Medicni perspektivi, 2020;25(3)
2020 Vol. XXV N 3
Key words: pharmaceutical education, quality of education, vocational training trends
Abstract. Trends in the professional training of pharmacy specialists in Ukraine. 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.
Key words: rat embryo, cardiogenesis, cadmium, metal citrate, sulfur citrate, iodine citrate, heart
Abstract. Experimental determination of the accumulation of cadmium salts in the heart of the embryo of rat and their effect on rat cardiogenesis. Nefedova E.A., Halperin A.I., Shatornaya V.F., Shevchenko I.V., Demidenko Yu.V., Pridius I.A., Myasoyed Yu.P. The article discusses the results of an experimental effect of cadmium chloride / cadmium citrate on the cardiogenesis in conditions of intragastric administration to pregnant female rats. The aspect of accumulation of cadmium salts in the heart of the embryo was studied under the condition of daily administration of a salt solution to female rats from the first day of pregnancy to the end of embryogenesis (20 days). In addition to the groups of isolated cadmium administration, there were groups of combined administration of cadmium salts with citrates of germanium, cerium, and the iodine + sulfur composite. The second task was to study the effect of the studied salt solutions on the cardiogenesis of rat’s embryos, for which serial histological sections of the heart were made. The thickness of the compact myocardium of the heart chambers was measured as the main indicator of cardiogenesis. The use of multielement analysis showed that the highest level of cadmium accumulation was found in the group of isolated cadmium citrate administration against the background of a decrease in the zinc content in the heart tissues of the embryo. It has been proven that cadmium citrate maintains a high level of accumulation in the groups with combined administration of cerium citrate, germanium citrate, iodine + sulfur citrate composites, but in these groups the level of zinc in the myocardium significantly increases, which can be regarded as an element of the compensatory effect of cerium citrate, germanium and composite iodine + sulfur. The effect of the indicated doses of cadmium salts on cardiogenesis in rats was reflected in the thickness of the myocardial layer of all chambers of the heart in different ways: cadmium chloride thickened the walls of the left and right ventricles, both atria with a thickening of the interventricular septum. Cadmium citrate provokes thinning of the myocardium of the wall of both ventricles and local thickening of the interventricular septum. In the groups of combined administration, the indicators of the thickness of the compact myocardium restored, which indicates the modifying effect of citrates of the studied trace elements on the cardiotoxicity of cadmium salts.
Key words: dentures, boundary element method, stress-strain state, statistical loads
Abstract. The study of the strength of dentures with different surface reliefs under the action of static loading. 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.
Key words: chronic generalized periodontitis, modeling, regenerative dentistry, laboratory animals
Abstract. Modeling of chronic generalized periodontitis in laboratory animals (literature review). Kopchak O.V., Marchenko N.S., Yanishevska Ya.V. Modern experiments in the study of periodontal deseas are aimed at improving the effectiveness of innovative methods of early diagnosis, treatment and prevention of this disease in patients. The conducted analysis of the literature showed that the disorder of microcirculation occupies one of the leading places in the pathogenesis of periodontitis. Disruption of the microcirculatory bed, based on the dyscirculatory changes of the capillary blood flow is accompanied by a decrease in the intensity of blood filling of vessels, their spasm. These changes, in case of chronization, include tissue disorders of the ischemic nature, up to the development of a capillary stasis. This can lead to disorder in gas exchange, trophism and pathomorphological damage to periodontal tissues. This type of change is most typical for age-related, traumatic, vascular, and stress-induced models. Morphological lesions in the vessels, namely ischemic phenomena were most pronounced in them. Microscopically, this was manifested in the heterogeneity of the epithelial layer, the thickening of individual layers, the detachment of the epithelial lining of the mucosa. As for the basal layer, the most common was the vacuolization of cells, the appearance of a significant number of cells that lacked nuclei (pathology, indicating a decrease in functional activity, impaired regenerative properties of the cell), expansion of intercellular contacts, a sign of tissue edema. In the basal membrane (function - dissociation of the epithelium from the actual lining of the mucous membrane), collagen fibers were loose, hypertrophic, their hyperplasia was observed, neutrophil leukocytes, lymphocytes, histocytes were found between the fibers, this testified to changes in cells. Some models lack a clinical picture of chronic hyperplastic periodontitis. The disorders consisted of changes in normal metabolism in periodontal tissues, decreased immune function, changes in morphological structure without induction of the inflammatory process.
