At the same time, in each fourth patient aseptic necrotizing pancreatitis develops, the total mortality of which even in specialized clinics of the world remains high (evidence of A, B level) range from 2.1% to 15%. Therefore, the search for new detoxifying agents with high indicators of clinical efficacy is an important trend in modern pharmacology. The purpose of this work was to establish the clinical efficacy and tolerance of the new infusion solution with the working name "Neoreodez", used against the background of basic therapy in patients with acute pancreatitis compared with the group of patients receiving baseline therapy only. A clinical study included 96 patients aged 20 to 65 years (52 men and 44 women) diagnosed with acute pancreatitis. All patients received baseline therapy (spasmolytics, proton pump inhibitors, protease inhibitors, somatostatin, antibiotics). In addition, the patients in the main group were prescribed an experimental infusion solution with the working name "Neoreodez" within 3 days. To evaluate the degree of endogenous intoxication, the method of determining the average mass molecule was used. The estimation was carried out with spectrometry in different modes of X=254 nm and X=280 nm. In addition, at the screening stage a level of malondialdehyde was determined: the latter is a clinical and laboratory marker of oxidative stress and blood pH. It was established, that the clinical efficacy of treatment in the main group of patients receiving the drug "Neoreodez" was 91.6%, which is significantly higher, than the clinical efficacy in the control group – 60.4%. Thus, the hypothesis about higher clinical efficacy of treatment in the main group of patients as compared with the control is confirmed.

67-78

Authors: Yehudina Ye.D., Kalashnykova O.S.

Pulmonary arterial hypertension (PAH) is a serious condition caused by the damage to the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic scleroderma (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy in these groups are observed, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials.

84-92

Authors: Shostakovych-Koretska L.R., Shevchenko-Makarenko O.P., Tymofyeyeva L.V., Tkachenko V.D.

The authors present the experience of antiviral treatment of patients with chronic viral hepatitis C (HVHC) within the framework of the State Target Social Program for the Prevention, Diagnosis and Treatment of Viral Hepatitis until 2016 and the local program "Population Health of Dnipropetrovsk Region for 2015-2019". The authors reviewed the treatment regimens that can be used in patients according to the latest recommendations of WHO and international organizations on the study of the liver (EASL, APASL and AASLD). The authors discussed the problematic issues of the effectiveness of treatment regimens containing interferon and ribavirin, as well as interferon-free regimens of therapy. At the first stage of the work, the authors noted the coverage of with antiviral therapy of HVHC patients in the Dnipropetrovsk region, taking into account the patients followed up the Unified electronic registry of patients of adult age with chronic viral hepatitis B, C and B + C. 3875 patients are included in the register, 3334 have HVHC, of them – 2795 patients with viremia. Antiviral therapy was received by 1038 patients with chronic viral hepatitis, including those with HVHC – 912 patients. In 2017, 725 people with HVHC completed antiviral therapy, the coverage of treatment was 21.75% of the total need, based on the number of patients in the Registry. As a result of treatment, 22 patients with the 1st genotype of HCV, had failed therapy with interferon-containing regimens. However, in a detailed analysis, the authors found that in one case there was a reinfection with another HCV genotype. Relapse was determined in 14 (63%) patients, partial virological response in 3 (14%) patients and non-response in 4 (23%) patients. At the second stage of the work, the re-treatment regimen was evaluated in patients with treatment failure after the use of PEG-IFN regimens using interferon-free regimens containing direct-acting antiviral drugs (DAA) for 12 weeks in 21 patients with an average age of 42.4±2.89 years, with the 1st HCV genotype, with an average disease duration of 6.52±1.05 years. There were 14 men with a mean age of 39.67±4.16 years and 9 women with a mean age of 46.22±4.01 years. The level of fibrosis: F1 – 8 people, F2 – 7, F3 – 3 and F4 – 3. 3D treatment regimen was used for retreatment including the following: Ombitasvir / Paritaprevir / Ritonavir + Dasabuvir + Ribavirin (3D+RBV) in 16 patients, moreover, 3 of them had compensated liver cirrhosis. 5 patients with HCV genotype 1 without the presence of liver cirrhosis were given the following scheme: Ledipasvir + Sofosbuvir + Ribavirin (SOF+LDV+RBV). All patients had a sustained virological response (SVR-24) and the effectiveness of the antiviral therapy was rated as 100%. Also two clinical cases of treatment of HVHC in patients with antiviral therapy failure are presented. For further implementation of the WHO strategy for the elimination of viral hepatitis, it is necessary to continue the work on the formation of the Registry of patients with chronic viral hepatitis in order to improve the provision of care to patients in this category. Further study of the issue of personalization of antiviral therapy and minimization of risks that adversely affect its results are required.

