The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

13-23

Authors: Mariia Brynza

Introduction. Atrial flutter (AFl) and atrial fibrillation (AF) are ones of the most common arrhythmias, they constitute a significant proportion of cardiovascular events. Radiofrequency ablation (RFA) is the most common strategy of rhythm control in these patients, affects many endpoints, including quality of life. Existing validated questionnaires are not specific, need a lot of time as for patient during filling in, as for doctor during interpretation. In English resources Ferrans and Powers questionnaire has shown high sensitivity and specificity for patients with heart rhythm disturbances, which further uses in different patients’ cohorts. The aim of our work was to evaluate acceptability, reliability, legitimacy and sensitivity of the Ukrainian-language modification of the Ferrans and Powers questionnaire for patients with AFl and AF before and after RFA. Materials and methods. The original Ferrans and Powers questionnaire, which consists of 15 questions, was translated and adapted from English into Ukrainian. The survey was conducted among patients before the RFA procedure, in the acute postoperative period (3–5 days), 3 months and 12 months after the procedure. According to the results, the sum of points was calculated and classes were allocated: class 1 (significant decrease in quality of life) – 15–44 points, class 2 (moderate decrease in quality of life) – 45–74 points and class 3 (slight decrease, or high quality of life) – 75–90 points. Acceptability, reliability, legitimacy and sensitivity of the survey scale were assessed. Results. The study included 118 patients with a mean age of 58.98 ± 9.6, 49 women (41.5 %). The scale of the Ukrainian-language modification of the Ferrans and Powers questionnaire had a high internal sequence (logic), the average correlation between the points of the scale was 0.51; Cronbach’s alpha coefficient is 0.9. All the recommended criteria for constructing such scales were agreed, 15 points were combined into a single scale, in which 32 % of discrepancies with the original points were observed. By acceptability, the highest and lowest extremes of quality of life were below the recommended maximum of 20 %. Reliability was confirmed by compliance with the recommended criteria of internal density and reproducibility in repeated measurements. A high intrinsic density was demonstrated, confirming the design-related validity of the questionnaire. The sensitivity of the proposed scale was reflected in the increase in the quality of life of patients after all types of RFA procedures. The study proved the high acceptability, reliability, validity and sensitivity of the quality of life questionnaire of patients with cardiac arrhythmia in patients with paroxysmal, persistent and persistent forms of AFl and/or AF, as well as their observation in the stages after RFA. Conclusions. The Ukrainian-language modification of the Ferrans and Powers questionnaire has high levels of acceptability, reliability, legitimacy and sensitivity for patients with AFl and AF, which is a useful practical tool for the treatment and control of these patients.

30-39

Authors: Diana Dorosh, Tetiana Liadova, Popov Mykola, Iryna Kadygrob, Mykola Shustval , Roman Malantschuk

Introduction. Highly active antiretroviral therapy is the current standard of care for patients with HIV/AIDS. Although antiretroviral therapy is etiotropic, quite effective in reducing viral load, recurrent opportunistic infections can lead to adverse effects in the management of such patients, and side effects may limit its effectiveness. Among opportunistic infections, a large group are herpesvirus infections, they are frequent manifestations of dermatological manifestations of HIV, which can sometimes lead to death. Melatonin (N-acetyl-5-methoxytryptamine) was thought to be of purely epiphyseal origin, but recent studies have shown that melatonin synthesis can occur in some other cells and organs of the human body. In addition, it was found that melatonin regulates circadian rhythms, has a number of important functions and areas of influence. Studying its structure and action, researches over the past decade have shown that melatonin enhances the immune response of T-helpers, stimulates the production of cytokines, has antioxidant properties. Due to these effects, and possibly other mechanisms yet to be determined, melatonin has been shown to reduce drug toxicity and have immunomodulatory effects. Objective: to study the effectiveness of melatonin as an immunomodulatory agent in herpesvirus skin diseases associated with HIV as part of combined therapy. Objectives of the study: to determine serum levels of CD4 + cells and to investigate changes in immunogram parameters in patients with herpesvirus infection associated with HIV before and after melatonin therapy and to compare them with the levels of the control group. Materials and methods. In the current study, HIV patients who had an acute herpesvirus infection caused by HSV-1, HSV-2, VZV, EBV, and HHV-8 were selected. Patients were divided into two groups: group I consisted of patients receiving antiretroviral therapy, valaciclovir in standard therapeutic doses and melatonin as immunomodulatory therapy, once daily, in the evening at a dose of 3 mg. Group II included patients who received antiretroviral therapy alone in combination with valaciclovir. Clinical and laboratory evaluation was performed before and after 30 days of therapeutic intervention. Patients were asked to report any complications. Results. The study involved forty HIV patients who had an exacerbation of herpesvirus infection; the levels of CD4 + cells averaged 311 ± 128. All patients received antiretroviral therapy for at least five years with a mean infection period of 10 years. The age of patients ranged from 32 to 60 years with a mean of 41.4 ± 17.2 years. After treatment, CD4 + cells were significantly higher in group I subjects receiving antiretroviral therapy in combination with valaciclovir and melatonin than in control subjects wo not receiving melatonin after one month of treatment. The level of CD4 + cells was 37 % higher in patients taking melatonin compared with the control group (p < 0.05). The current study showed that 60% of patients (12/20) had positive changes in the parameters of the immunogram (p < 0.05). Significant differences between groups, which were statistically validity in levels of CD4 + cells and immunogram parameters, indicate that melatonin had a positive effect on the state of the immune system. Conclusion. Our study has proven the beneficial effect of melatonin on the state of the immune system in patients herpesvirus skin diseases associated with HIV. Given the low toxicity of melatonin and its ability to reduce side effects and increase the effectiveness of therapeutic agents, its use may be important and significant in combination therapy in combination with highly active antiretroviral therapy.

49-61

Authors: Sintija Miluna, Juta Kroica, Mara Pilmane, Ingus Skadins, Rudite Koka, Dagnija Rostoka

Objective: The link between snus, periodontal diseases and oral malignancy is still in question in different literature. This study aims to explore the impact of snus on mucosal lesions and oral malignancy along with evaluation of strategies for snus cessation and approaches to communication with patients. Methods: A questionnaire about tobacco consumption habits was made. A heavy snus group, a light snus group and a control group were made. Oral biopsy samples were tested for protein gene product 9.5, tissue inhibitor of matrix metalloproteinase 2, chromogranin A and B, matrix metalloproteinase 2, interleukin-1, interleukin-10 using immunohistochemical techniques. Periodontal pocket biofilms were tested with combined polymerase chain reaction and were subsequently analyzed in order to determine the presence of pathogenic periodontal bacteria, such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia. Results: Biopsy results showed cellular disorganization, apoptosis, hyperkeratosis and prevalence of keratotic seborrhea in the area of snus sachets. Microbiological examination revealed the presence of periodontal pathogens in the snus users group. High concentration of pathogenic periodontal bacteria Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia was found in groups of both heavy and light snus users, yet they were absent in the samples of the control group. High concentration of Tannerella forsythia and Treponema denticola was also found in the groups of heavy and light snus users, whereas they were present in samples of only two patients of the control group. Conclusions: Snus changes cell function, it can lead to oral malignancy and promote periodontal disease regardless of the frequency and amount of snus used.

73-82

Authors: Ksenia Pavlikova, Tetiana Liadova, Olha Volobuieva, Alla Hamilovska, Natalia Shepileva

Abstract. The study of the role of Epstein-Barr virus infection in the development of various human pathological conditions is of great importance. This is due to the significant epidemiological role and social significance, because according to epidemiological data, more than 90 % of people are infected with VEB when they reach adulthood. The steady increase in the number of diseases caused by VEB in both adults and children is associated with its specific susceptibility to immunocompetent cells, lifelong persistence and latent course, which necessitates a comprehensive study and development of effective treatments. The aim of this study was to evaluate the effectiveness of ribonucleic acid in the correction of immune disorders in patients with infectious mononucleosis caused by Epstein-Barr virus. Materials and methods: To achieve this goal, 110 patients with IM were examined, including 58 women (52.7 %), men – 52 (47.3 %). The mean age of patients was 23.3 ± 4.2 years. The material for the study was the serum of patients obtained in the dynamics of the disease. The complex of examination of patients with IM included clinical and biochemical methods, enzyme-linked immunosorbent assay, polymerase chain reaction method, immunogram. The results of the research were processed by the method of variation and correlation statistics using the program «Statistica 10.0 for Windows». The analysis of the obtained results allowed to establish that in patients with IM changes in the system of cellular and humoral parts of the immune system and the diversity of the immune response were detected. The progressive nature of changes in immune parameters indicates the formation of secondary cellular immune imbalance, activation of the humoral link, a change in the balance of immunoregulatory mediators towards Th2 cells. In the acute period, probable disorders of the cellular immune system, characterized by an increase in the number of cells with killer activity: mature T-lymphocytes (CD3+), cytotoxic T-suppressor cells (CD8+), cells expressing the activation marker CD25+ (receptor IL2) and increase Th1/Th2. Under the influence of complex immunomodulatory and antiviral action with the appointment of ribonucleic acid, there is a more positive dynamics of immunological parameters compared with patients who received only basic therapy, which is manifested by an increase in the proliferative response. Conclusions. For the correction of immune disorders in patients with IM, associated with VEB the use of complex therapy with the drug nuclex (ribonucleic acid) (250 mg) 2 capsules 3 times a day for 14 days and valaciclovir (500 mg) at a dose of 1000 mg (2 table) 3 times a day for 14 days.

