Medicni perspektivi, 2020;25(1)
2020 Vol. XXV N 1
Key words: professional socialization, professional competencies, international social projects, medical students
Abstract. Student initiative in international projects on preventive cardiology. Khomazyuk T.A., Krotova V.Yu., Kosova Н.A., Kirichko M.G. The article provides a practical example of the positive experience of the students of the medical academy in the international social project on combating arterial hypertension in order to improve the level of general competence and effective intellectual and professional socialization in getting higher medical education. The phenomenon of professional socialization should be considered along with the concepts of professional orientation, professional development, professional adaptation and professional becoming. Professional socialization is the ultimate link in the professional way of the individual. The algorithm of professional socialization of students in higher education consists of the following stages: professional orientation → professional development → professional adaptation → professional becoming → professional socialization. It should be noted that a personality who successfully socializes, has a well-defined social orientation, actively strives to self-determination and self-realization in society and is able of productive adaptation to the surrounding society on the basis of knowledge about social reality. In this case, the success of socialization is connected not only with the presence of specified qualities in the person, but, first of all, with the real actions in which these qualities are realized. By mastering the roles system, students acquire socially significant qualities, develop their worldview, their goals, motives, interests, feelings, personal and socially important needs, develop different types of competencies, including social competence, which will allow them to become what they want to become. Professional development of young talented individuals is possible only in open communication and interaction systems, it is in the international social projects of medical societies that constantly exchange energy and information with the environment, and at the same time, being a source of development and prospects for preserving the life of nation. Such a model of education supposes changing the role of teacher: the transition to joint actions with the student in new situations in an open, changing, modern world.
Key words: military dentistry, military personnel, Joint Forces Operation, NATO standards, dental diseases prevention
Abstract. Status and prospects of development of military dentistry in Ukraine. Lyshchyshyn M.Z., Kovalenko V.V. Providing a high level of dental care to military personnel during military activities is one of the major tasks of military dentistry. The work objective is to increase the effectiveness of the system for providing dental care to military personnel of the Armed Forces of Ukraine taking into account the experience of military operation of the Joint Forces in the East of Ukraine in the terms and conditions of transition to Euro-Atlantic standards. It is established that in Ukraine significant changes have been introduced in the system of dental care delivery for military personnel. Dental care is provided to military personnel against extremely high dental disease incidence rate among the military personnel of the units. In the area of the operation of the Joint Forces, a new model of providing dental care to military personnel has been created and successfully operates, which is represented by a network of hospital and removable (mobile) offices. Possibilities of implementation of Euro-Atlantic dental care standards in Ukraine have been studied and the ways of their implementation in military dental institutions have been identified. Several significant differences were detected in the system of domestic dental care organization in the action area: human resourcing, extent of care and complete service facilities. A comprehensive program for prevention of dental diseases and the classification of dental health condition of military personnel which must ensure qualitative staffing of Ukrainian troops in action area has been developed. The scope of assistance has been substantiated and local clinical practice guidelines of dental care for military personnel in action area have been developed taking into account military experience gained in the area of JFO as well as NATO standards. Obtained results give the possibility to make conclusion that the principal mainstream for improvement of military dentistry in Ukraine is bringing of all aspects of its operation into conformity with relevant NATO standards, taking into account own experience gained during military activities in the East of Ukraine.
Key words: combinatorial (precursor-directed) biosynthesis, Lactobacillus reuteri DSM 17938 derivatives, modified ascorbic acid, HPLC-analysis
Abstract. Potentiation of the antimicrobial effect of Lactobacillus reuteri DSM 17938 cell-free extracts by ascorbic acid. Knysh O.V., Martynov A.V. The purpose of this study was to evaluate the effect of supplementing the culture medium with ascorbic acid on the antimicrobial properties of Lactobacillus reuteri cell-free extracts (CFEs). CFEs were prepared using commercial strain L. reuteri DSM 17938 by culturing lactobacilli in its own disintegrated cell suspension (DCS) supplemented with ascorbic acid in sub-inhibitory (5 mg/ml, CFE5) or minimal inhibitory concentration (20 mg/ml, CFE20) and without supplementation (CFE0). Staphylococcus aureus AТСС 25923, Escherichia coli AТСС 25922 reference strains and Pseudomonas aeruginosa extensively drug resistant (XDR) clinical isolate were used as indicator cultures. Screening of the inhibitory properties of the studied CFEs and elucidation of the nature of inhibitory products were done using modified Micro scale Optical Density Assay (MODA). The inhibition indices (InhI) were calculated for the studied CFEs and ascorbic acid of appropriate concentrations. CFEs were subjected to HPLC-analysis. CFE5 and CFE20 showed significantly higher antimicrobial activity toward to indicator cultures than CFE0. InhI calculated for extracts CFE5 and CFE20 mainly exceeded the sum of the corresponding indicators calculated for CFE0 and ascorbic acid (АА) of appropriate concentrations: InhI CFE5 ≥ InhI CFE0 + InhI AA5; InhI CFE20 > InhI CFE0 + InhI AA20. Acidic metabolic products have made the greatest contribution to the antimicrobial effect of the studied CFEs. HPLC-nalysis showed that the modified ascorbic acid was the substance found in CFE20 in the greatest quantity. The revealed effect of potentiation of antimicrobial activity of CFEs by ascorbic acid should be taken into account when developing new biotechnological products based on derivatives of L. reuteri DSM 17938.
Key words: embryogenesis in rat, cadmium, germanium citrate, selenium citrate, liver
Abstract. Determining the effect of cadmium on embryogenesis in isolated administration and in combination with selenium and germanium citrates. Nefodov O.O., Bilyshko D.V., Kushnaryova K.A., Shevchenko O.S., Shatorna V.F., Kefeli-Ianovska O.I., Kozlovskaya O.G. Cadmium compounds found in biological systems form the ecological crisis of the planet. An urgent task for researchers is to determine the morphological changes that occur in the body under the action of cadmium compounds in both prenatal and postnatal ontogenesis. The article discusses the results of effect of intragastric administration of cadmium chloride/cadmium citrate in isolation and in combination with selenium and germanium citrates on embryogenesis of pregnant female rats. The aspect of the accumulation of cadmium salts in the liver of a 20-day-old embryo by polyelement analysis was also studied. The use of multielement analysis showed that the highest level of cadmium accumulation in the liver of embryos was found in the group of isolated administration of cadmium chloride. It has been proven that cadmium citrate accumulates in the liver to a lesser extent than cadmium chloride in the liver. The accumulation of cadmium chloride with selenium citrates, germanium in the groups of combined administration showed a decrease in the cadmium content in the liver of embryos. An analysis of the basic indicators of embryonic development of the experiment proved the embryotoxic effect of cadmium salts during enteral administration in modeling chronic cadmium intoxication, which is expressed in a decrease in the number of embryos in the litter and an increase in embryonic mortality in relation to the control group at all studied developmental periods. A decrease in embryonic mortality and an increase in the number of embryos at all stages of gestation in the experiment with the combined administration of cadmium salts with germanium citrate and selenium citrate indicates their antagonistic effect on cadmium embryotoxicity.
Key words: radiculopathy, discogenic radiculopathy, stenosis, quantitative sensory testing
Abstract. Concept of a complex therapy in restorative treatment of discogenic lumbosacral radiculopathies. Dzyak L.A., Shulga O.O. Currently, the treatment of lumbosacral radiculopathy (LSR) is an urgent problem due to the frequent chronic pain syndrome, the lack of a unified methodological approach to the recommendations, taking into account the pathological characteristics of the compressed root. The purpose of the work is the development of the concept of a comprehensive etiopathogenetic treatment of acute lumbosacral radiculopathy. 100 patients, divided into two groups were examined (the main – 45 people, the control – 55 people). Each group was divided into subgroups depending on the treatment received (basic and complex). Basic therapy included treatment according to European and American recommendations. Complex treatment consisted of a combination of basic therapy and vibrotraction postisometric muscle relaxation (PIMR) with biomechanical stimulation of the paravertebral muscles. Treatment control was based on the analysis of the neurological and neuroorthopaedic status, severity of a pain syndrome using a 5-point verbal scale, PainDETECT questionnaire, the muscle syndrome index, as well as quantative sensory testing. The stages of the study were chosen taking into account the pathological stages of the disease: 1-7 days and 30 days. When analyzing the results of ELISA to IgG for urogenital infections in 46.7% of patients of the main group and 47.3% of the control, urogenital chronic infections were detected, while in the main group mycoplasmic and ureaplasmic infections were more common, and in the control group patients mostly had chlamydial infection. When antibacterial drugs were included in the treatment, the most pronounced regression of the pain syndrome was determined. Thus, it was found that the use of vibrotractional postisometric relaxation with biomechanical stimulation of the paravertebral muscles in combination with the use of NSAIDs is aimed at quickly removing the muscular-tonic and compression symtoms during 10-14 days (p<0.05), and the further use of neurotropic therapy led not only to a persistent analgesic effect, but also contributed to the improvement of the biomechanical indicators of the spine (p<0.05), positively affecting the motor activity.