Key words: alloxan-induced hyperglycemia, diabetic encephalopathy, cognitive deficit, metformin, piracetam
Abstract. Experimental substantiation of the expediency of the combined use of piracetam and metformin for pharmacological correction of cognitive disorders in conditions of prolonged hyperglycemia. 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.
Key words: healthcare, medical assistance, NAMS of Ukraine
Abstract. Provision of medical assistance to military personnel and civilians in clinical institutions of the National Academy of Medical Sciences of Ukraine during the ATO/JFO. Tsymbalyuk V.I., Lurin I.A., Zhakhovskiy V.O., Livinskiy V.G., Shvets A.V. Purpose – analysis and generalization of the experience of the National Academy of Medical Sciences (NAMS) of Ukraine and its subordinate research institutions, with clinical units in their structure, on the provision of highly specialized medical care to the wounded, injured, injured and sick servicemen during the anti-terrorist operation and the operation of the Joint Forces (ATO/JFO), as well as the civilian population and internally displaced persons from the temporarily occupied territories. The object of the research is the health care system of military personnel. The subject of the research is the work of the National Academy of Medical Sciences of Ukraine on the organization and provision of medical assistance to military personnel and civilians during the ATO/JFO. Research methods: bibliographic, statistical, analytical, systems approach. The NAMS of Ukraine and its subordinate research institutions, with clinical units in the structure, during the ATO/JFO took an active part in the provision of medical care to the wounded, injured, injured and sick servicemen of the Armed Forces of Ukraine and other military formations. The work of the NAMS of Ukraine in providing medical assistance to servicemen was multi-vector and was carried out in several directions: organizational, direct provision of medical care and its scientific support. Clinical institutions of the NAMS of Ukraine during the ATO/JFO did not stop providing highly specialized medical care to the civilian population of Ukraine, including internally displaced persons from the areas of the ATO/JFO. Thanks to the coordinated activities of the Presidium of the NAMS of Ukraine and its subordinate research institutions, a significant contribution has been made to the provision of highly specialized medical care to the wounded, injured and sick servicemen, as well as internally displaced persons from the temporarily occupied territories.
Key words: acute ST-elevation myocardial infarction, morphological features of thrombi, manual thromboaspiration, prognosis, percutaneous coronary intervention
Abstract. Correlations between morphological features of intracoronary thrombi and left ventricular structure and function in patients with ST-segment elevation myocardial infarction. Zerbino D.D., Besh D.I., Sokolov M.Yu., Besh O.M. The majority of cases of acute ST-elevation myocardial infarction (STEMI) are caused by the rupture of an atherosclerotic plaque and subsequent thrombus formation. The study of clot structure may be important for the prediction of further course of the disease. The study included 100 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with manual thromboaspiration within the first 12 hours after the onset of symptoms. Sufficient aspiration material for histological examination was obtained in 97 patients. These intracoronary thrombi were investigated macroscopically and microscopically. Subsequently, correlations between morphological structure of thrombi and structural and functional features of the myocardium after revascularization were analyzed. Pathological QS pattern was detected in 45 (46.39±5.06%) patients. Peripheral infiltration of intracoronary thrombus with neutrophils was the only morphological feature associated with the presence of QS (r= -0.36; p<0.001). The mean left ventricular ejection fraction (LVEF) measured during echocardiography was 48.34±9.39%. Positive and significant correlation was found between LVEF and peripheral infiltration of intracoronary thrombus with neutrophils (r=0.37; p<0.001), while negative correlation was found between LVEF and presence of microchannels within the clot (r= -0.27; p<0.01). The mean total segmental left ventricular contractility index at the time of hospital discharge was 1.38 [1.25; 1.63]. This index negatively correlated with neutrophil infiltration (r= -0.37; p<0.001), and positively – with the presence of microchannels in the obtained clot samples (r=0.26; p=0.01). Signs of left ventricular aneurysm formation before discharge from the hospital were found in 15 (15.46±3.67%) patients. A significant negative correlation was found between this parameter and the presence of peripheral neutrophil infiltration of intracoronary thrombi (r= -0.32; p<0.01). The presence of peripheral infiltration of intracoronary thrombi with neutrophil leukocytes was associated with better left ventricular systolic function and less likely hood of development of left ventricular aneurysm or electrocardiographic QS pattern. The formation of microchannels within the clot was associated with poorer recovery of systolic cardiac function.
