Medical perspectives (Medicni perspektivi)

12-18

Authors: Kopchak O.V., Yakovenko L.F., Marchenko N.S., Кovach I.V., Pavlenko E.M., Nimenko O.A., Kroupskaya I.V., Filonenko V.V.

Heat shock protein 60 (Hsp60) is considered as one of the possible autoantigens involved in the pathogenesis of a number of chronic diseases including periodontal diseases. The application of hyaluronic acid or hyaluronan (HA) in the treatment of periodontitis has been evaluated in several clinical trials, however, the effect of hyaluronic acid on heat shock protein 60 level in periodontal soft tissues has not been studied. The aim of this work was to evaluate the effect of HA injections on levels of Hsp60 in periodontal tissue of the rats. Samples of periodontal tissue of mandibular incisors of adult male Wistar rats at 10-12 months of age were investigated. Rats were distributed into the control group and the periodontitis group. Visual manifestations of hyperemia of the gums around the incisors were the criterion for selecting animals into the periodontitis group. There were two subgroups in the control group: intact rats (I); intact rats after HA “hyaDENT BG” 1.0 MDa (BioScience GmbH, Germany) treatment (I+“G-1.0”). There were four subgroups in the periodontitis group: rats with periodontitis (P); rats with periodontitis after HA “hyaDENT BG” 1.0 MDa (BioScience GmbH, Germany) treatment (P+“G-1.0”); rats with periodontitis after HA “SERTOBEC” 2.4 MDa (S.C. Rompharm Company S.R.L., Romania) treatment (P+“S-2.4”); rats with periodontitis after HA “SERTOBEC Tendon” 2.4 МDа (S.C. Rompharm Company S.R.L., Romania) treatment (P+“ST-2.4”). There were three animals in each subgroup. Rats were injected 0.05 ml HA in the area of alveolar processus of central incisors once a week, three times. Levels of Hsp60 in total lysates of periodontal tissue were tested by Western blotting method before and after the treatment with HA (one month after the last injection). There was no significant difference between levels of Hsp60 in total lysates of periodontal tissue of intact rats and rats with periodontitis before treatment (p>0.05). Rats with periodontitis showed decreased inflammation in the periodontal tissue after treatment with HA with different molecular weight. Intact rats and rats with periodontitis which were treated with HA “hyaDENT BG” 1.0 MDa showed reduced levels of Hsp60 in total lysates of periodontal tissue comparatively with levels of Hsp60 before treatment (by 15.4 and 10.7 times respectively, p<0.001). Rats with periodontitis which were treated with HA “SERTOBEC” 2.4 MDa or HA “SERTOBEC Tendon” 2.4 MDa also showed reduced levels of Hsp60 in total lysates of periodontal tissue com­paratively with levels of Hsp60 before treatment (by 21.3 and 16.4 times respectively, p<0.001). Rats with pe­riodontitis showed the decrease in inflammation in periodontal tissue after treatment with HA with different molecular weight. Injections of HA has contributed to reduce levels of Hsp60 in periodontal tissue of intact rats and rats with periodontitis.

26-32

Authors: Demkovych A.Ye., Bondarenko Yu.I., Fastovets O.O., Hrad A.O., Hasiuk P.A., Denefil O.V.

The article presents an assessment of the dynamics of changes in the content of the marker of collagenolysis – free oxyproline in the homogeniate of soft tissues and bone in experimental bacterial-immune periodontitis and elucidation of the effect of flavonol quercetin on these indicators. The aim of this study was to determine the role of cytokinogenesis and the effect of flavonol on it in the pathogenesis, development and course of experimental periodontitis. During the experiment, a fragment of the mandible was taken from the animals, from which the soft tissues and bone were carefully separated. The state of collagen was determined by the content of free oxyproline in the soft and bone tissues. The concentration was determined according to the calibration graph and expressed in μmol/g. The results of studies of the indicators of the state of biopolymers of connective tissue structures of periodontium on the 7th, 14th and 30th day of experimental bacterial-immune periodontitis and after its correction with flavonol (from the 7th to the 14th day of the experiment) are presented. The data on the nature of changes in the content of collagen monomers in the process of formation of the inflammatory focus in the periodontal complex are given. During the acute phase of the inflammatory process in rats there was revealed a slight increase in blood free oxyproline in bone homogenate and homogenate of soft periodontal tissues, on the 14th day the dynamics continued to increase, at a later stage of the experiment, namely on the 30th day, increase in bone resorption continued as compared to the 7th and 14th day. During the correction of disorders resulted from the development of this pathological process there was a decrease in the level of free oxyproline in the bone homogenate and homogenate of soft tissues of mandibular periodontium, as compared to the same indicators of animals who did not receive quercetin on the 14th day. The use of flavonol quercetin, which, by affecting immune processes, limited the inflammatory response in periodontal tissues and stabilized collagenolysis processes in periodontal tissues was manifested by a decrease in free oxyproline in bone and soft tissue homogenates of experimental animals.