Key words: vacuum drainage, phlegmons of the maxillofacial area and neck, maxillofacial surgery
Abstract. Vacuum drainage of tissues in treatment of inflammatory diseases of the maxillo-facial area and neck. Malanchuk V.A., Sidoryako A.V., Sidoryako S.V. Objective of the study: to increase the efficiency of drainage of tissues with phlegmons of the maxillo-facial area and neck using vacuum drainage.The device was used in 55 people with phlegmons of the maxillo-facial area and neck, aged from 21 to 65 years in the maxillo-facial department of the City Clinical Hospital for Emergency and Medical Care, Zaporizhyzhya. The proposed device improves the efficiency of evacuation of exudate from the wound. The decrease in the number of complications, the occurrence of bedsores in the wound caused by tubular drainage is observed, it prevents the spread of the inflammatory process in the adjacent tissue spaces. The improvement of the clinical picture and stabilization of the general condition in 53 (96.4%) patients of the second group was noted on the 2.4±0.7 day after surgery, in 43 (95.6%) patients of the first group – on 3.7±0.6 day; the intensity of the pain syndrome decreased on average on 3.2±0.4 day. In 48 (87.3%) patients of the second group suppuration was absent already on 2.4±0.6 day, the formation of granulations – on 3.2±0.5 day, and complete cleansing and convergence of the wound edges – on 6.2±0.7 day. In 4 patients of the first and second groups, the healing time of the postoperative wound was longer: the cessation of suppuration was noticed on 6th-7th day, the appearance of granulations – on 7th-8th day, complete cleansing, and the marginal convergence of the wound – on 11.2±0.8th day р<0,001. Vacuum drainage accelerates the onset of the second phase of the inflammatory process, reduces the dynamics of the disease course and the patient's recovery at least twice.
Key words: cognitive function, hypertension, hypothyroidism, MMSE scale, ACE-R scale
Abstract. Cognitive functions in patients suffering from hypertension and hypothyroidism with retrospective evaluation of control over disease compensation. Lesiv M.I. The aim of the study was to study the status of cognitive functions in hypertensive patients, patients with hypothyroidism, and in patients with combination of these diseases, taking into account the state of disease compensation. 67 patients (36 men and 31 women), average age – 49.84±2.83 years were examined. The control group (CG) consisted of 18 practically healthy individuals (8 men and 10 women). Patients who received appropriate nosology treatment were divided into 3 groups: Group I – 21 patients with hypertension, systolic blood pressure (SBP) – 134.26±5.23 mm Hg, diastolic blood pressure (DBP) – 84.37±4.51 mm Hg; Group II – 18 patients with hypothyroidism, thyrotropic hormone (TSH) – 3.16±0.79 mIU/L, stage of hypothyroidism compensation was diagnosed in 83.3%, subcompensation – in 16.7%; Group III – 28 patients with hypertension (SBP 145.52±5.45 mm Hg; DBP 82.41±3.86 mm Hg) with concomitant hypothyroidism (TSH – 2.92±0.78 mIU/L, stage of compensation for hypothyroidism was diagnosed in 85.7%, subcompensation – in 14.3% of cases. Information about visits to the therapist/cardiologist/family doctor and endocrinologist was used to analyze the therapeutic correction of the disease: ambulatory medical records of patients with measurement of blood pressure (BP) and TSH during the disease were processed. To assess cognitive functions, Mini Mental State Examination (MMSE) and the Addenbrooke’s cognitive examination (ACE-R) were used. The relationship of average blood pressure data in patients with hypertension and TSH in patients with hypothyroidism during the disease period and the level of cognitive function was investigated. The average level of office BP (SBP/DBP) in Groups I and III compared to CG during the examination was: SBP 134.26±5.23 mm Hg (p=0.047), DBP 84.37±4.51 mm Hg (p=0.041) in Group I; SBP 145.52±5.45 mm Hg (p=0.031), DBP 82.41±3.86 mm Hg (p=0.050) in Group III. Analyzing the TSH levels it was found that at the time of the physical examination of patients in Group II the TSH was 3.16±0.79 mIU/L (p=0.009), the stage of compensation was diagnosed in 83.3%, subcompensation – in 16.7%; in Group III the TSH was 2.92±0.78 mIU/L (p=0.027), the stage of hypothyroidism compensation was diagnosed in 85.7%, subcompensation – in 14.3%. When evaluating MMSE scores, the proportion of patients in Groups I-III who had cognitive impairment (CI) was 6.9%, 10.3% and 13.8% respectively. On individual assessment of ACE-R test scores, CI in Groups I-III was in 6.4%, 9.6% and 13.8% respectively. A detailed analysis of the patterns of the ACE-R scale revealed that patients in Group I had a significantly lower score in the memory domain (22.68±0.96, p=0.037); patients in Group II had a low score in the concentration domain (15.85±1.14, p=0.045) and executive functions domain (11.62±8.63, p=0.041). Taking into account the interaction of factors (hypertension and hypothyroidism), it was found that in 40% of patients in Group III the most affected cognitive domains were memory (21.12±0.98, p=0.012) and speech (22.41±2.32, p=0.038); 60% of patients had problems with executive functions (11.90±9.17, p=0.033) as well as with visual-spatial skills (14.40±8.15, p=0.045). MMSE test showed a significantly lower score in the memory domain (1.87±0.46, p=0.008) in Group I, patients of Group II had a significantly lower score in the concentration domain (2.53±0.54, p=0.018). Basing on the interaction of factors (hypertension and hypothyroidism), it was found that in 45% of patients the most affected cognitive domain was memory (2.3±0.38, p=0.028), and 55% suffer from impaired speech, praxis (7.48±0.59, p=0.018) and perception (2.45±0.67, p=0.028). A retrospective analysis of medical records regarding the control of patients’ diseases was conducted. It was found that the average level of SBP/DBP in Groups I and III was 154.38±5.11 (p=0.000) \ 96.47±3.49 (p=0.006) mm Hg; 158.26±5.64 (p=0.001) \ 98.42±4.93 (p=0.005) mmHg, respectively. The TSH level over the disease period in patients of Groups II and III was 7.14±2.37 mIU/L (p=0.002) and 8.03±3.77 mIU/L (p=0.000), respectively, which was different from the data obtained in the last study. Retrospective analysis of medical records made it possible to establish a real long-term control of blood pressure, TSH in patients with hypertension, in patients with hypothyroidism and in patients with combination of these diseases, which caused CI in 6.9% of patients with hypertension, in 10.3% of patients with hypothyroidism and in 13.8% of patients with combined pathology based on MMSE test results. The ACE-R test results show the same sequence. Individual assessment of ACE-R test scores revealed CI in Groups I-III: 6.4%; 9.6% and 13.8%, respectively. The MMSE scale evaluates the selective deficits of one or more cognitive domains; the ACE-R scale is a wide-ranging study tool but it should be noted that the implementation of this scale requires time outlays.
