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Medicni perspektivi, 2021;26(4)

2021 Vol. XXVI N 4

Published

2021-12-20

THEORETICAL MEDICINE

Tsymbalyuk V.I., Lurin I.A., Usenko O.Yu., Gumeniuk K.V., Krymchuk S.G., Gryshchenko O.V., Lopatuk K.A. Results of experimental research of wound ballistics of separate types and calibers of modern bullets

Tsymbalyuk V.I., Lurin I.A., Usenko O.Yu., Gumeniuk K.V., Krymchuk S.G., Gryshchenko O.V., Lopatuk K.A. Results of experimental research of wound ballistics of separate types and calibers of modern bullets

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https://doi.org/10.26641/2307-0404.2021.4.247409

Key words: wound ballistics, ballistic plasticine, expansive properties of a sphere, fragmentation, flower of death

Abstract. Results of experimental research of wound ballistics of separate types and calibers of modern bullets. Tsymbalyuk V.I., Lurin I.A., Usenko O.Yu., Gumeniuk K.V., Krymchuk S.G., Gryshchenko O.V., Lopatuk K.A. There was made the analysis of wound ballistics of modern expansive bullets in comparison with shell bullets on 25 blocks of ballistic plasticine (ROMA PLASTILINA No. 1, Ballistic Testing Backing Material), made in the USA, in which one shot from an AKS-74 automatic firearm and carbine ZBROYAR Z-10 with an optical sight was fired. The bullet speed was the highest in 5.45x39 caliber cartridge with a V-max bullet. – 1185 m/s, low in the bullet caliber cartridge .308 Win with a bullet SP, – 664 m/s. The difference is significant at the level of significance α=0.05. In terms of the size of the entrance hole, the largest is from the bullet of cartridge .308 Win with a bullet SP – 10.0 cm, the smallest - from the bullet "PS" with a steel core 5.45x39 mm, cartridge sample of the year 1974 (7H6) – 1.2 cm. The difference is significant at the level of significance α=0.05. In the expansive bullet of type "V-Max" of shortgun cartridge of caliber 5.45x39 mm, the size of the entrance hole was 9.1 cm, with asterial shape having radial gaps and turned edges of ballistic plasticine on the outside. All cartridges with expansive bullets did not have an exit hole after the shot. The dimensions of the formed residual cavity were the largest after firing with .308 Win caliber cartridge with a bullet SP – 25.0x5.0 cm., the smallest – bullet of a military caliber cartridge of 5.45x39 mm (7H6) – 6.0x4.0 cm. The difference is significant at significance level α=0.05. The shape and character of the residual cavity in ballistic plasticine was significant for all expansive bullets, in contrast to the bullet of a military cartridge 5.45x39 mm (7H6), where no such changes are detected. The considerable signs of expansion properties and deformation of the bullet in the form of a "flower of death" were identified in the bullet of caliber cartridge .308 Win with a bullet SP, other bullets with expansive properties showed significant fragmentation, with the location of fragments both in the residual cavity and outside its borders at different distances. Expansive bullets differ significantly at the level of significance α=0.05. The low flight speed of bullets (m/s) of .308 Win caliber cartridges with bullets BTHP and SP is due to their structure, weight, and caliber. Bullet of type V-max with cartridge 5.45x39 mm has the highest speed – 1185 m/s, and due to its design has significant expansive properties. Common to expansive bullets is a entrance hole, the blind nature of the lesion with the presence of a large residual cavity, which is due to kinetic energy return 114.37 E, J/mm2 inside the object of lesion. Fragmentation of expansion bullets occurs inside an object with fragments located at different distances. A .308 Win caliber cartridge with SP bullet causes deformation of s bullet by the type of "death flower" causing significant damage.

Zhyliuk V.I., Lievykh A.E., Shevtsova A.I., Tkachenko V.A, Kharchenko Yu.V. The impact of perindopril and metformin on the markers of endothelial dysfunction in rats with acute intracerebral hemorrhage and type 2 diabetes mellitus

Zhyliuk V.I., Lievykh A.E., Shevtsova A.I., Tkachenko V.A, Kharchenko Yu.V. The impact of perindopril and metformin on the markers of endothelial dysfunction in rats with acute intracerebral hemorrhage and type 2 diabetes mellitus

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https://doi.org/10.26641/2307-0404.2021.4.248055

Key words: type 2 diabetes mellitus, endothelial dysfunction, intracerebral hemorrhage, perindopril, metformin

Abstract. The impact of perindopril and metformin on the markers of endothelial dysfunction in rats with acute intracerebral hemorrhage and type 2 diabetes mellitus. Zhyliuk V.I., Lievykh A.E., Shevtsova A.I., Tkachenko V.A, Kharchenko Yu.V. This comparative research is aimed to study the effect of perindopril and metformin on the levels of biochemical markers of endothelial dysfunction in rats with type 2 diabetes mellitus (T2DM) complicated by a brain hemorrhage. The study was carried out on 30 white male Wistar rats. T2DM was simulated by a single intraperitoneal injection of nicotinamide and streptozotocin (NA/STZ). Intracerebral hemorrhage (ICH) was induced by microinjection of 1 μL of bacterial collagenase 0.2 IU/μL into the striatum on the 60th day of the experiment. Animals were randomized into 5 groups: A – negative control (intact, n=6); B – positive control 1 (NA/STZ, n=6); C – positive control 2 (NA/STZ+ICH, n=6); D – perindopril (“Prestarium”, 2 mg/kg+NA/STZ+ICH, n=6); E – metformin (“Siofor”, 250 mg/kg+NA/STZ+ICH, n=6). The studied drugs were administered intragastrically for 20 days, starting from the 50th day after the induction of T2DM. Endothelial function was assessed by the content of homocysteine (Hcy), advanced glycation end products (AGEs), endothelin-1 (ET-1), and von Willebrand factor (vWF) in blood serum. It was found that long-term separate T2DM is accompanied by hyperhomocysteinemia, as well as an increase in AGEs, ET-1, and vWF levels, indicating dysregulation of the hemostasis system and vascular tone. It should be noted that brain hemorrhage in T2DM can enhance these manifestations, although the obtained differences were characterized only by a persistent trend. At the same time, the effect of perindopril was limited only by a significant decrease in AGEs levels by 31.2% (p<0.05). In turn, the action of metformin was characterized by a positive glycemic control, as well as an effect on the state of the vascular endothelium, namely, a significant decrease in AGEs, ET-1 and vWF levels by 37.6% (p<0.05); 5.5% (p<0.05) and 9.5% (p<0.05), respectively. It was also found that the endotheliotropic properties of the studied drugs were not associated with an effect on homocysteine levels. Thus, metformin in conditions of diabetes mellitus complicated by acute intracerebral hemorrhage has advantages over perindopril in relation to endothelial dysfunction.

