Medical perspectives (Medicni perspektivi)

4-11

Authors: Diachuk D.D., Hidzynska I.M., Moroz G.Z., Tkachuk I.M.

Scientific interest to the problem of multimorbidity is increasing due to the increase of the number of such patients. The aim of this work was to analyze and summarize current approaches to optimizing care for patients with multimorbidity and the results of their implementation in clinical practice. Since the beginning of this century, a number of documents have been created by WHO, government agencies and professional medical societies to improve medical care to patients with multimorbidity. The evidential basis of the effectiveness of the majority of the proposed measures based primarily on expert consensus. In 2016 NICE has published a clinical guideline NG56 «Multimorbidity: clinical assessment and management», WHO – a monograph «Multimorbidity: Technical Series on Safer Primary Care». In 2017 NICE has published a quality standard – Quality Standard №153 «Multimorbidity». The strategy of improvement of medical care for patients with multimorbidity is directly related to the patient-centered approach formation, which includes comprehensive assessment of the patient's condition. The main component of medical care is the definition of a realistic goal of medical intervention according to patient`s preferences, and making the choice of the optimal amount of diagnostic, treatment, and preventive measures, which can lead to the desired goal. A number of studies (the 3D randomized controlled trial, the MultiCare AGENDA, the SPPiRE study, the WestGem study etc.) have being conducted to evaluate the effectiveness of implementing proposed approaches in clinical practice. The results of the studies and meta-analysis do not provide conclusive evidence of the medical and economic effectiveness of their implementation at the presentstage. Improving the outcomes of medical care to patients with multimorbidity involves conducting further clinical trials that can provide evidence to determine the list of most effective interventions for clinical practice.

22-31

Authors: Ivanov V.P., Shushkovska Yu.Yu., Afanasiuk O.I., Pentiuk L.O.

The main morphological structural lesion substrate is myocardial fibrosis. The processes of fibrosis in a certain way are associated with the severity of a variety of cardiac arrhythmias. Myocardial fibrosis may be manifested by prolongation of the QRS complex, frequent ventricular arrhythmias and ventricular tachycardia on the electrocardiogram. Echocardiography is the main tool used to assess the structure and function of the heart, it reveals an increase in the left ventricle, and decrease in ejection fraction and diastolic dysfunction of the left ventricle and an increase in filling pressure. Biological markers are quantitatively defined biological parameters that, as indicators, determine the norm, pathology and result of medecinal correction of the disease (definition of experts from the Biomarkers Definitions Working Group, USA). Changes of biomarkers can be controlled to determine the individual risk of cardiovascular diseases development and measures to normalize them. Among the main causes of fibrosis activation, hyperactivation of the renin-angiotensin-aldosterone system and, as a consequence, the excessive formation of angiotensinogen and aldosterone are considered; increased levels of galectin-3, which contributes to the migration of macrophages, proliferation of fibroblasts and collagen synthesis in cardiomyocytes. Recently, much attention is paid to the study of biochemical markers such as aldosterone, galectin-3 and transforming growth factor- beta-1.Thus, these markers were determined in hypertension, metabolic syndrome, congestive heart failure, hypertrophic cardiomyopathy, myocardial infarction, atrial fibrillation. However, to date studies considering association between frequent ventricular premature beats, as a marker of electrical instability and plasma levels of biomarkers of fibrosis, such as aldosterone, galectin-3and transforming growth factor beta-1, in patients with essential hypertension without / or in combination with coronary heart disease are absent. Based on the aforesaid material,, further thorough study of this problem is promising.

39-47

Authors: Volotovska N.V.

The organism’s reaction to pathogenic impacts such as blood loss and ischemia can appear either on systemic or on ultrastructural level. The tourniquet inflation pressure on the extremity triggers local lipid peroxidation. However, the systemic influence of tourniquet is not completely studied. This experiment was dedicated to study of the changes that occur in the liver on the background of ischemic-reperfusion syndrome of the limb. In our experiment the animals were divided into 5 groups, in which the effect of ischemia-limb reperfusion, blood loss, mechanical injury of the thigh bone and their combination on the concentration of malonic dialdehyde and glutatoin peroxidase activity was studied. Biochemical investigation of the liver has shown that each of these experimental interventions had caused activation of lipid peroxidation in the liver and proper increase of the activity of the antioxidant protection enzyme in the blood. The peculiarities of the reaction were an increase of the first index, which was the highest among all experimental groups – on the background of blood loss combined with the use of a tourniquet; at the same time the critical suppression of antioxidation was noted as well. Besides 2 periods of exhaustion of the wounded organism were established – on the 3rd and 14th day. At the same time, the content of malonic dialdehyde was higher in the group where the imposition of the tourniquet was combined with mechanical trauma, comparatively to isolated mechanical trauma of the thigh, this indicated the role of the tourniquet as a factor complicating the course of posttraumatic period due to ischemic reperfusion syndrome. Understanding the pathogenesis of traumatic disease will allow to find a new way of valuing of the effects of limb decompression, to cope with oxidative stress and more successfully treat multiple organ failure.