Key words: community-acquired pneumonia, pharmacotherapy, clinical recommendations, doctors, students, pharmacoepidemiology
Abstract. The assessment of physicians' and senior medical students’ knowledge in the field of community-acquired pneumonia: preliminary results of the KNOCAP-II project (2017-2019). Bontsevich R.A., Gavrilova A.A., Vovk Y.R., Adonina A.V., Goncharova N.Y., Prozorova G.G., Kompaniets O.G., Barysheva V.O., Ketova G.G., Bochanova E.N., Mironenko E.V., Shagiyeva T.M., Kirichenko A.A., Krotkova I.F., Shabanov E.A., Tilekeyeva U.M., Luchinina E.V., Galkina I.P., Maksimov M.L., Nevzorova V.A. Community-acquired pneumonia (CAP) is one of the most relevant problems of modern medicine. Today, CAP takes 4th place in the structure of mortality (after cardiovascular, cerebrovascular diseases and malignant neoplasms) and 1st place among all deaths from infectious diseases. The aim of the study is to assess the level of general physician’ and senior medical students’ basic knowledge in CAP treatment. The article represents the results of anonymous prospective surveys within the framework of the second stage of KNOCAP multi-centered research project (full name of the project «The assessment of physician’ and students’ knowledge of community-acquired pneumonia basics») aimed at accessing the knowledge and preferences of doctors and students on the fundamental issues in diagnosis and treatment of community-acquired pneumonia. The survey conducted in 2017-2019 involved 588 physicians and 394 students from seventeen Russian, Kyrgyzstan and Ukrainian centers. The method of anonymous questioning was used in this study, for which an original questionnaire was developed on the basis of current clinical recommendations. The following fundamental questions caused the greatest difficulties in the respondents: terms for a repeated X-ray examination in positive dynamics of CAP treatment, the choice of main diagnostic criteria of CAP, the choice of the typical mistakes of CAP treatment, the choice of the initial antimicrobial therapy. In general, the respondents’ knowledge in CAP patients’ management deviates significantly from the current clinical guidelines, as of 2010, and from the new clinical guidelines draft, 2018-2019. Currently, there is a need to increase the level of knowledge and improve the professional activities of therapists and senior medical students, as a multicenter section of the knowledge and preferences of specialists in many issues revealed their insufficient level for the correct management of patients with CAP.
Key words: nonalcoholic steatohepatitis, obesity, fibrosis, histological diagnostics
Abstract. Diagnostics of progression of liver fibrosis in patients with non-alcoholic steatohepatitis combined with obesity and chronic calculous cholecystitis. Filippova A.Yu. The aim of the work is to investigate the diagnostic value of laboratory blood biomarkers – alanine aminotransferase, aspartate aminotransferase, oxyproline and prothrombin time in comparison with morphological indicators for diagnosis of the degree of liver fibrosis in patients with comorbid course of non-alcoholic steatohepatitis (NASH) combined with obesity and chronic calculous cholecystitis. The data of 22 patients with NASH combined with obesity and chronic calculous cholecystitis was analyzed by laboratory and morphological indicators. There were 6 (27.2%) men and 16 (72.8%) women among the patients. Liver biopsy was performed intra-operatively on performing surgical treatment of calculus cholecystitis. METAVIR and Е. Brunt criteria were used in the histological diagnosis of NASH, as well as for determination of the stage of liver fibrosis (LF). Hepatic tissue fibrogenesis was assessed by serum values of total (OPT), free (OPF) and protein-bound (OPB) oxyproline, activity of indirect fibrosis markers – alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT ratio and prothrombin time (РТТ). As a mathematical tool for modeling, stepwise discriminant analysis was used. Fibrosis of the first stage (F1) was observed in 5 (22.7%) patients, the second stage of fibrosis (F2) – in 7 (31.8%), F3 stage of fibrosis - in 10 (45.5%) patients. Analysis of the morphological study of liver biopsy samples in examined patients with NASH indicates that established histological changes combine the signs of fatty and protein degeneration of hepatocytes, inflammation and necrosis in the lobules. Among the indicators included in the mathematical model the highest diagnostic significance can be attributed to the AST / ALT ratio (F = 9.03; p = 0.003) and the level of OPF (F = 5.67; p = 0.016), whereas OPB level has the lowest value (F = 2.94; p = 0.086). Evaluation of the accuracy of the method for determining of the LF phase based on the proposed algorithm showed that the frequency of correct detecting of F1 and F2 stages of LF was 100%, for the F3 stage - 90% (1 case attributed to the F2 stage). In general, the accuracy of the method was 95.5% (95% CI 86.8-100%), sensitivity – 90.0% (95% CI 71.4-100%), specificity – 100% (95% CI 92,5 – 100%), validity - 90.0%. Evaluation of the stage of LF in patients with NASH combined with obesity and chronic calculous cholecystitis, which was determined using discriminant functions calculated from laboratory data (OPT, OPF, OPB, ALT, AST / ALT ratio and PTT), is very much in line with the corresponding results of histopathological studies of liver biopsy samples.
Key words: transient visual disorders, blindness, arterial hypertension, hypoxic-ischemic encephalopathy, transient ischemic attacks
Abstract. Clinical characteristics of transient vision disorders and arterial hypertension. Wang Zi Wei, Pohorielov O.V. A study of 104 patients with a transient ischemic attacks (TIA) in the form of visual disorders was conducted to assess the factors that affect the development and probable localization of TIA. Neurological and ophthalmological status, structural characteristics of the brain and major arteries of the head (MAH) with the use of magnetic resonance therapy (MRT) and ultrasonic dopplerography were assessed. The age of patients ranged from 33 to 79 years (65.4 years in average). The control group consisted of 46 patients with an average age of 67.8 years without cerebral ischemic events and visual disorders. During the MRI, the presence of microstructural pathology of the brain was assessed; “leukoaraiosis” was considered; foci up to 2-3 mm that are vascular by genesis. Significant differences in the frequency of TIA occurrence in terms of gender were not detected in all age subgroups. In young patients with TIA, arterial hypertension was associated with signs of microstructural pathology (MSP) of the brain in 85.58% cases. TIA localization did not correlate with the grade of structural disorders of the MAH and the nature of retinopathy in all age groups. Frequency of TIA tended to increase (in the a. ophthalmica pool) with an increase in the grade of stenosis of the MAH and retinopathy. The control group had retinopathy of the 1st stage in 12 or 26.09%, showing a qualitative difference with the group of study. The study did not reveal any differences in the frequency of TIA (according to presentations to a medical institution) in patients of different age groups, which indicates the influence of others factors that are not related to aging, such as TIA factors. The state of the MAH and microcirculation of vessels are their markers and probable causative factors. Determination of markers for the prognosis of the development of cortical TIA or TIA in a. ophthalmica pools are still an open issue, as well as the chances of the TIA development in other areas of cerebral blood supply. Thus, according to clinical and anamnestic data, transient ischemia in the patients, who have applied to medical institutions with complaints of transient vision disorder (impairment) and who have been diagnosed with TIA is detected mainly in the a. ophthalmica blood supply pool (89 or 85.58%), more rarely (in 15 or 14.42%) in the cortical areas of visual analyzer without gender and age differences. All age groups had TIA associated with MAH structure impairment, retinopathy, MSP of the brain (in 82% of men and 67% of women), this leads to the interpretation of such TIA as non-random events preceded by systemic disorders, which are the basis for the prediction and prevention of such conditions.