Key words: coronary artery calcium score, glomerular filtration rate, sex, age, blood pressure, cholesterol
Abstract. The association of coronary artery calcium score with glomerular filtration rate and the influence of sex, age, blood pressure, and cholesterol. 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.
Key words: carotid endarterectomy, restenosis, carotid artery disease
Abstract. Low rates of restenosis in primary lateral carotid artery endarterectomy. Mackevičius A., Mosenko V., Laurikėnas K., Šatavičiūtė A., Baltrūnas T., Chernyaha-Royko U., Demkova N., Bardachenko L. Carotid artery endarterectomy (CAE) is a treatment of choice for symptomatic and asymptomatic high-grade carotid stenosis, showing great results in reducing stroke morbidity. The optimal technique of the arterial closure is, however, still under discussion, with both patch angioplasty and primary closure having numerous advantages and pitfalls. The definite evidence is still lacking. The aim of this study was to evaluate the results of the modified primary closure technique during CEA. Incidence of restenosis more than 8 months after the surgery was measured. A retrospective observational study to evaluate modified primary internal carotid artery closure was conducted in Republican Vilnius University Hospital from January 1st, 2014 to December 31st, 2018. The patients were enrolled in the trial during their routine follow-up by their surgeon. During the visit, after an informed consent was signed, a qualified investigator performed carotid duplex ultrasound scan, documenting the restenosis rates. Patients also filled in the comorbidity assessment questionnaire, which included their smoking habits, history of hypertension and their adherence to antihypertensive medication as well as cholesterol levels and statin therapy, additional related comorbidities. Out of 342 patients that underwent CAE with primary closure in the Republican Vilnius university hospital from 2014 to 2018, 42 patients were identified as deceased, therefore a follow-up was impossible. Out of planned 150 (50%) consequently selected patients, 125 gave an informed consent to be enrolled into the study. Out of those 6 pre-occlusions were established during the review of the patient medical data and therefore were excluded from the study. In general, we analyzed the data of 119 patients and 125 CAE with a modified primary suture closure. The mean follow-up time was 35.78 months (SE 0.992; SD 11,046). At the time of a follow up, 3 (2,4%) carotid artery occlusions were identified and promptly evaluated. Restenosis rates varied: 5,6% of patients had low grade (<50%), 5,6% had moderate grade (50-69%) and 1,6% had high grade (70-99%) stenosis. The modified lateral CAE with primary closure technique, used in our hospital’s contemporary practice has shown to be a promising alternative to the classical primary suture, due to reduced restenosis rates. More prospective and randomized studies are needed to evaluate this technique in comparison to other CAE closure techniques.
Key words: laryngeal papillomatosis, immunological reactivity, antirelapse therapy, antiviral quadrivalent vaccine
Abstract. Dynamics of immunological reactivity indices in patients with laryngal papillomatosis at different periods after complex treatment with antivirus qudrivalent vaccine "Gardasil". 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.