98-103

Authors: Ruda T.V., Korshun M.M.

The results of the risk assessment of combined hazard effects of diflufenzopyr, dicamba, nicosulfuron (herbicide Kelvin Plus) and azoxystrobin, difenoconazole (fungicide Amistar Gold 250 SC) on workers involved in working with them are presented. The field study on maize and sunflower crops, in which Kelvin Plus and Amistar Gold were used at maximum flow rates of 0,4 kg/ha and 1,0 l/ha, respectively was performed. During ground handling, the working solution consumption was 300 l/ha, while during aviation – 50 l/ha. Air samples of the working area, washings from the skin, stripes on the overalls of workers were selected, followed by the determination of the residual quantities of the active substances under study in the selected samples. Hazard coefficients and indices, based on exposure and permissible inhalation and percutaneous doses (a. s.) were calculated. It has been established that the working conditions of agricultural workers are permissible, since the hazard indices of the harmful combined effect of the pesticides under study are lower than 1. Before carrying out full-scale studies, the coefficients of possible inhalation poisoning were calculated, and it was established that all pesticides under study are of low risk as for this coefficient – 4 class. An assessment of the possible occurrence of acute toxic effects when working with pesticides was made as well, that is, the selectivity coefficients of the action were determined for inhalation and percutaneous effects on humans. It was established that all investigated a. s. at inhalation influence on the person have sufficient selectivity of action, except for azoxystrobin, which has a low selectivity of action; when applied to the skin all the a. s. have sufficient selectivity of action. The use of the tested combined preparations on maize and sunflower crops does not endanger the workers, while observing the established hygienic regulations.

110-113

Authors: Hopko N.V.

The relevance of leptospirosis is associated with its wide spread in many countries of the world, an increase in the number of severe forms of the disease, often with a fatal outcome, which determines its high medical, social and economic importance. In modern conditions, it is necessary to evaluate the influence of various factors on the incidence of leptospirosis through the use of a wide arsenal of statistical methods. Preventing epidemic growths is possible through effective preventive and anti-epidemic measures developed on the basis of epidemiological surveillance and risk assessment. In order to determine the relationship between the incidence rates of leptospirosis and the environmental factors, we conducted a study using regression analysis with subsequent correlation analysis. The study used data from the State Institution "Chernivtsi Regional Laboratory Center of the Ministry of Health of Ukraine", as well as data from the State Statistics Service of Ukraine on social factors for 2008-2018. Given the results of multivariate regression analysis, the most significant factors that affect the incidence of leptospirosis were the infection of cattle, pigs, dogs, cats. The influence of migration processes on the incidence of leptospirosis is proved, which should be taken into account in reporting forms for further correlation analysis and optimization of the epidemiological surveillance system. Improving the system of epidemiological surveillance of leptospirosis by identifying elements in the information, diagnostic and management subsystems will facilitate timely intervention to make adequate management decisions.

9-14

Authors: Kovalenko О.М.