Key words: "high-grade" serous ovarian carcinomas, cancers without known primary localization, p53, ImageJ
Abstract. Importance of serous intraepithelial ovarian tubal carcinomas in the occurrence of "high-grade" serous carcinomas and / or peritoneal serous carcinomas of unknown primary origin. Shponka I.S., Poslavska О.V., Savchenko O.A. Studies of the recent decades on serous pelvic adenocarcinomas in women have set the goal of distinguishing between two diagnostic units: "low-grade" and "high-grade" carcinomas. The predecessor of the "low-grade" variant (type I) is considered to be a borderline serous tumor / atypical proliferative serous tumor (8442/1), which according to the International Classification of Diseases for Oncology ICD-O 2013 of the female reproductive system refers to non-specific, borderline tumors and tumors with unpredictable clinical behavior. The predecessors of the “high-grade” variant (type II) are serous tubular intraepithelial carcinomas (in situ) or “high-grade” serous invasive tubal carcinomas, since they have the TP53 mutation identical to “high-grade” ovarian carcinoma, an aberrant p53 protein expression, high proliferative activity, and significant genomic instability. In addition, according to the carcinogenesis of "high-grade" serous ovarian carcinoma with metastases to the peritoneum, it can also be interpreted as "pelvic high-grade serous carcinoma". A retrospective analysis of the histological, morphometric and immunohistochemical characteristics of the biopsy material of 31 women aged from 28 to 76 years (mean 57.32±11.54; median 57), divided into 3 groups, was carried out. Group 1: 14 observations of the tubal epithelium (8 tubes without pathological changes (subgroup 1a) and 6 with signs of intraepithelial neoplasia (subgroup 1b); group 2: 12 cases of serous adenocarcinoma of the ovary of the “high-grade” variant; group 3: 6 metastatic peritoneal serous carcinoma without a known primary site. Results. Group immunophenotypes showed uniformity in the expression of markers CK7 (+, +/-), CK20 (-), WT-1 (+), CA125 (+, +/-), with an affinity to distal uterine tube fragments. The expression of p53 in all groups with signs of carcinomas (compared with the control subgroup 1a without atypia) was divided into two options - negative samples and samples with overexpression, where no statistically significant difference was found (p>0.05), which is possibly a single way of carcinogenesis. The morphometric study revealed a significant difference in the area of the nuclei between group 3 and the first three groups (1a, 1b, 2), which indicates the similarity of ovarian and tubal neoplasias and uterine tube epithelium. The number of intranuclear reactions with ER and PGR progressively decreased from group 1 to group 3, with an increase in cases with ER (+/-) / PGR (+/- or -) to 50% in group 3, which greatly complicated the diagnostic search for unknown carcinomas of primary localization. HER-2-new expression revealed a possible amplification (gradation 2 + / 3 +) only in group 2 at the level of 16.67% and in group 3 at the level of 33.33%.
Key words: diabetes mellitus type 1, heart rate variability, control markers
Abstract. Dependence of heart rate variability on indicators of type 1 diabetes mellitus control. Pertseva N.O., Gurzhiy O.V., Moshenets K.I. The aim of our study was to evaluate the influence of the main indicators of type 1 diabetes mellitus (T1DM) control on heart rate variability (HRV). We examined 62 patients at the age of 18-45 years with an average T1DM duration of 11.0 (5.0; 18.0) years. HRV in the time and frequency range was evaluated by analyzing a 24-hour Holter electrocardiogram (ECG). The following laboratory parameters were used as markers of course and compensation of T1DM: C-peptide, HbA1c, blood creatinine, albuminuria (AU), estimated glomerular filtration rate (eGFR) by CKD-EPI formula. In addition, the maximum and minimum blood glucose levels and the blood glucose range (maximum minus minimum blood glucose values) were conducted by continuous glucose monitoring system iPro2 (Medtronic MiniMed, USA). The daily monitoring of electrocardiogram (ECG) was made in parallel with long term monitoring of blood glucose. Echocardiography in all patients was performed to exclude organic heart disease and the possibility of its influence on HRV. Poor control of T1DM negatively influences HRV through decrease in both frequency and time characteristics. The blood glucose range can be an additional negative factor for cardiovascular system in T1DM patients, regardless of HbA1c, whereas it positively correlates with HRV- relative hypersympathicotonia markers: LF/HF 24-h, ρ=0.43 (p<0.05), LF/HF day ρ=0.37 (p<0.05), ρ=0.38 LF/HF night. Diabetic nephropathy is another factor of cardiovascular disease progression in T1DM, since its criteria have reliably negative (for eGFR) and positive (for AU) correlations of mean force with all HRV characteristics. Selected markers of T1DM control cause 45, 73% of variance in HRV, mainly affecting TP 24-h, TP daytime, VLF 24-h, VLF daytime. Reduction of these frequency HRV characteristics may indicate autonomic neuropathy in patients with poor control of T1DM.
Key words: myasthenia gravis, depression, class, QMG, antibodies to acetylcholine receptors, muscle-specific tyrosine kinase, disease duration
Abstract. Features of depression development in myasthenia gravis. Kalbus O.I., Makarov S.O., Shastun N.P., Somilo O.V., Bukreyeva Yu.V. The relative risk of developing depression in myasthenia gravis is 2.14 times higher than in the general population. The features of depression in myasthenia patients remain poorly understood and need to be clarified. The purpose of this work was to study the features of the development of depression in patients with myasthenia gravis. From 2014 to 2017, 182 patients with myasthenia gravis were examined. 147 (80.8%) patients had a generalized form of the disease, 35 (19.2%) had an ocular form. The clinical examination included assessment of complaints, medical history, neurological examination, as well as MGFA (Myasthenia Gravis Foundation of America) disease class and subclass of the disease determination. The severity of myasthenia gravis has been quantified according to the QMG score (Quantitative Myasthenia Gravis Score). All the patients were examined for the titer of antibodies to acetylcholine receptors (AchR) and muscle-specific tyrosine kinase (MuSK) by enzyme-linked immunosorbent assay (ELISA). Patients were also tested for the presence of antibodies to titin and SOX1 by indirect immunofluorescence. To detect depression the Beck depression inventory (BDI) was used. The mean depression score in the total sample was 16.0 (10.0; 24.0), which corresponds to a moderate depression level. The mean depression score in patients with ocular form was 6.0 (3.0; 11.0) points (ie, depression is absent), whereas in patients with generalized myasthenia gravis – 19.0 (12.0; 29.0) points (corresponds to moderate depression) (p <0.001). The distribution of patients with mild depression was also uneven: significantly bigger part of the patients was recorded with myasthenia gravis of class I (ocular form) – 10 (28.6%), and with myasthenia gravis of class II – 23 (44.2%). Among the patients with myasthenia gravis of class III, only 13 (20.3%) patients were reported with mild depression and 1 (3.2%) with class IV, p<0.001. The distribution of patients with moderate depression was the opposite of others: most patients had myasthenia gravis of class II – 12 (18.8%), and there were no patients with myasthenia gravis of class I. A similar tendency is also observed in the case of severe depression: patients with myasthenia gravis of class II – 23 (35.6%) dominated, to a lesser extent - patients with myasthenia gravis of class IV – 6 (19.4%). Among patients with ocular myasthenia gravis, only 1 (2.9%) patient was found to have severe depression. Severe depression was mainly recorded in patients with myasthenia gravis of class IV – 22 (71%) patients. The number of patients with severe depression has been decreased in the class of myasthenia gravis: 13 patients (20.3%) patients with ІІІ class, 1 (1.9%) with II class, no patients with class I. The degree of depression correlates with the clinical form of myasthenia gravis (ρ= -0.52; p<0.001), class (ρ= -0.30; p<0.001) and the subclass of the disease according to MGFA (ρ= -0.36; p<0.001). A reliable correlation relationship was established between the quantitative evaluation of the severity of myasthenia gravis (according to the QMG score) and the results of the evaluation according to the BDI score in the total sample (ρ=0.73; p<0.001). The assessment indicators on the QMG score and the BDI score significantly correlated in patients with ocular (ρ=0.36; p<0.05) and generalized forms (ρ=0.67; p<0.05). In addition, the level of depression correlates with the presence (ρ=0.15; p=0.040) and the titer of antibodies to AchR (ρ=0.42; p<0.001), with the presence (ρ=0.18; p=0.016) and the titer of antibodies to MuSK-AB (ρ=0.19; p=0.011). No correlation was found between the presence of antibodies to titin and to SOX1 (ρ=0.14; p<0.05 and ρ=0.07; p<0.05, respectively). There are no relationships between the use of anticholinesterase drugs, prednisone, the combined use of prednisone with / without azathioprine with / without anticholinesterase drugs and the development of depression in patients with myasthenia gravis.