Key words: fatty tissue, autolipografting, skin scars, morphological, immunohistochemical research
Abstract. Morphological features of skin scars on the background of treatment with autologous adipocytes. Baranov І.V., Nor N.M., Slesarenko S.V., Badiul P.О., Tsyhankov К.V. So far the pathogenesis of changes and reconstruction of recipient tissues after transplantation of autologous adipocytes have not been studied sufficiently. The purpose of the research was to carry out the estimation of efficiency and morphological grounding of the surgery of transplanting autologous adipocytes for treating skin scars. The study included 35 patients (12 males and 23 females at the age of 18-55 years) with skin scars after deep burns. The majority of patients were with atrophic scars – 25 (71.4%); with hypertrophic – 8 (22.9%); with normotrophic – 2 (5.7%). To verify the processes in scar tissues the histological biopsy examination of the scar tissue was carried out; the samples were taken from patients with post-burn skin scars before and after the operation of transplanting autologous adipocytes. Sections were studied and photographed under the microscope Zeiss "Primo Star", photocamera DCM 500. To verify the mechanism of action of autoadipocytes on the reparative processes in the scar tissues, biopsy of 11 patients with atrophic scars was studied, with immunohistochemical methods of determining CD-34 + - cells with the help of monoclonal mouse antibodies to CD-34 (clone QBEnd/10) and determination of Ki-67– antigen in the nucleus of cells in all phases of the cellular cycle, except for G0 which was studied with the help of monoclonal rabbit antibodies (clone SP6), Thermo Scientific, USA. The carried out research has shown that after transplantation of autologous adipocytes in patients with post-burn scars, the process of tissue reconstruction starts in the recipient area. On the 12th and 21st day after the operation in areas of hyalinosis there was “discementing” and “separation” of collagen fibers, which may testify in favor of the probable lysis of the smallest dense hyaline deposits by the enzymes of the transplanted autologous adipocytes, in particular by lipoproteinlipasa. Thus there was a release of the skin fiber structures from lipoproteins of the blood plasma, the drainage function of the stroma and circulation of the tissue fluid were restored, intercellular communication was mitigated. In the tissue gaps which were freed from massive molecular deposits and polymers, capillaries were formed. Thus the total number of CD34 + - elements in biopsy before the operation on average was 39.3±7.3 (p<0.01), on the 14th day after the operation this indicator increased up to 53.5±11.0 (p<0.01), and on the 21st day it reached 83,4+22,8 (p<0.01), that is it has increased twice in comparison with the values before the operation. According to the results of the immunohistochemical research of the proliferative activity of Ki-67 cells in all cases the positive reaction was observed exclusively in cells of the basal multi-layered keratinized squamous epithelium, cells of glandular and peloid appendages of skin. In the areas where there were CD34 + - elements among the bundles of collagen fibers, reaction with Ki-67 was negative. Only in scar biopsy on the 21st day after the operation, in hypoderm there were singular epithelioid cells near gaps with extracellular fat which had Ki-67+ reaction. The increase in the number of endothelium and other CD34+ elements testifies in favor of transformation of the transplanted autologous fat cells in endothelium and other CD34+ cells.
Key words: bronchiectasis, sputum, drug resistance, Pseudomonas aeruginosa
Abstract. Microbiological profile of sputum in stable adult patients with bronchiectasis in the Dnipro region of Ukraine. 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.