59-65

Authors: Pertseva T.A., Konopkina L.I., Koval D.S., Guba Yu.V.

The aim of the study was to determine the categories of COPD patients with a predominance of fibrotic or inflammatory processes. The study included 37 stable COPD patients (men – 33 (89.2%), women – 4 (10.8%), mean age – 63.5±1.18 years, the level of forced expiratory volume for the first second after the test with bronchodilators (FEV1post) – 46.7±5.81% of the proper value). To determine the categories of COPD patients with a predominance of inflammation or fibrosis, a cluster analysis was performed. For this purpose the most important indicators from a clinical point of view were selected: the number of exacerbations over the past year, dyspnea severity according to the mMRC scale, the level of FEV1 post and reversibility level in absolute values, systemic inflammation markers levels (CAA, C-RP) and profibrotic cytokine TGF-β1. Thus, according to the results of cluster analysis, two categories of patients were identified. The first category – COPD patients with a predominance of the inflammatory process with low dyspnea severity, high functional indicators (FEV1 >50% of the proper value), high airway reversibility level, low level of profibrotic cytokine TGF-β1, high levels of systematic inflammation markers (C-RP and CAA). The second category – COPD patients with a predominance of the fibrosis process, with a high dyspnea severity, low functional indicators (FEV1 ≤50% of the proper value), low airway reversibility level, low levels of systematic inflammation markers (C-RP and CAA), and high profibrotic cytokine TGF-β1 levels. The prevalence of inflammatory processes was observed mainly in COPD patients, who belong to clinical group C; the prevalence of fibrotic processes – mainly in patients of clinical group B.

73-80

Authors: Poniatovskyi V.A., Bondarchuk O.L., Prystupiuk M.O., Smikodub O.O., Shyrobokov V.P.

Staphylococcus aureus is one of the most common opportunistic pathogens that causes a variety of diseases, from minor skin infections to life-threatening sepsis, meningitis, pneumonia and a number of other diseases. Particular attention was paid to methicillin-resistant Staphylococcus aureus (MRSA) strains with multiple drug resistance. The purpose of this study is investigation of the sensitivity of clinical isolates of Staphylococcus aureus, including methicillin-resistant strains, to bacteriophage drugs and determination of possibility of using this agent for the treatment of staphylococcal infections. A number of classical and modern microbiological methods for the isolation and identification of Staphylococcus aureus: an indication of genes, responsible for antibiotic resistance (PCR analysis), determination of sensitivity to antibiotics (disc diffusion method) and bacteriophages (spot test, Gracia method, Appelman method) were used in the study. The susceptibility analysis of Staphylococcus aureus with presence and absence of mecA gene to the commercial bacteriophage product – “PYOFAG® BACTERIOPHAGE POLYVALENT” was performed. The results of the study showed that the total number of susceptible strains of bacteria was 95±0,2%. The use of investigational Bacteriophage drug for the treatment of furunculosis caused by MRSA has shown positive results. After one week of using the bacteriophage as monotherapy, the patient experienced regression of the clinical symptoms. For the period of use no adverse effects have been detected. Thus, the phage drugs using can become an important tool in the control of antibiotic-resistant strains, which cause a variety of infections in humans.

87-93

Authors: Kovalyova O.M., Chukhrienko N.D., Pasiieshvili T.M., Pasiyeshvili L.M., Zhelezniakova N.M.