Objective: to investigate the influence of L - arginine on platelets activity in patients with COPD and concomitant arterial hypertension. 30 patients with COPD of A - D category combined with hypertension (Н) I - II stage in the state of disease control were examined. In I gr. (n=20) patients received L – arginine (Tivortin) in a daily dose of 4g as additional medication to the basic therapy for 30 days. Patients of II gr. (n=10) received only basic therapy. The adhesion of platelets (pl), induced with adenosine diphosphate (ADP), collagen and thrombin (optical turbidometric aggregatometry method) were determined. Additionaly, in I gr. (n=6) there were determined the level of activated, aggregated, degranulated pl, packing density of pl granules (transmission electron microscopy). Under the influence of therapy in patients of I gr. degree of pl adhesion, degree of induced pl aggregation (collagen, thrombin), rate of aggregation (ADP, thrombin), activity of pl von Willebrandt factor activity (collagen, thrombin) decreased, level of activated, aggregated and degranulated pl decreased; packing density of α - granules increased (p<0.05). In II gr.of patients significant changes in the indices of adhesion and induced aggregation of pl were not detected. In comorbid patients with COPD and arterial hypertension L-arginine (Tivortin) reduces platelet activity and may reduce thrombogenic potential and risk of thrombotic events.

19-24

Authors: Kuryata O.V., Garmish I.P.

Our aim was to assess the level of proteinuria and changes in vascular endothelial function in patients with chronic kidney disease (CKD) in combination with subclinical hypothyroidism (SHT) under the influence of antihypertensive combination therapy (valsartan 160 mg and amlodipine 5 mg). We examined 48 patients with CKD I-II stages and AH 1 and 2 degrees. Depending on the functional state of the thyroid gland, patients were divided into 2 groups. Within 12 weeks patients took a fixed combination of amlodipine 5 mg and valsartan 160 mg. Target BP levels were achieved in 19 (86.3%) patients of the main group and 22 (84.6%) of the comparison group. More often violation of brachial artery flow-mediated dilation and higher level of daily proteinuria were found in the main group patients. At the end of the study, the level of daily proteinuria in the main group decreased by 46.03% (p<0.01), and in the comparison group – by 55.3% (p<0.01). SHT can be considered as an additional factor that affects the course of CKD and AH by worsening the state of endothelial function and increasing the level of daily proteinuria. Combination of valsartan 160 mg and amlodipine 5 mg has lead to achieving of target blood pressure levels, improving of endothelial function and decreasing of daily proteinuria in both groups.

32-36

Authors: Naumenko L., Borisova I., Berezovskyi V., Fesenko H., Zub T., Chub D.

Evaluation of the functional state of the patient is the basis for recognizing him persistently incapacitated. The reform in the field of medicine in our country entrusts the function of the initial selection of such patients to general practitioners and primary care physicians. In 2001, the working group of the World Health Organization approved the International Classification of Functioning, Disability and Health. There are 7 basic parameters for detailing the functioning of a person: the ability to self-service, to move, to work, to orientate, to control own behavior, to learn, to communicate. The ability to self-service characterizes a person's capability to provide own physiological needs, to adhere to own hygiene and to perform daily activities. A person with a preserved capacity for self-service does not depend on other people.The ability to move allows the person to move in space independently: to walk, to run, to overpass the obstacles, to use public transport. If this criterion is limited, the person needs more time to overcome the distance or uses the additional support or needs help from outside. The ability to orient allows the person to analyze the surrounding world with the help of eyes and ears.The ability to communicate provides an opportunity to establish contacts and maintain relationships with other people. For communication spoken, written and non-verbal speech is used. The ability to control one's own behavior consists in the awareness of one's own personality and one's own place in the world, limited by certain norms and rules of behavior. The ability to learn allows the person to perceive, comprehend, accumulate and reproduce the information. Due to this,the person can accumulate knowledge and skills. Ability to work allows the person to perform work according to the level of one’s own education. The definition of criteria for disability and the degree of their severity requires a certain level of medical training for general practitioners and primary care physicians.

41-45

Authors: Pertseva T.O., Konopkina L.I., Guba Yu.V.

