Medical perspectives (Medicni perspektivi)

4-10

Authors: Loskutov O.Ye., Shponka I.S., Bondarenko O.O., Bondarenko N.S., Bozhko A.G.

Utilization of functional-protective coatings for implants based on corundum ceramics seems promising from the point of view of stability, bioinertness, and low cost. In order to study the histo­logical criteria for evaluating the osteoinductive properties of functional protective coatings, 6 types of coatings were studied on an experimental animal model: 90 Wistar rats were implanted with 6 test types of implants with various combinations of surface treatment (sand-blasting, surface treatment with a plasma torch with simultaneous application of aluminum oxide, powdered titanium, etc.) with an exposure of 1, 2 and 4 weeks. After euthanasia, a histological exa­mination of decalcified bone with Masson-Goldner trichrome staining and TRAP-histochemical reaction for osteoclasts was performed. The obtained results de­monstrated significantly higher osteoinductive properties of functional protective coatings with a more pronounced roughness (Ra>10 μm) compared to an untreated titanium surface after 2 (p<0.01) and 4 (p<0.05) weeks of implantation. The corundum ceramic coating prevented the formation of implant wear particles, hence contributed to the stabilization of the newly formed bone. Therefore, the use of functional protective implant coatings based on corundum ceramics can increase the survival rate of conventional titanium implants, since the combination of factors such as surface roughness, mechanical stability, and chemical inertness of coatings with corundum ceramics provides better osteoinductive properties of implant materials.

19-25

Authors: Borysenko А.А., Antonenko А.М., Shpak B.I., Omelchuk S.Т., Bardov V.G.

Global strategies, including application of chemical plant protection products, are important in the cultivation of safe corps and preservation of human health. A promising area of preventive medicine, agronomy, agroecology and agroengineering is the optimization of methods of pesticide formulations application. The aim of the work was a hygienic assessment of the most common and latest methods of crops treatment with chemical pesticides. Results. The biological effectiveness of different types of pesticides is achieved by different application rates of the working solution. The most common method of pesticide application is spraying, which ensures the application of pesticides in the drop-liquid state and is characterized by low consumption of active substance per unit area, variable-controlled distribution on the treatment surface, provides good adhesion and retention on facilities, allows the use of combined formulations. One of the most effective ways to minimize the negative impact of chemical plant protection products and achieve economic success is a rational approach to the choice of pesticide application, as it takes into account the hazard class of pesticides, the presence of water protection zones, the sensitivity of target crops, etc. Conclusion. Rational application of pesticides includes minimizing the overall effect of pesticides on human health and the environment and achieving high-targeted biological efficiency. Adherence to the methodology of choosing the type of pesticide application and selection of the type of spray is a key point in optimizing the rational use of chemical plant protection products, which requires a detailed study from the standpoint of both efficiency and safety. Control over compliance with the recommendations should be included in sanitary-hygienic and sanitary-ecological monitoring.

33-39

Authors: Savchuk R.V., Kostyev F.I., Golovko S.V., Dekhtiar Y.M., Zalyva K.A.

Aim – to assess the electromyographic features of the pelvic floor muscles and the sphincter apparatus in patients who underwent radical cystprostatectomy with the formation of an artificial bladder.The main study group consisted of 57 patients with muscle invasive bladder cancer who underwent a standard radical cystprostatectomy with ileocystoplasty. The study of the pelvic floor muscular bioelectric activity with computed electromyography (EMG) of the sphincter apparatus of the pelvic organs was carried out on a 2-channel computer electromyograph "NeuroTrac ™ MyoPlus4". The obtained results of the study of the bioelectric activity of the pelvic floor muscles showed a decrease in the amplitude of contractions in the Work Average mode by 42.1% (p≤0.001) for the perineal electrode, and by 35.7% (p≤0.05) for the rectal electrode, compared with the control group, which indicates a low contractility of the muscular diaphragm of the pelvis and may cause incontinence in patients with an artificial bladder. The average deviation over the entire duration of the session in Work mode in the group of patients with neobladder in channels A and B was 2.3 (p≤0.05) and 1.9 (p≤0.05) times higher, respectively, compared with control group. These data indicate an imbalance in the muscle tone of the pelvic floor in patients after extensive reconstructive intervention on the pelvic organs and can potentiate urodynamic disorders in the study group of patients. The average amplitude (Rest Average) of the activity of biopotentials in the resting state of the pelvic floor muscles along channels A and B is higher by 42.4% and 47.6% (p≤0.05), in comparison with the control group, which indicates insufficient relaxation and rest of striated muscles and sphincter. Despite the change in bioelectric potentials from the rectal electrode in the study group of patients, there were no signs of functional insufficiency of the anal sphincter, in contrast to the severity of urinary incontinence, which correlated and corresponded to the results of bioelectrical changes obtained through channels A and B, up to oscillations and loss of complete control. The EMG analysis of the pelvic floor muscles revealed characteristic changes in the biopotentials of the pelvic sphincters and indicated their relationship with the clinical features of the rehabilitation of this group of patients and the prospect of including the biofeedback method. It is a derivative form of the electromyographic signal in the treatment of incontinence in patients with neobladder.

47-54

Authors: Lishchuk-Yakymovych K.O., Haiduchok I.H., Ischeykin K.E., Chopyak V.V.

The article presents the study of effectiveness of inosine pranobex (IP) in patients with systemic autoimmune diseases (SAD) on the background of reactivation of persistent Epstein-Barr (EBV) infection. Among 380 patients with SAD (systemic lupus erythematosus, systemic vasculitides, rheumatoid arthritis, psoriasis), in 144 patients (37.9%) the reactivation of persistent EBV infection was detected through virus DNA identification using polymerase chain reaction (PCR) in three biological matrices (blood, saliva, scraping from the lesion site). 48 patients were receiving inosine pranobex at a dose of 50 mg/kg per day for three months. Treatment efficacy was controlled by studying the levels of expression of miR-146а, miR-155, miR EBV (BART-13 and BART-15), TLR9, the quantity of lymphocytes populations and subpopulations. After treatment, PCR results showed a decrease in viral replication in 66.7% of cases. The use of IP contributed to a significant decrease in the level of IgM, IgG specific antibodies, an increase in the level of expression of anti-inflammatory miR-146a, a decrease in the level of expression of pro-inflammatory miR-155 which may signify the strengthening of antiviral control. The study data demonstrated the decrease in the expression of miR EBV (BART-13 and BART-15) and TLR9 on the immunocompetent cells that can also be attributed to the criteria for IP effectiveness. The effectiveness of IP was also proved by the stabilization of cell mechanisms, namely the tendency to normalizing T and B cell populations, decrease in the number of natural killer cells and activated cells (CD25+, CD3+ HLA DR+). On the other hand, the number of lymphocytes with suppressor activity (CD4+25+) remained significantly high mitigating autoimmune aggression. The results of the study show that the use of IP for treating the acute phase of EBV infection contributed to the decrease of repliсative activity of the virus; suppressing the aggressiveness of autoimmune reactions. The decrease in the expression of miR EBV (BART-13 and BART-15) can be recommended as a criterion for the IP effectiveness; the decrease in the expression of TLR9 on immunocompetent cells –as a criterion for suppressing autoimmune reactions.

61-69

Authors: Gryb V.A., Tretyakova A.I., Titov I.I., Chudovska L.D., Nasonova T.I., Slobodin T.M., Doroshenko O.O.

To confirm the diagnosis of myasthenia gravis (MG), in addition to clinical observation of the muscle weakness dynamics, pharmacological and functional tests, Computed tomography/Magnetic resonance imaging (CT/MRI) of the mediastinum, detection of antibodies to acetylcholine receptors (AChR) and to muscle specific tyrosine kinase (MuSK)/; electrophysiological tests are used: rhythmic nerve stimulation (RNS)/decrement test and electro­myography of a single muscle fiber (single-fiber EMG (SF-EMG)/jitter). The aim of our study is to determine the possible relationship between the level of antibodies to AChR and the decrement test value, to verify a correlation between SF-EMG and the severity of MG seropositive to AChR. To evaluate the effectiveness of pathogenetic treatment and prediction of the duration of remission according to the results of the study. A total of 31 patients with myasthenia gravis seropositive to AChR were examined, among whom there were 19 (61.3%) women aged 19 to 74 years. The pattern of muscle weakness was evaluated by a score of the International Clinical Classification of Severity of Myasthenia gravis scale (MGFA). The presence of respiratory failure and its degree was assessed by spirography. The number of antibodies to AChR was determined using enzyme-linked immunosorbent assay (ELISA). The criteria for inclusion in the study were the confirmed diagnosis of seropositive myasthenia gravis with an AChR antibody level of more than 0.5 nmol/L. All patients underwent electrophysiological studies. Patients were examined three times: 1) at the time of visiting the doctor (in the hospital or on an outpatient basis); 2) in 16 and 3) in 24 weeks from the start of the study. Depending on the clinical condition of the patients the following treatment was prescribed: pyridostigmine, methylprednisolone, azathioprine. Statistical analyses were performed using the statistical computing environment R (R Core Team). In the dynamics of observation, a decrease in the level of antibodies to AChR and an improvement in the condition of patients according to the MGFA classification were generally observed but no correlation was found between the severity of MG and the level of antibodies to AChR during the first visit (Kruskal-Wallis test: H (4, N=31)=2.23 p=0.69); during the second visit (Kruskal-Wallis test: H (5, N=31)=9.44 p=0.09), as well as during the third visit (Kruskal-Wallis test: H (2, N=30)=2.74 p=0.25). A correlation was found between the concentration of antibodies to AChR and a thymectomy in the clinical history (Kruskal-Wallistest: H (1, N=7)=3.153752 p=0.07): over time, the level of antibodies decreased. Decrement test deviations were detected in 23 (74.2%) of the 31 patients, SF-EMG – in 20 (95%) of 21 patients. Abnormal jitter was recorded in 100% of cases with a generalized form of myasthenia gravis. During all three visits, a correlation was determined between the highest decrement test of symptomatic muscle and MG severity according to MGFA (r=0.39; p=0.042), (r=0.35; p=0.048), (r=0.41; p=0.039); and also between the jitter value and MG severity (r=0.54; p=0.032) (r=0.35; p=0.048), (r=0.61; p=0.034 respectively). Analysis of the contingency tables using the exact Fisher test provided information on the best method of treating patients. We consider that the most effective prognostic test that may affect the choice of further treatment is SF-EMG. However, due to the difficulties of using this method in routine practice, rhythmic nerve stimulation (RNS) test in clinically weak muscles should be recommended. It is not recommended to monitor antibodies to AChR in order to predict the course of the disease, it is better to use this test only for the diagnosis of seropositive myasthenia gravis.

78-84

Authors: Kravchenko B.S., Klimenko A.V., Klimenko V.N., Sergееva L.N.

The problem of surgical treatment of post­operative ventral hernias remains relevant today. Currently, a large number of methods of surgical interventions for hernias of the anterior abdominal wall have been proposed, the variety of which requires systematization and analysis of the immediate and distant results of treatment. Goal: to analyze the effectiveness of laparoscopic hernia repair in patients with postoperative ventral hernia with a body mass index of 30 kg/m2. The results of treatment of 29 patients with postoperative ventral hernia were analyzed. Men – 8 (27.5%), women – 21 (72.5%). In 16 (55.2%) patients (main group) laparoscopic intraperitoneal onlay mesh – IPOM was performed, in 13 (44.8%) patients (comparison group) open hernia repair with fixation of the mesh graft in the Sublay position was performed. The analysis of the duration of the surgical intervention indicates that with open hernia repair, there is a significant increase in the duration of the surgical intervention, p˂0.0001. Comparison of the duration of operations in both groups depending on the body mass index also indicates the dependence of the duration of surgery on this indicator. Thus, in the comparison group, there was a tendency to an increase in the duration of the operation with an increase in the body weight of patients with a significant difference in the duration of the operation between the main group and the comparison. The duration of a patient's stay in the hospital and the occurrence of respiratory complications correlates with the level of postoperative pain and the duration of surgery. Postoperative complications in the form of fluid accumulations in the wound area of the abdominal wall depend on the method of surgery and the location of the mesh graft. The use of laparoscopic – IPOM in obese patients significantly improves the results of surgery by reducing the level of postoperative pain, shortening the duration of surgery, and the absence of complications in the early and late postoperative period. When choosing the method of surgical intervention in patients with postoperative ventral hernia, laparoscopic IPOM should be preferred.

94-100

Authors: Kravets O.V., Yekhalov V.V., Krishtafor D.A., Zozulia O.O., Volkov O.O., Vlasov O.O.