Aim of research was assessment of the levels of antioxidant biomarkers associated with mitochondrial function in young patients with gastroesophageal reflux disease (GERD) and autoimmune thyroiditis (AIT). This study included 165 patients of them 120 patients with GERD and AIT - the main group, 45 patients with isolated GERD - the comparison group. The examined contingent was presented by students aged 18 to 25 years. The control group consisted of 20 healthy individuals of corresponding gender, age and social status (students). Total antioxidant activity (TAS-TAC) was determined in blood serum of study persons with enzyme immunoassays (ELISA, Elabscience, USA), levels of manganese superoxide dismutase (MnSOD) – with enzyme immunoassays (ELISA, Elabscience, USA) and Klotho protein - with enzyme immunoassays (ELISA, Elabscience, USA). Statistical data processing by the Statistica Basic Academic 13 for Windows En local was made. In examined patients with esophageal and thyroid pathologies the decline of total antioxidant activity has been revealed. The MnSOD level in patients with comorbidity of GERD and AIT and isolated GERD was significantly higher as compare to control group. Significant increasing of Klotho protein in serum of young patients was observed. We assessed imbalance between decline of extracellular antioxidants and activation of mitochondrial antioxidants which is more pronounced in combination of diseases. The increase of biomarkers of mitohondrial antioxidant defense system with non-specific citoprotection mechanism in patients with GERD provides the basis to consider MnSOD and Klotho protein as prognostic indicator of clinical outcome of disease in young age. Under combination of GERD and AIT the tendency to overexpression of MnSOD and depression of total antioxidant activity has been revealed, this may cause the deterioration of mitochondrial function.

99-106

Authors: Gamian A., Zubchenko S.O., Havrylyuk A.M., Kril I.Y., Chopyak V.V.

Advanced glycation end-products (AGEs) are created during the process of glycation of cells from various tissues and fluids and are a heterogeneous group of molecules formed from the nonenzymatic reaction of reducing sugars with the amino group of proteins, lipids, and nucleic acid. In normal conditions, they play the immunoregulatory role. In pathologic conditions AGEs activate the receptors for advanced glycation end products (RAGE) and cause long-lasting inflammation. RAGE participates actively in various disorders such as rheumatoid arthritis, diabetes, etc. However, there is relatively small number of scientific studies on the possibility of using the role of AGE in the pathogenesis of allergic diseases. RAGE transcript and protein are expressed in the lung by pulmonary type I alveolar epithelial cells, suggesting that RAGE has an important role in lung pathophysiology. They repress some endogenous autoregulatory functions leading to many diseases, including allergy. Oxidative stress increases the inflammatory reaction in asthma and allergies. Long-lasting inflammation followed by free radicals production are important factors involved in allergic reactions, they negatively influence the incidence and prognosis of allergy. RAGEs are expressed on circulating immune cells, they activate NF kappaB and intracellular oxidative stress also increases the inflammatory reaction in asthma and allergies. The membrane RAGE (mRAGE) signaling is proinflammatory, whereas soluble RAGE (sRAGE), a secreted form of RAGE, is generally anti-inflammatory. The study of AGEs, soluble RAGE, ligands of RAGE HMGB1, and S100A8/A913 and IL-33 is useful in the context of their considering as biomarkers to the differentiation diagnostic between eosinophils-derived and neutrophil-derived asthma/AAD. The mean serum levels of RAGE may be the target of new therapeutic interventions.

114-121

Authors: Makarchuk O.M., Ostrovska O.M., Okolokh Onieka Gibson, Orishchak I.K., Cheredarchuk A.R.

In recent years, the number of cases of uterine factors infertility is constantly growing. Unfortunately, the analysis of scientific works is characterized by the lack of data on the improvement of the diagnostic algorithm and the expediency of accentuating the significance of the preconceptional stage. The purpose of this study was to develop sonographic criteria for endometrial readiness for implantation at the stage of preconceptional care in women with uterine factor infertility. The first group included 80 women with uterine factor infertility, the second group (40 women) consisted of patients who entered the IVF program for the first time. The control group consisted of 30 women with normal fertility. Studies of the structure of the endometrium, myometrium and ovarian tissue were performed on a Voluson 760, on the 4th-6th days of the menstrual cycle (according to the International Endometrial Tumor Analysis (IETA) – consensus of ultrasound description of endometrial changes) and on the 20th-24th days of the cycle. To assess the indirect signs of chronic endometritis the echographic criteria developed by V.N. Demidov et al. were used. The sonographic diagnosis was verified during morphological and immunohistochemical examination. The most common menstrual disorders in women with uterine factor infertility were algodysmenorrhea – 33.3%, algohypomenorrhea –22.2%, hypoopsomenorrhea – 64.4%. Thinning of the endometrium was significantly more often observed in the group with uterine factor of reproductive disorders; one third of patients (33.8%) had dyschronosis of the endometrial echotexture; heterogeneity of M-echo with a predominance of hyperechoic areas was diagnosed in 41.3% of cases. Hyperechogenic inclusions in the basal layer, multiple structures of a linear nature and increased echogenicity were revealed in every fifth patients and hypoechoic uterine contour – in 47.5% of cases. The most significant odds ratio associated with IVF failures and early reproductive loss was found in patients with endometriosis (OR – 5.85; 95% CI: 1.32-13.32), synechiae (OR – 2.27; 95% CI: 0.96-10.16) and polyps (OR – 2.48; 95% CI: 0.84-11.36). It was possible to distinguish the following criteria of functional readiness of the endometrium for implantation: endometrial thickness was more than 8 mm, compliance with the echostructure phase of the menstrual cycle, homogeneity of M-echo, absence of hyper-and hypoechoic inclusions, and full hemodynamics in the vascular pool of the pelvis.

