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

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.