Among the main factors of pathological changes that accompany acute abdominal pathology are the inflammatory process of the peritoneum and fluid deficiency due to its pathological losses. The aim of our study was to analyze the initial state of fluid compartments of the body and hemodynamics in high surgical risk patients with acute surgical abdominal pathology. There were examined 157 patients with acute abdominal pathology who underwent emergency laparotomy. The presence and severity of fluid deficiency were determined clinically by tissue hydrophilicity test by P.I. Shelestiuk, biochemically – by assessing the levels of hematocrit, hemoglobin, erythrocytes, blood electrolytes, vasopressin (antidiuretic hormone (ADH)) and brain natriuretic propeptide (proBNP), as well as the mean erythrocyte volume and plasma osmolarity. Variables of fluid compartments of the body and central hemodynamics were studied using the non-invasive bioimpedancemetry. Based on the values of oxygen concentration in arterial and venous blood, total oxygen consumption (VO2) and delivery of oxygen (DO2), oxygen extraction ratio (O2ER) were calculated. The detected changes indicate intravascular fluid deficiency and concomitant hemoconcentration with normal electrolytes levels and plasma osmolarity. In patients with high surgical risk and moderate dehydration according to P.I. Shelestiuk, urgent surgical pathology of the abdominal cavity reduces extracellular fluid volume by 19.1% (p=0.019) of the reference by reducing the volume of the interstitium and intravascular fluid respectively by 20.7% (p=0.002) and 16.3% (p=0.001) of regional values, which forms in patients a state of "volume depletion" of moderate severity. This is accompanied by an increase in the ADH concentration by 16.7% (p=0.041) above reference and normal proBNP levels. Stroke volume decreases by 28.8% (p=0.021) against tachycardia (increase in heart rate by 39.7% (p=0.001) above normal) and vascular spasm (increase in systemic vascular resistance by 86.9% (p=0.001) above reference), which supports the normodynamic type of blood circulation (cardiac index – 3.2 (0.4) l/min/m2) with the decrease in stroke index and peripheral perfusion index by 41.3% (p=0.002) and 55.2% (p=0.002) from reference, respectively. DO2 decreases by 11.1% (p=0.011) from reference with VO2 increased by 16.3% (p=0.004) above reference, which leads to a decrease in oxygen utilization by 7.2% (p=0.041) from reference.

107-113

Authors: Zakharov S.V., Zakharov V.K., Gorbuntsov V.V.

Objective – before and after the treatment to determine the functional state of the liver, serum levels of enzymes and biochemical indices in syphilis patients with viral hepatites B and C. The results of the study are based on the data from a comprehensive examination of 35 patients with syphilis alone and 127 patients with syphilis co-infected with viral hepatites B and C before and after treatment. Test methods: hepatology, rheogeopathography, enzyme content and biochemical parameters determined in the serum. According to the results of radionuclide hepatology it has been established that disorders of the functional capacity of the liver already occur in the early stages of the disease. The most significant disorders have been in the patients with the prescription of infection for more than 12 months and in the patients co-infected with viral hepatites B and C. A disorder of pigment metabolism and increased activity of trans­aminases have been revealed in early latent syphilis. In co-infection with viral hepatites B and C an increase in total bilirubin, Lactate dehydrogenase, Alanine transaminase, Aspartate aminotransferase and albumin has been revealed. Dysproteinemia has been revealed in patients with early latent syphilis co-infected with hepatitis C. Patients with early latent syphilis treated with immunomodulators tend to normalize these indices. In patients with syphilis a disorder of the functional state of the liver have been revealed already at an early stage of the disease. The most pronounced disorder of biochemical parameters and activity of liver enzymes are observed in syphilis patients with viral hepatites B and C, as well as in patients with early latent syphilis only with the prescription of the infection for more than 12 months; in such a case it is advisable to use drugs affecting the immune system.

119-125

Authors: Pavlysh O.S., Snisar V.I.

Hydrocephalus is one of the most common diseases of the nervous system in young children. Features of structural and morphological changes of the brain in children with hydrocephalus are the predominance of signs of periventricular ischemia of brain tissue due to cerebral circulatory disorders. Despite the existence of a large number of methods for assessing cerebral hemodynamics, in the modern literature there is only limited information about the oxygen status of the brain when using different types of anesthesia in children. The aim of the study was to assess the dynamics of noninvasive cerebral oximetry and central hemodynamics in young children with hydrocephalus during ventriculoperitoneal shunting. The research included 59 young children with acquired hydrocephalus who underwent ventriculoperitoneal shunting. 34 children underwent total intravenous anesthesia with propofol, 25 children – total inhalation anesthesia with sevoflurane. Intraoperative control of vital functions of the patient was performed: systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, regional saturation, carbon dioxide level on exhalation, sevoflurane concentration on inspiration and exhalation, non-invasive cerebral indicators. Children with acquired hydrocephalus had cerebral oximetry within normal regional level. The use of sevoflurane leads to increased cerebral oxygenation by inhibiting cerebral metabolic needs for oxygen and vasodilation of blood vessels with increased cerebral blood flow. Total intravenous anesthesia does not change the rate of intraoperative cerebral oxygenation, leads to hemodynamic changes in the form of decreased stroke volume, which may indicate that propofol reduces the level of oxygen consumption by the brain with decreased cerebral blood flow against the background of hemodynamic inhibition.

131-138

Authors: Ishchenko O.V., Stepanskiy D.O.

The purpose of the study was to determine the frequency rate of Pseudomonas aeruginosa infection among children with cystic fibrosis (CF) in Dnipro region and to provide microbiological characteristics of the obtained isolates. The study was conducting from January 2019 to December 2020. Children with genetically confirmed CF diagnosis were enrolled. The main research method was bacteriological with identification of microorganisms by biochemical properties; antimicrobial susceptibility was determined by disk-diffusion method. Biological material: mucus from a deep smear from the posterior pharyngeal wall, sputum and tracheobronchial lavage waters. The Leeds criteria were used to define persons with chronic infection. The study involved 21 children. We collected 183 respiratory samples with 49 isolates of P. aeruginosa. The most important co-existing pathogens were Staphylococcus aureus, Aspergillus spp. and Candida spp. In our study, P. aeruginosa was associated with Aspergillus spp. (χ2=20.952; df=1; p˂0.001). Mucoid isolates were found in 24.49% of cases. P. aeruginosa showed variable sensitivity to different groups of antimicrobial agents, but the highest resistance was to penicillins. Mucoid P. aeruginosa was more resistant to penicillins (p˂0.001) and cephalosporins (p=0.036). Infection P. aeruginosa is frequent among children with CF; there were three children with chronic bronchopulmonary infection P. aeruginosa in Dnipro region in the end of 2020. The likelihood of Aspergillus spp. infection was higher in the case of current P. aeruginosa infection. P. aeruginosa showed variable susceptibility to different groups of antimicrobial agents, but mucoid isolates were more resistant.

145-151

Authors: Kovach I.V. , Varzhapetian S.D., Bunyatyan Kh.A., Reyzvikh O.E., Babenya A.A., Strogonova T.V.

Oroanthral fistula (anastomosis) is an element preventing the restoration of homeostasis in the maxillary sinus due to the constant flow of microbes from the oral cavity. It is also contributes to frequent exacerbations of maxillary sinusitis. Saprophytic gram-positive cocci and fungi of the oral cavity are dominating representatives of the microbial flora in the maxillary sinus. As the result of research, we found that in the case of maxillary sinusitis with oroantral fistula fungi made up 25.0% of microbiota, gram-positive bacteria – 41.7%, gram-negative bacteria – 33.3%. Gram-positive cocci from the Staphy­lococcus genus (Staphylococcus aureus and Staphylococcus epidermidis) and fungi (Candida albicans) comprised the biggest proportion of microbial flora that 33.3% and 16.7%, respectively. Slightly decreased levels of monocytes in venous blood was noted in 69.2% of patients. The average value of total serum IgE in group with oroantal fistula was 226.2 (70.4) IU/ml, the result exceeded normal limits almost in 2.26 times. Large circulating immune complexes (CICs) were normal in all patients in the group with iatrogenic maxillary sinusitis. The average lavels of small size CICs was 170.2 (4.23) ОU, which is in 1.06 times higher the upper limit of the norm (160 ОU). Elevated levels of total Ig E in serum of patients with oroanthral fistula indicates allergic sensitization. The detection of increased levels of CICs with small and medium sizes in serum may indicate a susceptibility of this category of patients to the development of immunopathological reactions.

161-168

Authors: Deputat Yu.M., Gulich M.P., Savytskyi V.L., Ivanko O.M., Levit Yo.R., Bogomolets O.V.

The article is devoted to the research of the problem of compensation of energy losses of servicemen doing qualification course of the UAF Special Operations Forces as well as development of the method of promp response of the officials of food service on changing of energy losses of servicemen on different phases of qualification course by corresponding correction of their daily nutrition ration. The aim of work was directed for development and substantiation of informational model of nutrition ration calculation for compensation of energy losses of the Ukrainian Armed Forces servicemen. Time and tabular method of energy losses calculations, calculations of ration composition, instrumental estimations, laboratory and statistics assessments were used as methods of research. Calculations of informational model were done in Microsoft Excel 2007 functional environment. The description of informational polyparametrical model of the computational system of nutrients composition and energy value of servicemen daily nutrition ration depending on revealed energy losses doing qualification course of UAF Special Operations Forces has been presented. The model is meant for operative calculations of nutrients composition and energy value for compensation of energy losses of corresponding servicemen doing different phases of qualification course. Informational model got approval and was implemented in the UAF Special Operations Forces activities.

179-187

Authors: Yavorovsky A.P., Rygan M.M., Naumenko A.N., Skaletsky Yu.N., Gichka S.G., Ivanko A.V., Brukhno R.P., Gorval A.K.

Using a questionnaire from the United States Agency for Research and Quality in Health Care (AHRQ), the characteristics of patient safety (PS) culture in the staff of various health care facilities (HCF) in Ukraine were analyzed. In addition, the characteristics of PS culture were analyzed depending on the length of service and affiliation of the respondents to the medical or nursing staff, as well as the profile of therapeutic or surgical activities. It is established that the weakness of the PS culture of the staff of domestic HCF is "Reaction to mistakes" (less than 30% of positive responses), which indicates the predominance of culture of accusation (unfair culture) in Ukrainian HCF and as a consequence fears of the staff to disclose mistakes and accordingly, the lack of opportunity to learn from these mistakes.“Staffing” is identified as a weakness of the PS culture (less than 50% of positive responses) in most comparison groups. It is worth noting such a characteristic of the culture of BP, as the "Frequency of error messages" (less than 70% of positive responses). The Cronbach's alpha coefficient in all groups of respondents ranged from 0.62 to 0.78, which indicates the truth of the results of the study.

197-204

Authors: Berest I.R., Berest R.Ya., Pasichnyk M.S., Pasichnyk S.M., Savchuk H.M., Strelbytska S.M.

Based on the prin­ciple of historicism, systematic analysis, scientific and objective approach, the article analyzes the evolution and shows the activities of the Galician trade unions in health-related activity. The current state and development of historiography of the issue is shown, the history of the medical and trade union movement is studied, it is proved that common problems for all segments of the population became the main event among the trade unions of the early-XIX XX centuries. These issues provide significant material for the scientific study of other key issues of the complex history of Galicia in the Austro-Hungarian period, in particular: the organization of health care, medical education, governance, economic and social development, the rise of the Ukrainian national movement and the like. In the conditions of building democratic institutions of independent Ukraine, the analysis and accumulation of historical experience have not only scientific, but also cognitive, ideological-political and especially applied, practical significance. Almost any professional organization has tried to protect its members in some way. In early 1867, doctors in Lviv recognized the need to create their own professional association to organize social protection, to create a fund to support sick, infirm and impoverished colleagues, as well as their widows and orphans. Thus, it was decided to establish a separate Medical Society. In accordance with the provisions of the statute, the purpose of the Society of Galician Physicians was to work together on the development of medicine, primarily in the direction of its practical application, taking into account the relations of the population as a whole; promoting a spirit of cohesion and friendship between health professionals to jointly oversee medical affairs; providing material assistance to impoverished colleagues, families of deceased colleagues. Similar tasks were set by the societies of printers, weavers, and oil refiners. All of them were united by the medical and health-improving activity.

212-218

Authors: Antipkin Yu.H., Kyrylova L.H., Miroshnykov O.O., Yuzva O.O., Orzheshkovskyi V.V., Nechay A.F.

The paper reports on two cases of young women from Ukraine with autosomal recessive limb-girdle muscular dystrophy type 2A with different age of symptoms onset and an absence of any family history presented with gradual onset of proximal muscle weakness in four limbs and thinning of shoulders, arms and thighs. Both patients had elevated creatine phosphokinase level and c.550delA mutations in CAPN3 gene. Sequence analysis and deletion/duplication testing of the 159 genes from skeletal muscles disease testing panel of 5-year-old girl identified deletion of exon 8 (heterozygous) and c.550delA (p.Thr184Argfs*36) mutation (heterozygous), were in CAPN3 gene. Magnetic Resonance Imaging of soft tissue of the proximal lower extremities was performed which showed signs of symmetrical atrophic changes in the major adductor muscle, the long and short adductor muscles, the semitendinosus muscle of the thigh, as a manifestations of autosomal recessive limb-girdle muscular dystrophy type 2A. Homozygous, pathogenic variant of the defect in the CAPN3 gene c.550del (p.Thr184Argfs * 36) was identified in a 25-year-old woman. Type 2A is the most common form of limb-girdle muscular dystrophy, accounting for about 30% of cases. The autosomal recessive limb-girdle muscular dystrophy type 2A is on caused by mutations in the CAPN3 gene, and it is characterized by selective atrophy and weakness of proximal limb and girdle muscles. The age of onset of muscle weakness is extremely variable; the most common being between 8 and 15 years, although it can range between 2 and 50 years. The diagnosis can be suspected by findings on a muscle biopsy or when a doctor experienced in muscular dystrophy examines you. A serum creatine kinase blood test may also show raised levels which indicate a problem in the muscles. The diagnosis has to be confirmed by means of identifying a mutation in the CAPN3 gene which is done on a deoxyribonucleic acid sample from a blood test. To date there are no specific treatments for limb-girdle muscular dystrophy, however careful management of the symptoms of the condition can improve a person’s quality of life. Joint contractures (tightening) can occur in limb-girdle muscular dystrophy and therefore regular physiotherapy is recommended.