93-106

Authors: Roman Kravchenko, Yuriy Avdosiev

This article considers the unsolved problem of diagnostic and therapeutic approach to patients with mediastinal tumors. The aim of the study was to increase the efficacy of treatment of patients with mediastinal epithelial tumors by using intra-arterial chemoembolization as a neoadjuvant therapy to create ischemia and high concentrations of cytostatics in tumors over a long period of time to devitalize tumor tissue and reduce overall chemotherapy toxicity. Object of study. Epithelial tumors of the thymus gland. Research methods: Clinical, laboratory, morphological, instrumental, statistical. Laboratory tests will include general clinical blood tests, biochemical parameters (ALT, AST, bilirubin, alkaline phosphatase, gamma-glutamine transpeptidase, lactate dehydrogenase, albumin), biochemical markers of thymus tumor (AFP, HGT), acetyl. General blood test (hemoglobin, erythrocytes, leukocytes, platelets). Instrumental methods of examination will include CT (computed tomography) with intravenous contrast, MRI (magnetic resonance imaging). Conclusions can be drawn from the literature. It can be stated that there is no single point of view on the diagnosis and choice of treatment tactics for patients with epithelial tumors of the thymus. Histological heterogeneity of tumors of this anatomical region with the similarity of clinical manifestations and radiological symptoms requires the development of algorithms for their differential diagnosis and optimization of treatment. In addition, over the last decade in Ukraine there has been a significant increase in the number of mediastinal tumors, especially thymus. Given mainly the young age of patients with this disease and the high degree of aggressiveness of the disease, the problem is transformed at the social level. It is also necessary to reconsider the traditional approach to the treatment of this pathology, the first link of which is considered to be surgery.

115-126

Authors: Vira Kolesnichenko , Gregory Golka, Taras Khanyk, Victor Veklych

Introduction. Osteoarthritis of the knee joint is a progressive incurable disease, which in the case of a severe course at a late stage leads to total joint replacement. Recently, experts have focused their attention to the prevention and treatment of early osteoarthritis, so it is important to understand the prevalence, frequency, and modified risk factors for knee OA. The aim is to investigate the patterns of morbidity and prevalence of osteoarthritis of the knee joint on the basis of scientific analysis of relevant modern literature. Materials and methods. Research material – scientific articles in the MEDLINE database for the period 2016–2020, reflecting the epidemiological indicators of osteoarthritis of the knee joint, and additional search for articles from bibliographic lists of selected literature sources. Research methods – a systematic review of relevant sources of literature. Results. Osteoarthritis of the knee joint is one of the most common diseases of the musculoskeletal system. The frequency of osteoarthritis steadily increases with age, overweight. The progressive nature of the disease, the presence of persistent pain lead to limited functionality and reduced efficiency; such patients in some cases require surgical treatment aimed at replacing the compromised joint, which requires significant economic costs, medical rehabilitation and social readaptation of patients and is a heavy burden for both the patient and society as a whole. The lack of correlation between clinical symptoms and radiological signs of osteoarthritis of the knee joint leads to low availability of orthopedic care: more than 30 % of patients with a first diagnosis have a pronounced stage of the disease, and in some cases the pathology is diagnosed only in connection with complications; the diagnosis of osteoarthritis due to the high percentage of painless development of the disease (40 %) is often established in the terminal stages. All this indicates the need for further research on various factors influencing the frequency, prevalence, economic and social burden of osteoarthritis of the knee. Conclusions. Osteoarthritis of the knee joint is characterized by high incidence, which increases with age, progressive course, limited functional capabilities. Treatment of such patients requires significant economic costs of society. A significant increase in the prevalence of osteoarthritis of the knee is associated with increased life expectancy, obesity and some other factors that require further research.

14-23

Authors: Ludmila Bogmat, Viktoria Nikonova, Natalya Shevchenko, Tetiana Holovko, Irina Bessonova

Резюме. У пацієнтів із ревматоїдним артритом ризик серцево-судинних захворювань, які пов’язані з атеросклерозом, значно збільшується у порівнянні з загальною популяцією. Дослідження когорти дітей та дорослих молодого віку свідчить про те, що атеросклеротичний процес, як правило, починається задовго до його клінічної маніфестації, а ступінь змін судин пов’язана як з кількістю факторів ризику, так і з їх інтенсивністю. Використання базисних препаратів у ревматологічних хворих сприяло зниженню кардіоваскулярної смертності, переважно за рахунок ліквідації активності процесу, яка сама по собі є індуктором виникнення та прогресування атеросклерозу. Мета дослідження – встановити характер змін ліпідного спектру крові у дітей із ювенільний ідіопатичний артрит під впливом базисної терапії. Об’єкт і методи дослідження. Обстежено 85 дітей (8–18 років), хворих на ювенільний ідіопатичний артрит з оліго- (61,5 %) та поліартикулярним (38,5 %) варіантами захворювання, двічі з інтервалом в 1 рік. Показники ліпідного спектру крові визначали за рівнем: загального холестерину, тригліцеридів, ліпопротеїдів високої щільності та коефіцієнту атерогенності ферментативним методом на біохімічному автоматичному аналізаторі-фотометрі А25, ліпопротеїдів низької та дуже низької щільності розрахунковим методом. Результати дослідження. Аналіз ліпідограм в цілому по групі показав, що у пацієнтів із ювенільним ідіопатичним артритом вірогідно вищими були показники загального холестеріну (р < 0,05), тенденція до підвищення рівня тригліцеридів, холестерину низької щільності та дуже низької щільності, що призводило до зростання рівня коефіцієнту атерогенності. При аналізі ліпідного спектру крові через рік відмічено тенденцію до зниження рівня атерогенних та підвищення антиатерогенних фракцій ліпідного спектру із нормалізацією коефіцієнту атерогенності. В групі хворих, які отримували монотерапію метотрексатом, через один рік суттєвих змін в ліпідному спектрі крові не відмічено. На тлі комбінованої базисної терапії відбувається нормалізація ліпідного спектру крові, а саме – зниження загального холестеріну, приріст ліпопротеїдів високої щільності, зниження рівня тригліцеридів (р < 0,01), холестерину низької щільності (р < 0,05), як наслідок, значне зниження коефіцієнту атерогенності (р < 0,01). Висновок. Динаміка змін показників ліпідного спектру крові у дітей із ювенільним ідіопатичним артритом підтверджує необхідність використання комбінованої базисної терапії не тільки для контролю основного патологічного процесу, а й для профілактики розвитку атерогенних дисліпопротеїдемій.