Koval S.M., Snihurska I.O. Role of gut microbiota in the pathogenesis of type 2 diabetes mellitus (literature review)

Yuryeva L.M., Sharun A.I. Аdjustment disorders in students who have suffered psychoemotional stress: systematic review of diagnostics, treatment and preventive care

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https://doi.org/10.26641/2307-0404.2021.4.248082

Key words: students, adjustment disoders, psychoemotional stress, psychocorrection, prevention

Abstract. Аdjustment disorders in students who have suffered psychoemotional stress: systematic review of diagnostics, treatment and preventive care. Yuryeva L.M., Sharun A.I. Currently, the mental health problem of students, which often leads to the creation of unfavorable foundations for the development of non-psychotic mental disorders, is particularly relevant and socially significant. The purpose of this article was to conduct a systematic literature review of the current state of the problems of students` adjustment disorders, taking into account interventions aimed at preventing and correcting them, and analyzing the results. We searched the electronic databases Oxford, Google Scholar, PubMed, Medline and Web of Science, ScienceDirect, Scopus, Cyberleninka, PsycInfo on prevalence, adverse effects, and interventions in students with adjustment disorders. Of the 25 studies published over the period from 2004 to 2020, 10 (40%) data on treatment and preventive measures are reported. The search revealed that interventions aimed at correcting and preventing adjustment disorders in students may improve various aspects of well-being, including psychological, pedagogical and medical ones. However, the evidence is limited by the relative inadequacy of long-term and reliable experimental studies. In view of this, it is advisable to further implement larger projects and conduct broader and longer-term research, which will contribute to a more reliable and in-depth study of the impact and effectiveness of such interventions. Based on a scientific search, the theoretical and methodological foundations of psychocorrection of students with adjustment disorders are substantiated, taking into account the specifics of the mental functioning of this category. While there are few works devoted to the study of developmental issues, clinical and psychopathological features, dynamics of non-psychotic mental disorders, taking into account gender and organizational factors in university students in the context of higher education reform, such issues require further study applying systemic approach in order to develop and implement in practice the early diagnosis as well as corrective and preventive measures.

Lukashchuk S.V., Lemko O.I. Possibilities of rehabilitation treatment of children with lymphoblastic leukemia (literary review)

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https://doi.org/10.26641/2307-0404.2021.4.248084

Key words: children, lymphoblastic leukemia, rehabilitation

Abstract. Possibilities of rehabilitation treatment of children with lymphoblastic leukemia (literary review). Lukashchuk S.V., Lemko O.I. According to nowaday protocols of acute lymphoblastic leukemia (ALL) treatment, the percentage of recovering patients has increased significantly. This determines the necessity for comlex long-term rehabilitation, as chemotherapeutic drugs are highly toxic and contribute to the development of comorbid diseases of the gastrointestinal tract, nervous and musculosceletal systems. The purpose of the study was to review and analyze data from foreign and domestic literature concerning possibilities for rehabilitative treatment of children with ALL and to reveal informative methods assessing the effectiveness of rehabilitation. Important elements of rehabilitation goals and assessment of its the effectiveness are the International Classification of Functioning, Disability and Health of Children and Adolescents, and the Quality of Childrens’ Life. Rehabilitation begins at the hospital and includes psychological support for the child with the involvement of psychotherapists and family, as well as the performance of certain physical exercises lasting for 15-30 minutes, which are selected individually, taking into account the functional capabilities and motivation of the child. After the acute period, physical activity is carried out in accordance with an individual plan, which takes into account the peculiarities of the disease and includes active video games, cycling and other activities. Rehabilitation treatment on the basis of sanatorium-resort institutions with the participation of a multidisciplinary team is actual. Such treatment, in addition to physical exercises, includes the use of natural and preformed physical factors in order to influence the manifestations of comorbid pathology, and also contributes to an increase of the social activity and independence of the child. However, the number of such studies is limited, which determines the necessity to develop clear practical recommendations regarding methods of exposure, their duration and intensity.

CLINICAL MEDICINE

Shostakovych-Koretskaya L.R., Kireyeva T.V., Shevchenko-Makarenko O.P., Turchin MO., Chumak V.I., Chortok V.O., Drobyshevska O.M. Clinical and laboratory markers of the new coronavirus disease SARS-CoV-2 COVID-19 in hospitalized patients

Shostakovych-Koretskaya L.R., Kireyeva T.V., Shevchenko-Makarenko O.P., Turchin MO., Chumak V.I., Chortok V.O., Drobyshevska O.M. Clinical and laboratory markers of the new coronavirus disease SARS-CoV-2 COVID-19 in hospitalized patients

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https://doi.org/10.26641/2307-0404.2021.4.248085

Key words: coronavirus disease, COVID-19, SARS-CoV-2, 2019-nCoV, pneumonia, antiviral therapy, invasive mechanical ventilation

Abstract. Clinical and laboratory markers of the new coronavirus disease SARS-CoV-2 COVID-19 in hospitalized patients. Shostakovych-Koretskaya L.R., Kireyeva T.V., Shevchenko-Makarenko O.P., Turchin MO., Chumak V.I., Chortok V.O., Drobyshevska O.M. The prognostic predictors of an unfavorable course of coronavirus disease (COVID-19) and its complications with manifestations of pneumonia and the need for oxygen support and connection to the invasive mechanical ventilation were studied. Clinical and laboratory associations in hospitalized patients with COVID-19 were evaluated, the possible predictors of connection to the invasive mechanical ventilator in 37 patients were identified. Patients were hospitalized on day 6.65±3.32 of the disease, blood oxygen saturation (SpO2) depended on the severity of the disease and response to therapy. Positive significant correlations between the level of growth stimulating factor (ST2) and D-Dimer, creatine phosphokinase MB fraction (CPK-MB) and D-dimmer, CPK-MB and ST2 were revealed, as well as of ferritin and D-Dimer with ST2. There were no significant associations with troponin. C-reactive protein (CRP) probably correlated with CPK-MB and ferritin. The International Normalized Ratio (INR) indicator had significant correlations with D-dimmer, ST2 and CPK-MB. Cox regression analysis showed that the survival curve has a stepwised nature and the highest risk of deterioration, which requires mechanical ventilation, was noted on the 6th day of illness (95.0% CI = 0.9-1.0, with an average SpO₂ level =87.3%). ROC analysis showed the presence of a possible relationship between D-Dimer, ST2 protein, CPK-MB and the risk of developing a critical condition requiring mechanical ventilation in patients. The study showed that COVID-19 disease has a phase nature, when after the first phase of the disease, the pulmonary phase and hypercytokinemia progress in some patients with the development of hypoxia, a decrease in SpO₂. Therefore, the identification of markers of disease progression is essential for predicting the course and possible prevention of the development of acute respiratory distress syndrome with the use of invasive mechanical ventilation.

Gavrysyuk V.K., Merenkova I.O., Gumeniuk G.L., Pendalchuk N.V., Morska N.D., Vlasova N.A. Efficacy and tolerability of methotrexate at a dose of 15 mg/week and 10 mg/week in patients with pulmonary sarcoidosis

Gavrysyuk V.K., Merenkova I.O., Gumeniuk G.L., Pendalchuk N.V., Morska N.D., Vlasova N.A. Efficacy and tolerability of methotrexate at a dose of 15 mg/week and 10 mg/week in patients with pulmonary sarcoidosis

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https://doi.org/10.26641/2307-0404.2021.4.248088