4-11

Authors: Smorodska O.M., Moskalenko Yu.V., Vynnychenko I.O., Vynnychenko O.I., Kostuchenko V.V.

Tumor molecular profiling in patients with non-small cell lung cancer (NSCLC) is used to identify driver mutations, which lead to premature carcinogenesis in more than 80% of adenocarcinoma cases, including epidermal growth factor receptor (EGFR) mutations. Identification of specific somatic aberrations allows to personalize treatment. Personalization of treatment resulted in improvement of NSCLC outcomes. The aim of our study was to consider scientific data on modern concepts of treatment of patients with non-small cell lung cancer with previously detected oncogenic mutations, especially EGFR mutation. In our study we analyzed scientific papers and data of international scientific literature on the problem of lung cancer treatment. Methods used: scientific research, analytical and generalizing. Different drugs are used in treatment of lung cancer. Choice of treatment scheme depends on type and presence of mutations. Patients with advanced non-small-cell lung cancer and detected mutation in the EGFR can be treated with tyrosine kinase inhibitors (TKIs). Nowadays three first generation drugs are recommended by FDA: afatinib, erlotinib, gefitinib. They showed good clinical benefit. Most patients with metastatic NSCLC typically show disease progression after approximately 9 to 13 months of erlotinib, gefitinib, or afatinib therapy. The first and only commercially available third-generation EGFR TKI is оsimertinib - an oral drug, which selectively inhibits both EGFR-TKI and EGFR T790M resistance mutations. Nowadays scientists are in active investigation of mechanisms of acquired resistance to TKIs, but little is known yet. Clinical success can be observed in patients who were treated with TKIs. EGFR T790M is a mutation that leads to acquired resistance to EGFR TKI therapy. Its incidence is approximately 60% after disease progression on TKI drugs (erlotinib, gefitinib, or aphatinib). Third-generation EGFR TKIs demonstrate high efficacy, but acquired resistance development cannot be avoided. Mechanisms of acquired resistance to these agents are still investigated.

19-25

Authors: Shtrygol S.Yu., Kapelka I.G., Mishchenko M.V., Mishchenko O.Ya.

The participation of arachidonic acid metabolism products – prostaglandins and leukotrienes – in the process of inflammation is a common pathogenetic link of cold injury and epilepsy. Montelukast is widely used for the treatment of bronchial asthma and allergic rhinitis as a leukotriene receptor blocker. However, the mechanism of action of the drug suggests a wider range of its pharmacological properties and the corresponding scope of application. This study is aimed to determine the effectiveness of montelukast as a potential frigoprotective and anticonvulsant drug. Experiments were performed on 73 white mice weighing 20-22 g on models of acute general cooling and pentylenetetrazol convulsions. Frigoprotective properties were studied at a temperature of –18°C, recording the lifetime. Montelukast ("Singular", 2 mg/kg), acetylsalicylic acid ("Aspirin", 50 mg/kg), celecoxib ("Celebrex", 74 mg/kg), diclofenac sodium ("Voltaren", 14 mg/kg) were administered intragastrically as a suspension in a prophylactic mode, 30 minutes before the cold injury. In the study of anti­convulsant activity, montelukast ("Singular", 4 mg/kg) and sodium valproate ("Depakin", 300 mg/kg) were admi­nistered intragastrically 30 minutes before stimulating convulsions by subcutaneous administration of pentylene­tetrazole (90 mg/kg). The latent period of convulsions, the number of convulsions per 1 animal, % of mice with clonic and tonic paroxysms, the severity of convulsions in points, the duration of the convulsive period, the lifetime of animals and lethality were recorded for an hour. On the model of acute general cooling, montelukast showed a dose-dependent frigoprotective effect at a dose of 2 mg/kg surpassing drugs with proven frigoprotective properties – acetylsalicylic acid and celecoxib. On the model of pentylenetetrazole-induced convulsions, montelukast statistically significantly reduced the integral indicator of anticonvulsant activity – lethality – by 2.57 times. Thus, the experiment proved the significant role of leukotrienes in the pathogenesis of cold injury and epilepsy and justified the feasibility of further study of the frigoprotective and anticonvulsant properties of montelukast – leukotriene receptor blocker a drug as for adjuvant therapy, especially when these pathologies are combined with bronchial asthma and allergic rhinitis.

33-39

Authors: Bocharov V.A., Bocharova V.V., Lebediuk M.M., Sarayreh A.A.S., Kuts L.V.

According to the decisions of international scientific forums, the problem of phenomenon of rosacea (acne rosacea), a common dermatosis with numerous unexplained aspects of etiopathogenesis is a promising area of modern medical research. The aim of the study was theoretical substantiation of the essential features of the mechanisms of occurrence, development and clinical manifestations of the first signs of rosacea in women of reproductive age. The use of a systematic analytical methodical approach to assess the data of clinical and laboratory examinations of women with rosacea, conducted in different regions of the world, allowed to establish the originality of such manifestations of dermatosis as the appearance of unexpected rushes to limited areas of the face, accompanied by local redness and local heat areas of the skin differring significantly from similar rushes in other diseases or syndromes (menopause, migraine, etc.). It is established that the peculiarity of the relationship of these clinical characteristics (from English: rush, ruddy, redness, rosacea, reproductive age of women, reaction) allows to indicate the first signs of dermatosis as a phenomenon inherent in this disease Rush-Ruddy-Rosacea-Reproduce-Reaction (abbreviated – «5-R»), the key pathophysiological target of which (as well as the disease as a whole) is a disorder of a set of hierarchically dependent mechanisms of the evolutionarily determined motivational need to ensure reproductive function in women (both at the cellular level and extracellular structures of the ovaries, and at different levels of subcortical formations and centers of the cortex of the cerebral hemispheres). The phenomenon of rosacea rush is closely related to other phenomena of this dermatosis – hypersensitivity of bradykinin receptors, actinic elastosis, development of post erythematous telangiectasia. The prospect of further research on the problem of rosacea is to study the relationship of disorders in the functional systems of molecules of signaling compounds of different classes (hormones, eicosanoids, neuropeptides, kinins, cytokines and others) in the pathogenesis of the disease.

45-51

Authors: Yaremenko O.B., Dobrianskyi D.V., Tarchenko I.P., Meliksetian A.V., Fedkov D.V.

The modern model of education and the present conditions demand of the teacher to choose the latest teaching methods. The teacher is no longer the main source of information, he should manage education, implementing competence-based study methods. In order to achieve this, the latest teaching methods are introduced in Bogomolets National Medical University with the new lecture frameworks. Changing the lecture style at a medical universities and, in particular, using the modern lecture educational technologies provide important conditions for improving training future doctors. As Bogomolets National Medical University experience shows, this provides opportunity for turning traditional lectures into interactive lessons to increase students’ interest, to provide improved material perception through the dialogue between the lecturer and students. The article presents the results of surveys of 387 students conducted at the Department of Internal Medicine №3, as well as generalized information regarding students’ evaluation of changes in the lecture framework and the implementation of new training methods in Bogomolets National Medical University. According to the survey results, most students are satisfied with the quality of the updated lecture frameworks at the therapeutic departments. The main characteristics of the lectures that teachers need to pay attention to in order to improve the lecture quality have been analyzed separately. In the view of the students, the best features of the lectures are: actuality, availability of material, structure and laconicism, informativeness, interactivity, video footage using, practical orientation of the presentation, illustration and sufficient number of visuals, an opportunity to be engaged in dialogue with lecturer. Students find traditional attendance control useless, the majority of respondents supported free lecture attendance.

59-66

Authors: Shifris I.M., Dudar I.O., Krasiuk Е.К., Shymova А.Yu.

The aim of the study was to establish the frequency and possible predictors of cardiovascular disease (CVD) in chronic kidney disease (CKD) VD stage patients, treated with hemodialysis, based on results of prospective observation. The prospective observational cohort study included 223 patients with CKD V D stage who were treated with hemodialysis (HD) during 2012-2019. The research was carried out in two stages. At the first stage, main demographic, laboratory and clinical characteristics of patients, including the frequency of CVD, at the time of beginning the study were examined. At the second stage, based on prospective studying of the dynamics of the frequency of CV pathology, an assessment of potential predictors of CVD in CKD V D stage patients treated with HD was made. Patients’ characteristics determined at the beginning of the study were used as possible predictors. The average duration of prospective study was 35.5±17.8 months, cumulative – 579.3 patient-years. For determination of prognostic factors of CVD events, ROC-analysis, univariate and multivariate Cox proportional hazard regression analysis were done. The primary endpoint (newly diagnosed CVDs) was assesses at the end of the study. Statistical processing of the obtained results was performed using the MedCalc Statistical Software, version 19.3. During the study period, a significant increase of all CVD frequency by 80% (р<0.001) was stated, more than twice – of coronary artery disease (CAD; р<0.001) and atrial fibrillation (AF; р=0.0039). The incidence rate of CVD and CAD was 9.8 and 9.15 per 100-patient-years, respectively. The primary endpoint was observed in 92 (41.26%) patients: newly diagnosed CAD – in 53 patients, heart failure – in 12 patients, AF – in 9 patients, acute myocardial infarction – in 8 patients, other heart diseases – in 10 patients. Independent predictors on increased CVD risk in chronic kidney disease VD stage patients treated with hemodialysis are: age over 35 years, use of a central venous catheter as a vascular access during HD initiation, history of nasal MRSA collonization. In the other hand, serum albumin level of more than 36,6 g/l was associated with reduced risk.

72-79

Authors: Potabashnii V.A., Kniazieva O.V., Markova O.Ya.

Ischaemic Heart Disease (IHD) and Chronic Obstructive Pulmonary Disease (COPD) are common diseases that rank highest in the Global Burden of Disease Study (2019). IHD and COPD are often combined, making diagnosis and treatment of patients difficult in actual clinical practice. The aim of the study was to identify problems in the diagnosis and treatment of patients with a combination of chronic IHD and COPD, based on a retrospective analysis of medical records. Patient’s adherence to treatment was also assessed with the Morisky Scale (MMAS-8). The analysis of 108 inpatient charts with a combination of chronic IHD and COPD was carried out. The quality of diagnosis and treatment of IHD was evaluated in accordance with the order of the Ministry of Health of Ukraine N152 dated March 02 2016, considering the recommendations of the European Society of Cardiology (2019). It was found that smoking history was in 23.1% of patients, a body mass index (BMI) was calculated in 51,9%, and a carotid ultrasound examination was carried out in 7.4% of cases. The total cholesterol level was determined in 59.2% of patients, while the level of low-density lipoprotein cholesterol (LDL-C) was determined in only 43.5%. Transthoracic echocardiography (TTE) was performed in 62.9 % of patients, but stress-echocardiography and exercise ECG were not performed. Daily ECG monitoring was performed in 60.2% of cases. The levels of brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) were not detrmined to precise etiology of dyspnea. It was also found that beta-blockers (29.6% of patients), ivabradine (11.1% of patients) and statins (65.7% of patients) are seldom administered to patients with IHD and COPD. The targeted doses of these drugs are not reached. Fixed combinations of long-term bronchodilalarors were insufficiently used in therapy of COPD. However, patients' adherence to basic IHD and COPD therapy is weak. 45.4 % of patients were non-adherent to treatment, 43.5% were medium-adherent, and only 11.1% of patients were adherent to treatment.

88-96

Authors: Vatseba T.S., Sokolova L.K., Tronko M.D., Churpiy I.K., Vatseba M.O., Derpak V.V.