Key words: volume and osmoregulatory function of the kidneys, insulin-independent diabetes mellitus, syndrome of endogenous intoxication of purulent-septic origin, xylate
Аbstract. The influence of xylate on the volumo- and osmoregulatory function of the kidneys in diabetes complicated by the syndrome of endogenous intoxication of purulent-septic origin. Konovchuk V.M., Kushnir S.V., Andrushchak A.V., Andrushchak M.O. The combination of insulin-independent diabetes mellitus with endogenous purulent-septic genesis syndrome is a fairly common nosology. The search for ways to optimize the results of its treatment, after screening observations, led to the expediency to consider the pharmacodynamic aspects of the action of polyhydric alcohols through the prism of homeostatic support functions. Detailing this direction was focused on the consideration of the action of xylate mediated through the volumetric and osmoregulatory function of the kidneys. The effect of xylate on the volumo-and osmoregulatory function of the kidneys in insulin-independent diabetes mellitus complicated by the syndrome of endogenous intoxication of purulent-septic origin was investigated. The study group consisted of 53 patients with insulin-independent diabetes mellitus complicated by the syndrome of endogenous intoxication of purulent-septic origin (IDCSEI). Under the condition of infusion loading (3 ml/kg/h for three hours) with Ringer's solution or xylate within the fragments of planned intensive care, indicators characterizing the state of the volumo- and osmoregulatory function of the kidneys were investigated. The loading with Ringer's solution in patients with IDCSEI increases sodium clearance by 260±47.8% (Δ, p=0.020), without changing the concentration of sodium ions in the blood plasma and filtration fraction and purifying the blood plasma from osmotically active substances 147±46.9% ( Δ, p=0.011). Extension of the extracellular space by infusion solutions by 3 ml/kg/h for three hours in patients with insulin-dependent diabetes mellitus, complicated by the syndrome of endogenous intoxication by purulent-septic genesis, activates volumetric and osmoregulatory function. Extension of extracellular space with infusion solution by 3 ml/kg/h for three hours in patients with insulin-independent diabetes mellitus activates volumo- and osmoregulatory function. Activation of volumetric function occurs by reducing the reabsorption of sodium and water in the proximal nephron, without increase of glomerular filtration rate, increasing the distal transport of sodium and water.
Key words: urinary tract infection, girls, antibacterial resistance, vaccine therapy
Abstract. Influence of vaccine therapy on clinical and laboratory parameters in patients with recurrent urinary tract infection. Budnik T.V., Kvashnina L.V. Recurrent urinary tract infection (UTI) remains a pressing issue in the era of large-scale antibiotic resistance (ABR). Modern discoveries testify to the paradigm's error regarding sterility of urine, pointing to the decisive role of the microbial symbiote in the persistence of infection. The purpose of the study was to study the clinical and laboratory efficacy of vaccine therapy in children with recurrent UTI. During the period 2018 - 2019, 21 children (girls) aged 7-18 years with recurrent UTI in the exacerbation phase were observed. By the nature of therapy, children were divided into groups: Ia - received vaccine therapy (VT) in the complex of therapy, Ib - a combination of VT and ABT, II – ABT. In addition to the generally accepted methods of assessing the clinical and laboratory status of a nephrologicals patient, modern non-routine diagnostic methods such as the identification of a microbial pathogen by MALDI TOF mass spectrometry and the determination of the susceptibility of microorganisms by the MIC 90 method were used. As vaccine therapy, the original multicomponent drug was used: Ecsherichia coli (CCM 7593), Enterococcus faecalis (CCM7591), Klebsiella pneumonia (CCM 7589), Proteus mirabilis (CCМ 7592), Pseudomonas aeruginosa (CCM 7590), Propionibacterium acnes (CCM 7083). The drug was prescribed according to the instructions, the duration of use was determined individually by clinical indicators, from 3 to 12 months. According to the study, it was determined that VT leads to the restoration of the sensitivity of resistant strains of pathogens. The probability of recovery of sensitivity after the 3rd cycle of treatment was OR=1,87±1,13 [0,2; 17,3] at CI 95% (p<0,05), after the 6th cycle of therapy – OR=4,5±1.32 [0.33; 60.1], which is 2.4 times higher than the previous one. The effect of restoring the sensitivity of the strains was significantly confirmed in patients after the 9th cycle of therapy (p=0.008). A high association strength according to the Spearman criterion indicated the dependence of bacterial efficacy of VT on its term of application – p= -0.97, (p<0.05). It is shown that the probability of reinfection after 3 cycles of vaccine therapy is 20.5 times lower than after the course of ABT.
Key words: polynosis, cytokines, combined allergen-specific immunotherapy
Abstract. Dynamics of IL-4 and IFN-γ cytokine profile under the influence of combined allergen-specific immunotherapy (ASIT) in patients with polynosis and combined sensitization to pollen and household allergens. Dytyatkovska E.M., Biletska S.V. The article presents the results of the clinical evaluation of the cytokine profile (IL-4, IFN-γ) in combined allergen-specific ASIT immunotherapy in patients with polynosis and combined sensitization to pollen and household allergens. Studies were conducted in 49 patients aged 19-57 years (24 women and 25 men) suffering from polynosis from 1 to 38 years. Patients underwent an allergological examination, including history taking, diagnostic skin tests - prick test, immunological studies of blood by enzyme-linked immunosorbent assay and allergic component diagnosis ALEX, on the basis of which polysensitization to pollen and household allergens was revealed in all patients. All patients underwent pre-season ASIT. The main group of 31 patients received a combined ASIT with solutions of pollen and household allegens. 18 patients of the comparison group received ASIT only with pollen allergens. The observation groups were comparable by sex, age, and disease duration. Studies were conducted during the period of remission of the disease before the onset of ASIT and 1 year after. It was found that under the influence of combined ASIT, an immunospecific effect was observed in patients with a significant decrease in the level of IL-4 in simultaneous increase in the production of interferon-gamma by 59.8%, which indicates the activation of the process of switching the immune response from Th-2 to Th-1 cells. The positive results of clinical and immunological studies convincingly prove the advantages and effectiveness of the use of ASIT in patients with polynosis and combined sensitization to pollen and household allergens.
Key words: microflora, antibioticresistance, biopsy samples of wounds
Abstract. Improving effectiveness of microbiological diagnostics in patients with surgical infection of soft tissues. Biesiedin O.M., Storubel L.N., Yevtushenko E.V., Biesiedina K.O. Recently, there has been a steady tendency towards increase in the resistance of microorganisms to antibacterial drugs, which is due to the lack of development of new antibiotics, their uncontrolled administration, total use in animal husbandry, etc. leads to fatal outcomes, unsatisfactory results of treatment, rise in cost of treatment, formation of hospital pan-resistant strains. The increasing ability of microorganisms to cooperate in biofilms, production and improvement of resistance mechanisms in symbiosis are intractable issues in the treatment of patients with surgical infection of soft tissues. In patients with surgical infection of soft tissues, surgical treatment of a purulent focus and antibiotic therapy are fundamental doctrinal, determining the success of treatment.The choice of an antibacterial drug in most cases is based on the results of an antibioticogram. A study of wounds by smear technique and biopsy samples of wound tissues in 81 patients was performed. The quantitative and qualitative composition of wound microflora of patients was evaluated during the study of biopsy samples and standard culture from the wound surface. When examining the biopsy samples, 86 strains were isolated, and 110 – in the material from the wound surface. There was no growth on the wound surface in 11 cases (13.5%), against 20 (almost 25%) in biopsy samples. One species of flora was isolated from 37 wound surfaces (about 46%), biopsy samples of wounds with monoculture – in 61 samples (75%). Associations (two or more) are present in 33 (41%) wound samples, and only in 21 biopsy samples (26%). Thus, the conducted studies confirm the fact that wound surface is more contaminated by foreign microflora than biopsy samples. The data obtained allow us to recommend the method of wound biptates instead of a smear, as more specific and sensitive in patients with surgical infection of soft tissues.