Key words: pulmonary sarcoidosis, methotrexate, efficacy, tolerability

Abstract. Efficacy and tolerability of methotrexate at a dose of 15 mg/week and 10 mg/week in patients with pulmonary sarcoidosis. Gavrysyuk V.K., Merenkova I.O., Gumeniuk G.L., Pendalchuk N.V., Morska N.D., Vlasova N.A. The objective of this study is to conduct a comparative study of the efficacy and safety of methotrexate (MT) at a dose of 10 mg/week and 15 mg/week in patients with pulmonary sarcoidosis having contraindications to GCS therapy. Material and Methods. The study involved 44 patients with stage II pulmonary sarcoidosis (26 females and 18 males aged 24 to 70) with contraindications to the appointment of therapy glucocorticosteroid (GCS). In group 1 (28 patients), methotrexate was prescribed at a dose of 10 mg/week, in group 2 (16 patients), methotrexate was prescribed at a dose of 15 mg/week. The diagnosis and assessment of the dynamics of sarcoidosis were carried out taking into account clinical symptoms based on the results of high-resolution computed tomography and body plethysmography. The significance of differences in indicators was determined using the Student's t-test and Fisher's exact test. The number of cases of clinical treatment without residual changes of a fibrous nature in the lung parenchyma in patients after treatment with methotrexate at a dose of 15 mg/week significantly increased compared to the same indicator in the group of patients after treatment at a dose of 10 mg/week (81.3% and 42.4% respectively, p=0.025). An increase in the therapeutic dose of methotrexate from 10 mg/week to 15 mg/week leads to a decrease in the time to achieve a clinical cure (10.1±0.5 months and 12.8±0.8 months respectively, р˂0.02), indicating an accelerating rate of regression of sarcoidosis. Immunosuppressive therapy of patients with pulmonary sarcoidosis using the drug at doses of 10 and 15 mg/week is characterized by satisfactory tolerability.

Gashynova K.Yu., Usenko G.V. Pulmonary comorbidity in chronic lymphoproliferative diseases: realities of the problem in the Dnipro region

Nedzvetsky V.S., Sirenko O.Yu., Tkachenko V.A., Kuryata O.V. Advanced glycation end products, galectin-3, matrix metalloproteinase-9 activity in men with heart failure and concomitant benign prostatic hyperplasia with androgen deficiency

Nedzvetsky V.S., Sirenko O.Yu., Tkachenko V.A., Kuryata O.V. Advanced glycation end products, galectin-3, matrix metalloproteinase-9 activity in men with heart failure and concomitant benign prostatic hyperplasia with androgen deficiency

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https://doi.org/10.26641/2307-0404.2021.4.248094

Key words: heart failure, preserved ejection fraction, testosterone deficiency, advanced glycation end products

Abstract. Advanced glycation end products, galectin-3, matrix metalloproteinase-9 activity in men with heart failure and concomitant benign prostatic hyperplasia with androgen deficiency. Nedzvetsky V.S., Sirenko O.Yu., Tkachenko V.A., Kuryata O.V. The aim was to evaluate serum levels of matrix metalloproteinases-9 activity, advanced glycation end products, galectin-3, C-reactive protein in men with heart failure and benign prostatic hyperplasiawith testosterone deficiency. The testosterone level was determined by immune-enzyme analysis. The content of advanced glycation end products in plasma were analysed by quantitative autofluorescence. The metalloproteinases-9 activity was estimated with fluorometry. The level of galectin-3, C-reactive protein was determined by immune-enzyme analysis. 1^st group was made up by the men with heart failure and benign prostatic hyperplasia with testosterone deficiency; 2^nd group – by the men without testosterone deficiency. The men with heart failure and benign prostatic hyperplasia with testosterone deficiency had a significantly higher level of advanced glycation end products, galectin-3, matrix metalloproteinases-9 activity in comparison with men with heart failure without testosterone deficiency (p<0.001). Correlation relations between serum advanced glycation end products in patients of the main group with age, ejection fraction, testosterone level were determined – r=0.48 (p<0.001), r=-0.62 (p<0.001), r= -0.66 (p<0.001) respectively. Receiver operating characteristic analysis for predictive role in heart failure with preserved ejection fraction have shown high degree of sensitivity and specificity for advanced glycation end products in serum (p<0.001). Middle-aged men with heart failure with preserved ejection fraction and benign prostatic hyperplasia with testosterone deficiency are characterised by increased serum advanced glycation end products, galectin-3, matrix metalloproteinases-9 activity, C-reactive protein. Serum advanced glycation end products are potential biomarkers of development of heart failure with phenotype of preserved ejection fraction in this cohort.

Mitiuriaeva-Korniyko І.О., Kuleshov O.V., Medrazhevska Ya.A., Fik L.O., Klets T.D. The state of response of autonomic nervous system in children with mitral valve prolapse

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https://doi.org/10.26641/2307-0404.2021.4.248154

Key words: autonomic nervous system, cardiointervalography, children, mitral valve prolapse

Abstract. The state of response of autonomic nervous system in children with mitral valve prolapse. Mitiuriaeva-Korniyko І.О., Kuleshov O.V., Medrazhevska Ya.A., Fik L.O., Klets T.D. The article presents summarized materials on connective tissue dysplasia of the heart, primary mitral valve prolapse, dysfunction of the autonomic system. Aim of research: to estimate the condition of autonomic nervous system in children with primary mitral valve prolapse. We examined 106 children with mitral valve prolapse aged from 13 to 17 years old on the clinical base of city hospital “Center of mother and child” in Vinnitsya. Research included time and frequency domain (evaluation with cardiointervalography. Final results were compared with the control group records. The results showed no statistical significance among time domain parameters in the main group of children. All these indices displayed tendency to sympathetic and parasympathetic autonomic nervous system tonus increase in boys. However, sympathicotonia tendency was noted in girls only. Frequency domain parameters showed similar results, compared with the previous. Nevertheless, very low frequency parameters had statistically significant difference in both subgroups of patience with mitral valve prolapse, including males (3205.8±190.9 against 1717±154, р<0.05) and females (3280±220.1 against 1433±811, р<0.05). There were no statistically significant difference among other frequency domain parameters. Conclusions: we estimated that children with mitral valve prolapse have imbalanced autonomic homeostasis manifested by tone disturbances of both autonomic vegetative system branches with sympathetic predominance. Patients with primary mitral valve prolapse generally have increased sympathetic tone - both boys and girls - according to spectral analysis of heart rate variability indices, heart rate oscillation power of a very low frequency in particular (p<0.05). In children with mitral valve prolapse, the tone of parasympathetic nervous system is generally normal; there is a tendency to its increase in boys and decrease in girls. These children should be under close medical supervision by pediatricians and cardiologists.

Mykhaloiko I.S. Urinary thrombin as a marker of local disseminated intravascular coagulation in patients with chronic kidney disease

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https://doi.org/10.26641/2307-0404.2021.4.248157

Key words: disseminated intravascular coagulation syndrome, chronic kidney disease, glomerulonephritis, diabetic nephropathy, thrombin

Abstract. Urinary thrombin as a marker of local disseminated intravascular coagulation in patients with chronic kidney disease. Mykhaloiko I.S. The aim of this research was to study the diagnostic markers of nonovert local disseminated intravascular coagulation (DIC) syndrome in the urine of patients with chronic kidney disease (CKD). We conducted a prospective study involving 140 patients with CKD, of these patients, 100 patients (71.4%; 95% CI 53.4-76.7) had glomerulonephritis (GN) and 40 patients (28.6%; 95% CI 21.3-36.8) had diabetic nephropathy (DN). We diagnosed overt DIC syndrome on the International Society of Thrombosis and Haemostasis (ISTH) scale (>5 points) in 18.6 % of patients. We determined the level of thrombin in the urine of patients who had <5 points on ISTH scale for the diagnosis of local nonovert DIC syndrome in the kidneys. In the urine of healthy individuals, the level of thrombin did not exceed 1 ng/ml, so we found no thrombinuria at a thrombin level <1 ng/ml. In 56.1% of patients, we found urinary thrombin levels >1 ng/ml. The average level of thrombin in the urine of these patients was 6.5 (4.8; 10.6) ng/ml. In our opinion, the presence of thrombinuria indicates the intensity of monocytic-macrophage inflammation in the glomeruli and may be a criterion for nonovert, local DIC syndrome in the kidneys. The association of overt DIC syndrome with decreased blood albumin, reduced glomerular filtration rate (GFR), increased daily protein excretion (DPE) indicates its occurrence in severe underlying disease, in the presence of nephrotic syndrome and in the severe stages of CKD. Early diagnosis of nonovert local DIC syndrome would be more useful, since the process is still reversible and controlled, and timely use of antiplatelet and anticoagulant therapy would affect the course and the progression of CKD.