Recently, the problem of depressive syndrome in COPD patients often attracts the attention of doctors and scientists. It is important to study the relationship between the presence of the depressive syndrome, on the one hand, and the clinical and functional characteristics of COPD patients on the other, in order to determine the categories of patients inclined to develop a depressive syndrome. The purpose of the study: to determine the relationship between the presence of depressive syndrome in COPD patients with the severity of their clinical symptoms of COPD and the level of functional impairments. 52 COPD patients of clinical groups C and D were examined. Depending on the presence of depressive syndrome patients were divided into two subgroups: a subgroup 1 – 15 COPD patients with concomitant depressive syndrome, a subgroup 2 – 37 people without it. The examination included general clinical and functional methods. It was determined that the development of depressive syndrome in COPD patients can be affected by the high severity of clinical symptoms of COPD in general, decreased tolerance to physical activity, long duration of the disease, poor quality of life. At the same time, the levels of functional indicators, in particular, OFV1 and SpO2, may not have a significant relationship with the occurrence of depressive syndrome, even in patients with severe COPD.

50-56

Authors: Rodionova V.V., Karaseva O.V.

Purpose – to determine changes in the trypsin-like blood activity and its relationship with acute phase indices of inflammation in patients with pulmonary fibrosis (PF) as a marker of course severity and prognosis of the disease. Materials and Methods: The study included 18 patients: 15 (83%) women and 3 (17%) men, mean age 53±2.5 years. The control group included 15 practically healthy persons. All the examined patients (n=18) were divided into two groups: with mild or moderately severe PF – 8 (44.4%) patients (group I), severe PF – 10 (55.6%) of patients (group II). Duration of the disease - from 1 month. up to 4 years. Patients underwent clinic-laboratory and anthropometric studies, a mMRC questionnaire was used, blood saturation was measured, lung radiography in 2 projections, echocardiography, and if necessary a high-resolution computer tomography etc were performed. Results and discussion: More than half of the patients were overweight (44,4%) or had obesity of І-ІІІ st. (27.8%). The severity of dyspnea according to mMRC scale was 3.0 (3.0-4.0) points in patients of group II and 2.5 (2.0-3.0) points in patients of group I. There was a decrease in C-reactive protein (CRP) in group I and a tendency to increase in patients of group II. When analyzing the indicator of trypsin-like blood activity (TLA), it was found that the median TLA at the beginning of the observation was twice as high as in healthy individuals, direct correlation was established between the level of TLA and the severity of the disease course. After treatment the level of TLA decreased in group I patients. In the severe course of PF, the average TLA level remained high. The progredient course of LF is characterized by severe clinical symptoms, a significant increase in TLA, CRP, reduced O2 saturation, a lack of response to treatment and an unfavorable prognosis. The TLA index can be used as a biochemical marker of the severity of PF along with the CRPindex, O2 saturation and the degree of dyspnoea.

64-68

Authors: Yalovenko M.I., Khaniukov O.O.

Atrial fibrillation (AF) is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, considering the broad range of its negative consequences, not only due to significant deterioration in the quality of the patients’ life, but also due to related significant increase in the incidence of serious complications and death. The presence of permanent AF is associated with a twofold increase in the risk of myocardial infarction (MI) development. The purpose of the research is to study the features of the MI course, the condition of intracardiac hemodynamics, the volume of the cardiac muscle injury in patients with a permanent AF. It was done a retrospective study of 1145 patients’ case histories who were undergoing in-patient treatment for the acute MI on the basis of the CI "Dnipropetrovsk Clinical Association of Emergency Medical Aid". The first group included 134 patients with acute MI without concomitant heart rhythm disorders. The second group consisted of 102 patients with acute MI which arose on the background of a permanent form of AF. The groups were comparable in age and gender. The presence of permanent AF was associated with prognosis deterioration, early hospital mortality in patients with acute MI due to progression of heart failure, development of acute left ventricular insufficiency. A larger amount of myocardial necrosis was observed in patients with permanent AF compared to those with sinus rhythm. Conclusion: the presence of permanent AF impairs the course of acute MI, increases the risk of early hospital mortality, which requires a personalized approach to the management of patients with a permanent AF for preventing the risk of MI developing and thromboembolic complications.