Key words: varicose veins, radiofrequency ablation, venous hemodynamics, venous ulcers, monoablation
Abstract. Stem radiofrequency monoablation in the treatment of decompensated forms of varicose veins of the lower extremities. Kutovyi O.B., Sokolov O.V. Main recommendations in treatment of decompensated forms of varicose veins of the lower extremities, accompanied with the formation of trophic ulcers (stage C6 according to CEAP classification) are the use of compression therapy and various surgical procedures. In this case, the way of choosing a treatment tactic, taking into account the characteristics of venous circulation in the limbs, remains to be incomplete in every single case. The aim of the work is comparative evaluation of the results of using radiofrequency (RF) ablation of the trunk of the saphenous vein in patients with varicose veins of the lower extremities in stage C6, provided that pathologically altered tributaries are preserved or removed. The study included 59 patients with varicose veins of the lower extremities in stage C6, with reflux in the large saphenous vein pool. The total number of men was 17 (28.8%), women – 52 (71.2%). The age of patients ranged from 44 to 87 years (mean age 59.9±7.9 years). The average area of trophic ulcers was 9.6±5.7 cm2. During analysis of postoperative complications on day 7, hematomas and ecchymoses appeared in 29 (96.7%) patients of group I and only in 8 (27.6%) patients of group II. 1 month after the operation, hematoma residues were observed in 3 patients (10%) of I group and were absent in patients of II group. Also, in the postoperative period (day 7 and 1 month), we observed neuropathy phenomena in 3 (10.0%) patients of I group and 1 (3.45%) of a patient of II group. At the end of the follow-up period (6 months), neuropathy phenomena persisted in 2 (6.7%) patients of 1 group, while they were absent in patients of II group. During the first month after surgery, patients showed a significant decrease in leg swelling by 2.4% in I group and by 3.9% in II group. 1 month after the initial intervention, residual varicose-deformed inflows appeared in 5 patients (16.7%) of I group, and in 12 patients (41.4%) of II group (p<0.005). Relapse of an ulcer 6 months after surgery was detected in 2 (6.7%) patients of I group. Comparative results of stem RF monoablation and combined surgery using miniphlebectomy were comparable in terms of the degree of elimination of vertical reflux, reducing the severity of CVI (chronic vein insufficiency, the number of relapses of varicose veins, the healing speed and the frequency of relapse of trophic ulcers. Moreover, the performance of RF monoablation was accompanied by a significant reduction in the volume of drugs for local anesthesia, leading to a more significant decrease in the intensity of pain after surgery, the number of complications, in particular neuropathy, and to improvement in the quality of life. The number of additional sources of pathological horizontal reflux along incomprtent perforating veins and residual varicose-deformed tributaries after surgery requiring corrective interventions were comparable in both groups. Thus, the presence of horizontal reflux is not critical when choosing the method of primary surgical intervention.
Key worlds: HIV-infection, diphtheria, tetanus, immunity, adults, correlation analysis
Abstract. Clinical and laboratory predictors of antitoxic immunity against diphtheria and tetanus in adults with HIV infection. 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.
Key words: radical prostatectomy, pelvic lymph node dissection
Abstract. When the limited pelvic lymph node dissection in prostate cancer patients can be justified? Molchanov R.M., Stakhovskyi E.O., Kriachkova L.V., Pilin Ye.V., Malinovskyi S.L. Extended pelvic lymph node dissection (PLND) is an important diagnostic step in the surgical treatment of moderate and high risk prostate cancer (PCa) according to D'Amico criteria. However, it has a number of complications and prolonged time of surgery. Limited PLND has a more favorable complication profile, but is not used because of its low diagnostic efficacy in low-risk RP patients, while in higher-risk groups its relevance remains controversial. The goal – to determine the diagnostic efficacy of limited PLND in radical prostatectomy in patients of moderate and high risk. A retrospective analysis included 377 PCa patients in whom the radical prostatectomy with PLND was performed in the period between 2013 and 2016. Patients' age was 63.4±6.2 y.o. 40 (10.6%) patients had low, 126 (33.4%) – moderate and 211 (56.0%) – high risk PCa. No statistically significant differences in the number of complications of PLND in open and laparoscopic surgery (p=0.16) were found. The overall frequency of complications was 22.8% (95% CI 18.6 - 27.1). When comparing clinical and histological parameters in groups with and without metastases, statistically significant differences were found between the levels of total prostate specific antigen before surgery (p=0.010); the Gleason score (corresponding median values of 8.0 (8.0; 9.0) and 7.0 (6.0; 7.0); p<0.001) and local tumor status (T) – the patients with stage >T2 53.1% and 19.4%, respectively (p<0.001). In 32 (8.5%) patients metastatic lesions of lymphatic nodes were found. Of these, 28 (87.5%) were related to high- risk, 4 (12.5%) – to moderate- risk. The main prognostic criteria for lymph node metastasis are preoperative PSA level, the Gleason Score, and T-status of the tumor. According to ROC analysis, the diagnostic efficacy of limited PLND increases in patients at high and moderate risk at a total PSA level greater than 18.4 ng/ml. This can be used to justify the indications for limited PLND in patients in these groups to reduce the number of postoperative complications associated with extended procedure.