35-41

Authors: Diana Dorosh

Вступ. Впровадження антиретровірусної терапії значно поліпшило довгостроковий прогноз пацієнтів зі СНІДом, однак опортуністичні інфекції все ще можуть становити небезпеку для життя пацієнтів цієї категорії. Серед них велику групу складають герпесвірусні інфекції, які є частими маніфестними формами дерматологічних проявів ВІЛ. Вивчення ІЛ-31, як перспективного діагностичного предиктора дерматологічних захворювань, активно проводиться протягом останніх років. Це пов’язано з інтересом до його біологічної дії, яка розповсюджується перш за все на шкіру. Визначення молекулярних мішеней, що лежать в основі запальних і інфекційних дерматозів багатообіцяюче для розробки нових, цілеспрямованих методів їх лікування. Мета: вивчення ролі ІЛ-31 в імунопатогенезі герпесвірусних захворювань шкіри, асоційованих з ВІЛ-інфекцією. Завдання дослідження: 1) порівняти рівні ІЛ-31 в сироватці крові у пацієнтів з герпесвірусною інфекцією, асоційованою з ВІЛ та у здорових суб’єктів; 2) визначити наявність залежності між рівнями ІЛ-31 в сироватці крові і клінічною стадією захворювання. Матеріали та методи. У дослідження були включені пацієнти з герпесвірусною інфекцією, викликаною ВПГ-1, ВПГ-2, ВГЛ-3, ВЕБ та ВГЛ-8 у поєднанні з ВІЛ-інфекцією та здорові особи. Рівні ІЛ-31 в сироватці крові вимірювали за допомогою імуноферментного аналізу з використанням комерційних наборів (Human IL-31 ELISA Kit, Abcam, Cambridge, MA, USA). Були зібрані: первинна клінічна характеристика, оцінка активності інфекційного процесу та ступінь імуносупресії. Результати. У нашому дослідженні взяли участь 39 пацієнтів з герпесвірусною інфекцією, асоційованою з ВІЛ та 31 пацієнт контрольної групи. У пацієнтів з герпесвірусними захворюваннями на тлі ВІЛ-інфекції середній рівень ІЛ-31 в сироватці крові значно перевищував показники здорових суб'єктів. Рівні сироваткового ІЛ-31 у пацієнтів з герпесвірусною інфекцією істотно не розрізнялися залежно від тяжкості процесу і ступеня імуносупресії. Висновок. Рівні ІЛ-31 в сироватці крові у хворих герпесвірусною інфекцією відрізнялися статистично значущою достовірністю порівняно з аналогічними показниками здорових осіб, що підтверджує його роль в патогенезі інфекційних захворювань шкіри.

51-57

Authors: Serhiy Korovai , Igor Lakhno

Резюме. Порушення плацентації певним чином відіграють важливу роль у патогенезі великих акушерських синдромів. Тому привертає увагу можливість застосування біохімічних показників рівня плацентарного фактору росту (placental growth factor, PlGF) та fms-подібної тирозинкінази (sFlt-1) для прогнозування передчасних пологів. Метою роботи була розробка критеріїв прогнозування передчасних пологів на підставі сумісного використання ультразвукової цервікометрії та концентрації PlGF і sFlt-1. Матеріали та методи. Усього було обстежено 227 вагітних жінок, у 190 з яких відбулися передчасні пологи. До I групи залучено 48 жінок з загрозою невиношування вагітності, що завершилась пологами у термінах від 23 до 27 тижнів. У II групі під спостереженням знаходилось 142 жінки з загрозою невиношування вагітності в термінах від 28 до 36 тижнів. До III групи увійшли 37 жінок з фізіологічним перебігом вагітності, що завершилась пологами без ускладнень у термінах 38-41 тиждень. Усім залученим до роботи пацієнткам у терміні 16 тижнів проводили ультразвукову цервікометрію на апараті Voluson 730 (GE Healthcare, USA), а також вивчали концентрацію у сироватці крові PlGF та sFlt-1 методом електрохмілюмінісцентного імуноаналізу за допомогою аналізатора Cobas e411 (Roche diagnostics, Швейцарія). Результати. У ході дослідження виявлено вірогідне (р < 0,001) зниження в сироватці крові усередненої концентрації PlGF на 65 % на тлі підвищення рівня sFlt-1 на 93 % у жінок з перериванням вагітності в ранні терміни – 23–27 тижнів (I група) по відношенню до жінок з неускладненою вагітністю. У жінок з передчасними пологами у термін гестації 28–36 тижнів (II група) спостерігалась аналогічна тенденція змін: рівень PlGF вірогідно (р = 0,014) знижувався в середньому на 68 % по відношенню до жінок з фізіологічним перебігом вагітності. У жінок I групи значення співвідношення sFlt-1/PlGF перевищували (р < 0,001) значення пацієнток III групи в 14 разів. Але ще більш виражений дисбаланс ангіогенних факторів спостерігався у жінок II групи – в середньому в 16 разів. Для прогнозування передчасних пологів було використано два основних маркера: вкорочення шийки матки за даними ультразвукової цервікометрії менше 30 мм, а також співвідношення sFlt-1/PlGF більше 50 ум. од. Відношення шансів (ВШ) передчасних пологів у разі використання лише довжини шийки матки складало 34,133 (95 % довірчий інтервал – 12,308–94,660). ВШ у разі комбінованого використання даних цервікометрії та показників ангіогенезу було 148,750 (95 % довірчий інтервал – 33,243–665,593).

68-76

Authors: Alena Savanevich, Maryia Vasilkevich, Vitalii Abdrashitov, Tatiana Stepuro

Background: Breast cancer is the most common malignancy in women. In the countries of Central and Eastern Europe founder mutations in the BRCA1 and BRCA2 genes are responsible for a significant proportion of breast cancer cases; however, regional differences in the frequencies of various mutations may occur. The spectrum and frequency of BRCA1 and BRCA2 mutations among breast cancer patients have not yet been fully explored in Belarus. Aim: In this study, we aimed to estimate the incidence of BRCA1 and BRCA2 causative founder variants in breast cancer female patients with clinical signs of hereditary disease in western Belarus. Materials and Methods: Blood samples from 71 breast cancer female patients with clinical signs of hereditary disease from the western region of Belarus were examined. We studied 13 causative founder variants in BRCA1 (c.5266dupC, c.4035delA, c.5251C>T, c.181T>G, c.676delT, c.68_69delAG, c.3770_3771delAG, c.1687C>T, c.3756_3759delGTCT) and BRCA2 (c.658_659delGT, c.7910_7914delCCTTT, c.3847_3848delGT, c.5946delT) genes characteristic for the population of Central Europe. The study included 22 female patients with early-onset form, 8 individuals with bilateral and 41 women with multiple primary breast cancer. Results: 32 out of 71 patients (45 %) had one of the causative founder variants in the BRCA1 and BRCA2 genes. The most common mutation defined in these genes was BRCA1 c.5266dupC; it was detected in 19 women with breast cancer (27 %). The carrier of the pathogenic BRCA1 allele c.4035delA was confirmed in 8 cases (11 %). BRCA1 gene mutations were found to be significantly more common in presence of two or more signs of genetic predisposition to breast cancer. However, among 50 patients with a family medical history of breast and/or ovarian cancer and clinical signs of hereditary cancer, mutations in the BRCA1 and BRCA2 genes were found only in 24 (48 %) cases. Conclusion: The study showed high incidence of germinal BRCA1 mutations (45 %) among breast cancer patients in the western region of Belarus. Only two BRCA1 mutations (c.5266dupC, c.4035delA) are detectable in approximately 84 % of carriers. It is necessary to continue studying the mutations in the genes associated with development of breast cancer that are typical for Belarusian population, especially in the group of young female patients, since this study has confirmed the genetic predisposition only in every third patient under the age of 50.

83-91

Authors: Dmitriy Uzun, Vasyl Lazoryshynets, Katerina Uzun

Резюме. Клінічні дослідження вказують на значну роль в патогенезі розвитку гострого інфаркту міокарда функціонального стану агрегації тромбоцитів і в’язкості крові, які визначають характер плинності крові по судинах на рівні макро- і мікроциркуляції. Мета дослідження полягала в аналізі змін в’язкісних та тромбоцитарно-агрегаційних порушень під впливом різних тактичних, діагностичних і інтервенційних підходів у хворих на інфаркт міокарда із стійкою елевацією сегменту ST при наявності мультисудинного ураження коронарних артерій. Матеріали та методи. В дослідженні використано 4 тактичні і лікувально-діагностичні підходи протягом року спостереження. Результати. Виявилося, що у хворих на інфаркт міокарду із стійкою елевацією сегменту ST встановлено гіперв’язкий і гіперкоагуляційний синдроми, які проявлялися в перші тижні компенсаторним зростанням кількості тромбоцитів, в’язкості крові, рівня фібриногену, та зростанням агрегаційних властивостей тромбоцитів. Висновки. Проведення додаткового поглибленого обстеження коронарного кровообігу (когерентної томографії і внутришньосудинної сонографії) як основних методів детального оцінювання стану атероматозного процесу та подальше застосування відтермінованого стентування інфарктнезалежних артерій в групі 1, сприяло меншій амплітуді коливань всіх лабораторних показників порівняно з іншими тактичними і лікувальними підходами, а, відтоді, завдяки системному етапному поліпшенню артеріального кровопостачання, оптимізувати стан в’язкості і процесів адгезії/агрегації тромбоцитів. Традиційні тактичні та лікувально-діагностичні принципи ведення такої категорії хворих не дозволяють принципово поліпшити стан в’язкісних і коагуляційно-агрегаційних параметрів навіть при використанні подвійної антиагрегантної терапії.

