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

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.