Key words: esophageal perforation, purulent mediastinitis, surgical tactics
Abstract. Features of surgical treatment of esophageal injuries complicated by purulent mediastinitis. 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%.
Key words: colorectal cancer, colorectal anastomosis, complications
Abstract. "End-to-end" and "end-to-side” colorectal anastomosis: does the selection of surgical tactics influence insufficiency of the apparatus anastomosis? Savenkov D.Yu., Bielosludtsev O.D., Siryi S.S. It is still uncertain whether the choice of “end-to-end” or “end-to-side” anastomosis affects the risk of anastomosis insufficiency, with low anterior resections of the rectum in patients with colorectal cancer. The aim of our work was to determine the influence of choosing the surgical tactics of overlaying colorectal “end-to-end” or “end-to-side” anastomosis on the frequency and severity of the anastomosis leak in patients after rectal resection and postoperative recovery period. A retrospective analysis of the medical documentation of patients after anterior resection of the rectum in relation to rectal cancer was performed. Depending on the type of anastomosis the patients were divided into two groups: group 1 – patients with “end-to-end” anastomosis, group 2 – patients with “end-to-side” anastomosis. Surgical complications including the frequency and severity of intestinal anastomosis leak were analyzed. The total number of postoperative complications among patients in group 1 was by 2 times more frequent than in patients in group 2, and analysis of their severity points on advantage of overlaying “end-to-side” anastomosis. Thus, in 3 (20.0%) patients of group 1 there was a partial failure of anastomosis of the class B, in 2 (13.3%) patients – a partial failure of anastomosis of the class C, in 2 (13.3%) patients there was peritonitis; in 1 (6.7%) patient we found lymphorrhea. While in patients of group 2 there were isolated complications (partial failure of anastomosis of class B was in 2 (14.3%) patients, postoperative seroma was in 2 (14.3%) patients. However, partial failure of anastomosis of class C, peritonitis or lymphorrhea were absent. The number of days from surgery to discharge in patients of group 2 was less (9 [7–13] days compared with 13.0 [9–20] days in patients of group 1). In patients with rectal cancer after anterior rectum resection, the choice of surgical tactics of overlaying of colorectal “end-to-end” or “end-to-side” anastomoses influences the frequency of formation of anastomosis insufficiency; “end-to-side” anastomoses overlay reduces the frequency and severity of the colorectal anastomoses leak, which reduces the postoperative recovery period.
Key words: generalized periodontitis, aggressive periodontitis, systemic enzyme therapy, Wobenzym, recombinant morphogenetic protein, rhBMP-2, treatment of periodontitis
Abstract. Treatment of aggressive (rapidly progressing) generalized periodontitis using systemic enzyme therapy in combination with osteoinductive medicines. 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.