16-24

Authors: Oksana Zagorodnieva, Liliya Ponomaryova

Introduction. HIV infection is a very dangerous disease and due to the lack of specific prevention methods and effective treatment methods leads to early disability or death. Now this problem is actual for every state, especially for ours, because Ukraine has the highest rate of the epidemic in Europe, therefore, humanity is alarmed by what is happening to the country, which is located in the center of Europe. If this disease is not stopped, the threat of a demographic, economic and social crisis will also increase for other states. Aim – the study of epidemiological features and reasons for the further spread of HIV infection in Ukraine according to open sources of medical statistics in Ukraine and other countries of the world. Results. The article provides data on the study of the problem of the global spread of HIV infection, which has not lost its relevance over the past 40 years. Detailed official statistical information on the social significance of the prevalence of HIV infection in our country and in the world has been provided. The main measures for the prevention of this disease, which is the most dangerous for adolescents, are given. A characteristic feature of the current stage of the spread of infection is that transmission and infection are associated with populations including children of HIV-infected people, members of their families and victims of violations of safety standards in certain medical institutions. Numerous "secondary risk groups" are formed, the emergence of which has a completely social nature. Conclusions. Nowadays, it is understood that diseases that are dangerous to society, such as HIV infection, are phenomena in the fight against which exclusively medical measures are ineffective. Solution to the problem of HIV infection should be a priority of state policy; it should be aimed, first of all, at preventive and elucidating work with young people, who are, without exaggeration, the main risk group. The authors substantiated the need to strengthen control by state institutions and to develop and implement a system of special measures to protect the rights and legitimate interests of citizens and society to preserve the national security of Ukraine.

33-41

Authors: Volodymyr Bubalo

Introduction. Today in the world there is a tendency towards an increase in the incidence of salmonellosis. As well as an increase in the proportion of antibiotic-resistant and various temperature regimes of the pathogen strains. This justifies the urgency of studying this problem, because bacteria of the genus Salmonella are the causative agents of acute infectious intestinal disease – salmonellosis. The aim of the study. To give a comparative characteristic of the sensitivity of a number of Salmonella strains to the action of high temperatures of Salmonella strains. To study the degree of thermal resistance of Salmonella strains at different temperature conditions and exposure periods. One of the components of observations of the circulation of zoonotic Salmonella is the study of changes in their biological properties. One of such properties is the ability to evolve in the environment and the ability to adapt to its adverse conditions by changing the sensitivity of bacteria to temperature and the ability to acquire heat-resistant signs. One of these properties is high stability in the external environment and the ability to adapt to its unfavorable conditions and the sensitivity of bacteria to the action of high temperature conditions, and the ability to acquire thermoresistant signs. Research objectives. Objectives of the study. To determine the ability of current and archival strains of salmonella to the action of the temperature factor and to compare their thermal sensitivity spectra. Materials and methods. Materials and methods. The object of the study were 136 strains of salmonella obtained from the Museum of Pathogenic Microorganisms of the Laboratory of Medical Microbiology of the Institute of Epidemiology and Infectious Diseases LV Gromashevsky NAMS of Ukraine". Research methods: microbiological research methods, as well as statistical analysis of the results. Results. The research results were processed using the licensed program «GraphPad Prism 6» and statistical methods 2-way ANOVA. The data were presented graphically. The significance of the changes was denoted by the symbol ″ * ″ – the probable difference at p ≤ 0.05. It was found that the control strain of Escherichia coli ATCC 25922 was sensitive to all temperature conditions. The results of the study of susceptibility of S. typhimurium strains to the action of temperature in 70ºC showed that on average 75 % of archival strains survived at one-minute exposure, 33,00 % – at 3 minutes of exposure 70ºC, and up to 8,00 % at exposure of 10 minutes. The obtained results indicate an increase in heat resistance among S. Тyphimurium strains isolated in 2006–2012 compared to those isolated in 1996–2005 due to increased adaptive potential of microorganisms and increased chances of survival of bacteria in adverse conditions. The change of sensitivity to the action of high temperatures of Salmonella due to the accumulation of a significant number of heat-resistant strains in the population has been established. An increase in the percentage of moderately sensitive to high temperature actual strains of S. Тyphimurium and S. Еnteritidis in comparison with archival strains is shown. Increased adaptability to high temperatures was found in both S. Еnteritidis strains isolated from sick people and in salmonella strains of rare groups isolated from the environment. Topical strains of S. Еnteritidis and salmonella strains of rare groups were the most heat-resistant. In the course of the study, the author showed an increase in the percentage of moderately sensitive to high temperature actual strains of S. Тyphimurium and S. Еnteritidis in comparison with archival strains. Current strains of S. Еnteritidis and salmonella strains of rare groups were the most heat-resistant. Conclusions. The change of the biological properties of salmonella due to the accumulation of a significant number of heat-resistant strains in the circulating population has been established. An increase in the proportion of moderately sensitive to high temperature actual strains of S. Тyphymurium and S. Еnteritidis in comparison with archival strains is shown. Increased adaptability to the action of high temperatures was found in both S. Enteritidis strains isolated from sick people and in Salmonella strains of rare groups isolated from the environment. Topical strains of S. Еnteritidis and salmonella strains of rare groups turned out to be the most heat-resistant. The results of studies to assess the sensitivity of Salmonella to high temperatures indicate changes in the genotype of bacteria and as the result of evolutionary changes aimed at preserving the genus.

51-63

Authors: Dmytriiev Dmytro, Nazarchuk Oleksandr, Babina Yuliana, Oleksandr Stoliarchuk

Summary. The problem of treatment and prevention of postoperative purulent complications in abdominal surgery in our time remains extremely urgent. This is due to an increase in the number of complex operations using modern technologies, an increase in the volume and duration of surgical interventions, as well as current antibiotic resistance problems. Objective: to study the structure of the leading causative agents of perioperative infectious complications in patients with surgical pathology and study their antibiotic sensitivity. Materials and methods - 576 patients, the average age of 45 ± 10.5 years, took part in the investigation, who were treated in the departments of surgery and intensive care unit of medical institutions of Vinnitsa region. A microbiological study of materials collected from patients was carried out (selection of secretions, fluid during drainage of superficial and deep surgical wounds). From the obtained biological material, a pure culture of the pathogen was isolated with its identification by morphological, tinctorial, cultural and biochemical properties according to generally accepted microbiological methods and using the Vitec automatic bacteriological analyzer (France). And a comparison was made of the profile of the sensitivity of the most significant pathogens to modern antibiotics. Results. According to the results of the study, it was revealed that the most common pathogens of surgical wound infections include opportunistic bacteria E.coli (22.0 %), S.aureus (19.0 %), S.epidermidis (13.0 %), E .faecalis (15 %), P.aeruginosa (10.0 %), A.baumanii (11.3 %). An analysis of the sensitivity to antibiotics of various classes of studied strains of the dominant causative agents of perioperative infectious complications showed that β-lactam antibiotics (meropenem (75–100 %), cefepime (65–100 %) and fluoroquinolones chemotherapeutic agents had the greatest antimicrobial activity. A slightly lower antimicrobial activity was found for third generation cephalosporins (70–85 %), amoxicillin-clavulanate (40–75%), aminoglycosides (tobramycin – 80 %, amikacin – 40 %). A high level of resistance of most grams of (-) microorganisms to ampicillin-sulbactam, cephalosporins of I–II generations in different ratios was determined. S.aureus resistance to azithromycin, clarithromycin is shown. Conclusions: the high prevalence of multiresistant isolates of pathogens (gram-positive (Staphylococcus aureus, enterococci), gram-negative pathogens (Escherichia, Klebsiella, enterobacteria, acinetobacteria, pseudomonads) emphasizes the need for dynamic microbiological monitoring in the surgical departments and the use of alternative antimicrobial drugs only.