Biletska S.V., Dytyatkovska E.M., Nikolaychuk M.A. Analysis of the dynamics of clinical indicators in patients with allergic rhinitis with sensitization to pollen and household allergens using combined allergen-specific immunotherapy

Biletska S.V., Dytyatkovska E.M., Nikolaychuk M.A. Analysis of the dynamics of clinical indicators in patients with allergic rhinitis with sensitization to pollen and household allergens using combined allergen-specific immunotherapy

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https://doi.org/10.26641/2307-0404.2021.4.248161

Key words: allergic rhinitis, rhinoconjunctivitis, combined allergen-specific immunotherapy, clinical effect

Abstract. Analysis of the dynamics of clinical indicators in patients with allergic rhinitis with sensitization to pollen and household allergens using combined allergen-specific immunotherapy. Biletska S.V., Dytyatkovska E.M., Nikolaychuk M.A. The aim of this study was to evaluate the clinical efficacy of combined allergen-specific immunotherapy (ASIT) in patients with allergic rhinitis (AR) with combined sensitization to pollen and household allergens. To achieve this goal, 49 patients with AR of working age were examined – 35.5±1.5 years with clinical manifestations of seasonal rhinoconjunctival syndrome with a long period of 9.2±1.1 years, among which there were 25 (51.0%) males and 24 (49%) females. All patients were divided into 2 homogeneous groups by age, sex, duration of the disease, the average number of etiologically significant allergens: the main one – 31 patients who received combined ASIT with solutions of pollen and household allergens and a comparison group – 18 patients for whom only pollen allergens were used. Allergological examination included anamnesis, skin tests with pollen allergens (wormwood, ragweed, quinoa, corn, etc.) and household (house dust, mites, epidermal agents) and / or molecular research methods using the ALEX technology. The quantitative integral assessment of the intensity of AR clinical symptoms was calculated as a total score for the main symptoms. The maximum score for the severity of nasal symptoms – 12, eye - 6, total – 18. The results obtained and their analysis indicate that under the influence of ASIT pollen and household allergens in patients there is a significant and reliable decrease in the intensity of clinical manifestations of seasonal rhinoconjunctive syndrome: nasal manifestations – by 52,2%, conjunctival – by 60%, integral – by 54.3% and an increase of 2.2 times in the percentage of patients in the main group with the disappearance or minimization of clinical symptoms of the disease after treatment compared with patients from the comparison group, which convincingly proves and confirms high efficiency of the selected type of therapy in patients with AR in combination with sensitization to pollen and household allergens.

Shchukina O.S. Changing in the profile of a patient with acute coronary syndrome without ST-segment elevation over the years 2015-2020

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https://doi.org/10.26641/2307-0404.2021.4.248164

Key words: acute coronary syndrome, register, clinical outcomes

Abstract. Changing in the profile of a patient with acute coronary syndrome without ST-segment elevation over the years 2015-2020. Shchukina O.S. The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome without ST segment elevation. A distinctive feature of the work is the recruitment of patients in the same medical institution for different periods of time, which makes possible to trace the dynamics of the clinical profile of patients in the population of Dnipro, a large industrial center of Ukraine. The prevalence of arterial hypertension, chronic heart failure and previous myocardial infarction remained at the same level. In the 2017-2020’s group compared with the 2015’s group, electrocardiographic manifestations of acute coronary syndrome without ST-segment elevation upon admission were more often detected. Laboratory indicators such as hemoglobin, creatinine and total cholesterol levels remained the same. Another interesting finding is a statistically significant decrease in the number of patients with a reduced glomerular filtration rate according to MDRD (less than 60 ml/min/1.73 m²) in the 2017-2020’s group compared to patients in 2015’s group, although the clinical course of the disease remained practically unchanged. There was a trend towards a worsening of the clinical status and prognosis, namely, increase in the prevalence of atrial fibrillation and diabetes mellitus, increase in the risk of GRACE, as well as increase in the quantity of verified diagnoses of unstable angina, which is most likely associated with the increased use of high-sensitivity troponin. Noteworthy feature is that increase in the quantity of high-risk patients led to an increase in the mean GRACE score.

Kalashchenko S.I. Peculiarities of changes of psychophysiological functions, state of human adaptive capacity and stress resistance of students of higher medical institutions

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https://doi.org/10.26641/2307-0404.2021.4.248240

Key words: short-term memory, stress resistance, psychophysiology, functional mobility of nervous processes

Abstract. Peculiarities of changes of psychophysiological functions, state of human adaptive capacity and stress resistance of students of higher medical institutions. Kalashchenko S.I. The study is devoted to assessing the psychophysiological adaptive capabilities of students of higher medical institutions. There was conducted a screening study on the basis of which a correlation analysis of a group of 42 students was performed. The main inclusion criterion was good physical activity. Exclusion criteria - the presence of chronic diseases, acute respiratory viral infections at the time of examination, taking antidepressants or psychoactive substances. The study was aimed to identify the peculiarities of changes in psychophysiological functions and the state of adaptive capacity of students of higher medical institutions being in stressful conditions. The following methods from the software and hardware complex "Psycholot-1" were used for the study: "Functional mobility of nervous processes according to Khilchenko" and "Memory." The survey was conducted under micro-stress, it means all tasks had to be completed in a limited period. Statistical analysis of the data was performed to establish correlations between psychophysiological indicators of short-term memory and functional mobility of nervous processes (Spearman's rank correlation index). It was found that the faster the stimulus appears in conditions of time deficit, the lower the mobility of nervous processes in the student, which is directly reflected in the indicators in increasing the minimum exposure time of the figure on the screen (0.27±0.007 s). In addition, a relationship was found between the rate of reaction of the left hand to a stimulus and the amount of information that a person can store in short-term memory. The information obtained will help to determine the initial data of the adaptive capacity of a potentially healthy contingent of people and predict their success in further professional activities in the sphere of medicine.