Key words: obesity, metabolic syndrome, sleeve gastrectomy, gastroplication, fundoplication, laparoscopy, gastroesophageal reflux disease, reflux esophagitis
Abstract. Post-operative reflux esophagitis as a predictor of choice of restrictive operation in patients with metabolic syndrome. Savoliuk S.I., Lysenko V.M., Krestianov M.Y., Zavertylenko D.S., Krugliak Y.K. The purpose of this study was to conduct a comparative analysis of the retrospective results of laparoscopic sleeve gastrectomy (LSG), laparoscopic gastroplication (LGP) and laparoscopic fundogastroplication (LFGP) (simultaneous performance of fundoplication by Nissen and gastroplication) obtained at the follow-up period of 1 year, to evaluate and compare the effectiveness of prevention of short-term postoperative complications, which are manifested in the form of GERD, by performing preventive antireflux procedure in combination with restrictive bariatric surgery. Evaluation of the effectiveness and long-term effects of the presented restrictive operations was carried out on the basis of retrospective data obtained during the supervision of 46 patients with obesity and metabolic syndrome (men / women - 16/30, average age – 41.19±6.07, body weight – 128.26±7.37 kg, abdominal circumference – 133.4±4.71 cm, body mass index (BMI) – 42.66±2.41 kg/m2, I-III ASA). In the preoperative and postoperative periods, during consultations, in all patients measurements of anthropometric indicators were performed, laboratory data and results of instrumental research were considered. All metabolic procedures presented were performed at the basis of the Department of Surgery and Vascular Surgery of NMAPE named after P.L. Shupik in the period from 2016 to 2019. 13 patients underwent LSG, 20 – LGP and 13 - LFGP. In order to control the results, repeated consultations were carried out at 1, 3, 6 and 12 months of the postoperative period. The average duration of the operation was: LSG – 88.5±6.49 min, LGP - 120±5.42 min, LFGP – 135.38±7.48 min. The average period of hospitalization was: LSG – 3.2±0.63 days, LGP – 3.53±0.62 days, and LFGP – 3.5±0.67 days. After a year, the body mass index (BMI) was: LSG – 31.17±0.31 kg/m2, LGP – 32.48±0.23 kg/m2, LFGP – 32.43±0.21 kg/m2. According to the results of a repeated questioning of patients one year after the operation, 3 (23.07%) of the LSG group and 5 (25.0%) of the LGP group had symptoms of GERD, which failed to be eliminated with the help of conservative therapy, life quality of patients became significantly worse. In the group of patients who underwent LFGP, this complication was absent. After the control gastroscopy, 1 year after, de novo signs of reflux esophagitis were detected (according to the Los Angeles classification): in the LSG group – 3 (23.07%) patients (2 - grade A and 1 - grade B), in the LGP group – 5 (25.0%) patients (3 – grade A and 2 – grade B). Among patients who underwent LFGP, there were no signs of reflux esophagitis. Considering the possible development of GERD and reflux esophagitis in one year after the restrictive surgery, the use of preventive measures consisting in the simultaneous performance of antireflux and metabolic operations is relevant, this is demonstrated by the example of LFGP. We recommend to give preference to simultaneous operations for the achievement of not only high rates of weight loss, but also for improvement of the quality of patients` life in the future.
Key words: non-atypical endometrial hyperplasia, reproductive age, immunohistochemistry, CD-138,
Abstract. Clinical-immunohistochemical characteristics of atypical endometrial hyperplasia in women of reproductive age. Vovk I.B., Zadorozhnaya T.D., Gorban N.E., Kondratiuk V.K. The article presents the analysis of clinical-morphological and immunohistochemical features of endometrial hyperplasia. 60 patients of reproductive age with non-atypical endometrial hyperplasia (EH) were examined. The following morphological distribution of its different types was established: glandular – 56.6%, glandular-cystic – 40.0%, stromal and cystic-atrophic forms – 1.7%, respectively. When carrying out immunohistochemical studies, the expression of CD-138, a modern reliable marker of the presence of an inflammatory process in endometrial tissue was determined. In the group with non-atypical glandular EH, signs of the inflammatory process in the endometrium were verified in 7 (20.59%) patients. In the group with signs of glandular-cystic change of EH – in 11 (45,83%) patients, as well as in the only patient with non-atypical stromal EH (100,0%). In almost one-third of patients with different morphological types of EH in 19 (31.7%) of 60 the presence of structural-morphological signs of chronic endometritis was revealed, which was manifested by signs of lymphoplasmacytic infiltration, indicating the presence of chronic inflammatory process. These data indicate the possible pathogenetic role of inflammation as one of the trigger factors for the hyperplastic transformation of endometrial structures, which allows to confirm the role of infectious factors in the occurrence of these processes in almost one third of patients with non-atypical ЕН. Thus, the conducted studies indicate that the development of EН is a process based on both the infectious factor and hormonal metabolic disorders, which dictates different personalized approaches to therapeutic tactics.
Key words: gout, hyperferritinemia, arterial hypertension, ferritin, blood uric acid, iron metabolism
Abstract. Features of impact of hyperferritinemia in combination with hyperuricemia on the course of gout. Kuzmina G.P., Lazarenko O.M. The purpose of the study is to find out the frequency of development of hyperferritinemia in combination with hyperuricemia in patients with gout, to assess their pathogenetic significance and to outline their role in the development of joint syndrome, to identify informative prognostic criteria. 72 patients with gout were examined. The 1st (main) group included 37 patients with gout with hyperuricemia combined with hyperferritinemia, whose mean age (SD) was 55.9 (10.7) years. Group 2 (comparison group) included 35 patients with gout and hyperuricemia and normal levels of ferritin (mean age - 52.8 (4.8) years). Group 3 (control) group included 20 practically healthy individuals (mean age 52.0 (2.9) years). The average level of blood uric acid was significantly different (p=0.0254) in the main group and the comparison group and amounted to 464.5 (122.5) μmol/L and 403.8 (403.8; 403.8), respectively. The value of ferritin in the main group was significantly higher 410.2 (356.2; 415.2), p<0.01) ng/mL, than in the comparison group (132.1 (20.5) ng/mL, as well as the values of the urine uric acid and C-reactive protein values (hs-CRP) (p=0.0001) 8.2 (6.0; 8.2) and 5.8 (6.1) mg/L, respectively. A direct reliable correlation was established (r=0.30; p<0.05) between the level of blood uric acid and ferritin, the duration of gout (r=0.41; p<0.05), the total number of affected joints (r=0.35; p<0.03), the severity of gout (r=0.36; p<0.05), as well as between the level of ferritin and the number of exacerbations of gout (r=0.44; p<0.05). Hyperferritinemia in combination with hyperuricemia is found in 51.0% of patients with gout, significantly worsening the course of the inflammatory process Patients with gout and high levels of ferritin, unlike patients with normal levels of ferritin, have the following clinical anamnestic signs: greater number of exacerbations of gout per year, duration of gout and last outbreak of gout, exacerbation of arthritis, total number of affected joints, pain intensity during exacerbation by scale VAS. In patients with gout, the severity of the course and the form of gouty arthritis, which are determined according to imaging methods (erosion, peripheral and bone tophus, the sign of "double contour", the degree of narrowing of the joint gaps and the severity of subchondral sclerosis), have prognostic significance. The association of ferritin with blood uric acid in gout does not depend on the level of hs-CRP.
Key words: high level of obstructive jaundice, external drainage of bile ducts, poor bile flow (debit), liver status
Abstract. Functional state of the liver after external drainage of bile ducts in patients with a high level of obstructive jaundice. Kutovyi O.B., Balyk D.V., Kysilevskyi D.O. The results of the examination and treatment of 67 patients with a high level of obstructive jaundice were analyzed. Diagnosis of obstructive jaundice syndrome was based on the data of anamnesis, complaints, physical, laboratory and instrumental research methods. Among the latter we performed ultrasound investigation (USI) of abdominal organs and bile ducts as a screening method, fibrogastroduodenoscopy (FGDS), computed tomography(CT), magnetic resonance cholangiopancreatography (MRCPG) was carried out if necessary. The cause of a high level of obstructive jaundice: pancreatic head cancer - 27 (40.3%); choledocholithiasis - 21 (31.3%); Klatskin tumour - 5 (7.5%); cancer of the large duodenal papilla – 4 (6.0%); chronic pseudotumor pancreatitis – 4 (6.0%); choledoch cancer – 3 (4.5%); choledochal stricture – 3 (4.5%). The first stage of treatment started from the implementation of percutaneous and hepatic external drainage of the bile ducts under ultrasound control. The functional state of the liver was evaluated according to the level of total bilirubin and its fractions, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). The researches were performed at the admission of patients to the clinic and on day 1, 3 and 7 after external drainage of the bile ducts. Patients were divided into 2 groups, depending on the bile flow rate on the first day after decompression of the biliary tract. It was concluded that the degree of hepatitis in the early period after the performed procedure is directly associated with the bile flow rate during the first day after external drainage of the bile ducts.