74-83

Authors: Oksana Matsyura

Introduction. Food allergy is an urgent problem in modern pediatrics. Cow’s milk is the main food allergen in young children. By the age of one year, from 0.5 % to 3 % of children suffer from cow’s milk protein allergy. Aim. To analyze the existing standards of conducting oral provocation tests with milk in young children and suggest own algorithm of diagnostics. Materials and methods. Algorithm of diagnosing cow’s milk allergy was probated in 107 children aged from one to three years in Communal Municipal Children’s Clinical Hospital. To diagnose cow’s milk allergy, compilation of allergological anamnesis, examination, assessment of physical development, and determination of specific IgE to cow’s milk are performed. Then, different oral provocation tests are conducted based on the obtained results: at the allergist’s office on an outpatient basis, in a specialized inpatient department, in an intensive care unit. Results. Among 107 children, who were subjected to oral provocation test with milk, cow’s milk protein allergy was diagnosed in 67 (62.62 %). In children, who were diagnosed cow’s milk protein allergy (n = 67), skin (41.79 %) and gastrointestinal (28.36 %) symptoms prevailed. In the group of children with predictable low risk of allergy, diameter of a papule equaled 3.86 ± 0.62 mm2, the level of specific IgE to milk in blood serum was 0.58 [0.37–0.68], and in the group with medium risk – 5.51 ± 1.38 mm2 and 3.62 [0.86–9.66] kU/L, respectively. All 40 children, in whom cow’s milk protein allergy was not confirmed, constituted the group with predictable low risk of reaction development. Diameter of a papule during prick-test equaled 3.13 ± 0.24 mm2, the level of specific IgE to milk in blood serum was 0.36 [0.35–0.67] kU/L. In this group of children, complaints of gastrointestinal symptoms (82.5 %) prevailed. Conclusions. A complex diagnostic approach, in particular, study of anamnesis, examination, assessment of physical development, record of food diary, determination of specific IgE to milk, oral provocation tests enable to optimize diagnostics of food allergy and choose further therapeutic tactics. Algorithm of diagnosing cow’s milk protein allergy in 1–3-year-old children has been elaborated, which can be recommended for common application in clinical practice.

92-97

Authors: Kyrylo Parkhomenko

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

107-114

Authors: Larysa Strilchuk

Introduction. The monocytes to high-density lipoproteins ratio (M/HDL) is known as an integral indicator of inflammation, oxidative stress and lipid accumulation, which allows its use in the assessment and prediction of a number of diseases. Purpose: to determine the clinical significance of M/HDL according to the literature and to establish its changes and correlations. Materials and methods. We made a literature search in the Pubmed database and domestic sources, and analyzed data of 1190 outpatients with various diagnoses and 116 inpatients with unstable angina (UA). Digital data were statistically processed with Statistica 6.0. Results and discussion. Elevated M/HDL is associated with the development of atrial fibrillation after coronary artery bypass grafting, hospital mortality, and all-cause mortality. M/HDL can be a criterion of inflammation and oxidative stress, as well as a predictor of the severity of coronary heart disease and the risk of cardiovascular events. According to own data, in 1190 outpatients the average level of M/HDL was 6.50 ± 0.21. The increase in the M/HDL ratio occurred in parallel with an increase in the number of blood basophils, the development of intrahepatic cholestasis, increased endogenous intoxication, decreased total cholesterol and fasting blood glucose, and diastolic left ventricular dysfunction. In patients with UA M/HDL averaged 5.41 ± 0.40. An increase in the M/HDL ratio was associated with male gender, a decrease in total cholesterol and fasting blood glucose, and lower integrative hematologic markers of immune reactivity. The M/HDL was maximal in patients with bent gallbladder body, which was accompanied by the elevated values of very low density lipoproteins cholesterol (0.80 ± 0.10 mmol/l), triglycerides (1.76 ± 0.21 mmol/l), both Castelli indices and lower high-density lipoprotein cholesterol. An inverse correlation of M/HDL with left ventricular ejection fraction was found in patients with intact gallbladder. Conclusions. 1. M/HDL is a valuable marker of atherosclerosis and inflammation. 2. M/HDL was maximal in patients with bent gallbladder body, which was accompanied by dyslipidemia. 3. The inverse correlation of M/HDL with left ventricle ejection fraction in case of intact gallbladder and direct correlation with the aorta diameter in patients with cholecystitis confirm the association of the increase of this ratio with the unfavorable course of cardiovascular diseases. 4. In patients with UA and intact gallbladder or cholelithiasis M/HDL correlated with the nuclear index of intoxication.

123-130

Authors: Viktor Slivka

The literature review summarizes the data on the classification and characteristics of the antioxidant defense system. This model combines a number of different substances. Each of the components of the antioxidant system acts in close connection with its other structural elements, harmoniously complements, and in many cases – enhances the action of each other. The functional basis of the system of antioxidant protection is formed by the glutathione system, the constituent elements of which are actually glutathione and enzymes that catalyze the reactions of its reverse transformation (oxidation ↔ reduction). Most researchers conventionally divide the system of antioxidant protection into enzymatic and non-enzymatic. The enzyme links of the antioxidant defense system include: catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase, glutathione transferase and other enzymes. The non-enzymatic system includes fat-soluble vitamins A, E and K, water-soluble vitamins C and PP, biogenic amines, glutathione, carotenoids, ubiquinone, sterols. Both enzymatic and non-enzymatic antioxidant defense systems are present in the bloodstream. The activity of the enzymatic antioxidant system is very well regulated and depends on age, physiological condition, hormone dynamics, intensity of antioxidant enzyme synthesis, pH, presence of coenzymes, inhibitors, activators and other factors. The non-enzymatic part of the antioxidant system does not require as many regulators as the chemical itself - the antioxidant - reacts chemically with the radical. Only the reaction rate can change. The lungs are directly exposed to oxygen and oxidants of polluted air, they are most sensitive to oxidative damage, so they have an increased possibility of free radical reactions. Protection against the damaging effects of reactive oxygen species and free radicals is provided by anti-radical protective systems, especially the glutathione system and its enzymes. Numerous papers have obtained clinical and experimental data on the important role of free radical oxidation of lipids (FROL) and antioxidant systems (AOS) protection in the development of many diseases, including pulmonary tuberculosis (TB). The review presents modern views on the state of the system of lipid peroxidation (LPO) and antioxidant protection in TB. The main topic of the review is information on the generation of free radical compounds by different populations of leukocytes with further enhancement of LPO and secondary deepening of functional disorders. The article substantiates the feasibility of identifying LPO products as non-specific markers of aseptic inflammation in TB and the need to develop new generations of antioxidants. One of the universal mechanisms of damage to cell membranes is LPO, the excessive activation of which is normally prevented by factors of the antioxidant defense system. Membrane-bound enzymes involved in the formation of LPO products include lipoxy and cyclooxygenases. Lipoperoxidation processes change the structure and phospholipid composition of cell membranes, which negatively affects the cellular immune response due to damage to the mechanisms of information transfer from extracellular regulators to intracellular effector systems.

13-22

Authors: Oksana Bobrova, Natalia Mikhanovska, Krystyna Kryvonos

opsychiatric complications of socially significant parasitosis – toxoplasmosis in Ukraine. The clinical features of the course of chronic toxoplasmosis, changes in the bioelectrical activity of the brain in patients with toxoplasmosis in the acute stage are described. In order to objectify the assessment of the nature of damage to the nervous system of patients, an electroencephalographic (EEG) study was performed with visual assessment and computer processing of the results. Changes in the infrastructure of correlations between clinical and EEG parameters in patients with chronic toxoplasmosis in the acute stage before treatment are described. The main solutions for non-specific prevention of neuropsychiatric complications in this parasite are presented. The significance of the study of the parameters of bioelectrical activity of the brain in patients with toxoplasmosis, which can be used as auxiliary prognostic criteria, is substantiated. The main measures for the prevention of congenital toxoplasmosis, which is dangerous, especially for newborns and people with immunodeficiency, are outlined. The above is a necessary basis for improving the system of epidemiological monitoring for the spread of toxoplasmosis in Ukraine, and strengthening control by state institutions to prevent parasitological pollution, as well as the creation of a National Program for surveillance of parasitic infestations, to control the spread of parasitosis, and warn of severe consequences for the health of the infected

33-38

Authors: Yuliia Karpushenko, Nataliia Pavlenko, Kostiantyn Voloshyn

Introduction. Pediatric allergy problems are widely spread among children of almost all age groups. Number of cases with combined allergic a digestive disorders increases and study of gastrointestinal lesions in children with allergies became an urgent medical and social problem. It is based on the increasing frequency of both allergy and pathology of the digestive system, increasing severity of cases and necessity to analyze type of gastrointestinal disorder in children with allergy and correlation among it. Objective. To study the clinical features of gastrointestinal symptoms in children with food allergies. Materials and methods. 169 pediatric patients 3–17 years old were examined. The main group was of 105 children with food allergies, the control group – 64 children without allergies. Verification of food allergy and pathology of the digestive system was carried out in accordance with the current protocols. All patients had skin prick tests, provocative test, determination of specific IgE. All patients were divided into 3 groups by age: 1st – 3–6 years old, 2nd – 7–11 years old, 3rd – 12–17 years old. The results were processed by the methods of variation statistics. Results. Gastrointestinal manifestations were observed in children of all age groups (59 %, 65 %, 74 %). Skin manifestations predominated in the 1st and the 3rd group. Respiratory symptoms – in groups 2 and 3. A combination (more often of skin and gastrointestinal) manifestations was found in group 3. Pain syndrome in children of the main group was characterized by moderate intensity (55.2 %), more often not associated with food intake (45.7 %), localized in the umbilical region (58 %), less often in the epigastrium (23.4 %), in 15 % there was no pain. Dyspeptic syndrome was manifested by nausea (36.2 %), decreased appetite (25.7 %) and belching (17.1 %). Dyspeptic syndrome was absent in 34.3 % of patients. The manifestations of asthenovegetative syndrome were noted in 38.1 % of children in the main group. The correlation between the type of allergen and the reason of gastrointestinal symptoms has not been identified. Conclusions. A variety of clinical manifestations of food allergy has been proven in the form of skin, gastrointestinal, respiratory symptoms and their combination. Gastrointestinal symptoms indicate the presence of functional disorders of the digestive tract. With age, the variety of food allergens increases, without qualitatively affecting the nature of gastrointestinal symptoms.