Zabolotny D.I., Melnikov O.F., Timchenko S.V., Sambur M.B., Rylska O.G., Volosevich L.I., Zayets T.A., Timchenko M.D., Faraon I.V. The influence of parenteral influenza vaccination on local immunity indices and microbiota of oropharyngeal secretion in patients with chronic inflammatory diseases of the upper respiratory tract

Zabolotny D.I., Melnikov O.F., Timchenko S.V., Sambur M.B., Rylska O.G., Volosevich L.I., Zayets T.A., Timchenko M.D., Faraon I.V. The influence of parenteral influenza vaccination on local immunity indices and microbiota of oropharyngeal secretion in patients with chronic inflammatory diseases of the upper respiratory tract

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https://doi.org/10.26641/2307-0404.2021.4.248169

Key word: chronic inflammatory diseases of the upper respiratory tract, local immunity, microbiota, vaccination, influenza

Abstract. The influence of parenteral influenza vaccination on local immunity indices and microbiota of oropharyngeal secretion in patients with chronic inflammatory diseases of the upper respiratory tract. Zabolotny D.I., Melnikov O.F., Timchenko S.V., Sambur M.B., Rylska O.G., Volosevich L.I., Zayets T.A., Timchenko M.D., Faraon I.V. When studying the effect of vaccines against influenza, attention is mainly paid to obtaining high titers of protective antibodies in the blood and reducing the incidence of respiratory infections among vaccinated people. At the same time, the changes occurring in patient^,s body from the factors of local specific and innate immunity remain insufficiently studied. The aim of the study was to determine the effect of parenteral influenza vaccination on the state of local immunity, cytology and microbiota of oropharyngeal secretion (OS) in patients with chronic inflammatory diseases of the upper respiratory tract. The study of immunological and microbiological parameters was performed in 32 patients with chronic inflammatory diseases of the upper respiratory tract, including 11 diagnosed with chronic rhinosinusitis, 9 – with chronic tonsillitis, 12 – with chronic pharyngitis, 3 and 12 weeks after vaccination with trivalent inactivated influenza-vaccine (PASTEUR, SA, France), which was administered intramuscularly. Single vaccination against influenza A and B has been shown to normalize reduced local humoral immunity indices, in particular sIgA and immune complexes concentrations, increase lymphocyte output to oropharyngeal secretions and cause a significant decrease in the representation of OS transient microflora without affecting the overall level of bacterial contamination. In both periods after the vaccination the reduced content of interferon-α in the OS of patients with chronic inflammatory diseases of the upper respiratory tract did not change. The obtained data allow to recommend vaccination against influenza virus in the period up to 3 months before the the beginning of mass infections as an effective means of stimulating the protective reactions of local immunity of oropharynx and nasopharynx mucous membranes in patients with chronic inflammatory diseases of the upper respiratory tract.

Shaprinskyi V.O., Vorovskyi O.O., Kaminskyi O.A., Pashynskyi Ya.M. Diagnosis and surgical treatment of liver echinococcosis

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https://doi.org/10.26641/2307-0404.2021.4.248172

Key words: echinococcosis, liver, echinococetctomy, pericystectomy

Abstract. Diagnosis and surgical treatment of liver echinococcosis. Shaprinskyi V.O., Vorovskyi O.O., Kaminskyi O.A., Pashynskyi Ya.M. The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

Shevchuk I.M., Snizhko S.S. Surgical treatment of patients with descending purulent mediastinitis

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https://doi.org/10.26641/2307-0404.2021.4.248192

Key words: acute mediastinitis, surgical treatment, intramediastinal administration of antibiotics, video-assisted thoracoscopy

Abstract. Surgical treatment of patients with descending purulent mediastinitis. Shevchuk I.M., Snizhko S.S. The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

Kutovyi О.B., Zhmurenko E.V. Differentiated approach to surgical treatment of adrenal glands tumors

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https://doi.org/10.26641/2307-0404.2021.4.248196

Key words: benign adrenal tumor, adrenalectomy, adrenal resection

Abstract. Differentiated approach to surgical treatment of adrenal glands tumors. Kutovyi О.B., Zhmurenko E.V. Objective – to improve the results of treatment of adrenal tumors by optimizing a differentiated approach based on the analysis of the results of various surgical invasions. The paper analyzed the results of treatment of 145 patients with various adrenal tumors, which were divided into 2 groups: І (n=71) - patients after adrenalectomies, II (n=74) – after adrenal resections. Organ-preserving invasions showed better results during the early and long-term postoperative period in patients with corticosteromas, pheochromocytomas and incidentalomas by reducing the severity of fluctuations in hemodynamic parameters and the frequency of adrenal insufficiency. Due to the introduction of the treatment algorithm, the number of adrenal resections increased by 26.6% in patients with neoplasms more than 4,0 cm in diameter (p=0.0001). The choice of surgical invasion should be individualized, taking into account the clinical features of the disease, hormone indicator parameters, the size of tumors, the comprehensiveness of the adrenal gland lesion and the ratio of the latter to nearby organs and structures. Adrenal insufficiency was detected 14.2% more often after adrenalectomies (р=0.044) compared to adrenal resections. Treatment according to the developed algorithm reduced the incidence of adrenal insufficiency by 5.8% (p=0.028). In the long-term postoperative period, contralateral gland tumors occurred with the same frequency (4.8%) among patients after adrenalectomies and resections. Relapse of the neoplasm after resections was detected in 3 (7.1%), as a result of which 2.4% underwent repeated operations with the final removal of the gland. An increase in the size of a single adrenal gland was more common by 21.4% after adrenalectomies.

Beniuk V.O., Ginzburg V.G., Vygivska L.M., Maidannyk I.V., Chorna O.O., Oleshko V.F., Marushchenko Yu.L., Lastovetska L.D. Assessment of correction effectivenes of psychoemitional state in pregnant women after application of assisted reproductive technologies

Beniuk V.O., Ginzburg V.G., Vygivska L.M., Maidannyk I.V., Chorna O.O., Oleshko V.F., Marushchenko Yu.L., Lastovetska L.D. Assessment of correction effectivenes of psychoemitional state in pregnant women after application of assisted reproductive technologies

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https://doi.org/10.26641/2307-0404.2021.4.248201

Key words: assisted reproductive technologies, reactive anxiety, personal anxiety, gestational dominant

Abstract. Assessment of correction effectivenes of psychoemitional state in pregnant women after application of assisted reproductive technologies. Beniuk V.O., Ginzburg V.G., Vygivska L.M., Maidannyk I.V., Chorna O.O., Oleshko V.F., Marushchenko Yu.L., Lastovetska L.D. To determine the role and effectiveness of the proposed therapeutic and preventive complex in the correction of psychoemotional state in the dynamics of pregnancy in pregnant women after assisted reproductive technologies (ART) application in order to improve the tactics of antenatal observation and prevention of obstetric and perinatal complications. 299 pregnant women were comprehensively examined and a set of therapeutic and preventive measures was carried out: the main group included 249 women whose pregnancy occurred as a result of ART application. The control group consisted of 50 pregnant women with spontaneous pregnancy. The complex of measures for pregnant women after ART application included: micronized progesterone, magnesium oxide, folic acid, L-arginine aspartate, Omega-3 polyunsaturated fatty acids and long-term psychological correction – before ART program, at 8-10 weeks of pregnancy, at 16-18 weeks of pregnancy and at 28-30 weeks of pregnancy. Introduction of the proposed complex of psychoemotional correction contributed to the formation of reactive anxiety and personal anxiety levels at a moderate level in women of subgroups IA-44 (89.8%) and 43 (87.6%), IIA – 43 (89.6%) and 44 (91.7%) and IIIA – 30 (83.3%) and 26 (72.2%), which is considered to be an adaptive, physiological type during pregnancy. The positive effect of the proposed complex of psychoemotional correction demonstrates the improvement of processes of formation of type of component gestational dominant, its return to the optimal type in women of subgroup IA – 41 (83.6%), IIA – 39 (81.3%) and IIIA – 26 (72.2%) that is close to the physiological course of pregnancy and contributes to the reduction of perinatal and obstetric complications among pregnant women of these subgroups.