75-136

Authors: THESES

THESES

13-20

Authors: Poslavska O.V., Shponka I.S.

Cancers of unknown primary localization (CUPL) are a heterogeneous group of metastatic neoplasias for which a standardized diagnostic examination did not determine the primary localization of the origin. In 5% of histological form of CUPL is squamous cell carcinoma, which, in the case of an isolated lesion of the cervical lymph nodes is treated as a "favorable phenotype". Tactics of treatment of such a CUPL is suggested in both primary local squamous cell carcinoma (SCC) of the, head and neck with regional lymph nodes involvement (T1-3N1-3M0) and in 25% -30% of patients leads to a 5-years survival rate. This calls for the use of an immunohistochemical method for the accurate verification of the histological form of an isolated metastasis of the cervical lymph nodes and use of the appropriate therapy. In the work 62 samples of isolated lesions of the cervical lymph nodes with carcinomas without another established primary localization for the period 2015-2017 were investigated. The control group consisted of 12 samples of SCC of the head and neck of the known localizations. The immunohistochemical panel of markers included Cytokeratin Pan, Vimentin, CD45, S100, Cytokeratin HMW, Cytokeratin 7, Cytokeratin 20, p63, TTF1. The parameters of the areas, perimeters and “roundness” of the nucleus were determined in the ImageJ pro­gram. The aim of the study was to investigate the complex of morphological, morphometric and immunohistochemical characteristics of SCC without primary localization with isolated lesion of the cervical lymph nodes, in comparison with other histological forms and control group of SCC of the head and neck of the known localizations to improve diagnostic algorithms. A difference in the distribution of histological forms for all CUPL with isolated lesion of the cervical lymph nodes was determined in the predominance of SCC, in comparison with the general distribution of histological forms for all CUPL. Similarity of morphometric parameters of metastatic SCC of subgroup 1 (phenotype of Cytokeratin, Pan AE1 / AE3 (+) / Cytokeratin HMW (+) / p63 (+) / Cytokeratin 20 (-) / TTF1 (-) / Vimentin (- / +) / Cytokeratin 7 (- / +)) with samples of the control group of SCC of the head and neck of known localizations. The es­tablished decrease in the size and "roundness ratio" of the nuclei of the SCC cells is a reflection of the weighting of cellular atypia and correlates with the polymorphism of the nuclei and decrease in the degree of differentiation of the SCC.

26-34

Authors: Kuryata O.V., Muhammad Muhammad, Mytrokhina O.S.

The combination of chronic heart failure and atrial fibrillation is considered one of the most prognostically unfavorable alliances among cardiovascular diseases. Now the need for new markers as potential targets for therapeutic intervention is being actively discussed. To date, active study of cardiorenal syndrome continues, which in turn leads to an active search for drugs that reduce nephrologic risk, especially in the category of people with a combined cardiovascular pathology. The aim of the study was to compare the effects of irbesartan and ACE inhibitors on the level of galectin-3, β-2-microglobulin, albuminuria and end glycation products (AGE) in patients with chronic heart failure with atrial fibrillation and impaired renal function. The results of the effect of drugs in patients with chronic heart failure and atrial fibrillation are presented and analyzed. The data indicate the need for more careful attention to this group of patients, namely, the need to diagnose the functional of the kidneys, which is very important for the development of effective interventions aimed at preventing the progression of these diseases.

46-52

Authors: Mankovsky G.B.