47-55

Authors: Mariia Matvieienko

Disorders of the oxygen transport play an important role in the development of multiple organ disfunction syndrome and are a marker of tissue hypoxia and ischemia. Disorders of the oxygen transport could be use for predicting patient survival and as criteria for the severity of the pathological process. The aim of this study was to explore the indicators of systemic oxygen transport in the perioperative period in patients with traumatic deases in multi-stage surgical correction at polytrauma in terms of standard and advanced intensive care. Materials and methods. A prospective study of 88 patients with traumatic deases was conducted. The dynamics of indices of oxygen delivery (iDО2) and oxygen consumption (iVO2), oxygen extraction coefficient (KEO2) at different variants of intensive care was studied. Results. The patients in both groups was noted iDO2 decline, which was due to massive blood loss and decreased cardiac output on admission to the operation room. Despite the fact that during the acute period was held stop bleeding, correction of hypovolemia and posthemorrhagic anemia, the average level of iDО2 was quite low. iDO2 was multidirectional nature of the changes in the studied groups at the second and third stages of the study. In turn, the average values KEO2 characterized the degree of tension compensatory mechanisms and metabolic changes caused by hypoxia and hypoperfusion. Normalization of oxygen homeostasis parameters was achieved in the fourth stage of the study. Conclusions. The maximal intensity of development of compensatory mechanisms and changes of oxygen transport occurs within the first 5 days after the injury. The optimized intensive care which has been used in the treatment patients of Group II, has positive effect on the ability to potentiate adaptive defense mechanisms and reduce oxygen debt.

64-69

Authors: Tamara Pasiieshvili

Introduction. In recent years, there has been an increase in the prevalence of gastroesophageal reflux disease and autoimmune thyroiditis in young people. This is associated with a hereditary predisposition, viral diseases, which are often recorded in children's and adolescent groups, the unreasonable use of a large number of drugs, as well as the influence of various negative environmental factors, instability of the autonomic nervous system, eating disorders, the presence of bad habits, chronic stress and others. The aim of the work was to investigate the state of total antioxidant status and the content of biomarkers of the second phase of detoxification of xenobiotics - manganese superoxide dismutase and glutathione peroxidase in young people with gastroesophageal reflux disease and autoimmune thyroiditis. Materials and methods. To achieve this goal, 120 patients with a combined course of gastroesophageal reflux disease (GERD) and autoimmune thyroiditis (AIT) were examined, which made up the main group and two comparison groups: with isolated GERD (45 people) and AIT (42 patients). All patients were students of various universities and were between the ages of 18 and 25. Duration of the disease did not exceed 3 years. The total antioxidant status as an indicator of the first phase of defense and the levels of mitochondrial manganese superoxide dismutase and glutathione peroxidase – the second phase of antioxidant defense was determined. Results. The study showed that in all surveyed groups there was a decrease of total antioxidant status, which characterizes the first phase of the antioxidant defense system. Changes in the first phase of antioxidant defense affect the indicators of the second level of the system, which became the basis for studying the activity of mitochondrial manganese superoxide dismutase. Thus, the value of this indicator in all examined individuals exceeded the norm, which confirmed the inclusion of the second controlling phase of antioxidant system into the pathological process. At the same time, an increase inhibition of the glutathione defense link, the second phase of xenobiotic detoxification, were diagnosed. Conclusions. Negative changes occur in the enzyme system of the first line of antioxidant system in patients with GERD and AIT which may be the result of an unfavorable autoimmune background. Control over the work of antioxidant system moves to the second phase of the system, manifested by an increase in the content of mitochondrial manganese superoxide dismutase and inhibition of the activity of glutathione peroxidase in patients with a combination of GERD and AIT.

80-89

Authors: Natalia Tselik, Alexander Martynenko, Oleksander Bilchenko

Introduction. Arterial hypertension is associated with electric instability of the myocardium and the development of fatal ventricular arrhythmias. One of the main causes for the electric instability of the myocardium is the in homogeneity of the ventricular repolarization processes, which can be estimated by studying QT interval duration and dispersion. Objectives.To study the dependence of QT interval (QTc) duration on the level of blood pressure in patients with arterial hypertension using a standard ECG recording and an ambulatory ECG monitoring. Materials and methods. Were examined147 patients, 124 of which with arterial hypertension and 23 without arterial hypertension. Patients were divided into 5 groups according to their blood pressure level: group 1 – normal or elevated blood pressure on a background of antihypertensive therapy: 56 patients (38.1 %), group 2 –grade 1 hypertension; 39 patients (26, 5 %), group 3 –grade 2 hypertension: 22 patients (15 %), group 4 –grade 3 hypertension: 7 patients (4.8 %), the fifth group – normal or elevated pressure: 23 patients, which is 15.6 % (comparison group, without arterial hypertension). The study of the dependence of QT interval (QTc) duration on the level of BP was carried out according to the analysis of the data of standard ECG, ECG Holter monitoring and 24-hour blood pressure monitoring. Results. A statistically significant regression dependence of the duration of minimal nocturnal QT intervals and corrected QTc on the stage of arterial hypertension in groups 1 and 4 with p < 0.05 was establishedon the basis of Student’s t-test for independent samples. Conclusions. There was a statistically significant regression dependence of the minimum QT interval at night and the minimum corrected interval QTc at night on the daily level of variability 1 of systolic blood pressure, which indicates a direct dependence of the QT interval and QTc on blood pressure.

99-107

Authors: Nataliya Veresniuk, Vira Pyrohova

Summary. Reproductive health is a priority in today’s global health care system. Among the factors of reproductive health disorders are female genital tract malformations. This pathology is mostly diagnosed with the onset of reproductive disorders at different ages of women, negatively affecting not only the reproductive but also the sexual functions of women, absorbing the quality of her life. The objective: to develop measures for the prevention of reproductive disorders in patients with female genital tract malformations based on the assessment of clinical manifestations and the frequency of reproductive disorders. Materials and methods. A retrospective assessment of reproductive disorders in 84 patients with a verified diagnosis of abnormalities in the development of the female genital organs was performed. The diagnosis was based on complaints, anamnestic data, the results of objective examination, clinical, laboratory and instrumental methods. The control group consisted of 25 women without abnormalities in the development of the female genitalia. Results. The mean age of the surveyed women was 27.6 ± 3.8 years. The duration of verification of the diagnosis of female genital tract malformations from the moment of the first visit to the gynecologist took an average of 3.1 ± 1.3 years. Of all the abnormalities in the development of the female reproductive system, 14.3 % were so-called «obstructive» abnormalities associated with impaired menstrual blood flow. Therefore, their clinical manifestation was earlier and more pronounced than in other patients and was manifested primarily by severe dysmenorrhea. Deviations in the age of onset of menarche occurred in 25 % of patients (OR =8; 95 % CI 1,019 – 62,798). In 73.8 % of women, the first reproductive disorders began during puberty. Dys menorrhea of varying severity occurred in 69.1 % of patients (OR = 7,064; 95 % СІ 2,527 – 19,744), of whom 70.6 % used medical treatment. The share of infertility among the women with anomalies in the development of the reproductive system was 19.1 %, pregnancy loss – 40.5 %. It was found that the risk of miscarriage in patients with congenital pathology of the female genitalia increases significantly (OR = 3,570; 95 % CI 1,125 – 11,325). 34.5 % of patients were diagnosed with genital endometriosis (OR = 6,064; 95 % СI 1,335 – 27,540). In 21.4 % of cases, abnormalities in the development of the female genitals were combined with congenital kidney disease. Conclusions. Prevention and predictability of reproductive disorders in patients with female genital tract malformations should begin with the pubertal period of the girl. A separate risk group consists of girls with pathology of the kidneys diagnosed prenatally. The basis for the prevention of reproductive health disorders in women with female genital tract malformations is the timely verification of congenital pathology and the development of a personalized system of management. The results of our research and the literature suggest that verification of the diagnosis of female genital tract malformations in women usually begins when patients have lost pregnancy or are experiencing infertility, while dysmenorrhea, menstrual irregularities that may occur in adolescence, often do not alert and do not become the basis for exclusion of congenital anomalies. That is why we believe that screening ultrasound examination of the pelvic organs in the presence of these disorders, it is advisable to conduct girls during puberty, if necessary – using 3D ultrasound and/or MRI.