Zakharov S.V., Zakharov V.K. Nonspecific protective factors in patients with early latent syphilis (report 1)

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https://doi.org/10.26641/2307-0404.2021.4.248202

Key words: early latent syphilis, pro-inflammatory and anti-inflammatory interleukins, subpopulations of T-lymphocytes, nitroblue tetrazolium test, circulating immune complexes, phagocytosis

Abstract. Nonspecific protective factors in patients with early latent syphilis (report 1). Zakharov S.V., Zakharov V.K. The objective of this work is to study nonspecific protective factors in patients with latent early syphilis. The results of the study are based on the data of a comprehensive examination before treatment of 142 patients with early latent syphilis and 20 patients of the comparison group. Methods of investigation: serological methods for the diagnosis of syphilis complex of serological reactions, enzyme-linked immunosorbent assay (IgM, IgG), Indirect immunofluorescence reaction (RIF) RIF-200, RIF-abs; determination of cytokines IL-2, IL-6, IL-10, TNFα and INFγ in blood serum by enzyme-linked immunosorbent assay; determination of the phenotype of lymphocytes (CD-receptors), the concentration of circulating immune complexes, phagocytic number, phagocytic index, Nitroblue tetrazolium test. In the blood serum of patients the concentration of IL-2, IL-6, IL-10 and TNFα, INFγ was significantly increased. The concentration of IL-10 and IL-6 was also significantly increased in patients with more than 1 year of infection. The most significant disorders of the parameters of the metabolic activity of neutrophils were found in patients with an infection of more than 1 year; an imbalance in the circulating immune complexes concentration was also established. Under the increasing duration of the infection, the concentration of CD16+ in the blood serum progressively decreases. The content of pro-inflammatory and anti-inflammatory cytokines in the blood serum of patients with early latent syphilis was significantly increased and depended on the timing of infection. This relationship was most pronounced for IL-6 and IL-10. In patients with early latent syphilis there is also an imbalance between CD25+ and late activation factor HLA-DR against the background of a progressive decrease in the number of CD16+ lymphocytes. A direct relationship was established between the time of infection and the number of NK-cells. The revealed disorders may be the consequence of significant disorders on the part of neutrophils and may be one of the factors of the latent course of syphilitic infection.

Kovach I.V., Kopchak O.V., Dychko E.N., Buniatian Kh.A., Khotimska Yu.V., Gargin V.V., Lavreniuk Y.V. Use of odontotropic material in treatment of traumatic pulpitis in experiment

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https://doi.org/10.26641/2307-0404.2021.4.248203

Key words: experimental pulpitis, biological method of treatment, paste with tricalcium silicate

Abstract. Use of odontotropic material in treatment of traumatic pulpitis in experiment. Kovach I.V., Kopchak O.V., Dychko E.N., Buniatian Kh.A., Khotimska Yu.V., Gargin V.V., Lavreniuk Y.V. The problem of diagnosis and effective treatment of one of the most common complications of dental caries, such as pulpitis, including pediatric patients, is still quite relevant at the present time. Considering anatomy-physiological and age-related features of temporary and permanent teeth in children, the rapid and aggressive course of the carious process in poorly mineralized hard tissues due to the untimely and incomplete “maturation” of them, it is beyond any doubts that scientists and practitioners involved in pediatric dentistry deal with such complications in the clinic much more often than when dealing with adults. A particularly risky group are those who develop decompensated caries, according to classification by T.F. Vinogradova. Therefore, the search for more advanced methods of diagnosis and treatment of both acute and chronic inflammation of pulp, especially with the preservation of its viability, is logical and relevant in modern dentistry. Existing methods for the biological treatment of pulpitis have their positive aspects, but possible complications up to necrosis or pulp gangrene in remote terms indicate the need for improvement both the choice of a more effective method with clear indications for its use, and the technology and material of odontotropic direction. The aim of the work was to study the results of treatment of pulpitis in experimental animals by using tricalcium silicate cement for its further application in the clinic. An experimental study was conducted on 18 animals (9-month-old male rabbits, Dutch breed) in vivarium setting to obtain information on the morphogenetic mechanisms of regeneration of living tissues and cells of dental pulp in which traumatic pulpitis was induced artificially. By the nature of odontotropic material, four groups of experimental animals were divided into: group I (control) – traumatic pulpitis was treated without special odontotropic paste, group II - treatment of pulpitis with material based on calcium hydroxide, group III - material with trioxide aggregate, group IV - material with tricalcium silicate. Every two, four, and six weeks from the moment the animals were introduced into the experiment, the damaged teeth were removed and treated in a certain way and, after special treatment, were amenable to histological examination. In the pulp tissue, the state of its main components was studied: stroma, cellular elements and blood vessels of the microvasculature. After excretion of animals from the experiment on the 2nd and 6th weeks tissues of tooth were fixed in 10% formalin. Fixed in formalin tissue has been routine proceeding after decalcification in acetic acid with making histological slides which were stained with hematoxylin and eosin (H&E), according to van Gieson, Mallory, PAS-reaction was performed. The slides were studied with the microscope “Olympus BX-41” and followed interpretation by “Olympus DP-soft version 3.2”, which was used for morphometric study. Statistical comparison was performed using Mann-Whitney test for statistical analysis. The accepted level of significance was p<0.05. Studying the state of the pulp in the phase of acute traumatic pulpitis in dynamic observation for a month and half period, at the end of the second, fourth and sixth week the possibility of a stable restoration of the viability of the pulp as well as all its components was clearly proven. If at the beginning of a morphological study, pulp injury was accompanied by clear signs of aseptic inflammation, both cellular, vascular and stromal formations, then after a month and a half there were signs of a clear restoration of pulp viability in the biological treatment of artificial pulpitis of the second, third and fourth study groups. The most significant dynamic signs of microscopic formations of the pulp were noted in animals of the forth study group treated with odontotropic paste with tricalcium silicate. The ability of this paste to complete tissue restoration in a short time period was provn. Therefore, it should be noted that artificially induced pulpitis in experimental animals is accompanied by significant breakages in the viability of the main components of pulp tissue, such as stromal fibers, microvasculature vessels and cellular elements. Filling and odontotropic materials in pastes for capping of the damaged pulp, such as calcium hydroxide, trioxide aggregate and tricalcium silicate, have full potential for restoring the viability of injured pulp, but with varying degree of effectiveness. According to histological research, biological material with tricalcium silicate is the most effective one for restoration of the pulp in a short time period.