40-45

Authors: Fedosieieva O.V.

During the individual development and exposure to infectious agents of the organism, the structural components of the thyroid gland can change significantly. In modern research, great importance is attached to the study of mechanisms for maintaining morphological homeostasis of the thyroid gland and ideas about its structural and functional restructuring in response to the body's immune system to various infections. The morpho-functional features of the thyroid gland of newborn animals after prenatal action of thyroid-nonspecific antigen (staphylococcal toxoid) have been experimentally established. In antigen-premiumed rats, the timing of folliculogenesis changes, as well as the size, distribution and immunohistochemical expression of antibodies to thyroglobulin, the functional state of thyrocytes and follicles compared to normal. The detected immuno­histochemical changes indicate signs of morpho-functional immaturity of the organ with hypoactivity elements.

52-58

Authors: Kulikova D.A., Safonova I.N., Chumak L.I., Poddubnaya I.N. , Protsenko O.S., Dotsenko D.G.

The paper presents an analysis of echocardiographic data of patients with PDA having different hemodynamic significance. Presently, the concept of “degree of hemodynamic significance” remains controversial. Criteria for determining the hemodynamic significance of PDA in term infants are not described. In our work, we used a classification of three degrees of hemodynamic significance: non-hemodynamically significant PDA – insignificant, moderately hemodynamically significant – moderately significant and large PDA – hemodynamically significant PDA. Aim – to work out an algorithm for determining the degree of PDA hemodynamic significance for prediction of its further development. The study involved children under 18 years old (80% of them ‒ children under 3 years old) who were examined in the cardiac surgery department of the SI “IGUS n.a.V.T. Zaytsev NAMS of Ukraine” during 2013-2017 yy. Gestational age (from 37 weeks), the presence of left to right PDA shunt, absence of a ASD shunt and other congenital heart defects served as enrollment criteria for the trial. Two prognostic tables were formed with the main criteria for determining hemodynamic significance of PDA by the sum of the signs according to gradations (insignificant, moderately significant and hemodynamically significant) as an outcome of the trial. Based on the determination of the main and additional criteria of hemodynamic significance and the strength of their influence, a diagnostic algorithm is formed for a patient with PDA with the possibility of predicting a further clinical scenario. For determination of hemodynamic significance, an increase in pulmonary gradient with an information index of 1.135 and a prognostic factor of +5.90/-1.75 were dominant, while the left ventricular dilatation located from the A4C with an informational index of 1.020 and a prognostic coefficient of +3.69/-2.50 dominated in determining the degree of hemodynamic significance in the presence of secondary changes. The proposed mechanism for determining the level of hemodynamic significance of PDA for children with borderline changes will predict more precisely the development of the disease, determine the patient’s observation tactics and regulate the decision-making process of surgical intervention.

67-72

Authors: Masia J., Savenkov O.Y.

Breast cancer (BC) is one of the most common causes of death in women up to 50 years old. For today the choice of an adequate methods of surgical intervention and the need for an adequate surgical adjuvant therapy, quality of life of patients after surgeryis are important. The aim of our study was to select the volume of surgery for breast cancer using the technique of intraoperative identification of the sentinel lymph node (intraoperative ICG technology) and to evaluate the results of its urgent histological examination. It was shown that the most common method of surgery in patients who underwent intraoperative ICG technology was quadrantectomy, which was performed in 27 cases (54%), rarely subcutaneous mastectomy was performed (30%) and radical mastectomy (by Madden) – 16%. In the control group, priority was given to radical removal of the breast (63.2% of cases); partial resection (by U. Veronesi) was performed in 33.3% of patients, and subcutaneous mastectomy – in 3.5%. Pathomorphological examination of the sentinel lymph node during its intraoperative imaging using ICG-technology established metastatic lesion in 10 of 50 cases (20%) in the main group. The obtained results of the assessment of the regional lymph dissection size in the main group indicate its adequate nature to ensure the radicality of surgical treatment. In our opinion, this is one of the important preliminary conclusions of this study, because to assess the clinical significance of signal lymph node (SLN) analysis as a marker of regional tumor spread, firstly it is necessary to be sured that existing surgical techniques provide radical tumor removal.