The aim of the study was to investigate the effect of obesity on the development of cancer of certain localizations in patients with type 2 diabetes mellitus (T2D) and to explain the association mechanisms of obesity in diabetes and cancer. The study included retrospective analysis of first time diagnosed cancer cases in patients with T2D in 2012-2016 in Ivano-Frankivsk region. Analysis of the data was carried out using Statistica 12.0 (StatSoft Inc., USA) program. The data are presented in the tables as M±SD (M± standard deviation). Differences between the studied parameters were determined using the ANOVA- test, taking into account the Bonferroni correction. The relationship between the studied data was evaluated using the criterion of chi-square with Yates correction (χ²). The odds ratio (OR), 95% confidence interval, the positive and negative predictive value were calculated to determine the association between two events. The differences were considered significant at p<0.05. According to the results, 533 cases of the first time diagnosed cancer were detected in patients with T2D. It was found that obesity is inherent in women with breast, uterine, ovarian and colorectal cancer; for men with prostate cancer and with colorectal cancer. According to the criterion of χ², the effect of obesity on the incidence of breast cancer in women (x2=8.46; p<0.05), and prostate cancer (x2=7.02; p<0.05) and colorectal cancer (x2=7.94; p<0.05) in men was proven. OR revealed an increased risk of breast cancer in women [OR=2.06; 95% CI (1.28-3.29); p<0.05], and prostate cancer [OR=2.94; 95% CI (1.37-6.32); p<0.05] and colorectal cancer [OR=2.87; 95% CI (1.42-5.82); p<0.05] in men associated with obesity. Thus, among patients with T2D, obesity increases the risk of breast cancer in women, prostate cancer and colorectal cancer in men. The mechanisms of association of obesity and cancer in patients with T2D are hyperglycemia, hyperinsu­li­nemia, cytokine imbalance, hyperestrogenism (in estrogen-dependent cancer), and intestinal dysbiosis (in colorectal cancer).

104-110

Authors: Mirchuk B.M., Maksymov Y.V.

In the presence of dentition defects there is a complex of morphological, aesthetic and functional changes that significantly complicate the process of diagnosis and treatment of this pathology. Dentition defects, combined with various dental anomalies and deformations very often impede rational prosthetics and at times make it impossible at all. The aim is to increase the effectiveness of orthodontic treatment of secondary deformations in patients with dentition defects by using primary dental implants as an additional skeletal support. For clinical evaluation of the effectiveness of treatment of secondary deformations in 20 patients with partial dentition defects there was performed orthodontic treatment using a straight arc technique with metal braces of the Roth system and primary detailed one-component implants as an additional skeletal support. On the diagnostic models of the jaws, the meso-distal dimensions of the lost teeth and their possible position in the dentition were determined, the shape of the dentition by methods of Pon and Korkhaus, the position of the teeth in the area of dentition defects was analyzed and the jigs of occlusion according to Andrews were defined. The use of primary dental implants as an additional skeletal support in the area of dentition defects makes it possible to control the rotation of the teeth and at the same time to use orthodontic forces of different intensity during their distal or mesial movement. As a result of orthodontic treatment of secondary deformations, we managed to achieve positive changes in the normalization of angles of dental inclination that limit the defect in patients with dentition defects. Along with the normalization of the angles of dental inclination (torque and angulation) which limit dentition defects we have noticed an increase in the distance between these teeth, which allows to restore dentition defect with dentures, better corresponding to the size of the lost teeth. Important, in our opinion, is the possibility, when using a primary dental implant as an additional skeletal support, to use the technique of segmental braces. The use of primary dental implants in the area of the dentition defect as an additional skeletal support makes it possible to restore angulation and torque of the teeth, which limit the defect, using orthodontic forces of different intensity. As a result of orthodontic treatment of secondary deformations, the distance between teeth limiting dentition defects on the upper jaw increased on average by 2.39 mm (p<0.001) and on the lower jaw – by 2.57 mm (p<0.001).

119-125

Authors: Vintoniv O.R., Popadynets I.R., Hrodzinskyy V.I., Melnyk S.V., Herych P.R., Halipchak I.M.

In recent years, the requirements for the level of the life quality have increased significantly; an integral part of it is the sexual harmony, which in men largely depends on sexual desire and erectile function. According to the results of modern scientific studies, there is no doubt that erectile dysfunction in men is closely connected with the cardiovascular diseases, obesity, diabetes mellitus and other comorbidities. This problem can also be caused by systematic psycho-emotional overload, deterioration of the environmental conditions, harmful factors of production, uncontrolled use of medicines, inflammatory processes in the genital organs, the growth of somatic diseases. The vast majority of works concerning “male menopause” is reduced to the effectiveness of hormone-replacement therapy in erectile dysfunction, while only few research works are devoted to the study of the connection between somatic pathology and androgen deficiency. There is a negative correlation between total testosterone level and systolic blood pressure. According to the research results of some scientists, it was found that 38% of patients with arterial hypertension had androgen deficiency, confirmed in the laboratory, which is significantly higher than in patients of the same age category with normal blood pressure. These dominant factors exert and increase the influence on each other, which must be taken into account in modern therapeutic practice. The study of the formation of comorbid conditions in men with low levels of androgens is of particular importance, as the knowledge of pathophysiological mechanisms can prevent their development and progression. The aim of this investigation was to study the state of penile vascular blood flow in men with arterial hypertension with erectile dysfunction, using color Doppler imaging with pharmacological induction of erection. The indicators of daily monitoring of arterial pressure and arterial stiffness in men with arterial hypertension of the II degree against the background of androgen deficiency or at normal testosterone levels and ways of correction of erectile dysfunction in these patients were also evaluated.

134-140

Authors: Melnychuk M.P.

Such premalignant conditions of prostate cancer (PC) as prostate intraepithelial neoplasia (PIN) are classified between benign and malignant ones. Contemporary evidence wheather PIN develops malignancy is limited and (LGPIN) data present varied results. Morphological and clinical differencies between high (HGPIN) and low grade PIN specimens in the prostate remain unclear. Aim of the work – to determine clinical significance and progression ability of high grade and low grade prostate intraepithelial neoplasia. The results of examination of 276 patients with PIN (152 patients with high grade PIN and 134 patients with low grade PIN) were assessed comparatively. During a 3 year follow-up repeated prostate biopsies were performed with 6 months interval to detect PC. Initial and repeated multifocal transrectal prostate biopsies from 12 samples were performed under transrectal ultrasonic guidance. There were statistically significant differences in PC detection rates between HGPIN and LGPIN. Patients with HGPIN had malignization rate of 42.1% during a 3-year follow-up that was by 33.9% higher than in LGPIN patients. The spread of HGPIN lesions within prostate gland is a malignization risk factor. The mean malignization term of HGPIN is 18 months and of LGPIN – 30 months. Low and high grade PIN are gradual stages of cancerogenesis. PIN grade determines its clinical significance, while LGPIN has low malignization potential, HGPIN possesses morphological and clinical prostate characteristics similar to adenocarcinima.

147-152

Authors: Danylenko H.M., Cherniakova G.M., Merkulova T.V., Avdiievska O.H.

The aim of the work was to investigate how gender, age and type of activity in summer affects the indicators of physical development (PD) of children. 1054 students (493 boys and 561 girls) aged 7-16 years took part in the study. The PD of children was studied by assessing somatometric and physiometric indi­cators. To assess the impact of the type of activity, a thematic questionnaire "Summer" was used. It was found that the gender and age of children had a significant effect on PD indicators in the summer. The most intense increase in body length oc­curred at the age of 7-12 years, body weight - in 10-14-year-olds, and up to 16 years grouth of two parameters gradually slo­wed down. From the age of 10, children showed a positive increase in lung capacity (LC). In 15-year-old adolescents, a de­c­rease in both indicators (ChC and LC) was found. It was found that 62% of children carried out educational activities in the summer, 24% of those were engaged in business activities, almost 40% of students were participants in hiking trips and 23% of children attended a children's health camp. The chosen type of activity in the summer influenced the indicators of the pu­pils' PD as follows: educational activities were accompanied by a decrease in body length and strength of the left arm, busi­ness activity, hiking trips and staying in a health camp were accompanied by an increased weight gain and an increase in LC.

160-166

Authors: Ahmedova S.

The results of testing of the improved working classification of superficial mycoses of the skin and its appendages (SMS) in the Republic of Azerbaijan for the period of 2012-2016 are presented. Given the variety of classifications of fungal skin diseases, many years of clinical experience have shown that none of them fully meets the requirements of a practicing physician. The author has developed and improved the classification of mycoses of the skin and its appendages, which will facilitate the diagnosis and the appointment of therapy, since this classification takes into account the tissue and topographic localization of the mycotic process, which greatly facilitates the diagnosis by dermatovenerologists, and will also reveal the true prevalence of mycotic pathology. Based on the traditional form No. 9, among 246 cases of superficial mycoses of the skin and its appendages identified in the city of Baku for the period of 2012-2016, the largest number of patients (79.44±2.6%) were diagnosed with mycoses of the scalp – 32, 52±1.21%, smooth skin mycoses – 30.08%±1.28 multi-colored lichen – 14.80%±1.01, which corresponds to the frequency of occurrence of these forms of SMS at the age of 11-20 years (44.01±3,1%) and 0-10 years (39.08±3.1%), leaders in the age line of groups with SMS in Baku. A reliable statistical difference was revealed in the detection of superficial mycoses of the skin and its appendages in the city of Baku during the study period. Based on the developed working classification, the nosological structure of the incidence of SMS in the city of Baku for the period 2012-2016 is represented by the following – 1919 episodes: mycoses of the scalp – 675 patients (35.17±1.1%); mycoses of smooth skin – 638 patients (33.25±1.1%); multi-colored lichen – 264 patients (13.76±0.8%); combined mycoses of smooth skin and scalp – 134 patients (6.98±0.6%); onychomycoses – 97 patients (5.05±0.5%); purulent-infiltrative form of mycoses – 66 patients (3.44±0.4%); skin candidiasis – 19 patients (0.99±0.2%); feet of the mycoses – 19 patients (0.99±0.2%); inguinal epidermophytosis – 7 patients (0.36±0.1%). The prevalence of nosologies preserved in the largest number of patients (1578 patients – 82.23±0.9%), mycoses of the scalp – 35.17±1.1% (675 patients), smooth skin mycoses – 33.25±1.1% (638 patients), multicolored lichen – 13.76%±0.8 (264 patients). The greatest number of patients with SMS was also detected in the age group of 11-20 years (42.12±3.1%) and 0-10 years (40.32±3.1%). The data of a comparative analysis of the results of the developed and improved classification of superficial mycoses of the skin and its appendages with the data of the traditional reporting form, made it possible to expand the scope of the analyzed nosologies and increase the objectivity of statistical data for assessing the epidemiological situation in the study region.

173-180

Authors: Saidakova N.O., Yatsina О.І., Grodzinsky V.I., Stus V.P., Polion M.Y., Shiloh V.M., Коnonova G.E.

The work is based on the materials of official statistical reporting, the analysis of which was carried out for 10 years, divided into two five-year periods (2009-2013 and 2014-2018). Absolute and intensive rates of morbidity and distribution of bladder cancer of the adult population of Ukraine in the regional aspect, taking into account sex were studied, the basic indicators of the prevalence of pathology were analyzed as well. The revealed unfavorable situation is characterized by a steady increase in morbidity and prevalence at a slower pace during 2014-2018. It is noteworthy the high level of morbidity in men, which is growing against the background of its stabilization among women. At the same time, there was noted the tendency in the reduced number of newly diagnosed patients during professional examinations (in 2018-16.9% against 18.0% in 2014) with diagnosis at stages I-II (72.2% vs. 74.79%), wherein every fifth has stage III-IV. With a tendency to increase in the number of registered patients ≥ 5 years (59.1% vs. 56.5%), the death rate did not change significantly within a year from the time of diagnosis (14.7% vs. 15.6%, respectively). In the structure of specialized care, (65% are patients with the first diagnosis), surgical method accounted for 37-40% by years, the combined was second (up to 20% by years), then radiation and chemotherapy, which together did not exceed 5.0%. Areas with high or low relative rates in relation to the average Ukrainian indicators for all parameters studied were identified. In the presence of regional differences, there is a need for in-depth studies of the state of the issue, including the quality and organization of care.

188-196

Authors: Chorna V.V., Makhniuk V.M., Khliestova S.S., Gumeniuk N.I., Chaika H.V.

The article presents the results of theoretical and experimental studies of the degrees of value-motivational, cognitive, emotional, and behavioral components in health care workers of psychiatric health care facilities concerning their health. The degree of risk and value of the personal hygiene of health care workers is determined. The main components and factors that affect the attitude to personal health are revealed. The awareness of the own emotional and cognitive experiences by the medical staff of psychiatric hospitals regarding the preservation and strengthening of their hygiene is analyzed. According to research on the value-motivational component of the medical staff of psychiatric health care concerning the place of personal health in the hierarchy of values in life, it was found that own health is on the second place – 15.2% males, nursing staff (NS), 15.1% females, are psychiatrists and women NS, 14.8% are men psychiatrists. In case of a deterioration of own health both women (35,6%), and men (35,5%) psychiatrists are engaged in self-treatment, the similar tendency is among NS – women NS – 31,3%, men NS – 31, 5%), in 25.8% of cases female psychiatrists and in 23.1% of men NS do not pay attention to the disease at all, which leads to occupational diseases and chronic diseases. At the same time, occupational diseases among doctors and NS do not exceed 10% of the total number of occupational diseases in Ukraine due to self-medication and early treatment. Therefore, the statistics of occupational diseases of health workers in that field are underestimated compared to the actual ones.

202-207

Authors: Grygus I.M., Nagorna O.B., Nesterchuk N.E., Nogas A.O., Podoliaka P.S., Gamma T.V.