Key words: diabetes mellitus, oral mucosa, generalized periodontitis, tooth decay
Abstract. The state of oral mucosa in patients with type 2 diabetes. Shnaider S.A., Skyba V.Ya., Skyba O.V., Babenya H.O., Varzhapetian S.D. Aspects of the relationship between somatic and dental diseases are multifaceted. The bi-directional, mutually aggravating nature of the relationship between somatic and dental pathology is exemplified by diabetes mellitus. Numerous studies indicate that uncontrolled diabetes contributes to a multiple increase in the risk of caries and tooth loss, damage to the salivary glands, periodontium and oral mucosa. Given that diabetes affects all the main components of the etiology and pathogenesis of dental diseases, the urgent task of dentistry is to develop adequate methods for the treatment and prevention of dental pathology due to the presence of diabetes in the patient, which cannot be done without assessing the dental status of patients in this category. The purpose of the study was a comparative assessment of the state of oral tissues in patients with type 2 diabetes and in people of the similar age without somatic pathology. We examined 70 patients aged 34-48 years, of which 35 patients with type 2 diabetes and 35 healthy individuals of the similar age. Recruitment of patients with diabetes was carried out on the basis of the Communal non-profit enterprise "Odessa Regional Endocrinological Dispensary." All patients were clinically and radiologically examined. It was shown that the prevalence and intensity of the carious process in people with diabetes did not differ from the control group, however, the “M” component prevailed in the structure of the DMF index, the need for prosthetics was 79.1%. Hygiene was by 21.8% worse. All patients with diabetes were diagnosed with generalized periodontitis with the prevalence of an exacerbated course (25.7% more) and a direct dependence of the severity of periodontitis from the degree of decompensation of diabetes. Periodontal indices in patients with diabetes were increased: PMA index – by 70.6%, bleeding index – by 2 times, Russell index – by 1.9 times. In 63.6% of patients with diabetes, changes in the oral mucosa were noted. 25.7% of patients noted the development of candidal stomatitis / glossitis in the past. The functional activity of the salivary glands was reduced by 38.1%. Microcrystallization of saliva in patients with diabetes is represented mainly by IV and V classes according to Leus-Kukina, which indicates its reduced mineralizing ability and the maximum risk of tooth decay.
Key words: working conditions of teachers, morbidity of teachers, chronic laryngitis, voce load, prevention of occupational laryngitis, therapy of occupational laryngitis
Abstract. Prevention of occupational laryngitis in teachers. 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.
Key words: nanoparticles, fine fractions, air of working zone, occupational risk
Abstract. Nanoparticles in the air of the working zone as a risk factor for the health of workers of various industries. Sevalnev A.I., Sharavara L.P., Kutsak A.V., Nefodov O.O., Zemliynyi O.A., Pisarevskyi K.I., Shevchenko O.S. Purpose: analysis of scientific literature, summarizing data on domestic and foreign experience of assessing the determination of nanoparticles in the air of the working zone as a risk factor for the health of workers of various industries. The article analyzes the literature data on the study of the content of fine dust and nanoparticles in the atmospheric air and air of the working zone of different industries. Numerous studies indicate that fine dust is contained in the emissions of many industrial enterprises. According to the World Health Organization by level of impact on human health, suspended particles in the air and especially in the air of the working zone belong to the priority pollutants. Evaluation of the dust content in the air of large industrial cities is particularly relevant, because of a large number of sources of dust emissions of various origins in urban areas. Various technological processes contribute to the formation of fine dust and nanoparticles which pollute the ambient air and the air of the working zone. Data on the negative impact of fine dust and nanoparticles on health of workers are presented. Attention is paid to the problem of hygienic assessment of nanoscale dust content in the working zone air. The obtained results indicate that today the issues of studying the physicochemical properties of nanoparticles, their toxicity to the body, analysis of potential risks to humans, the development of an effective and reliable system for monitoring ultrafine particles in the environment and the production environment are still relevant as for informing employees about the risks involved, reducing and preventing harmful effects on humans. The potential negative effects on workers’ health determine the need and opportunity for further research in this area.
Key words: dietary supplements, questionnaire survey, statistical analysis, volumes of DS sales, pharmaceutical facilities, laboratory research, risks, safety
Abstract. Study and analysis of the situation regarding the consumption of dietary supplements by the population of Ukraine. 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.