Key words: asphyxia, hypoxic ischemic encephalopathy, hypothermia, neurosonography, near-infrared spectroscopy, newborns
Abstract. Near-infrared spectroscopy: bilateral brain monitoring in termed newborns with hypoxic-ischemic lesions. Mavropulo T.К., Sokolova K.Y. Assessment of cerebral oxygenation using near-infrared spectroscopy (near-infrared spectroscopy, near-infrared spectroscopy, NIRS) has significant strong correlation with the assessment of brain perfusion using MRI in full-term infants with severe hypoxic-ischemic encephalopathy. However, there are still no recommendations on the use of NIRS monitoring data for making important clinical decisions in newborns with asphyxia and hypoxic-ischemic encephalopathy in routine clinical practice. The role of interhemispheric variations in the values of regional tissue oxygen saturation (rSO2) in severe hypoxic-ischemic encephalopathy against the background of therapeutic hypothermia remains unexplored. The aim of the study was to evaluate the results of bilateral brain monitoring using NIRS in full-term newborns with severe hypoxic-ischemic lesions (with and without destructive changes in brain tissue). All examined children were full-term newborns with severe asphyxia at birth, who underwent therapeutic hypothermia. We analyzed the results of NIRS recordings of 33 newborns who did not have signs of destructive hypoxic-ischemic brain damage, and NIRS data of 15 newborns who were diagnosed with signs of destructive hypoxic-ischemic brain damage. The hemisphere difference in cerebral oximetry indices was presented in the form of statistical processing results - average, median, mode, 25th percentile, 75th percentile of pairwise comparisons, namely the difference of values (ΔrSO2) of the measurement “ΔrSO2=rSO2on the right-rSO2on the left” in each moment of recording (12000-22000 measurement moments during the monitoring session), as well as the percentage of recording time when the ΔrSO2 value was recorded below the 25th percentile and above the 75th percentile. Reliable correlations between the fact of the formation of destructive hypoxic-ischemic brain lesions in full-term newborns and the average ΔrSO2 values of the NIRS record (R=-0.410), median values (R=-0.400), modes (R=-0.357), and values 25-the percentile ΔrSO2 (R=-0.326) and the 75th percentile ΔrSO2 (R=-0.429) were registered. In 73.3% of children with destructive hypoxic-ischemic lesions, the average ΔrSO2 values were higher for the right hemisphere (the average ΔrSO2 value of the group was 0.11±2.39%). In 93.9% of children without destructive brain damage, the average rSO2 values were higher for the right hemisphere (the average ΔrSO2 value of the group was 6.92±0.80%). Significant differences in mean ΔrSO2 (p=0.005) were determined. Mean ΔrSO2 median for the group with destructive brain lesions was 0.33±2.38%, for the group without destructive lesions - 6.88±0.82% (p=0.004), the average ΔrSO2 mode for the group with destructive brain lesions was 1,46±1.73%, for the group without destructive lesions - 6.51±0.92% (p=0.014). The average of the 25th percentile of ΔrSO2 values for the group with destructive brain lesions was (-1.93)±2.72%, and for the group without destructive lesions it was 4.42±0.84% (p=0.026). The average of the 75th percentile of ΔrSO2 values for the group with destructive brain lesions was 2.87±2.11%, and for the group without destructive lesions it was 9.33±0.80% (p=0.003). The results of bilateral brain monitoring using NIRS in full-term newborns with severe hypoxic-ischemic lesions on the background of therapeutic hypothermia have significant differences between groups of children with and without destructive changes in brain tissue. In newborns with destructive brain lesions, a decrease in manifestations of dominance of rSO2 indicators of the right hemisphere was recorded, namely, significantly lower mean ΔrSO2, median, mode, average values of the 25th and 75th percentiles ΔrSO2.
Key words: HIV infection, epidemic, prognosis
Abstract. Main characteristics and prognosis of development of HIV epidemic in Dnipropetrovsk region. Shostakovych-Koretskaya L.R., Lytvyn K. Yu., Gubar I.O., Chukhalova I.V., Gudova M.G., Lopatenko A.A. The epidemiological situation on HIV infection in Ukraine remains complicated due to high morbidity and mortality, which requires a comprehensive study of this problem. Purpose of work: to clarify the main patterns and characteristics of prevalence of HIV infection in Dnipropetrovsk region and develop a forecast for changes in the main epidemic indicators. The study was based on reports from the Public Health Center of the Ministry of Health of Ukraine and Dnipropetrovsk Regional Center for AIDS Prevention and Control. (2005-2017). To determine the main trends of development and forecasting the epidemiological situation, methods of analysis of time series with the calculation of chain growth rates and regression analysis were used. Analysis of the number of newly registered cases of HIV infection and AIDS over a 13-year period (2005-2017) showed an increase in figures for HIV by 1.5 times, for AIDS - by 2.4 times in Ukraine and in Dnipropetrovsk region – by 1.9 times and 3.0 times, respectively. A significant prevalence of HIV/AIDS incidence rate in Dnipropetrovsk region as compared with national indicators in some years of the study and on average over the entire observation period was determined – 92.8±4.2 cases of HIV infection per 100 thousand and 45.2±5.2 cases of AIDS per 100 thousand in the region versus 41.0±1.4 and 16.1±1.6 per 100 thousand of the population in Ukraine (p<0.001). According to prognostic algorithms, in Dnipropetrovsk region until 2020, the annual AIDS incidence rate is expected to increase to 80.7±2.56 cases per 100 thousand people; AIDS mortality to 33.7±0.99 per 100 thousand people, which also predicts an increase in the incidence and mortality associated with opportunistic infections. A calculated forecast of HIV incidence rates and newly registered AIDS cases in Ukraine and the region for the coming years may be useful for predicting the number of opportunistic infections and calculating the needs for hospitalization and treatment of HIV/AIDS patients.
Key words: posture disorders, sports and ballroom dancing, program, correction, children
Abstract. Correction of posture disorders with sport and ballroom dancing. Grygus I., Nesterchuk N., Hrytseniuk R., Rabcheniuk S., Zukow W. Introduction – to develop a program for the prevention and correction of posture disorders in children through the wide introduction into the process of physical education of sports and ballroom dancing. In the pedagogical experiment, 169 children were randomly divided to control (n=85) and main (n=84) groups (age 11-12). All children attend secondary school. Several diagnostic tests were conducted with children and the control exercises were analyzed. With the help of the performed factor analysis, the correlation of the means to be implemented in the process of using the dance in relation to prevention and correction of posture disorders was calculated. The program of prevention and correction of posture disorders in children was based on methods of diagnostics of the functional state of the spine, the purpose, tasks and content of sports ballroom dance classes and included seven sections. The main components of the program are highlighted, its influence on the correction of posture disorders, functional state of children were experimentally tested. The main focus is on correctional dance events; measures aimed at forming skills of performing simple dance moves; measures aimed at the general physical development of children; measures aimed at preventing specific anatomical and physiological abnormalities. The program of correction of posture disorders through the introduction into the educational process of sports and ballroom dancing was based on the results of the diagnosis of the functional state of the spine, including complimentary goals and objectives. Introduction to the educational process of sports and ballroom dancing included seven sections with active involvement in this process not only children but also their parents and teaching staff.