The article deals with the problems of physical therapy in children with multiple sulfatase deficiency (MSD). The purpose of the study presented in the article was to substantiate the need to form a structured, personalized comprehensive rehabilitation program for children with multiple sulfatase deficiency. The objectives of the study were to analyze the literature on the topic of the study, to study the clinical phenotype of multiple sulfatase deficiency and potential complications of this pathology, to justify the use of physical therapy in children with multiple sulfatase deficiency. Research methods: analysis of scientific and methodological sources of domestic and foreign authors, pedagogical observation, collection of anamnestic information of the patient. The publication discusses the clinical phenotype of genetic pathology and possible potential complications of this orphan disease, strategic vectors of an individual rehabilitation program. The description of a clinical case of late infantile form of the disease is presented. The effectiveness of a six-months’ implementation of the physical therapy program is being investigated. For rehabilitation examination of children with MSD, it is proposed to use testing of children with psychomotor disorders. The technique of massage, the appropriateness of verticalization and orthotics, sensory enrichment of the environment of a child with this genetic pathology are revealed. Exercises of therapeutic physical culture are proposed, they will help to maintain postural control, support ability and functioning of arms, legs, hand-eye coordination, and help prevent diseases of the bronchopulmonary system. It is noted that MSD has been insufficiently studied not only from the standpoint of a treatment strategy, diagnostic algorithms for clinical multisystem manifestations, but also requires attention to analyze the effectiveness and efficiency of the system of modern rehabilitation technologies for children with this diagnosis.

4-11

Authors: Pertseva T.O., Kuryata O.V., Konopkina L.I., Bielosludtseva K.O., Stadnichuk G.M.

Continuing education in terms of improving the professional competence of doctors has a great importance. In May 2020 for the first time in Ukraine under conditions of quarantine connected with COVID-19 the Prydniprovsk Association of Internal Medicine Doctors organized a 2-day international conference on internal medicine in a web format. The purpose of the work was to organize, conduct, determine the effectiveness of the international conference of internists in online format and analyze the results of the survey of students. A questionnaire which included 28 test tasks was developed to obtain a feedback from the lecturers. The answers were analyzed and the reasons for possible errors were considered. The level of knowledge acquired by students is generally quite high; however, the most problematic issues were the most modern diagnostic methods in gastroenterology, ECG diagnostics, clinical pharmacology in cardiology and pulmonology. The prospect of developing a system of continuing professional education for internists is to improve teaching methods with the subsequent involvement of leading specialists in various therapeutic areas to cover current issues of medical science and practice.

18-29

Authors: Kizhaev S.O., Petrenko V.O., Mazur N.V., Belitsky V.V., Mazur А.V., Dudnikova O.I.

The article is devoted to the development and use of intelligent systems in the management of medical technological processes and health-related quality of life (HRQOL). The relevance of the work is due to the need for effective use of intelligent systems in healthcare. The purpose of this work is to study the possibilities and prospects of using information technologies and artificial intelligence systems in clinical medicine to improve the efficiency of providing medical care to the population. Information retrieval method; theoretical analysis of legislative and regulatory documents, literary sources, Internet resources, research results; spectral-dynamic and mathematical analysis of the current state and assessment of the quality of life of an individual using the artificial intelligence system "CME". The paper analyzes the development trends of information technologies and artificial intelligence systems, as well as the features of their use in medical technological processes. As an example, the technological capabilities of the intelligent system Complex Medical Expert are briefly described.

40-46

Authors: Ostrovska S.S., Shatorna V.F. Liholetov E.O.

The concept of the viral etiology of Alzheimer's disease (AD) was first proposed in 1982. Its author MJ Ball suggested that the herpes simplex virus (HSV1) may be involved in the pathogenesis of AD, finding that the areas of the brain damaged in acute herpetic encephalitis are the same as those that are affected in AD, and those who survived usually suffer from memory loss and other cognitive impairment typical of AD. Subsequently, in all postmortem brain samples (temporal, frontal, and hippocampal) viral sequences of the viral thymidinekinase gene were found in a high proportion (70-100%) both in AD and in elderly people without it, while in young people and children the virus was found in very low proportions, so it was suggested that HSV1 comes from the peripheral ganglia, where the virus can remain inactive for many years, then enters the brain at an older age due to a decrease in the activity of the immune system. The increased risk of AD is associated with the presence of HSV1 in the brain and the carriage of a specific genetic factor – allele-ε4 of the apolipoprotein E4 gene (APOE-ε4). By themselves, neither HSV1 nor the APOE-ɛ4 allele were found as risk factors for the development of AD but their combination increased the risk of AD development by 12 times and made up 60% in patients with AD. The phenomena involved in the pathophysiology of AD are neurodegenerative changes that occur as a result of fibrillation and deposition of amyloid-β-peptide (Aβ) and neurofibrillary tangles – accumulations of aggregated phosphorylated tau-proteins (P-tau), leading to brain atrophy due to neuronal death. Traditionally, Aβ has been characterized as a catabolic by-product. However, it has recently been shown that Aβ-peptide has antiviral activity and protective effects against HSV infections in the brain. А 16-year study in Thailand with more than 33,000 patients showed that long-term use of antiherpetic drugs reduces the risk of dementia, including AD patients infected with HSV1. Patients with HSV1 infection who received antiherpetic drugs showed a lower risk of all types of dementia compared with the group without these drugs. Their positive effect on stopping the accumulation of amyloid beta and tau protein in the body has been confirmed. In this regard, it is assumed that vaccination against HSV1 may be useful not only for treatment, but also for the prevention of AD.

54-62

Authors: Berestoviy V.O., Ahmad Mahmood, Venckivska I.B., Ginzburg V.G., Sokol I.V., Berestoviy O.O., Govsieiev D.O.

A search of peer-reviewed articles regarding heat shock proteins (HSP’s) especially HSP 60 and 70 was conducted in this review to understand its role in the development of various complications like miscarriage, preterm birth, tubal infertility and spontaneous abortion associated with chlamydial HSP 60 in IVF, male infertility, preeclampsia, cancer, immune system activation, autoimmune diseases, coronary heart disease, dysregulation of steroidal hormone from the endometrium and its up-regulation in stress response. ELISA, western blotting, immunofluorescence, and affinity chromatography were the most common methods researchers used to determine and separate HSP 60 and antibodies related to it. Heat shock proteins are responsible for normal folding of other proteins and prevent its abnormal folding and cause degradation of abnormally folded proteins, mitochondrial protein transport, DNA metabolism, regulation of apoptosis are their significant functions. HSP 60 is a homologue of bacterial HSP 60 (GroEL) and needs co-chaperonin HSP 10 for its proper functioning. Gynaecological and obstetrical complications were more prevalent in most studies. Pregnant women were mostly affected subjects. Abnormal HSP 60 leads to a high level of unfolded or misfolded proteins, which in turn activate other body systems to produce the clinical outcome. Some researchers stated that there is no association between preterm birth and HSP 60 & 70, chlamydial HSP 60 antibodies trigger tubal infertility, preeclamptic pregnancies has detectable HSP60 as compared to control, GroEL leads to tubal infertility and IVF failure, chlamydial (CHSP 60) activates autoimmunity. HSP60 seropositivity reduces the opportunities of ectopic pregnancy, levels of HSP 60 does not stay constant throughout the menstrual cycle in reference to control, while other opposed these conclusions in their research works. According to some researchers, HSP 60 is a risk factor for pregnancy-related pathologies development, and some other opposed this theory and considered HSP 60 as a safety factor for normal pregnancy outcome, according to this review harmful effect of HSP 60 dominate, in future further high-quality studies need to be done for better understanding.

69-77

Authors: Shevchyk L.O., Kravets N.Ya., Grod I.M.

The purpose of the work was the need to study the change in weight and hematological indicators of the rats as a reaction-response to being in difficult and unfavorable experimental conditions. The biological experiment was conducted in compliance with the normative conditions of keeping the rats, in accordance with ethical standards and recommendations for humanization of work with laboratory animals. In order to accomplish these tasks, rats were divided into two groups: control rats were housed in a spacious cage with comfortable living conditions and experimental animals were housed in a small cage with limited ability to move freely. For the purity of the experiment, the feed ration of animals of two groups was the same. Weight and hematological indicators were determined by conventional methods in physiology. It has been found that improper housing conditions, causing a stressful situation adversely affect the eating activity of the test animals, which explains the weak correlation of the dynamics of the weight of the animals in the control and experimental groups. The analysis of the absolute mass of the internal organs of rats showed their direct dependence on body weight and the correlation of these parameters between animals of both groups. The study found that the quantitative ratios of the main hematological parameters of each of the rodents are strictly different. The tendency to increase of the investigated parameters in the experimental group in comparison with the control one is symptomatic and can be explained by sympathetic-vegetative influences. The amount of hemoglobin is directly correlated with the number of red blood cells. Comparison of the content of hemoglobin, erythrocytes, leukocytes with body weight showed inversely proportional relationship between them. The persistent predominance of leukocytes in the blood of rats in both groups is likely to genetically determined.

85-90

Authors: Cherniy V.І., Sobanska L.O., Topolov P.O., Сherniy T.V.

The damage to erythrocytes during cardiopulmonary bypass (CPB) remains a recent problem. The aim of this research was to study the effect of fructose-1,6-diphosphate on the state of the erythrocyte membrane during CPB and the level of phosphorus in blood as a marker of the energy potential in the cell. Patients were divided into two groups. The control group 1 (Gr 1) consisted of 75 individuals. The group 2 (Gr 2) included patients to whom fructose-1,6-diphosphate (FDP) was administrated according to the developed scheme as follows 10 g of the drug was diluted in 50 ml of a solvent, 5 g of the drug was injected intravenously with the use of perfusor immediately before initiation of CPB at a rate of 10 ml/min and 5 g at the 30th minute of CPB (before the stage of warming) the same way. When comparing two groups the best results in hemolysis (p<0.01), mechanical (p<0.01). osmotic resistance of erythrocytes (p<0.01), the time of acid hemolysis (p<0.01) and the permeability of the erythrocyte membrane in postperfusion period were in Gr 2. Вefore cardiac surgery hypophosphatemia was detected in 18% out of 150 and in 32% out of 150 patients – a lower limit of normal phosphorus content in the blood. After CPB in Gr 1 phosphorus content in blood was 0.85±0.32 mmol/l and hypophosphatemia was in 53% out of 75 patients. This indicates a pronounced energy deficit in this group. In Gr 2 phosphorus level was 1.7±0.31 mmol/l and there was no hypophosphatemia. As a result, FDP as an endogenous high-energy intermediate metabolite of the glycolytic pathway leads to resistance to hemolysis, protects the erythrocyte membrane from damage and increases the energy potential of the cell during CPB.

98-105

Authors: Kopchak V.M., Pererva L.O., Shkarban V.P., Trachuk V.I., Lynnyk S.V.

Several studies showed that sarcopenia is associated with an increase of postoperative complications, with worse postoperative results in patients with pancreatic cancer. According to European Working Group on Sarcopenia, it is a "progressive and generalized skeletal muscle loss" characterized by both loss of skeletal muscle mass and strength (Cruz-Jentoft AJ et al., 2019). Aim of our work was to evaluate the effect of sarcopenia on the occurrence of postoperative complications after pancreatic resections in patients with pancreatic and periampullary cancer. We performed a retrospective analysis of treatment of 152 patients who underwent radical pancreatic resections. Sarcopenia was determined by preoperative computed tomography using the Hounsfield Unit Average Calculation (HUAC). In our investigation we measured the psoas area and density (Hounsfield Units) at the level of the third lumbar vertebral body (L3). Sarcopenia was diagnosed in 66 (43.4%) patients. Among patients with sarcopenia complications occurred in 41 (62.1%), mortality was 4 (6.1%). In the group of patients without sarcopenia, complications occurred in 29 (33.7%) of 86 patients, mortality was 2 (2.3%). The level of postoperative complications in patients with sarcopenia was significantly higher (c2 =12.1, p=0.0005). Postoperative mortality in patients with sarcopenia was higher without significant difference (c2 =1.3, p=0.24). Sarcopenia significantly affects the level of postoperative complications and its detection can be used to improve the selection of patients before pancreatic resections in patients with pancreatic cancer.

115-121

Authors: Vlasov О.О.