117-124

Authors: Tetiana Zolotarova, Mariia Brynza

Introducrion. Recent randomized controlled trials suggest that catheter ablation of atrial fibrillation (AF) in heart failure (HF) patients leads to improvements in left ventricular function, exercise capacity, and quality of life, but focused on HF with reduced left ventricle ejection fraction (LVEF). Aim. To study the clinical course of chronic heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation. Materials and methods. 194 patients with AF and chronic HF with preserved ejection fraction were included in the study: 136 patients – underwent catheter ablation (CA) for AF; 58 − control group, who continued pharmacological therapy (PT) for rhythm control strategy. All the patients had New York Heart Association (NYHA) class I, II or III HF, LVEF > 40 %. Baseline characteristics comprised demographic and clinical data, medical history echocardiography and ECG results of the included patients. Results. Patients on PT were significantly more symptomatic for HF in comparison to CA patients (the average value of NYHA class HF 2,2 ± 07 versus (vs.) 1,8 ± 0,6; p = 0,019), but AF for itself were more symptomatic in CA group (the average value of EHRA 3,1 ± 0,5 vs. 2,9 ± 0,6; p = 0,001). Among patients with HF with preserved LVEF who underwent CA and were followed-up 24 months 52,9 % of patients remained free of AF recurrence; while in the control group only 7 %. At the 24 months follow-up NYHA class significantly improved in ablation group, as well as EHRA score. Conclusions. Radiofrequency catheter ablation was associated with improved the clinical course of chronic heart failure with preserved left ventricle ejection fraction and AF – related symptoms itself.

134-140

Authors: Kateryna Kharina, Veronika Shepel, Taisiia Sazonova

Introduction. Meniere’s disease is accompanied by a non-infectious pathology of the inner ear, during which can lead to systemic labyrinth dizziness, nausea, vomiting, hearing loss and tinnitus in one ear. It is a rare disease, affecting up to 200 cases per 100,000 people. Aim. The purpose of this article was to analyze the clinical case of a patient with Meniere's disease. Materials and methods. Patient S., was admitted to the Department of Vascular Pathology of the Brain and Rehabilitation of the State Institution «Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine» with complaints of regular attacks of systemic vertigo with a frequency of up to 7 times a week lasting 1–4 hours, sometimes accompanied by vomiting, constant noise and whistling in the left ear. He considers himself ill since 05.11.19, when during training in the gym there was the first case of dizziness and vomiting, which lasted 3 hours. In August 2019, the attacks continued, became more frequent and prolonged, passed on their own, sometimes in a specific position of the head - the head tilted forward with the neck stretched out. Neurological examination revealed that the palpebral fissures and pupils were equal. Eye movements are full, painless. Convergence insufficiency was examined. Corneal reactions are reduced. Horizontal positioning nystagmus was examined. There are no pathological signs, no sensory disturbances. The patient performed coordination tests with uncertainty. The patient showed unsteadiness during Romberg's test. The patient felt pain during the palpation of paravertebral points. The patient experienced exaggerated changes in mood. Results. 1. Brain MRI results showed a thinning and a decrease in the MR signal on T2 from the cochlea of the inner ear to the left. CT scanning of the mastoid processes revealed an increased density of bone structures of the labyrinth nucleus on the left. 2. During the otoneurological examination, the asymmetry of vestibular responses along the labyrinth, slight stimulation of the left labyrinth were established. The patient was diagnosed with peripheral cochleovestibular syndrome on the left, Meniere's syndrome. Conclusions. This clinical case illustrates the importance of collecting a detailed medical history and examination of a patient with complaints of dizziness, hearing loss, tinnitus, and repeated vomiting. To establish a diagnosis and develop a treatment plan for a patient, the coordinated work of a multidisciplinary group is required, which should consist of a neurologist, audiologist, and otolaryngologist.

26-31

Authors: Olga Gryshchenko, Mamedova Sevindzh Shahin kizi

Annotation. In 2001, M. S. Robson proposed a classification based on criteria to identify pregnant women whose birth is not possible naturally. The purpose of the study is to analyze the frequency and structure of indications for caesarean section to determine promising ways to optimize the management of labor. Materials and methods. Based on the final diagnoses, an analysis of the structure of the absolute and percentage number of women groups M.S. Robson, the caesarean section frequency in each group, and the caesarean section structure for individual groups in 2071 women giving birth in the Kharkov city perinatal center, including 726 (35,1 %), by caesarean section. Results. The most promising in terms of reducing the frequency of cesarean section are women of the 1st, 2d and 3rd groups. In most cases, caesarean section in these groups was performed due to complications of childbirth or in connection with obtaining new data on the risk of complications during childbirth. Among these women, a rather frequent indication for emergency surgery is primary weakness of labor (in the 1st and 3rd groups) or weakness of labor after unsuccessful induction of labor (2a and much less often – 4a group). It is this contingent of pregnant women and women in childbirth that requires special attention. On the one hand, it is a reserve to reduce the frequency of cesarean section, on the other hand, in some cases, the operation is performed late, which leads to severe depletion of the woman in labor during childbirth, complete suppression of the contractile function of the uterus with a lack of sensitivity to oxytocin and to severe hypoxic-ischemic complications in the fetus. Conclusions. To substantiate a decrease in the frequency of cesarean section, the most promising is the group of women with first or repeated births with full-term single-term pregnancy and head presentation of the fetus (groups 1 and 3 according to M.S. Robson), and with planned induction of labor (groups 2a and 4a), that make up more than 20 % of women after cesarean section. Planning the optimal tactics of labor management for these women on the basis of identifying risk factors and determining the contingent of women for whom a set of preventive and therapeutic measures is appropriate is to reduce the frequency of cesarean section.

40-48

Authors: Yevgen Khvorostov, Olexii Tsivenko, Yuriy Zakharchenko, Sergii Bychkov, Roman Hrynov

One of the most threatening complications of cholelithiasis (cholelithiasis) is obstructive jaundice (MF), which leads to the development of hepatic-renal failure. The results of surgical treatment of 386 patients were analyzed for various forms of cholelithiasis complicated by breast. The use of a combination of ultrasound, endoscopic, and radiation studies in the diagnostic program to visualize the cause of the mammary gland against the background of the complicated course of the cholelithiasis made it possible in almost 100 % of cases to make a correct diagnosis and conduct a staged minimally invasive surgical treatment: stage I included endoscopic retrograde cholangiopancreatography, papillosphincterotomy with choledocholithotraction, debridement and nasobiliary drainage of the common bile duct; at the II stage, 83,94 % of patients underwent laparoscopic cholecystectomy. The tactics of widespread use of a combination of highly informative diagnostic methods and staged minimally invasive treatment is characterized by high efficiency and good results.

60-68

Authors: Alexey Kuznetsov

Introduction. Seasonal allergic rhinitis is allergic diseases (AD) of mucous membranes (primarily the conjunctiva of the eye and nasal mucosa), due to hypersensitivity to aerosol allergens of plant pollen and fungi spores, the concentration of which in the air periodically becomes causal. The leading clinical manifestation of SAR is considered as allergic conjunctivitis. According to statistics, about 70–90 % of patients with SAR develops Pulawy conjunctivitis, characterized by itching of eyes, eyelids, their redness, photophobia, lacrimation. Clinically important is the combination of SAR and conjunctivitis. Although the SAR attention usually emphasize on nasal symptoms, more than 80 % of patients, as practice shows, suffer from symptoms from the eyes. According to the European and North American researchers, more than 70 % of patients with SAR suffer from eye and nasal symptoms, and their severity the majority of patients assessed as moderate or severe. Materials and methods. Were examined in 120 patients with seasonal allergic rhinitis in combination with conjunctivitis: 58 patients with moderate and 62 patients with severe disease. Research results. The patients of the 1st group the level of total IgE was increased 5.6 times, patients of group 2 – 7.1 times in comparison with the control group. The level of specific IgE in group 1 was 37.7 KU/L in group 2 – 46.9 KU/L, when reference levels – 0 – < 0,35 KU/L in the study, the CІC was established an increase of their concentration in patients of groups 1 and 2 groups. However, patients 1st group mainly increased levels of high molecular weight, the CІC, and in patients 2 groups – mainly the level of low molecular weight CІC. Discussion of research. The study of the population structure of the lymphatic peripheral blood of patients SARK revealed changes in T-cell link of immunity, characterized by a decrease in the content of CD3+-cells from patients 1 group by 10,7 %, in patients of group 2 – by 19,0 % in comparison with similar indicators of control group. Conclusions. Certain disorders in patients with severe disease are more profound than in patients with the moderate course of the disease. In patients with severe, in contrast to patients with moderate to severe flow disturbances and in the phagocytic link of immunity. In patients with severe as reduced the absorption activity of phagocytes and their ability in induction of reactive oxygen species. In patients with severe marked increase in the level of low molecular weight CІC, in patients with moderate to severe over – mainly high molecular weight of the CІC, which have less toxic than low molecular weight.