80-87

Authors: Gladchuk I.Z., Rozhkovska N.M., Kashtalian N.M.

The last decades showed the worldwide tendency to finding consensus between diagnostics improvement and constant increase of cost of medical services in conditions of restricted financing. The aim of the article was to analyze the diagnostic value of p16 and Ki-67 biomarkers in diagnostics of precancerous diseases of cervix. Data of 80 patients with cervical dysplasia of varying degree who received excisional treatment were analyzed. It was shown that cytological study has a high sensitivity (79.17%) for the diagnosis of CIN 2-3, but low specificity (53.57%). The p16 immunocytochemical biomarker has a high sensitivity for the diagnosis of CIN 2 (0.92; 95% CI: 0.76-0.98) with good specificity (0.78; 95% CI: 0.67-0.82), for the diagnosis of CIN 3 both sensitivity (0.93; 95% CI: 0.82-0.98) and specificity (0.93; 95% CI: 0.82-0.98) is high. The immuno­cytochemical biomarker Ki-67 has a high sensitivity for CIN 2 (0.92; 95% CI: 0.65-0.99), but insufficient specificity (0.62; 95% CI: 0.54-0.64), for the diagnosis of CIN 3 the sensitivity is very high (0.96; 95% CI: 0.80-0.99) as well as specificity (0.78; 95% CI: 0.69-0.81). The combined use of p16 and Ki-67 biomarkers can significantly increase the diagnostic accuracy of the diagnosis of high-grade precancerous pathology of cervix and justify timely surgical intervention. Such an approach for the differential diagnosis of severe dysplasia, on the one hand, may contribute to a decrease in the risk of developing cervical cancer, and on the other hand, it will allow to avoid unnecessary operations and preserve reproductive function of women, reduce the economic costs of treatment.

97-104

Authors: Shkodina A.D., Grinko R.M., Starchenko I.I., Vynnyk N.I., Sovhyria S.M., Kyslyi V.F.

The role of human olfactory bulbs remains one of the most interesting questions concerning work of the brain, because this organ is one in which neurogenesis is continuously generated in post-natal and adult periods. Impaired sense of smell is not a pathology that threatens human life, therefore, often remains unnoticed. However, it can directly affect the quality of life, as it leads to malnutrition and certain problems in interpersonal relationships. The study of the functional structure of the olfactory analyzer plays an important role both in clinical and experimental studies, but the question of its features in humans needs detailed research. The material of the research was 18 pairs of the olfactory bulbs of males and females aged from 30 to 90 years that were received at the Poltava Regional Department of Pathology. In order to objectify the data obtained on micropreparations, the following morphometric indices were determined: the specific gravity of the location of cellular elements; the proportion of mitral neurocytes in the entire cell population; percentage ratio of relative quantity between cellular elements, blood microvessels, fibrillar component and homogeneous eosinophilic structures. Correlation analysis of morphometric indices in the general sample revealed the existence of an inverse communication of average strength between the relative number of homogeneous eosinophilic cells and the relative number of cellular elements and blood microvessels, which in turn indicates the etiopathogenetic mechanisms of the formation of these structures. The conducted research makes it possible to conclude that mitral cells as one of the most differentiated in olfactory bulbs are sensitive to the development of hypoxic states; under the conditions of cerebrovascular pathology, the relative amount of the blood vessels of the microvessels decreases, which leads to the disorder of the trophy of the nervous tissue and as a result can lead to neurocytolysis of mitral cells. Changes in the vascular and cellular com­ponent indicate a different pathogenesis of changes in human olfactory bulbs in these pathologies and suggest that eosinophilic homogeneous cells are the result of apoptotic neurocytolysis against the background of development of hypoxic states.

111-119

Authors: Povoroznyuk V.V., Dedukh N.V., Bystrytska M.A., Dzerovych N.I., Shapovalov V.S.