In pediatric anesthesiology in surgical interventions various methods of combined anesthesia with a combination of inhalation, regional, and intravenous anesthesia are used. The provision of high-quality anesthetic support in newborns and infants during surgical treatment of congenital defects is complicated by risk factors, concomitant diseases and different pathology conditions. The study of risk factors and their influence on the functional indices of the child's vital activity in prescribing anesthesia at all stages of the surgical intervention will help prevent complications and deaths in children. Aim – to сonduct a comparative assessment of various types of anesthesia for surgical correction of congenital defects in children and create a predictive model of the association of risk factors and deaths in the selected methods of anesthetic support. The retrospective study included 150 newborns and infants with congenital defects of the surgical profile depending on anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). After identifying and evaluating prognostic variables by simple logistic regression with calculating the odds ratio, stepwise multiple logistic regression analysis was performed and a predictive model of the association of risk factors and deaths with various types of anesthetic management was created. In thoracic operations a combined anesthesia with sevoran and fentanyl was most often used – 20.4%. In abdominal operations, in total anesthetic support with sevoran and regional anesthesia was used– 69.4%, while in urological operations combined total intravenous anesthesia with 2 drugs – 18.4% ranked first. No significant diffe­ren­ces were found between the types of anesthesia in various surgical interventions for congenital pathologies, between the types of surgery and deaths (p = 0.863). To prevent fatalities in various types of surgical intervention and options for anesthetic support of newborns and infants with congenital defects, it is advisable to more closely monitor the cerebral and peripheral oximetry indicators at all stages of treatment and timely correct the impaired condition of the child.

128-135

Authors: Mynka N.V., Kobelyatskyy Yu.Yu.

Various techniques are applied to reduce the severity of postoperative pain and discomfort in patients. The purpose of this research work was to evaluate the effectiveness and safety of Dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. The study included 80 patients who underwent corneal transplantation on the basis of Dnepropetrovsk Regional Clinical Ophthalmologic Hospital. Patients were divided into 2 groups: control (group K) – 30 men and main (group D) – 50 ones. Multicomponent balanced anesthesia was applied in both groups. Sibazone was administered as the sedative medicine in the group K, Dexmedetomedin was administered in the group D. The main criteria for evaluating the research results were hallmarked: hemodynamic stability during surgery, the amount of administered opiates, the severity of intraoperative pain syndrome by evaluating the ANI index (ANI – analgesia nociception index), the severity of postoperative pain syndrome and the frequency of postoperative nausea and vomiting (PONV). Both schemes of anesthesia allowed avoiding pronounced fluctuations in hemodynamic parameters and gas exchange at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group K pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the surgery, while in group D the ANI index did not fall below 50. Statistically significant differences were obtained on minute 1, 2, 5, 6, and 7 of the surgery. The number of episodes of insufficient anesthesia during the most traumatic stage of the surgery in group K was statistically significantly higher than in group D. Analyzing the quality of pain relief in the postoperative period it was determined, that the level of pain on the Visual Analog Scale (VAS) after awakening in both groups was equal to 0. At the next three stages of the study (2 hours, 6 hours after surgery, and the next morning), the level of pain in group K was significantly higher than in group D. In addition, it was determined that the need for narcotic analgesics and the number of episodes of postoperative nausea and vomiting in group K was statistically significantly higher than in group D. These given data allow us to conclude that Dexmedetomedin is the effective adjuvant of the anesthesia for corneal transplantation.

143-149

Authors: Zubarenko O.V., Stoieva T.V., Koval L.I., Kopiyka G.K., Papinko R.M.

Pneumonia is one of the most severe respiratory pathology forms in children, which contributes significantly to infant mortality. The high risk of chronic bronchopulmonary process and child`s disability, in case of severe and complicated disease, requires careful pathophysiological change's analysis in community-acquired pneumonia (CAP) in children. In particular, for the prediction of these disorders in children with CAP are important the dysmetabolic phenomena study and the specific approaches development. The immediate aim of this work is to study the cellular energy metabolism (CEM) features and to develop approaches for the early bioenergetic disorders diagnostics in conditions of community-acquired pneumonia in adolescents.The aim of the study is to develop approaches for the early diagnosis of shifts in energy metabolism in children aged 14-18 years with CAP. An examination of 41 children aged 14-16 years with the definition of CEM indicators was conducted in order to develop an approach for predicting CEM disorders in community-acquired pneumonia using the method of logistic regression. A logistic regression method was used to develop a method for predicting CEM disorders in children with CAP. The characteristics of CEM in children with CAP were determined. A decrease in the succinate dehydrogenase activity and an increase in the lactate dehydrogenase / succinate dehydrogenase ratio in children with CAP relative to the reference parameters were observed, which indicated an inhibition of the anaerobic energy synthesis pathway. Two mathematical models for predicting CEM disorders in CAP based on logistic regression equations were proposed. The first mathematical model consisted of social and health characteristics and of pneumonia clinical course characteristics. In ROC analysis the area under the curve (AUC) was 0.82, diagnostic specificity – 71%, diagnostic sensitivity – 90%. The second model included only hematological parameters, AUC – 0.78, diagnostic specificity – 69%, diagnostic sensitivity – 81%. Thus, changes in CEM in children with CAP aged 14 – 18 years have been established. Two methods for predicting disorders of CEM in children with CAP have been developed, which can be applied to optimize the treatment of children with CAP aged 14-18 years.

156-162

Authors: Borysova T.P., Obolonska O.Yu.

Premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) have a high risk of developing acute kidney injury (AKI) due to renal hypoperfusion and use of ibuprofen for duct closure. The aim of the study was to evaluate the effect of ibuprofen for the closure of HSPDA on the development of AKI in preterm infants depending on high dose of the drug on the first day of life. 40 preterm infants with HSPDA who were admitted for observation on the first day of life were examined. To close the ductus arteriosus, infants received restrictive therapy. In addition, 32 (80,0%) preterm infants on the first day of life were prescribed ibuprofen: 19 infants – in high dose (20 mg/kg), 13 infants – in standard dose (10 mg/kg). Clinical examination and treatment of preterm infants was carried out according to the generally accepted methods. Echocardiography with Doppler was performed at 5-11 hours of life and then daily to determine the size and hemodynamic significance of patent ductus arteriosus. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. According to the results of the study, it was established that the frequency of AKI on the third and fifth days of life in preterm infants with HSPDA, who received ibuprofen in a high dose (20 mg/kg) on the first day, was 73.7% and 84.2%, respectively, which is 2.2 (OR=5.6; CI: 1,43-21,95; р<0.02) and 2.5 (OR=10.67; CI: 2.31-49.31; р<0.002) times, more often than in infants without such therapy. High dose of ibuprofen on the first day of life in preterm infants with HSPDA are most often associated with the development of stage I AKI on the third or fifth day of life, which was temporary in one third of patients. The use of a high-dose ibuprofen for HSPDA closure on the first day of life in preterm infants was significantly more often associated with foci of infection in the mother, large duct size and furosemide use.

169-175

Authors: Stashkevych A.T., Shevchuk A.V., Uleshchenko D.V., Martynenko V.G., Melenko V.I.

Currently, insufficient attention is being paid to an issue of the necessary anti-osteoporotic therapy after percutaneous vertebroplasty for vertebral fractures associated with osteoporosis, which leads to premature termination of medical treatment and worsening of the treatment results in this group of patients. An objective of the research is to study the results of treatment of patients with vertebral fractures associated with osteoporosis, depending on the use of anti-osteoporotic therapy. The results of percutaneous vertebroplasty of 91 postmenopausal women aged 50-90 years, depending on the use of anti-osteoporotic therapy during the postoperative period were analysed. An assessment was made according to the dynamics of pain syndrome using the Visual Analogue Scale (VAS), the Quality of Life Scale by J.R. Gaughen to estimate the patient's mobility and a need for pain medication. The results of the treatment were assessed 3 and 6 months after the percutaneous vertebroplasty. Bone mineral density was measured using Dual-energy X-ray absorptiometry 6 month after the treatment. Anti-osteoporotic therapy, which was prescribed for all patients comprised calcium supplements, antiresorbents and in D-hypovitaminosis – alfacalcidol or cholecalciferol. Only half of the patients followed the recommendations – 46 (50.6%), while the rest of the patients stopped the therapy in 2-3 months due to the improvement of their condition. In the main group of patients, where necessary anti-osteoporotic therapy was administered, significant reduction of pain syndrome and increase in quality of life during 3 and 6 months’ observation period were revealed. In the group of patients where prescribed anti-osteoporotic therapy was not adhered, significant reduction of pain syndrome and increase in quality of life in the observation period 3 months was revealed but deterioration in the form of pain syndrome increase and decrease in quality of life in the observation period of 6 months occurred. Effectiveness of anti-osteoporosis therapy, with regard to measuring bone mineral density can be reliably confirmed only in the main group. Intraoperative and postoperative complications occurred up to 5.5%, and generally did not require further treatment and did not affect the overall treatment result. Thus, it was revealed that to ensure a stable effect after the surgery, long-term prescription of anti-osteoporosis therapy is needed.

184-190

Authors: Nikolaychuk M.A., Shostakovych-Koretskaya L.R., Budayeva I.V., Biletska S.V.

According to WHO, about 150-200 million people are currently infected with the HCV virus worldwide. Recently, in the professional literature, the number of publications on the role of vitamin D in patients with viral hepatitis C has increased as vitamin D metabolism occurs with the participation of the liver and its deficiency is associated with an increased risk of infectious diseases. The aim of this study was to investigate the effect of seasonal factor on vitamin D (25 hydroxycalciferol) levels in patients with chronic viral hepatitis C and healthy subjects. The study involved 100 patients in the registry of patients with chronic viral hepatitis in the Dnipropetrovsk region. The prevalence and deficiency of vitamin D in patients with chronic viral hepatitis C and conditionally healthy subjects at different times of the year were determined, which showed the presence or absence of a seasonal effect on serum 25(OH)D level. Patients were divided into two groups, depending on the time of the year (autumn-winter and spring-summer), in which the level of 25 (OH) D was determined. The serum was metabolised by vitamin D, which is synthesized by the liver – 25 hydroxycalciferol (25 (OH) D), an indicator of the supply of vitamin D to the human body. Vitamin D levels were evaluated according to the M.F. Holick classification. According to the level of vitamin D patients were divided into 3 groups (patients with normal level, insufficient (suboptimal) level and vitamin D deficiency). The results of the study showed no effect of seasonal factor on the level of 25 (OH) D in the serum of patients with chronic viral hepatitis C. Vitamin D levels are controlled by the time of the year: in spring and summer this indicator is normal, in autumn and winter – seasonal decrease in vitamin D.

196-200

Authors: Shapoval S.D., Vasylevska L.A.

The ideal marker of bacterial infection should not only allow for early diagnosis, but also provide information about the course and prognosis of the disease. Nowadays the most well-studied and widely used in clinical practice is procalcitonin (PCT), but its value in surgical forms of erysipelas is insufficiently defined. The aim of the article is to determine the diagnostic and prognostic significance of procalcitonin in patients with surgical forms of erysipelas.114 case histories of patients who were hospitalized in the center of purulent-septic surgery of the Non-profit municipal enterprise "City Hospital №3" in Zaporozhye for 2019-2020 period were analyzed retrospectively and prospectively. It was found that most often the focus was localized on the lower extremities. In the complex treatment of patients with erysipelas, the main place belongs to antibiotic therapy (ABT) and early surgical treatment of the area of the pathological process. Determination of the level of procalcitonin in the serum makes it possible to assess the progression and generalization of the process and is a sensitive test for the effectiveness of treatment.Radical surgery and timely targeted ABT are key elements of success in the treatment of surgical forms of erysipelas and are not subject to revision. Procalcitonin is a diagnostic marker that can predict the development of sepsis.

209-217

Authors: Idashkina N.H., Hudarian O.O., Chernov D.V., Samoilenko I.A.

The purpose of the work is improvement of the effectiveness of the mandibular fractures treatment in patients with partial or complete adentia by developing and experimentally testing transalveolar osteosynthesis technique. An experimental study was carried out by 3D computer simulation modeling by the final element analysis to assess the efficiency of mandibular fractures fixation at partial or complete adentia using the Ш-shaped plate, which we developed for the transalveolar osteosynthesis method. Calculations of the immobilized fractures for static (own weight) and dynamic (functional) loads were performed according to the author's method, taking into account pronounced resorptive processes in the bone from the beginning of the reparative reaction to assess the rigidity of fragments fixation during the entire period of the fractures healing. Under the conditions of the same three-dimensional model of the mandible, calculations were performed when the fracture was fixed with ordinary linear titanium osseous plates. It is proved that at functional load the new plate provides a compression effect in the fractures region, as evidenced by the negative displacements in the final elements of the mental region according to the results of design load combination 2- 3. The maximum efforts in the screws of the calculation model with a conventional bone plate were 136.955 N, which is almost ten times more than on the model with a Ш-shaped titanium retainer (12.656 N).

226-231

Authors: Serdiuk A.M., Chernychenko I.O., Lytvychenko O.M., Babii V.F.,Kondratenko O.Ye., Hlavachek D.O.

The objective – to study the dynamic changes for the health risk of the population of the industrial center in accordance with the state of atmospheric air pollution with carcinogenic compounds. The assessment of the state of atmospheric air pollution was carried out by us based on the results of physicochemical analysis of samples taken in places attached to the locations of stationary posts of state monitoring. The concentration of identified substances was determined by conventional methods: spectral-luminescent and gas chromatographic. Heavy metal concentrations were determined using data from the Central Geophysical Observatory of the Ministry of Emergency Situations. The calculation of the inhalation load of chemical carcinogens and the risks associated with them (non-carcinogenic and carcinogenic) was carried out in accordance with domestic guidelines. The assessment of dynamic changes in the nature of atmospheric air pollution with a complex of carcinogenic substances was made 5 of them are constantly recorded at levels exceeding hygienic standards. When compared with the reference concentrations, all compounds are characterized by high coefficients, indicating the likelihood of their effect on the body's immune system, respiratory organs, malformations, etc. A high individual carcinogenic risk of the effect of chromium VI and nitrosamines was determined. A total carcinogenic risk is formed at levels of 2.5 – 3.9×10-3, which should be considered as high; this requires development and implementation of preventive measures. On the territory of the industrial center, a high level of air pollution with increased carcinogenic and non-carcinogenic risk is stably registered.