Aim of the study – to investigate the prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes using different diagnostic approaches in patients with angiographically confirmed ischemic heart disease. Materials and methods. We studied 89 patients with ischemic heart disease, mean age 62+3,6 years. All patients had angiographically confirmed atherosclerotic lesions of coronary arteries. No patient had previously diagnosed diabetes mellitus or hyperglycemia in anamnesis. All patients underwent the detailed examination to reveal hidden diabetes or prediabetes, earlier non-diagnosed: glucose tolerance, fasting plasma glucose, glycated hemoglobin were measured and standard oral glucose tolerance test was performed. Results. Based on the results of fasting plasma glucose and oral glucose tolerance test, diabetes mellitus was diagnosed in 14 (16%) patients studied, elevated glycated hemoglobin suggesting the presence of earlier non-diagnosed diabetes was found in 11 (12%) patients. Each of the 3 diagnostic approaches used allowed to diagnose patients with non-diagnosed earlier type 2 diabetes mellitus and there were no statistically significant differences in the prevalence of earlier non-diagnosed diabetes depending on the method of diagnostics used, p>0.05. Prediabetes was diagnosed much more frequently – in 47 (53%) patients while measuring glycated hemoglobin, in 43 (48%) patients based on fasting plasma glucose levels and in 28 (31%) patients according to elevated plasma glucose levels 2 hours after taking glucose. Conclusions. Our data revealed high prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes in patients with ischemic heart disease. The measurement of fasting plasma glucose, glycated hemoglobin and oral glucose tolerance test contribute each other in diagnostics of diabetes and prediabetes in the majority of cases.

60-66

Authors: Krishtafor D.A., Klygunenko O.M.

The aim of the study was a comparative analysis of components in liberal and restrictive fluid resuscitation and their effectiveness. 90 patients with multiple trauma divided into two groups, depending on the fluid resuscitation type (liberal or restrictive) were studied. Infusion components in 1st day, intraoperative blood loss, ICU and hospital stay length, number of complications and lethality were investigated. Restrictive fluid resuscitation type in multiple trauma was characterized by a decrease of total infusion volume in ml/kg in 1st day by 34.8%, including crystalloids – by 34.2%, colloids – by 71.4% with a constant volume of FFP and erythrocytes. Balanced crystalloid solutions were used more often, and solutions of potassium and magnesium asparaginate and glucose, high-molecular HES and dextranes were not used at all. Blood components were introduced earlier. Volume of intraoperative blood loss decreased by 34.0%, the frequency of complications – by 1.6 times, the mortality rate – by 2 times.

71-78

Authors: Lуtvуn К.Yu.

48 patients aged from 21 to 54 years, infected with human immunodeficiency virus (HIV) and presence of diseases of the central nervous system (CNS) were examined. CNS diseases included cerebral tuberculosis, viral encephalitis (caused by Epstein-Barr Virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV)), encephalitis of unspecified etiology, cerebral toxoplasmosis, fungal meningitis. 29 (60.4%) of the patients were discharged from the hospital with a clinical improvement, and 19 (39.6%) of the patients died as a result of CNS disease. Significant differences in the content of the myelin basic protein (MBP) in the cerebrospinal fluid (CSF), depending on the outcome of the disease, were determined. The Median of MBP in deceased patients was 2.9 times higher than in the survived patients - 4.00 (1.90-7.70) ng/ml vs. 1.40 (0.99-2.00) ng/ml (p=0.002 U). An inverse correlation between the content of MBP in the CSF and the time from the determination of the HIV status to the manifestation of neurologic symptoms (rs=-0.30, p<0.05) was found. According to the results of the ROC analysis, the high risk of unfavorable course of HIV-associated CNS diseases is predicted when the concentration of MBP in the cerebrospinal fluid increases by more than 2 ng/ml (68.4% sensitivity, 75.9% specificity, 72.9% accuracy). The highest level of this protein was observed in patients with fungal lesions of the central nervous system (6.6 (1.9-7.8) ng/ml), and the lowest MBP level – in the group of patients with unspecified encephalitis (0.99 (0.9-1.1) ng/ml), which correlated to more favorable outcomes of the disease. The MBP in cerebrospinal fluid can be an important diagnostic and prognostic marker of HIV-associated neurological diseases.