The progressive and generalized loss of skeletal muscle mass and strength leads to sarcopenia in elderly people. A new geriatric syndrome has been revealed – osteosarcopenia (osteosarcoporosis), which combines low bone mineral density with reduced muscle mass, strength and functional activity. The review presents data on the peculiarities of manifestation of these syndromes, the mechanisms of which are multifactorial and continue to be investigated. They are associated with genetic factors, lifestyle – lack of physical activity and malnutrition. The pathogenesis of sarcopenia involves mechanisms of chronic inflammation, changes in endocrine function, disturbance of neuromuscular connections and low reparation level. Sarcopenia correlates with low quality of life, disability, and death. The review analyzes the prevalence of sarcopenia which increases with age. However, there are conflicting results in the populations, which may be related to different clinical conditions, patient area, lifestyle and the use of different assessment criteria. The analysis of sarcopenia prevalence in men and women showed ambiguous results related to the studied population, involvement of different age groups of patients, different evaluation methods. Metabolic disorders in muscular and bone tissues were summarized on the basis of the analysis of the cross-influence of regulatory factors and metabolism products of these tissues; a close metabolic and functional association between them was shown. Fat infiltration of atrophied muscles and bone marrow is common in patients with sarcopenia and osteosarcoporosis, which affects muscle and bone tissue. Lipotoxicity and local inflammation stimulate the biosynthesis of pro-inflammatory cytokines. Literature analysis has shown controversial data on the association of sarcopenia and osteosarcopenia with falls and fractures, but based on meta-analysis data, which include an extensive body of information, it should be noted that individuals with sarcopenia and osteosarcopenia are more at risk of falls and fractures and require special special attention. The most common fracture in osteosarcopenia is the hip fracture.

126-134

Authors: Bilovol O.M., Kniazkova I.I., Zemlianitsyna O.V., Dunaeva I.P., Romanova I.P., Kurilo O.D., Sinaiko V.M., Kravchun N.O.

The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p<0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.

141-146

Authors: Khomenko I.M., Ivakhno O.P., Pershehuba Ya.V., Piven N.V.

Purpose: scientific substantiation of training of medical personnel for the public health system of Ukraine. During 2017-2020, the Department of Public Health conducted a systematic analysis of public health staffing in Ukraine, developed countries and Europe. For the first time, a model of formation of specialists' competencies for the public health system of Ukraine in the postgraduate education program with a multidisciplinary approach to training is substantiated and developed, which includes such disciplines as epidemiology, hygiene, medical statistics, laboratory diagnostics, information technology, legal law and others. This enables to reveal the tools and methods of system management, improve the availability and quality of work during the formation and development of the industry. The need for medical education for public health specialists who are ready to perform basic operational functions to preserve and strengthen the health of the population of Ukraine has been established. For the first time, methodological approaches to the improvement of higher medical education at the undergraduate and postgraduate levels have been scientifically substantiated, taking into account modern requirements for the functioning of the public health system; competence models of the public health specialist in modern conditions of realization of his activity are created; standards of higher education at the first (bachelor's) and second (master's) levels in the specialty 229 “Public health” in the field of knowledge 22 “Health Care” have been developed.

153-159

Authors: Ipatov A.V., Sanina N.A., Khanyukova I.Y.

In order to determine the possibility of using a rehabilitation profile to assess the effectiveness of rehabilitation and develop a methodology for quantifying the effectiveness of rehabilitation measures in the short term in inpatients of the State Institution "Ukrainian State Research Institute of Medical and Social Disability of the Ministry of Health of Ukraine" we created a rehabilitation profile of the patient based on the principles of the International Classification of Functioning, Disability and Health (ICF). There were analyzed rehabilitation profiles of 522 patients with therapeutic pathology, musculoskeletal system diseases, and eye diseases. Rehabilitation of patients was comprehensive, with the use of methods of medical, psychological, and physical rehabilitation. The severity of dysfunctions was assessed by a quantitative scale from 0 to 4 points, where "0" – no issues, and "4" – extremely serious issue. The evaluation was performed twice by members of the multidisciplinary team: at the initial examination of the patient and at the discharge from the clinic. The statistical method and the method of expert evaluations were used to process the research results. The licensed software MS Excel for Windows was used. The study found that the proposed method of assessing the effectiveness of short-term rehabilitation is accurate and objective, it considers the initial functional status of the patient and allows to assess the quality and effectiveness of rehabilitation measures at the patient level and at the institution. Its implementation will provide a unified approach to the provision of rehabilitation services and draw conclusions about the effectiveness of rehabilitation activities of the medical institution differentially, considering the type of pathology, leading limitations of life, severity of disorders, age of patients.

166-172

Authors: Pletenetska A.O., Demchenko I.S., Ergard N.M.