PREVENTIVE MEDICINE

Yavorovsky A.P., Rygan M.M., Naumenko A.N., Skaletsky Yu.N., Gichka S.G., Ivanko A.V., Varyvonchyk D.V., Shkurba A.V., Bugro V.I., Brukhno R.P., Zinchenko T.О., Gorval A.K., Kirichuk I.M. A comparative analysis on safety culture in domestic and foreign health care facilities and enterprises of other activities (message 2)

Halak S.S., Dumansky V.Yu., Nikitina N.G., Bitkin S.V., Bezverkha A.P. Hygienic characteristic of the electromagnetic situation created by the electromagnetic radiation of the antennas of mobile base stations in Cherkasy region before and after the introduction of 4G technology

Halak S.S., Dumansky V.Yu., Nikitina N.G., Bitkin S.V., Bezverkha A.P. Hygienic characteristic of the electromagnetic situation created by the electromagnetic radiation of the antennas of mobile base stations in Cherkasy region before and after the introduction of 4G technology

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https://doi.org/10.26641/2307-0404.2021.4.248215

Key words: radiofrequency radiation, mobile base stations, 4G, 5G

Abstract. Hygienic characteristic of the electromagnetic situation created by the electromagnetic radiation of the antennas of mobile base stations in Cherkasy region before and after the introduction of 4G technology. Halak S.S., Dumansky V.Yu., Nikitina N.G., Bitkin S.V., Bezverkha A.P. This work is part of our researches to study the distribution of electromagnetic radiation from mobile base stations in populated areas. The aim of this work was to study and analyze the electromagnetic situation before and after the introduction of fourth generation 4G technology at mobile base stations. We analyzed the maximum and average levels of electromagnetic radiation from mobile base stations located in Cherkasy region. The electromagnetic situation was studied both in urban areas and in rural areas. It was found that after the introduction of the fourth generation 4G technology at the mobile base stations, the levels of electromagnetic radiation in Cherkasy region increased significantly. The median of maximum levels of electromagnetic radiation increased by 155.6% (in particular, in urban areas by 194.1%), and the median of average levels - by 75.2% (in particular, in urban areas by 141.1%). No significant changes in electromagnetic radiation levels were detected before and after the modernization of mobile base stations in rural areas. It has been proven that there are no prerequisites for increasing the maximum permissible level to 100 μW/cm² when implementing 4G and 5G technologies at mobile base stations.

Sevalnev A.I., Kutsak A.V., Sharavara L.P., Volkova Yu.V. A look at the problem of exposure of the population caused by X-ray diagnostics: approaches to analysis and forecasting

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https://doi.org/10.26641/2307-0404.2021.4.248218

Key words: medical exposure of the population, X-ray diagnostics researches, the state of the dose load of the population

Abstract. A look at the problem of exposure of the population caused by X-ray diagnostics: approaches to analysis and forecasting. Sevalnev A.I., Kutsak A.V., Sharavara L.P., Volkova Yu.V. The article is devoted to the analysis of limitation of dose load on the population as a result of radiological researches. It is especially actual and represents rather high scientific and practical interest. In this regard, it is very important to have information about the state of the dose load of the population in separate regions and to rank types of diagnostics by the amount of their contribution to the total dose of medical exposure. The aim of the work was to study the state of dose load of the population of Zaporizhzhia region due to X-ray diagnostics, to develop approaches to analysis and forecasting regarding its limitation. Analytical, statistical calculation and logical generalization methods were used in the course of the work. We used the results of studies carried out in accordance with the regional “Program for the Protection of the Population of Zaporizhzhia Region from the Effect of Ionizing Radiation. The authors analyzed scientific publications (15 sources), including 9 Ukrainian and 6 foreign on the relevance of the problem of exposure of the population caused by X-ray diagnostics. The analysis of the results allowed to determine that in 2010-2014 the radiation dose of the population of Zaporizhzhia region due to X-ray diagnostics averaged 0.92 mSv year^-1, in 2015-2016 the dose increased and amounted to 0.96 mSv year^-1. The proposed approach to the analysis makes it possible to summarize and model data on radiological studies of the population over a long period of time, to identify persistent trends in the contribution of different types of radiation diagnostics to the dose of medical radiation. All this is necessary for the development, first of all, of measures to reduce the frequency of radiography, its replacement by other diagnostic methods. Priority tasks aimed at reducing the dose load of the population due to X-ray examinations are proposed.

Andrusyshyna I.М. Elemental state of the organism of workers and population as manifestation of adaptation to the technogenic effect of metals: new methodological approaches

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https://doi.org/10.26641/2307-0404.2021.4.248220

Key words: adaptation, macro- and microelements, biological environments, synergism and antagonism of elements, elemental homeostasis

Abstract. Elemental state of the organism of workers and population as manifestation of adaptation to the technogenic effect of metals: new methodological approaches. Andrusyshyna I.М. The problem of adaptive, prepathological and pathological reactions of the body to the action of exogenous chemicals is closely intersected with the assessment of the norm and its fluctuations. The imbalance of chemical elements in the human body directly affects the functioning of almost all organs and systems, causing significant stress of adaptation mechanisms. In this article we study the elemental state of the human body depending on the physiological state (endocrine pathology and professional contact with heavy metals), analyze the correlation between macro- and microelements and assess the degree of adaptability of the body. In the work the elemental state of the human body, taking into account not only the absolute values of the concentrations of elements in the hair and whole blood was studied, the adaptability of the body according to the indicators of elemental imbalance in the blood and hair of volunteers, individuals with endocrine pathology (autoimmune thyroiditis and type II diabetes mellitus) and for those working in conditions of contact with heavy metals (for jewelers, welders and batterymen) is analyzed. The results of the study indicate that various non-specific adaptation reactions are accompanied by changes in the elemental state of a person. Under the prevailing pathology of the endocrine system (diabetes mellitus or autoimmune thyroiditis), the adaptation of the body was determined as a stage of tension and is associated with the duration of the disease. In persons exposed to professional contact with heavy metals (Mn, Cr, Pb, Ag), adaptation depended on the nature and duration of professional contact with them: the highest tension of adaptation processes was found in jewelers, and the least in welders and batterymen, which is associated with the duration of professional contact with these metals. The high number of connections between the elements indicates the tension of adaptive reactions in people with endocrine pathology and especially in jewelry workers. Adaptation to the high content of metals in the air of welders and batteries due to the longer experience of these workers and adaptation to production conditions with a decrease in the number of correlations between the elements, as a means of reliable operation.

SOCIAL MEDICINE

Volosovets О.P., Bolbot Yu.K., Beketova G.V., Berezenko V.S., Umanets T.R., Rechkina O.O., Міtiuriaeva-Korniyko I.O., Volosovets T.М., Churylina A.V. Allergic march in children of Ukraine

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https://doi.org/10.26641/2307-0404.2021.4.248227

Key words: children, allergic march, bronchial asthma, atopic dermatitis, allergic rhinitis, morbidity, prevalence, pollutants

Abstract. Allergic march in children of Ukraine. Volosovets О.P., Bolbot Yu.K., Beketova G.V., Berezenko V.S., Umanets T.R., Rechkina O.O., Міtiuriaeva-Korniyko I.O., Volosovets T.М., Churylina A.V. Allergic diseases, which have a certain stage in their development from food allergy to bronchial asthma / allergic rhinitis, are much more common in children than in adults. The aim of this study was to analyze data on the prevalence and incidence of atopic dermatitis, bronchial asthma and allergic rhinitis as components of the allergic march, in children of Ukraine from 1994 to 2017 to determine the possible impact of adverse environmental factors on their development. During the same period, due to the influence of a number of factors, in particular environmental, there were significant changes in the structure of allergic diseases making up the stages of the allergic march due to an increase in the proportion of allergic rhinitis with the reduced one of asthma and atopic dermatitis. Within 24 years, the incidence of atopic dermatitis in children aged 0-6 years including, increased by 27.6%, in adolescents - by 40.5% and significantly decreased by 39.5% in children aged 7-14 years including. Most cases of allergic rhinitis and bronchial asthma were observed in schoolchildren (47.6 and 54.0%, respectively) with a slight decrease compared to 1994. In general, allergic diseases in recent years have become more common in children from 0 to 6 years and their detection has decreased in school-age children and adolescents. Over the past 24 years, in children of Ukraine a steady increase in the incidence and prevalence of allergic diseases that form an allergic march has been noted: the prevalence of bronchial asthma has increased by 69.3% and the incidence has increased by 22.9%; the prevalence of atopic dermatitis increased by 43.9% and the incidence increased by 8.3%; the prevalence of allergic rhinitis increased by 488.3% and the incidence of allergic rhinitis increased by 380.3%, with a predominance of detection of this pathology in children from regions with developed infrastructure and industry, where there are significant emissions of pollutants into the atmosphere, that have a direct moderate effect on the increase in the prevalence of bronchial asthma, the incidence and prevalence of allergic rhinitis in children.