77-83

Authors: Oleksandr Reznichenko, Svitlana Gridnieva, Maksym Martynenko

The problem of student health has become of great importance in recent decades and remains unresolved at the current time. The article presents the data of the study of acute morbidity of students of higher educational establishments, its frequency and structure, the gender peculiarities and the state of resistance of their organism are analyzed. Highlighted the priority diseases groups, their specificity and differences. According to the results of the study, the state of adaptation of the students' body in the first year of study was revealed. At the same time, there are signs of tension and breakdown of these mechanisms, decrease in body resistance may be primarily due to sudden changes in the habitual environment of students, impaired diet and quality of work-rest cycle, the presence of a large number of students who have bad habits, constant increase of educational and information load in the present conditions. Only 18.46 ± 1.16 % of medical high schools and even fewer students of technical high schools have 7.81 ± 0.63 % satisfactory indicators of resistance to the body, which indicates a possible discrepancy between the impact of the educational complex and external factors to the adaptive capacity of the student body. In the structure of acute morbidity prevail respiratory diseases in both study groups (KhNMU − 80.16 ± 2.58 %, KhNURE − 80.37 ± 2.61 %). Also, quite a large part was taken by diseases of the digestive system and urogenital system. Students of a technical university had worse indicators of body resistance compared to students of a medical university. It was also found that boys had poorer body resistance compared to girls in all groups. In future all this has negative social and economic consequences for the country as a whole.

90-97

Authors: Kateryna Shtrakh, Larysa Rak, Natalia Shevchenko, Shalom Odigbo

Summary: The cardiovascular system is actively involved in the adaptive reactions of the body. The deterioration of adaptive processes decreases the functional capabilities of the heart. Arterial hypertension is often known as the main cause of fatal cardiovascular events in adults. The aim of our study was to determine the adaptive capabilities of the cardiovascular system of adolescents with non-inflammatory cardiomyopathies depending on physical activity’s level. There were examined 92 patients with arterial hypertension and connective tissue dysplasia, the mean age was 15,4 ± 1,33 years. In order to study tolerance to the minimum physical activity and its influence on the state of the cardiovascular system in children, the Ruffier test was conducted. The vegetative reactions of central nervous system were performed by the orthostatic test. The functional state of the myocardium was assessed according to the results of the ultrasonic Doppler study of the heart. As a result of the study, it was found that in connective tissue dysplasia and arterial hypertension adaptation mechanisms were affected, accompanied by a weakening of cardiac functional capabilities. This happens against the background of a decrease in the functioning of the left ventricle. These changes are accompanied by hyperactivation of the autonomic nervous system in patients in the studied groups. The physical activity and physical development of children affect the adaptive capabilities of a growing organism. This is due to the fact that the children in group with AH and CTD were less physically active than children without myocardial pathology. Adolescents who showed the reduced results of Ruffier's test and had regular sports sections need change of a mode of training and further inspection.

106-110

Authors: Mykola Popov, Olena Ognivenko, Olena Lisovets, Olga Sorokina, Vera Olenych

Paraganglioma is one of the tumors that is rarely found in the practice of an otorhinolaryngologist. Approximately 90% of tumors from nonchromaffin paraganglia occur in the adrenal glands. Nevertheless, 5 – 10 % of paragangliomas have different localization: 85 % - in the abdominal cavity, 12 % - in the chest, 3 % - on the head and neck. Paraganglioma grows slowly, but there is a risk of its degeneration into a malignant neoplasm. Diagnosis of paraganglioma includes CT, MRI; Ultrasound scintigraphy, arteriography, biopsy, histological examination. The main treatment for this education is surgical. As this tumor occurs rather rarely, we present a clinical observation of a paraganglioma of the nasal cavity. Purposes. The purpose of this article is to describe a rare clinical case of paraganglioma of the nasal cavity to determine diagnostic measures and treatment tactics to help a practical doctor. Materials and methods. On 01/18/2019 patient M., 52 years old, with complaints of recurrent nosebleeds, difficulty breathing in the right half of the nose was received at the ENT Center «V. T. Lisovets Dynasty». Bleeding from the nasal cavity has been disturbing the patient twice a week for 6 months, for no apparent reason. An increase in the frequency of bleeding up to 4–5 times a week has been noticed for the last month. On a series of MRI tomograms dated 12.24.2019, in the front sections of the nasal concha, on the right, a volumetric pathological formation with dimensions of about 10 × 12 mm, with tuberous contours, an inhomogeneous MR structure was determined. Bone structures were not affected. The neoplasm narrowed the lumen of the nasal cavity on the right. Conclusion: MR-picture of the pathological volumetric formation (of blastomatous nature) of the nasal cavity on the right. Results. On 01/21/2019 the patient underwent surgical removal of the neoplasm within healthy tissues using a radioknife. An anterior nasal tamponade with a hemostatic preparation was performed. The postoperative period was without complications. A morphological examination of surgical material N 330/2019 yielded the following results: a microscopic examination determined a tumor with the same histological picture in the form of alveolar and solid areas, a branched network of blood vessels of capillary type, fibrous tissue of various thicknesses. Tumor parenchyma was represented by epithelioid morphology cells with pronounced eosinophilic cytoplasm, a large nucleus with granular chromatin. Cells with a weakly expressed eosinophilic cytoplasm, with small monomorphic nuclei were also found. Conclusions. The patient was diagnosed with a rare tumor of neuroectodermal nature, which in most cases has a benign nature, slow growth and develops from nonchromaffin ganglia, which are scattered throughout the body. As the formation grows, the arterial and venous network of vessels develops. The clinical picture of a neoplasm of the nasal cavity is often masked by the symptoms of chronic polypousrhinosinusitis, vasomotor and chronic hypertrophic rhinitis. Based on the foregoing, this clinical cases valuable for the practitioner in terms of the features of localization, diagnosis and these lection of the correct therapy for this category of patients.

117-126

Authors: Tetiana Liadova, Mykola Popov, Diana Dorosh

Introduction. For a long time, HIV has been associated with a number of inflammatory, infectious and neoplastic skin diseases. In the era of anti-retroviral therapy researchers have found even more about the relationship between skin disease and chronic immunosuppression. In particular, clinicians continue to face the trend of difficult-to-control viral infections, chronic skin inflammation and itching in people living with HIV. Objectives. This article summarizes the latest updates in immunology, dermatology and HIV, revealing potential of the prospective substance melatonin and its efficacy in treating herpesvirus skin diseases as an alternative immunomodulator. Materials and methods. A comprehensive literature search was carried out in July 2020 using electronic databases PubMed, EMBASE, MEDLINE, U.S. National Library of Medicine Clinical Trials, ResearchGate, and Cocharane Library. Results. This review includes 24 articles, that demonstrated the modulating properties of melatonin and have established its effectiveness in the treatment of diseases associated with immunodeficiency conditions. Melatonin has been shown to have a regulatory effect on the immune system and directly enhance the immune response by improving the proliferation and maturation of natural killers, T and B lymphocytes, granulocytes and monocytes, and activates complement receptors. Conclusions. Currently, the course of dermatological manifestations associated with herpes viruses, unfortunately, remains unfavorable and persists with high mortality coefficients, so the development of new approaches to the provision of medical care to HIV-infected patients is still relevant. Recent scientific studies indicate the high effectiveness of melatonin in the treatment of diseases accompanied by immunodeficiency. Researching of its effects in the dermatological manifestations of herpesvirus infections on the background of HIV is prospective and necessary for expand drug provision, treating comorbid conditions and improving the quality of life of each patient.