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.

4-8

Authors: Pelo I.M., Reva T.D., Nizenkovska I.V., Kozak N.D., Konovalova L.V.

The article identifies and characterizes the leading trends in the development of the pharmaceutical industry in Ukraine, namely: observance of ethical principles of work of the expert of pharmaceutical industry; a focus on European standards for the quality of pharmaceutical services; development of a national system for the production of medicines. Emphasis is placed on the fact that the teachers of the University have a goal to convey to students ideas that are important for forming the humanistic foundations of a pharmacist’s work. The initial instruction, according to the authors, is to provide each participant of the educational process with the conditions for self-realization in learning and future professional activity. At the same time, in the formation of the content of pharmaceutical education a deep understanding of the value of a person’s health is the highest personal and social value. It is noted that an integral characteristic of the modern development of pharmacy in Ukraine is its dependence on imported medicines. During the educational process at the Faculty of Pharmacy of O.O. Bogomolets National Medical University, students and teachers believe that in Ukraine there are a number of prerequisites for overcoming the dependence of the domestic pharmaceutical market on imported medicines, namely: Ukraine has joined the International System of Cooperation of Pharmaceutical Inspections; the country has created a system of registration of medicines and adopted an international format of registration dossier; the State Pharmacopoeia of Ukraine was developed and put into operation; mandatory requirements for compliance with the rules of Good Manufacturing Practice and Good Distribution Practice were introduced; to the licensing conditions for the production and sale of medicines in Ukraine European recommendations regulating the development and research of medicines have been adapted and updated.

17-21

Authors: Kolomiets L.V., Orobey V.F., Lymarenko O.M., Ovcharov Y.V., Tsilvik O.V.

The paper presents modeling of denture specimens with different surface reliefs under the action of static loading using modern numerical methods - finite and boundary elements. Based on the analysis of literature, it is shown that the most effective approaches for calculating the stress-strain state (SSS) of dentures is the finite element method (FEM), which allows you to create 3D models with any complexity of geometry and surface, as well as the boundary element method (BEM), which allows in some cases to obtain more accurate calculation results than finite element method. The algorithm and procedure for exact integration of differential equations of hollow shells according to the algorithm of Kantorovich-Vlasov variational method are presented for the formation of the calculated finite element method ratios. The analytical expressions for the parameters of the hollow shells used for calculations of the state of dentures are given. Finite element method is represented in the work by the universal package SolidWorks. Different stages of solid-state modeling of prototypes of dentures with different surface reliefs are shown in detail. Dental stress-strain state calculations were performed by two methods. The results of the calculations are in good agreement with each other, which proves the reliability of both models developed and the results of the stress-strain state received. It is shown that the smallest values of stresses occur in dentures with a rhombic lattice; they are 5.9% less than prosthesis with a smooth surface, and 18.78% less than in prosthesis with a square lattice. Equivalent displacement of a rhombic lath prosthesis is less by 3.864% than that of a smooth surface prosthesis and 8 52% less than a square lattice prosthesis.

30-39

Authors: Lievykh А.E., Bondarenko N.S., Dronov S.N., Mamchur V.I., Tverdokhlib I.V., Zhyliuk V.I.

Chronic hyperglycemia, insulin resistance, endothelial dysfunction, and disturbance of the integrity of the blood-brain barrier are considered as strategically important links in the development of cognitive deficits in diabetic encephalopathy. Taking this into account, one of the modern trends in the optimization of the treatment of cognitive impairments induced by prolonged hyperglycemia is the co-administration of agents with antihyperglycemic and nootropic activity, in particular, metformin with piracetam. It has been shown that under conditions of experimental alloxan-induced hyperglycemia, piracetam has insufficient nootropic potential for eliminating cognitive deficits. Metformin has a weak nootropic effect in short-term use in low doses, without exhibiting these properties in prolonged administration. When combined with piracetam, metformin potentiates its antiamnesic properties, which helps to restore cognitive functions impaired by hyperglycemia. It is assumed that the mechanisms of such synergism are mediated by a decrease in the content of early and late markers of the destruction of protein molecules, the level of stable nitric oxide metabolites in the cerebral cortex, as well as a significant limitation of the manifestations of ultrastructural destructive changes in hippocampal neurons with a simultaneous improvement in the state of its microvasculature. The obtained results indicate the expediency of the combined use of metformin with nootropic agents for the prevention or treatment of cognitive impairments that occur as a result of diabetes mellitus.

50-61

Authors: Pertseva T.A., Bielosludtseva K.O., Kirieieva T.V., Konopkina L.I., Krykhtina M.A., Basina B.A., Matykina N.N., Turchin N.A.

The diagnosis of community-acquired pneumonia (CAP) on the background of COVID-19 is especially actual due to the prevalence of this pathology and the possible aggravation of the pathological process. The aim of our study was to improve the principles of CAP diagnostics on the background of COVID-19 and to determine risk factors for aggravating of the pathological process. Patients with respiratory symptoms who were hospitalized with suspected COVID-19 were examined. General clinical research methods were carried out, determination of SARS-CoV-2 virus RNA by PCR method, computer tomography (CT) to identify the features of lung tissue damage was performed. The main observation group consisted of 37 patients (men – 19 (51.4%), average age – 61 (57; 69) years) with pneumonia on the background of confirmed COVID-19. According to the severity of coronavirus disease, all patients of the main group were divided into 3 subgroups: subgroup 1 included 17 people with moderate COVID-19, subgroup 2 – 13 people with severe COVID-19, subgroup 3 – 7 people with critical COVID- 19 course. The levels of markers of systemic inflammation (C-reactive protein (C-RP) and fibrinogen) were also determined. Since patients with COVID-19 of moderate severity (which is characterized by the presence of community-acquired viral pneumonia) belong to the risk group of severe and critical course, it is suggested to consider the following risk factors for aggravating the pathological process as: temperature over 38.5°C, heart rate over 90 per minute, respiratory rate over 20 per minute, SpO2 ≤ 93%; absolute lymphopenia (less than 0.9 G/L) and an increase in serum levels of C-RP more than 50 mg/L and fibrinogen more than 5 g/L.

71-76

Authors: Bosdriesz J.R., Semenov V.V., Kuryata O.V.

Chronic kidney disease puts an individual at a higher risk of all-cause and cardiovascular death. Coronary artery calcium score reflects the accumulation of calcium in the walls of the coronary arteries and a higher coronary artery calcium score is associated with lower survival rates. It is unclear if control of conventional risk factors is enough to reduce cardiovascular risk in patients with chronic kidney disease. The aim of this study was to investigate if the association between estimated glomerular filtration rate and coronary artery calcium score in the Ukrainian population differs by sex, age, blood pressure, and total cholesterol. This cross-sectional study was conducted on a sample of patients who underwent measurement of coronary artery calcium score at Dnipropetrovsk Mechnikov Regional Hospital, Dnipro, Ukraine. Inclusion criteria: age >40 years old, available data about coronary artery calcium score and estimated glomerular filtration rate. Exclusion criteria: the presence of known cardiovascular disease, diagnosis of diabetes mellitus, estimated glomerular filtration rate <30 ml/min and extreme coronary artery calcification (coronary artery calcium score >1500 Agatston units). 137 patients (54 males and 83 females), median age 59.0 [54.0;67.0] years were enrolled in the study. In the patients with lower eGFR there was non-significantly higher coronary artery calcium score (p=0.07). In males with eGFR ≥90 ml/min, 60-89 ml/min, and 30-59 ml/min coronary artery calcium score didn’t differ significantly, while in females a lower estimated glomerular filtration rate was associated with a higher coronary artery calcium score. A lower estimated glomerular filtration rate was significantly associated with a higher coronary artery calcium score in the patients with systolic blood pressure ≥140 mmHg (p=0.04), but not in patients with diastolic blood pressure ≥90 mmHg. In the patients with total cholesterol <5.0 mmol/l and ≥5.0 mmol/l coronary artery calcium score tended to be higher in the patients with lower estimated glomerular filtration rate. A lower estimated glomerular filtration rate in our study was associated with a higher coronary artery calcium score in females, patients aged ≥55 years old and in patients with systolic blood pressure ≥140 mmHg.

87-95

Authors: Zabolotny D.I., Sambur M.B., Savchenko T.D., Krіvokhatskaуа L.D., Zayets T.A., Tymchenko M.D.

The aim of the study is to determine di­sorders of immune homeostasis in patients with laryngeal papillomatosis at different periods after complex treatment with the inclusion of the “Gardasil” quadrivalent vaccine in the adjuvant therapy. Studies of the immunity state were conducted in 26 patients with laryngeal papillomatosis (LP) before, 2-12 and 13-29 months after complex treatment, consisting of surgical removal of papillomas and anti-relapse therapy, including inhalation of Laferobion, taking a vitamin-mineral complex and a course of vaccination with antiviral “Gardasil” quadrivalent vaccine according to which the second and third injections were administered in 2 and 6 months after the first. Significant disorders of cellular and humoral immunity indices in patients with LP were revealed in the form of multidirectional changes in the functional activity of natural killer cells, a decrease in the total number of T lymphocytes, mainly due to CD4 + subpopulation, increase in circulating immune complexes level in blood serum and concentration of secretory IgA in the secretion of the oropharynx. Disbalance in the patient’s cytokine system resulted in increased γ-IFN and TNF-α serum levels, an increase in spontaneous production of interferon and inhibition of stimulated production of λ - and γ-interferon by blood cells in vitro. Complex treatment with the use of the “Gardasil” quadrivalent antiviral vaccine in the postoperative period contributed to the normalization of most immunological reactivity indices that were altered in patients. The results indicate the prospects of using the antiviral vaccine as part of adjuvant antirelapse therapy after surgical treatment of LP patients and indicate the advisability of long-term clinical and immunological monitoring at different periods after vaccination.

104-110

Authors: Gashynova K.Yu., Suska K.S., Dmytrychenko V.V.

Chronic respiratory tract infection and relapsing exacerbations worsen the quality and reduce the life expectancy of patients with bronchiectasis. This work aimed to identify the spectrum of pathogens and to determine their profile of antibiotic resistance in the sputum of patients with bronchiectasis in the Dnipro region. Sputum of 60 patients in a stable phase with confirmed bronchiectasis was a subject to microbiological examination and determination of antibiotic sensitivity according to generally accepted CLSI recommendations. According to the results of the study, it was found that 70% of patients have sputum colonization by pathogens in the stable phase of the disease, and the most common pathogens are Pseudomonas aeruginosa and Haemophilus influenzae, which is in line with the global trend. Haemophilus influenzae was sensitive to ampicillin, amoxicillin, amoxicillin/clavulanate, piperacillin/tazobactam, cefuroxime, ceftriaxone, cefotaxime, cefepime, cipro­floxacin, levofloxacin and moxifloxacin in a hundred percent of cases. However, more than half of the strains of Pseudomonas aeruginosa were resistant to one or more drugs with anti-Pseudomonas activity. In particular, the highest level of resistance was identified to such drugs as imipenem, aztreonam, ceftazidime. The problem of antibiotic resistance is alarming and once again indicates the need for the regular microbiological examination of the sputum of patients with bronchiectasis even in a stable phase for subsequent rational administration of antibacterial therapy.

117-124

Authors: Revenko H.O., Mavrutenkov V.V., Chykarenko Z.O.