Key words: children, incidence, prevalence, bronchial asthma, environment, pollutants
Abstract. Bronchial asthma in children of Ukraine: medical and environmental parallels of morbidity and prevalence. Volosovets O.P., Bolbot Y.K., Kryvopustov S.P., Mozyrska O.V., Kryvopustova M.V., Prokhorova M.P., Kupkina A.V. Bronchial asthma is one of the most common non-infectious diseases of children worldwide. More than half of such clinical cases may lead to functional disability and significantly affects the quality of life of a sick child. The aim of the study was to research trends in the incidence and prevalence of bronchial asthma among children in different regions of Ukraine over the past 25 years and assess the effect of air pollutant emissions from stationary sources in the region of children residence on the incidence and prevalence of bronchial asthma among them. According to the Center for Medical Statistics of the Ministry of Health of Ukraine, the incidence of bronchial asthma among children aged 0-17 years was 4513 0.59 of new cases per 1000 population in 2017. Prevalence of this disease was 37246 cases (4.91 per 1000 population). The majority of newly diagnosed bronchial asthma cases was observed in children aged 7-14 years – 2439 or 54.0% of the total, which is in line with global trends. The highest incidence and prevalence in all three age groups was observed among children of Kyiv and Kharkiv, Zaporizhia, Vinnitsa, Dnipropetrovsk, Donetsk regions. We have discovered a direct and close connection (ρ=0.741) between the reduction of air pollutant emissions from stationary sources and decreasing of the prevalence of bronchial asthma among children in recent years. Over the past 25 years in Ukraine there has been 69.3% increase in prevalence and 22.9% increase in incidence of bronchial asthma among children. Predominance of detecting this pathology was in the group of children from large industrial and agro-industrial regions of the country with significant volumes of atmospheric pollutants from stationary sources of pollution.
Key words: public management and administration, health care, senior healthcare personnel, training of the healthcare system personnel, educational programs
Abstract. Identifying training needs of healthcare managers of Ukraine. 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.
Key words: principle of anonymity, anatomical material transplantation, donor, recipient, confidential information
Abstract. Donor anonymity: national legal regulation and international experience. Shpuhanych I.I., Diukarieva-Berzhanina K.Yu., Yavorska O.S. The article is devoted to the analysis of legal, medical, moral and ethical aspects of the principle of donor anonymity. The principle of anonymity has a legal framework and appropriate regulation in international documents. These are: Directive on standards of quality and safety of human organs intended for transplantation, WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine and the Additional Protocol etc. This principle is the basis of the legislative regulation of donation in many countries, including Ukraine. The normative approaches to the legal regulation of donation and the principle of anonymity in accordance with national legislation are investigated. The Law of Ukraine "On the Application of Transplantation of Anatomical Materials to Man" bylaws and the application of the principle of anonymity depending on the type of donation: posthumous and lifetime are analyzed. The international experience of applying the principle of anonymity is characterized. The principle of absolute anonymity is enshrined, in particular, in the legislation of the Netherlands, Sweden. Accordingly, such regulatory approaches exclude any contact between the donor and the recipient. According to the principle of conditional anonymity (in particular, the United States and the United Kingdom), the exchange of information between the donor and the recipient is permitted, surely at the will. The advantages and disadvantages of direct communication between the donor and the recipient are described. The expediency of applying the principle of conditional anonymity in national practice is substantiated regarding moral, ethical, and psychological aspects. In order to implement this, it is proposed to consolidate the right of the donor and the recipient to approve or deny the data exchange at the legislative level. It is suggested to assign the appropriate functions aimed at facilitating the parties' interaction to the transplant coordinator.
Key words: West Nile Virus, West Nile Fever, arbovirus infection, Poltava Region, central part of Ukraine
Аbstract. West Nile Fever in the central part of Ukraine. 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.
IN MEMORY OF THE SCIENTIST