127-137

Authors: Gresko I.V., Kolesnichenko V.A.

The study included 80 patients aged 22-44 (31.7±4.4) years with lumbar osteochondrosis with impaired motor stereotype and myotonic reaction of the lumbar-pelvic region muscles. The patients were randomized into two homogeneous groups depending on the physical rehabilitation program: in the main group a combination of shock wave therapy (SWT) with the Masterplus MP200 extracorporeal shock wave therapy device (5 procedures with a frequency of 11 Hz, an impact force of 3.8-4.0 bar, intervals of 5-7 days) with a program of relaxing exercises according to the method of K. Levit was used; in the control group – only exercises program. The developed program of physical rehabilitation proved its effectiveness by a significant decrease in pain intensity indicators (p<0.001) by VAS scale, ODI disability level (p<0.001) and SKT kinesiophobia level (p<0.01), a significant increase in the spine mobility (p<0.05) and the lumbar spine mobility (p<0.05), flexion in the hip joints (p<0.05). The range of movements during extension, adduction and abduction of the hip joints also increased but not significantly. Normalization of the extensor muscle tone of the lumbar spine was observed in 87.5% of cases, the gluteus muscle tone – in 30.0%, and the piriformis muscle tone – in 27.5%. The frequency of registration of error patterns in the active combined movement of the lumbar segments and the pelvis decreased to 37.5% of cases as a whole. The developed program of physical rehabilitation proved to be effective compared with the results of the isolated application of relaxing exercises with a significant improvement by VAS scale (p<0.05), ODI (p<0.05) and SKT (p<0.05); normalization of the tone of the lumbar extensor muscles and the restoration of control of active movements in the lumbar-pelvic region are more often noted in more than a third of patients.

146-158

Authors: Fastovets O.O., Sapalov S.O., Shtepa V.O.

Complete dentures remain still popular due to the economic component of such prosthetic treatment. However, additional fixation on intraosseous implants provides a greater clinical and functional effectiveness and a greater level of satisfaction with the results of prosthetics in edentulous patients. At the moment, the biomechanical aspects of complete denture prosthetics and prosthetics with fixation on implants, taking into account the degree of atrophy of the edentulous jaws, are not complete understood. Such studies make it possible to create recommendations on the choice of prosthetic tactics for edentulous patients. The aim of the research was to study the distribution of stress-strain states in prosthetics of the edentulous mandible with complete dentures and with designs supported on intraosseous implants, taking into account the type of atrophy. It was carried out computer simulation of 8 virtual finite element models of mandible with different types of atrophy. According to Keller they were 4 models: of the biomechanical system simulation "complete denture – mandible" and 4 ones – "denture – intraosseous implants – mandible". In each of the models, a chewing load of 100 N was simulated (symmetrically and asymmetrically). The ANSIS 12.1 finite element analysis was used to calculate the stress-strain states in the described calculation systems. It was estimated the distribution of stresses in cortical bone and displacements of the dentures on the prosthetic bed. Under using complete dentures, the maximum stresses in the bone tissue of the prosthetic bed were observed for the third type of mandible atrophy with all types of power load, the smallest ones – for the fourth type. Additional fixation of removable dentures in simulation models of biomechanical systems “denture – intraosseous implants – mandible” lead to a significant increase in stresses in the alveolar bone. The maximum stresses were observed in the area of the marginal bone, while their greatest values were in the well-expressed alveolar part of the mandible for first and third types by Keller. The movements of bases of complete dentures were insignificant and fluctuated within hundredths of a millimeter for all types of atrophy. The use of intraosseous implants for fixation of dentures caused increase in movements by several times. Besides, displacement fields were characteristic: they were uniform for complete dentures but in the use of implants – not. The expressed alveolar process in the first and third types of atrophy of the edentulous mandible caused an increase in the displacements of the distal sections of the dentures on both sides with a symmetrical force load and on one side – with an asymmetric one. It can be assumed that such a distribution of stress-strain states accelerates atrophy of prosthetic bed tissues. As a result of prosthetics of complete defects of lower dentitions, both with traditional complete dentures and with additional support on implants, different distribution of stress-strain states occurs in different phases of the chewing act in the bone of the prosthetic bed, the character of which is determined by the shape of the alveolar part described by Keller's classification. The results allow us to develop an algorithm for determining the kind of prosthetics for edentulous patients, depending on the type of mandible atrophy.