85-91

Authors: Rossokha Z.І., Kyriachenko S.P., Gorovenko N.G.

The scientific literature presents contradictory data about influence of folate metabolism genes polymorphism on development of risk of reproductive disorders. The aim of the study was to determine the role of MTHFR, MTRR, MTR1 gene polymorphism in the development of reproductive disorders by evaluation of genetic risk models of inheritance. 658 patients with reproductive disorders from all Ukrainian regions were examined. The data from population studies presented in the online resource (1000 genomes) served as comparison group. There were no reliable risk models for polymorphic variants of MTHFR gene. We identified 3 and 4 significant inheritance models for MTRR and MTR1 genes respectively. The best inheritance models were the dominant model for MTRR gene and the additive model for MTR1 gene. The polymorphic variants frequencies of the studied genes did not differ among men and women. Further analyse is necessary for evaluation of genetic polymorphism and intergenic interactions influence on reproductive disorders risk, taking into account folate metabolism indices and exogenous factors.

97-103

Authors: Grek L.

The aim of the work is to ascertain the efficiency of the use of an offered way of the complex treatment of the patients with genital endometriosis and combined benign pathologies of genitals and СРР. A differentiated approach to treatment and analysis of its effectiveness was conducted among the patients of the 1st and 2nd study groups (85 patients) with the severe and moderate pain syndrome according to the VAS scale. On the basis of analysis of immunohistochemical markers ER, PGR, Ki-67, VEGF, COX-2 in glands and in stroma the therapy was developed: Severe pain syndrome was eliminated in all patients within 3 months of treatment. A moderate level of pain was noted in 77.65%, after 12 months of observation in 16.47% of women, the remaining 83.53% noted a weak level of pain by VAS scale (p<0.05). The level of depression dropped (from 11,22±0,5 baseline to 5,98±0,24 in a year, p<0,001) by the Hamilton scale. This indicates the effectiveness of treatment.

111-119

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

The purpose of this study was to determine the efficacy of using Wobenzim as a general therapy in the complex treatment of generalized periodontitis. 61 patients, I-II degree of severity, with tooth safety in an amount of at least 90%, without concomitant general pathology requiring treatment for the current time were examined. Comparative effectiveness of treatment was studied in 2 groups similar in all clinical indices. The main (31 people) patients, along with the symptomatic treatment received Wobenzim; control (30 people) - polytherapy (immunocorrecting, antioxidant, antimicrobial agents). As a result of the generally accepted clinical, paraclinical, immunological and biochemical studies conducted during the treatment and at long-term follow-up, it was found that the use of systemic enzyme therapy in this category of patients ensures rapid regression of the main clinical symptoms (on days 6-7), elimination of pathogenetic links of the disease more than in 90% of treated patients and the onset of remission for at least 6-12 months. It is characteristic that during the monotherapy with Wobenzim, positive results of treatment of generalized periodontitis were achieved, similar to those with the use of complex standard therapy, including administration of a number of medications with targeted action on pathogenesis mechanisms of the disease. From the position of evidence-based medicine, the expediency of replacing a broad arsenal of medicines in the complex treatment of generalized periodontitis with certain pharmacological preparations with a systemic effect is justified.

125-130

Authors: Sorokina E.Yu., Belykh L.S., Panin A.N., Nikitina E.V., Kovrizhin I.A., Strah O.P.