Key words: bilateral destructive pulmonary tuberculosis, surgical treatment, mini-invasive surgical interventions
Abstract. Results of treatment of bilateral destructive pulmonary tuberculosis patients using mini-invasive surgical interventions. Korpusenko I.V., Savenkov Yu.F. There were analyzed case-histories of patients operated on bilateral destructive pulmonary tuberculosis who underwent treatment at pulmonary-surgical unit of CI “DRCCTPA” Phthisiatria” from 2010 to 2018. Case histories of 259 patients’ were included in the study, in complex treatment of which, surgical stage of treatment was used. Analyzing direct results in 2 months after surgery, the estimation based on clinical, roentgenologic and laboratory studies by criteria of destruction cavities closure, bacterioexcretion termination and clinical stabilization of the tuberculosis process was used. In carrying out a research patients were divided into 2 groups: the main group consisted of 129 patients who underwent mini-invasive methods of surgical treatment with mini-access under the control of video-thoracoscopy (single-step or staging bilateral video-assisted lung resection – 58 patients, collapse-surgical video-assisted single-step or staging interventions – 53, staging mini-invasive pleuropneumonectomy – 18). The comparison group included 130 patients operated according to standard approaches with conventional methods. Comparison groups did not differ reliably (p>0,05) by the gender and the age, by tuberculosis forms, by disease duration, by functional parameters, by main prevalence and severity of tuberculosis. A biggest number of complications in both groups was noted after pleuropneumonectomies, lobectomies and thoracoplasty. In the comparison group postoperative complications were observed in 32 (24.6%) patients, that is 2.2 more often (p=0.002). In the main group, bronchopleural complications occurred in 8 cases (6.2%), and in the comparison group – in 16 (12.3%), that is 2 times less frequently, exacerbation of tuberculosis process was noted 3.8 times more often in patients of comparison group. Performed analysis of the nature of postoperative complications in both groups confirms the effect of traumatism of access not only on the course of the wound process, but also on the frequency of pleural, pulmonary and functional complications. A complete clinical effect in the patients of comparison group was achieved in 82 cases (63%), that is by 1.4 times less than in the main group (p<0.001). Abacillation, while maintaining destruction in one of the lungs, occurred at the time of discharge from the hospital in 12 (9.3%) patients of the main group and in 21 (16.5%) – of the comparison one. There were 3 (2.3%) patients discharging bacteria in the main group and 20 (15.4%) patients in the comparison group.
Key words: occlusion, disorders, occlusiography, diagnosis, prevalence, young people
Abstract. Prevalence and character of occlusional disorders among young people. Fastovets O.O., Shtepa V.O. Dynamic occlusion is the main indicator of the harmonious functioning of the dental apparatus. At the same time, irrational reconstructive treatment can lead to its disorders and, as a result, increased tooth wear, periodontal diseases, dysfunction of masticatory muscles and temporomandibular joints. To date, the computer diagnostic methods allow studying occlusion in dynamics. The aim of the research was to study the prevalence and character of occlusal disorders in young people with intact dentitions, and those whose defects in teeth and dentitions were restored by direct and indirect restorations. 300 persons aged 25-44 years were examined, equally men and women: the first group – 100 persons with intact dentitions; the second one - 100 persons with direct composite restorations located on the occlusal surfaces of the molars; the third one - 100 persons, who had indirect restorations of the crowns of teeth and dentitions of small sizes. Intercuspidation were analyzed using methods of occlusiography, the study of diagnostic models in the articulator, and computer analysis of occlusion. According to the peculiarities of centric and eccentric occlusions, the sequence of formation of the maximum occlusal load vector, the balance of occlusion and the time of closing and opening of dentitions, occlusal disorders were diagnosed in 14.0% of the first group, 35.0% of the second one and 44.0% of the third one. In 100% of patients these disorders were compensated, asymptomatic. The presence of supracontacts in centric occlusion leads to a displacement of the mandible in a forced position in 17.7% of cases. In 83.0% of the examined persons, the occlusion balance was at the level of 50% - 50% and in 13.7% – 60% - 40%. The remaining 3.3% of patients had an occlusive imbalance in the range of 70% - 30%. In this case, significant deviations of the total trajectory vector of the occlusal load were not revealed. The most common occlusion disorders were centric contacts, which are formed as consecutive single, multiple, unilateral and bilateral overload areas, constantly being changed on sliding in dynamic occlusion. Occlusive disorders are characterized by an increase in the time of closure and opening of the dentitions, and the time to reach the maximum number of interdental contacts. The efficiency of occlusiography was only 29.7%, the efficiency of the study of diagnostic models in the articulator was 59.7%, compared to the computer method with 100% of the information value. The widespread use of direct and indirect restorations of teeth and dentitions leads to an increased prevalence of occlusal disorders in young people. Usually, small restorations are integrated into the dentition by grinding their occlusal surface, focusing on patient's comfort on closing the teeth and unhindered movements of the mandible to the sides and forwards. This simplified approach is conformative and incapable of providing optimal functional occlusion. The presence of occlusal imbalance requires appropriate measures for its diagnosis and correction.
Key words: nonspecific resistance, lisocyme, α-defensins, acute lymphoblastic leukemia, mucous membrane epithelium of the mouth cavity
Abstract. Dynamics of findings of non-specific resistance in the mouth cavity in children with lesions of the mucous membrane epithelium of the mouth cavity against acute lymphoblastic leukemia in the treatment process. Bunyatyan K.A., Khotimska Yu.V., Kovach I.V., Lavrenyuk Ya.V., Khotimskiy B.L. There was conducted study of dynamics of findings of non-specific resistance in the mouth cavity in children with lesions of the mucous membrane epithelium of the mouth cavity against acute lymphoblastic leukemia in the treatment process by authors-developed methods. It is known that in children with leukemia immunodeficiency states develop immunological disorders resulted from treatment with cytotoxic drugs. Moreover, not only general, but also the local immunity of the mouth cavity suffers, which is accompanied by development of infectious processes in the tissues that perform the barrier function, which include mucous membrane epithelium of the mouth cavity. A key role in the system of antimicrobial protection of the mouth cavity is performed by mucolytic enzyme lisocyme and α-defensins (HNP 1-3). 76 children with acute lymphoblastic leukemia aged from 2 to 18 years suffering from such dental diseases as generalized chronic catarrhal gingivitis, erosive-ulcerative and candidal stomatitis took part in the clinical study. All children under clinical study were divided into 2 groups - the main and comparison. Standard protocol treatment was used in the comparison group. Developed treatment-and-prophylactic complex was used in the main group. The children of the main group were prescribed developed treatment-and-prophylactic complex depending on the period of the disease: the first version of local treatment was used in the acute period and the relapse of the disease, the second - in the period of remission. The results of research have shown a stimulating effect of therapeutic and prophylactic measures on the natural antimicrobial system of mouth cavity protection, both in children of the main groups under study and in the comparison groups. Such a phenomenon should be considered as a positive process that contributes to the increase of resistance in periodontal tissues and mucous membrane epithelium of the mouth cavity.
Key words: service personnel, dry rations, dietary calories, energy subside
Abstract. Nutrition of soldiers in battle conditions: the evolution from Zaporizhzhia Sich until today. Gulich M.P., Petrenko E.D., Lubarskaya L.S., Deputat Yu.M. Nutrition of military personnel in the field or during combat operations is of great importance for maintaining force performance. An indispensable element in the provision of service personnel with food is individual “dry rations”, which are most often formed based on the nutrition of one soldier for one to three days. Of interest was the question of how the nutrition of the service personnel changed in combat operations meanwhile. Objective – to study the historical aspect of nutrition in battle conditions during the period from the Zaporizhzhia Sich to the present day. Materials and methods – literary sources, regulatory documents, research results. The information retrieval and the theoretical analysis method are used. The literature data, legislative and regulatory documents, the results of scientific research related to the nutrition of Ukrainian service personnel in the combat operations for the period from XVII-XXI centuries are analyzed. The evolution of “dry operational ration” over several centuries took place depending on the development of the food industry: from dry products that do not spoil with long-term keepeng (crackers, cereals, dry meat, dry fish), dry food concentrates and canned foods to ready-to-eat first and second courses. The caloric content of dry rations from the middle of the twentieth century ranged from 3100 kcal to 3350 kcal. In the Ukrainian army it is from 3,500 kcal to 3,800 kcal, and only for Joint Force Operation (JFO) – 4,100. Until recently, the energy value (calorific value) of dry rations was calculated without taking into account the actual energy consumption of service personnel in carrying out combat operations. Further studies on improving the nutritional standards of service personnel should be aimed, first of all, at establishing real energy costs when they perform their mission, including military ones.