The peculiarities and specificity of the medical field complicate not only the assessment of quality and timeliness of medical care, but also the correctness of the choice of the method of treatment and diagnosis of the disease. The number of forensic medical examinations in «medical cases» has the tendency to increase, and experts in this case face difficulties with forensic medical assessment of medical care provision. Forensic medical analysis of the medical care provision to patients who died of acute blood loss, based on examinations of different forensic medical bureaus of Ukraine has been analyzed. The aforementioned examinations related to the corpses of people who died as a result of acute blood loss, including shock (150 from the total number of 6129 medical examinations were selected). This cause of a death was chosen as one of the leading causes of death in trauma (including a combination with shock). When evaluating gross medical care defects that were found during the examinations that influenced the result, 40.0% (60) – in the form of improper provision (action) were noted in 10 cases (the case of incorrect diagnosis made by the doctors due to underestimation of examination data), defects in the form of non-provision of medical care (inactivity) – in 83.3% (15 cases). In the statistical analysis of defects in the provision of medical care, the majority of cases were connected with delayed provision of medical care – 41,7%. Defects in cases of blood loss were under the following conditions: a) lack of instrumental research, medical treatment and surgery, b) lack of medical treatment and surgery by indications (each of 3,3%). When considering the reasons that led to defects in cases of blood loss, the isolated underestimation of the examination data was in 16,7% (25), a combination of reasons: a) underestimation of the examination data together with the underestimation of additional research data – 16,7% (25); b) underestimation of the examination data together with the negligent attitude to the patient who had a sloppy appearance – 6,7%. The unprofessional nature of the medical staff was in 16,7% of acute blood loss. When providing medical care in cases of death from acute blood loss, defects in the provision of medical care are made by experienced medical professionals in city hospitals (especially large cities of Ukraine), where there are adequate conditions for the provision of medical care, more qualified specialists of different profiles, and there are protocols for providing medical care in acute blood loss.

180-187

Authors: Aliyeva I.J.

The purpose of this study was to determine dynamics of the levels of type I diabetes mellitus (DM) incidence in the regions with its different incidence. Material from the Azerbaijan Republican and Regional Registers of Diabetes Mellitus were used in this study. All cases of newly diagnosed type 1 DM and documented according to the clinical protocol in 2012-2016 were selected. At the first stage of the study, the rates of diabetes were identified in all administrative-territorial entities. Two groups from administrative-territorial entities were formed for further observation: the first group included regions with high (>80) incidence of type 1 DM, the second group included regions with low (<40) incidence of type 1 DM. At the next stages, changes in type 1 DM incidence were studied and a mean chronological incidence over five years (2012-2016) was determined. Morbidity rate in cities and regions of Azerbaijan in 2012 changed within a range from 5.4 to 294.8. The lowest incidence was observed in three districts: 5.4 in Agjabedi, 5.8 in Jalilabad, 6.1 in Masalli. Very high incidence was observed in Shamkir (294.8) and Khachmaz (278.7) districts. Data from Agdash (30.6) and NAR (32.2) were closer to data from the districts with low incidence. Incidence in Shirvan (81.9) and Yexlakh (171.7) districts was high, but lower than in Shamkir and Khachmaz districts. Type 1 DM incidence has significant interregional differences. Interregional differences in type 1 DM incidence do not depend on the age of the population; age-adjusted incidence of type 1 DM is within a range of 5.0-77.4.

197-201

Authors: Kirieieva T.V., Pertseva T.A., Kravchenko N.K., Basina B.O.

Venous thromboembolism (pulmonary embolism (PE) and deep vein thrombosis (DVT)) is the third among all cardiovascular syndromes in the world, second only to heart attack and stroke. Estimation of clinical probability of this condition takes into account many factors, including age. But in case of PE probability in young patient data of scales such as Geneva Score (Revised), Wells' criteria for pulmonary embolism, the PERC rule may be misleading. For this group a new influential factor emerges – thrombophilia. The aim of our work was to demonstrate the approach to identifying whom and when to test for genetic predisposition for thrombosis, based on a clinical case of young male with unprovoked episode of PE. Testing patients for thrombophilia is a good way to develop a personalised approach in case of prescribing long-term anticoagulant treatment. Moreover, patient’s awareness about congenital condition helps to increase complience which is crucial, due to the fact that in case of unprovoked pulmonary embolism another episode can occur in up to 50 % of cases during the next 5 years. In addition, further accumulation and analysis of data on the amount of genetic risk factors for thrombosis will expand our understanding of this issue and in the future will allow us to better diagnose and treat this condition.