Potential mortality in acute pancreatitis (AP) is 5%. Patients with AP represent II type of intestinal insufficiency, which occurs on the background of dyspeptic syndrome and increased intra-abdominal pressure (IAP). IAP is a differentiated indicator. With the increase of IAP more than 10 mm Hg, intra-abdominal hypertension (IAH) arises. Increasing IAP to this level is considered as safe. Monitoring of IAP level allows to achieve better clinical results. Totally 47 patients with acute pancreatitis were examined. Depending on the function of the gastrointestinal tract and the selected type of starting nutritional support (NS), they were divided into 2 groups. The first group consisted of IAH patients of I degree and dyspeptic syndrome who underwent parenteral nutrition (PN) with 3-component compounds begun on the 2nd day of disease and after restoration of gastrointestinal tract function a late enteral feeding (LEF) was performed. In the second group, patients with AP were initially diagnosed with elevated IAP at a safe level and dyspeptic syndrome. They were prescribed early enteral nutrition (EEN) with specialized blends from the 2nd day of disease. In 2 days a significant reduction in pain syndrome with the persistence of dyspeptic syndrome and intestinal insufficiency (II) was recorded. In patients with intra-abdominal hypertension, total parenteral nutrition is the effective method of nutritional support, against which, after 5 days manifestations of dyspeptic syndrome and IAP indices decrease to a safe level. Therefore in-time detection of high level of intra-abdominal pressure in patients with acute pancreatitis can help to choose a more rational method of nutritional support.

138-143

Authors: Oprya Ye.V.

In order to identify the clinical features of schizophrenia associated with somatic diseases, 186 patients with schizophrenia (50 patients with schizophrenia with cardiovascular diseases, 42 patients with schizophrenia with type 2 diabetes, 44 patients with schizophrenia with obesity and 50 patients with schizophrenia without chronic somatic diseases) were surveyed. Socio-demographic, clinical-dynamic and clinical-psychopathological features of schizophrenia (according to PANSS scale), connected with somatic diseases in a comparative aspect with patients with schizophrenia without somatic pathology were studied. It was found that somatic pathology combined with schizophrenia aggravates psychopathological symptoms, modifies clinical manifestations of schizophrenia and is associated with decrease in the level of social realization of patients, increase in the number of hospitalizations and a significant course of psychotic process. Among clinical features of schizophrenia with somatic disorders there was defined: in cardiovascular diseases - the presence of hallucinatory behavior, hypochondrial ideas and anxiety-depressive symptoms; in type 2 diabetes - hallucinatory activity in combination with excitement, impulsivity, hypochondrial ideas, depressive symptoms, and attention deficit, in obesity - the prevalence of negative symptoms over positive, expressed social rejection, depletion of social contacts and the presence of depressive experiences.

148-159

Authors: Abdulaziz Abdullah Alqarni, Radhi Ghanem Alanazi, Anthony Morgan, Ahmed Saud Alharbi, Faisal Fahad Aljuaid, Abdulrahman Mohammed Aldawsari, Faisal Khaled Almugrin, Abdulaziz Nasser Alaskar, Yazeed Mohammed Aldhfyan, Abdullah Abdulrahman Alqeair

Motor Vehicular Accidents claim about 1.2 million lives and injure more than 10 million people annually worldwide. The injuries caused by MVAs can be analyzed based on the type of injury, injury severity score, Glasgow Coma Scale and required blood transfusion. Methodology: A total number of 190 patients were included in this retrospective study from January 01, 2010 to December 31, 2015. The study aimed to determine the correlation between the type of injuries and GCS, ISS, and blood transfusions in the patients suffering from Motor Vehicle Accidents, who were presented to the Emergency Department at the King Khalid Hospital. All the data of the patients fulfilling the inclusion criteria were collected from the database at medical records department of the hospital. Results: Majority of the patients were adults Saudi male. 68.9% of the patients did not sustain shock, and 75.8% of patients did not require a blood transfusion. Patients with head, neck, chest, abdominal, internal organ, pelvic or spinal injuries conferred a statistically significant higher mean ISS. Patients with abdominal or internal organ injuries had a statistically significant higher mean units of blood transfused. GCS was seen to be lower in the head, neck, chest, abdominal, internal organ, spinal and other injuries. Conclusions: The study documents a significant correlation between the type of injury and GCS, ISS, and blood transfusion in victims of road traffic accident. Emergency physician and the caregivers should be more careful about the injuries associated with lower GCS. Patients sustaining injuries of certain parts related to high ISS (i.e., head, chest, abdominal, internal organ, pelvic) should be addressed on priority basis.