166-173

Authors: Vavrinevych O.P., Shpak B.I., Antonenko A.M., Omelchuk S.T., Zinchenko T.I.

This work is the second part of our study to develop alternative experimental mathematic models for predecting toxicity of insecticides, where we carried out a statistical analysis and comparative estimation of the toxicometric parameters obtained experimentally and calculated according to the proposed equations. In the first stage calculations were carried out and the most reliable models were proposed. The purpose of the research is the scientific substantiation and statistical analysis of the calculation models for predicting the toxicity of insecticides of different classes. For research we took the insecticides of the following chemical classes: neonicotinoids, pyrethroids, organophosphorus compounds. Statistical analysis of the linear and nonlinear regression equations obtained for insecticides was conducted. The equations described the dependence of subthreshold doses in the chronic experiment of all insecticides, the median lethal doses at oral admission of pyrithoids and neonicotinoids from molecular weight; and toxicometry parameters of all insecticides and their individual groups (pyrithoids, neonicotinoids, organophosphorus compounds) on melting temperature and the octanol-water partition coefficient. On the basis of a comparison of the toxicometry parameters obtained experimentally (actual parameters) and calculated according to the proposed equations checking of possibility of using of the calculating models for predicting the danger of the investigated groups of insecticides was performed. For substantiated pairs of resultant and factorial variables for pyrethroids, neonicotinoids, and organophosphorus pesticides a reliable correlation was established (ractucal> rtable at p = 0.05) or trend (ractucal> rtable at p = 0.1). A good and very good consistency of the features selected for the calculations according to the Cronbach’s alpha (index ranged from 0.8 and above) was indicated. The developed algorithm makes it possible to significantly simplify the conduction of toxicological studies of the studied classes of insecticides.

181-188

Authors: Ipatov A.V., Khaniukova I.Y., Moroz О.М., Sanina N.A.

A full study was conducted using the statistical method of research in order to analyze the status and structure of primary disability of the adult population of the regions of Ukraine due to tumors in the period ща 2010–2019 and identify the causes that affect the indicators of primary disability and regional characteristics. We have performed the analysis of expanded statistical information regarding disability in Ukraine with the help of the "Report on the causes of disability, indications for medical, professional and social rehabilitation" (form № 14, approved by order of the Ministry of Health of Ukraine in coordination with State Statistics Committee of Ukraine dated 10.07.2007 № 378) within 24 regions of Ukraine and Kyiv over the last ten years. In addition, the correlation analysis was performed using Microsoft Excel© to find the connection between primary disability due to neoplasms and a number of medical and social factors using Pearson-Brave correlation coefficient (r). Over the last ten years, the rates of primary disability due to neoplasms and malignant tumors of both adults and able-bodied population have been increasing steadily. They have always been among the top three causes of disability in Ukraine. However, cardiovascular diseases occupied the first place over the last 27 years. In 2019, tumors took the first place. Fluctuations in primary disability due to neoplasms are connected with a number of medical and non-medical causes. The main ones are morbidity, prevalence of neoplasms, number of beds in cancer dispensaries and availability of specialized oncology medical expert commissions in the region, changes in legislation regarding criteria for assessing disability groups. In the structure of primary disability due to neoplasms people of working age (40-60 years) dominate, their number varies by year, but the tendency to predominance persists Among the disability groups a severe second disability group dominates, which indicates a late diagnosis due to untimely treatment of these people and the predominance of the so-called "neglected" forms of the disease. This trend takes place during the observation period of all ten years. The highest rates of primary disability due to neoplasms are also stable throughout the ten-year observation period and are observed in the regions that are considered the most affected by Chornobyl disaster: Kyiv region, Kyiv, Zhytomyr, Chernihiv, Volyn, Rivne. However, the increase in this indicator in Poltava region over the last three years is not entirely motivated. The obtained results will be the basis for the development of national and regional measures for the rehabilitation of people with disabilities caused by tumors and contribute to public funds saving due to their targeted distribution in regions and keeping labor resources.