Antiretroviral therapy has made HIV infection a chronic controlled disease, where aspects of the immunoprophylaxis of infectious diseases have acquired important clinical significance. The goal of the study was to determine the clinical and laboratory predictors of antitoxic immunity against diphtheria and tetanus in HIV-infected adults. The study included 90 HIV-infected patients aged 22 to 60 years (main group). The control group consisted of 49 immunocompetent volunteers of the corresponding age. The levels of anti-diphtheria and anti-tetanus antibodies were determined by ELISA using the diagnostic test systems RIDASCREEN Diphtheria IgG and RIDASCREEN Tetanus IgG (R-Biopharm AG, Germany). Statistical processing was performed using the licensed software product STATISTICA v.6.1. Significant differences were found between the titers of antitoxic antibodies in HIV-infected and immunocompetent adults. According to the correlation analysis, the decrease in the titers of antidiphtheria antibodies was revealed with an increase in the age of the HIV-infected patient (rs=-0.21; p=0.05). The fact of smoking (rs=-0.31; p=0.003), lowered body weight (BMI<18.5 kg/m2) (rs=-0.29; p=0.006), the presence of arterial hypertension (rs=-0.38; p<0.001), a history of bone fractures over the past 5 years (rs=-0.38; p<0.001), anemia (rs=-0.21; p=0.049), thrombocytopenia (rs=-0.44; p<0.001), accelerated ESR (rs=-0.61; p<0.001), the presence of hairy leukoplakia of the tongue (rs=-0.23; p=0.027), frequent infections caused by herpes simplex (rs=-0.52; p=0.003) and varicella zoster virus (rs=-0.34; p=0.013) are associated with low levels of antidiphtheria antibodies. A direct relationship was found between the intensity of anti-diphtheria immunity and patients receiving OST (rs=+0.54; p=0.003) and with a history of injuries with impaired skin integrity (rs=+0.31; p=0.003). Decreased anti-tetanus immunity in HIV-infected patients was also associated with smoking (rs=-0.48; p<0.001), decreased BMI (rs=-0.71; p<0.001), anemia (rs=-0.33; p=0.002), thrombocytopenia (rs=-0.75; p<0.001), a history of bone fractures over the past 5 years (rs=-0.67; p<0.001); the total number of HIV-associated opportunistic diseases (rs=-0.42; p<0.001), including the presence of oropharyngeal candidiasis (rs=-0.23; p=0.032) and hairy leukoplakia of the tongue (rs=-0.57; p<0.001), history of Herpes Zoster in the past (rs=-0.48; p<0.001), with frequent relapses of diseases caused by herpes simplex viruses (rs=-0.78; p<0.001) and repeated episodes of herpes zoster (rs=-0.74; p<0.001), as well as with pathology of the skin (rs=-0.55; p<0.001). Protective predictors of anti-tetanus antitoxic immunity strength were established: male gender (rs=+0.22; p=0.039), parenterally acquired HIV infection (rs=+0.21; p=0.05), HIV-infected patients receiving OST (rs=+0.40; p=0.041). A direct relationship was found with the decreased level of hemoglobin (rs=+0.41; p<0.001), the increase of relative number of lymphocytes in the blood (rs=+0.21; p=0.05), as well as with living in rural areas (rs=+0.40; p<0.001) and the presence of injuries with impairment of skin integrity (rs=+0.84; p<0.001). Clinical and laboratory predictors of strength of antitoxic immunity against diphtheria and tetanus in HIV-infected adults were identified, which allows us to create an individual “vaccination roadmap” for patients in this category.

132-139

Authors: Shevchuk I.M., Snizhko S.S.

The goal of the work is to improve the results of treatment of patients with esophageal perforations complicated by purulent mediastinitis. Examination and treatment of 30 patients with esophageal perforation (EP) complicated by purulent mediastinitis were performed. The causes of EP were foreign body damages in 12 (40%) of 30 patients, spontaneous rupture of the esophagus – in 11 (36.6%), iatrogenic damage to the esophagus – in 7 (23.4%) patients. The main method of surgical treatment of esophageal perforations complicated by acute purulent mediastinitis is thoracotomy with suturing of the perforated wall of the esophagus and sanation of mediastinal tissue. In case of purulent melting of the esophageal wall and total mediastinitis with severe endogenous intoxication, surgical interventions should be aimed at minimizing surgical trauma and elimination of the purulent process in the mediastinum using video-assisted thoracoscopy. The use of developed surgical tactics for the treatment of esophageal perforations complicated by acute purulent mediastinitis with intramediastinal administration of antibacterial drugs and the method of irrigation of the esophageal sutures contributes to a significant rapid reduction in endogenous intoxication, namely leukocytosis units up to 2.103±0.182 d. units (p<0,001) with normalization of the indicator on the 5th day from the beginning of treatment, the severity of the condition on the APACHE II scale in the modification of Radzikhovsky AP from 14.91±1.80 points at the time of hospitalization to 9.4±0.3 points on the second day after surgery (p<0.001), the severity of patients’ condition on the SOFA scale on the 3rd day to 3.221±0.445 points, on the 5th day – 1.832±0.219 points (p<0.001), the level of C-reactive protein on the 2nd day after surgery decreased from 236.2±21.4 mg/l to 144.3±9.3 mg/l, and on the 3rd day was 112.1±7.2 mg/l (in both cases p<0.001), reducing the content of procaltcytonin from 8.7±0.9 ng/ml to 3.828±0.251 ng/ml on the 2nd day after surgery. The use of this surgical tactic allows you to quickly eliminate the purulent process in the mediastinum, reduce the healing time of the perforation of the esophagus and reduce mortality from 28.5 to 6.2%.

144-152

Authors: Gudaryan O.O., Mashchenko I.S., Kucherenko T.O.

The modern treatment strategy for various forms of generalized periodontitis includes the use of a wide arsenal of drugs, which in turn leads to an excessive drug load on the body, this actualizes the search and use of drugs that have a systemic effect. The aim of the study is to develop and study the effectiveness of the use of systemic enzyme therapy in the treatment of aggressive (rapidly progressing) generalized periodontitis. The work is based on the results of comprehensive clinical and laboratory studies of 61 patients with an aggressive form of generalized periodontitis, without concomitant pathologies (30 main groups and 31 comparison groups). A control group consisted of 20 healthy donor volunteers. We used standard clinical, paraclinical, laboratory diagnostic methods, supplemented by dental volumetric tomography. In patients of both observation groups, standard protocol therapy was used, in the comparison group supplemented pathogenic therapy, and in the main group – multienzyme drug (Wobenzym) and rhBMP-2 injections. A comparative analysis of clinical, paraclinical, and laboratory studies has shown that the use of systemic enzyme therapy supplemented with recombinant morphogenetic protein (rhBMP-2) in patients with aggressive (rapidly progressing) generalized periodontitis is comparable to that of standard polymedicine therapy supplemented with pathogenic therapy, and leads to a faster control (average 13.7±0.7 days) of an active inflammatory and destructive process, normalization of indices of local humoral immunity, cytokine profile, free radical oxidation and antioxidant defense system, achievement of clinical and radiological remission in more than 90% of patients.

161-168

Authors: Savushina I.V., Pavlenko O.I., Zos'ka Y.V.

The number of people in need of phoniatric help is constantly increasing. People with voice problems are of working age. The object of researche: lowering risk of progression of vocal pathology based on a comprehensive system of management of teachers’ occupational risks. Hygienic, epidemiological, sanitary-statistical, in-depth medical examination method and mathematical-statistical methods were applied. Working conditions of teachers are characterized by complex effects of harmful production factors, which can reach 3d degree of 3d class of harmful work by intensity (according to the calculated points 3,63), 2nd degree of 3d class of harmful pressure on vocal apparatus (27,52±3,54 hours), 1st degree of 3d class of harmful by equivalent noise level and unfavorable microclimate. The most widespread pathologies of the vocal apparatus are chronic hypertrophic laryngitis (190,20±22,61) and chronic catarrhal laryngitis (131,00±15,07 cases). Almost 70% of occupational laryngitis cases are in the age group of 46-60 years. The critical length of service influenced by voice load is 10-19 years. The length of service more than 20 years in conditions of voice load increases the etiological percent of occupational pathology causes to 81,8%. Therefore, an age of 45,8±0,5 and older is dangerous for the occupational laryngitis progression and requires a special approach of development and imple­mentation of preventive measures aimed at maintaining of occupational health. Suggested complex of measures increase the healthy life by 7,3 years and reduce the loss of healthy life years determined by the impact of voice activity by 7,1 years. At the same time for physical health component (PH) by 4,5 and 4,3, and the psychological health component (MH) by 10,3 and 10,1 years QALY respectively.

176-183

Authors: Kuznetsova О.M., Ostanina N.V.

This article shows a study of different aspects of dietary supplement (DS) consumption by the population of Ukraine, the probability of using poor-quality DS is determined. As a part of this project, a questionnaire-based survey on the issue of DS consumption was conducted among residents of the following Ukrainian cities: Kyiv, Poltava, Kharkiv and Vyshneve (Kyiv region). The following data were analyzed: statistical data of the Ukrainian population, presence of pharmaceutical facilities in regions of Ukraine, DS sales volumes and laboratory data concerning correspondence of DS with the claimed content of active ingredients. Statistical analysis was carried out with use of the standard software Microsoft Excel 2007 and STATISTICA 8.0 portable The survey allowed to evaluate health level of respondents who take DS, obtain information concerning purposes or recommendations for DS taking, detect channels of purchase of such products, identify the risks of taking poor-quality DS. According to the survey results, about 72% of respondents are taking DS. The survey results indicate that 39% of respondents that take DS consider themselves healthy, almost half of respondents have insignificant health problems and about 12% of respondents have serious health problems. 79% of respondents purchase DS in pharmacies, which allows to conclude that about 59.7 million packaging of DS were consumed in Ukraine in 2019. It was confirmed that the presence of pharmaceutical facilities is even in all regions of Ukraine and, therefore, residents have access to necessary DS through pharmacies. Taking into account the results of laboratory tests of DS quality, the risks of poor-quality DS consumption in Ukraine in 2019 may be estimated as 9.5%. The research results of test purchases demonstrate that the aforementioned risks may increase significantly.

192-197

Authors: Bilynska М.М., Suray I.G., Vasiuk N.O., Savina T.V.

Purpose of the article is to determine the training needs of healthcare managers in Ukraine in the specialty "Public administration and management". As the main method, we used a written survey (questionnaire survey) of experts in the field of healthcare, using modern computer technologies. Participation of experts in this study is entirely voluntary. Confidentiality of information is guaranteed by anonymity of the questionnaire. Expert poll of healthcare leaders was conducted in March-April 2020 in order to determine training needs of the specialty "Public administration and management." A total of 54 respondents took part in the expert poll. Majority (96.3%) of respondents need to undergo training in the specialty "Public administration and management" (specialization "Management in the field of healthcare"). The overwhelming majority of them would like to undergo training on the topics: "personnel management in healthcare organizations (leadership, communication management, time management, stress management, self-management, psychological foundations of management in healthcare, etc.)" (64.8%) and "healthcare management "(59.3%). Summarizing results of the study, it has been proved that in order to improve the professional competencies of leaders in the health sector, it is desirable to introduce the training program "Leadership and Management in Health Care", which is aimed at solving problematic issues of management in the field of health protection; application of strategic management in the field of health care, quality management of medical care; obtaining communication skills and building an effective team; effective application of the knowledge gained in the environment is changing rapidly, etc. We believe that improving the mechanisms of training, retraining and raising their qualifications should be an important issue in the development of human resources in health care, especially managers. In particular, this applies to innovative forms of education, including trainings, online training, etc.

204-210

Authors: Kotelevska T.M., Pryimenko N.O., Dubynska H.M., Koval T.I., Iziumska O.M., Zviagolska I.M.

West Nile Fever (WNF) is the most common arbovirus infection with a transmission mechanism caused by West Nile Virus (WNV), present on all continents, except for Antarctica. WNV has a high epidemic potential and is dangerous for health of the population all over the world, due to rapid global spread, the formation of new natural foci and the ability to cause epidemics in endemic areas. Over the past 20 years, there have been numerous epidemic outbreaks of the disease among people, birds and horses, associated with WNV. On the territory of Ukraine WNV was first detected in the 70s of the XX century, but at present clinical and epidemiological aspects have been understudied. This study analyzed the epidemic situation regarding WNF in Poltava Region in 2011-2018, and clarified the epidemiological and clinical manifestations of serologically confirmed cases of acute WNF. This is the first actual survey of WNF cases in Poltava Region, its results indicate the prevalence of WNV in the central part of Ukraine. The aim of the study was to study the epidemiological and clinical characteristics of West Nile Fever in Poltava Region. The cases of WNF in Poltava Region in 2011-2018 have been analyzed, according to the annual reporting forms of the Ministry of Health of Ukraine. A serological study of pair blood sera for specific IgG-class antibodies to WNV of 232 patients with febrile conditions, requiring screening for WNF, was conducted. The clinical course was studied in a retrospective analysis of 14 case histories of patients with WNF under treatment in the Poltava Regional Clinical Infectious Diseases Hospital. The analysis demonstrated that in Poltava Region in 2011-2018 35 serologically confirmed cases of acute WNF were registered, with the largest number (14) in 2012. Serologic examination of the specific markers of WNV in 232 patients with febrile conditions allowed to detect 57 (24.6%) seropositive patients. Acute WNF was diagnosed in 35 (15,1%) patients, past WNF – in 22 (9,5%) persons. Analysis of case histories of patients with acute WNF showed that the most susceptible ones were females (64.1%), and the average age of the persons was 46.28±0.30 years old. According to the epidemiological history, the city residents dominated among the patients (71.4%), all of them (100%) marked mosquito bites, and the disease was of a seasonal nature, with the largest (78.6%) number of cases in July-August. The clinical course of WNF in all (100%) patients was moderate-severe and characterized by polymorphism of clinical manifestations. The leading clinical syndromes were: intoxication (100.0%), fever (100.0%), catarrhal (50.0%), allergic (42.8%), dyspeptic (35.7%) syndromes and lymphadenopathy (28.5 %). Thus, the conducted researches have shown that there are all conditions for formation of a natural center of WNF on the territory of Poltava Region. WNF was characterized by a typical course of the disease.