198-206

Authors: Gorbunova G.D.

In order to define the quality of life of labor migrants’ children, there were researched different aspects of their lives, such as physical functioning (PF), emotional functioning (EF); social functioning (SF) and school functioning (SF). The given research involved 150 children from Republic of Moldova. They were of different age groups (5-7, 8-12, 13-18), of whom 75 children were of the labor migrants and their parents/guardians who remain in the country and 75 children of labor migrants and their parents without labor migration experience. As the instrument for given research there was used the Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire. In the course of the research there was distinguished Quality of Life (QL) of children on high level, score from 100 to 91, the middle level – from 90 to 81, the low level – from 80 to 71 and the lowest level, less than 70 scores. According to the results of the investigation it was established that the migrants’ children of various age groups, from all the examined aspects had a very low level of QL (less than 70 scores). In all age groups presented by the migrants’ children, the QL in terms of physical functioning, has a considerably lower level of scores (р<0.001) in comparison to the children from the control group. The highest level of QL was observed in the group of children aged 5-7 and the lowest in 13-18 aged group. There was also evidentiated a very low level of QL of the migrants’ children in emotional aspect (from 42.0±25.32 to 43.7±25.94 scores), that considerably differs (р<0.001) from the middle level of QL of the children from the examined group (from 85.0±19.83 to 89.0±20.82 scores). The lowest data of QL in the emotional aspect of the migrants’ children aged 13-18 years old (42.0±25.32), demonstrate a very specific emotionally stressed state of these children. Migrants’ children demonstrate a very low level of QL in terms of social functioning and it certainly differs from the middle level of QL of the children from the examined group. That definitely demonstrates a low ability to social adaptation of children after their parents’ migration. The lowest indicators of the total score of QL were revealed at the age of 13-18, both in groups of migrants’ children (46.8±24.19 scores) and in the examined group of children (82.7±19.57 scores). At the same time the highest indicators of the total score of QL were revealed at the age of 5-7, both in groups of migrants’ children (55.9±30.85 points), and children of the examined group (85.9±23.70 scores). The presented results perform a very convincing fact that labor migrants’ children in comparison to their peers from the families without labor migration experience had considerably low indices by all scales and integral characteristics of quality of life.

214-220

Authors: Poiasnyk I.M.

Lyme borreliosis is a tick-borne transmitted infectious disease caused by the spirochete Borrelia burgdorferi sensu lato and spread by the bite of ticks of the genus Ixodes. Lyme neuroborreliosis is a clinical manifestation of Lyme borreliosis, which affects the central nervous system and peripheral nervous system in up to 15% of the affected patients. Nerve structures are affected by spirochetes both in acute and late phase of the disease. The clinical course of neuroborreliosis is highly variable. Although at least 80% of European patients present with facial nerve palsy and radiculitis, symptoms of neuroborreliosis may be quite unspecific or even mimic other neurological diseases. Idiopathic peripheral facial palsy has long been considered as the most common cause of prosopoparesis, but modern diagnosis significantly narrow the range of cases of unknown genesis. Neuroborreliosis is difficult to diagnose, especially when prosopoparesis is the only clinical manifestation, so practitioners should be mindful of possible etiology to avoid misdiagnosis. The article presents a clinical case of early neuroborreliosis in a woman of 57 years who manifested with peripheral facial palsy. The author describes in detail the course of the disease (the appearance of new symptoms on the background of standard medical therapy (poor response), the presence of additional criteria (erythema migrans, lymphocytoma (rarely), arthralgia), diagnosis (specific immunological examination of blood to Borrelia burgdorferi sensu lato). Antibiotic therapy made it possible to achieve complete recovery of facial nerve function and avoid future complications.