Babov K.D., Khomenko I.P., Tertyshnyi S.V., Babova I.K., Vastianov R.S. Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

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https://doi.org/10.26641/2307-0404.2021.4.248228

Key words: staged rehabilitation, servicemen, gunshot wounds, soft tissue defects

Abstract. Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care. Babov K.D., Khomenko I.P., Tertyshnyi S.V., Babova I.K., Vastianov R.S. Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

Pinchuk I.Y., Pishel V.Y., Polyvianaia M.Y., Yachnik Y.V., Virchenko V.V. Occupational stress in healthcare workers during a COVID-19 pandemic

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https://doi.org/10.26641/2307-0404.2021.4.248232

Key words: occupational stress, healthcare workers, risk factors, COVID-19

Abstract. Occupational stress in healthcare workers during a COVID-19 pandemic. Pinchuk I.Y., Pishel V.Y., Polyvianaia M.Y., Yachnik Y.V., Virchenko V.V. Healthcare workers experience overwhelming occupational and psycho-emotional stress during COVID-19 pandemic. Occupational stress leads to emotional burnout, can cause anxiety, depression and other psychopathological symptoms, influencing the quality of medical care. Existing situation necessitates to define risk factors, influencing occupational stress in healthcare workers in order to develop ways and methods to overcome it. Aim of the study was to identify socio-psychological factors associated with occupational stress in healthcare workers during the COVID-19 epidemic in Ukraine. Using a specially designed questionnaire, an online survey of 1,100 medical workers was conducted in all regions of Ukraine. Questioning was carried out over three weeks from 30.03.2020 to 21.04.2020, during the period of quarantine. The majority of respondents were female medical workers (79.9%). Age of respondents: up to 30 years – 179 (16.2%), from 31 to 60 – 824 (75.0%), over 60 – 97 (8.8%), among them doctors – 695 (63.1%) 236 nurses (21.5%), more than a third are general practitioners. Direct care for patients with COVID-19 was provided by 170 (15.5%) medical personnel. The analysis of the results of the questionnaire enabled to determine the peculiarities of medical worker`s response to the situation in connection with COVID-19 and highlight the emotional and behavioral factors associated with stress that are significant for most respondents. The study answered the questions regarding the perceived risk associated with the spread, contamination and death related to coronavirus. The most significant factors affecting the occurrence of stress in medical workers are identified. Along with this, factors contributing to stress coping have been identified as well. For subsequent statistical processing, all respondents were divided into two groups depending on the severity of the anxiety/fear. Comparison of these groups by socio-demographic indicators was done using the test χ2. There were no statistically significant differences between groups in all socio-demographic indicators, except for age. That is, only the age factor affected the severity of anxiety/fear among healthcare workers due to COVID-19 (p<0.05). Comparative analysis to assess the severity of stress in groups was performed using the Mann-Whitney U test. Healthcare workers with severe anxiety/fear have a high risk for development of occupational stress during a COVID-19 pandemic (p<0.01). In conclusion, the need for the development and implementation of methods for the prevention of occupational stress in medical workers in the current epidemic situation is substantiated.

Kyi-Kokarieva V.G., Kriachkova L.V., Padalkо L.I. Socio-economic substantiation of expediency of seasonal influenza vaccine prophylaxis among medical workers

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https://doi.org/10.26641/2307-0404.2021.4.248235

Key words: vaccine prophylaxis, influenza, vaccination, able-bodied population, effectiveness, cost-benefit analysis (CBA)

Abstract. Socio-economic substantiation of expediency of seasonal influenza vaccine prophylaxis among medical workers. Kyi-Kokarieva V.G., Kriachkova L.V., Padalkо L.I. The purpose of this study is to determine the socio-economic effectiveness of seasonal influenza vaccine prophylaxis among health professionals based on the analysis of the morbidity with temporal disability (MTD) and the financial benefits of this preventive measure. The study included the collection and analysis of information on MTD and direct and indirect costs of influenza treatment compared to vaccine prophylaxis in “Dnipropetrovsk Regional Perinatal Center with Hospital” Dnipropetrovsk Regional Council” (ME “DRPC with Hospital” DRC”) during 2017-2020 (3 epidemic seasons). To assess the consequences of vaccine prophylaxis, the analysis of MTD indicators was performed, and the index and coefficient of anti-epidemic effectiveness were used. The economic effect was determined on the basis of the cost-benefit method using the analysis algorithm in the form of a “decision tree”. The information base for the analysis was the accounting and reporting and financial and economic documentation of the health care institution (HCI). The analysis of influenza MTD during the observation period revealed that all studied morbidity rates (number of cases per 100 employees; number of days per 100 employees; average case duration) were statistically significantly lower in vaccinated compared to unvaccinated (p<0.001). Precautionary number of cases of MTD for influenza in the last year of observation (2019-2020) was 11.07 (95% CI 6.68-15.46) per 100 employees; days – 96.23 (95% CI 81.86-110.60) per 100 employees. The index of anti-epidemic efficiency during the study increased by 2.37 (95% CI 1.95-2.79), the coefficient of anti-epidemic effectiveness – by 15.16% (95% CI 11.17-18.01). The economic efficiency of vaccination of 69.44% of employees for one epidemic season (2019-2020) amounted to a total of UAH 248,976 or UAH 494 (56%) benefits per employee. The study proved the high medical, social and economic effectiveness of vaccine prophylaxis in HCI. Medical efficiency consists in a significant reduction in the morbidity with temporary disability, high levels and a tendency to increase the indicators of anti-epidemic efficiency. The economic effect is defined as the available monetary benefit from the vaccine prophylaxis. The resulting savings are the basis for optimizing the use of resources of the medical institution, including labor.

Saidakova N.O., Stus V.P., Havva N.V., Grodzinsky В.І. Peculiarities of the disease and prevalence of chronic cystitis among the female population of Ukraine in the regional aspect

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https://doi.org/10.26641/2307-0404.2021.4.248236

Key words: women, chronic cystitis, morbidity, prevalence

Abstract. Peculiarities of the disease and prevalence of chronic cystitis among the female population of Ukraine in the regional aspect. Saidakova N.O., Stus V.P., Havva N.V., Grodzinsky В.І. The study uses data from state and industry official statistics for 2008-2017. Absolute and relative indicators of morbidity and prevalence of chronic cystitis among the female population of Ukraine, its regions and areas were analyzed taking into account two five-year periods for comparative assessment of the nature and intensity of dynamic processes. It is revealed that the number of patients with chronic cystitis (СC) registered in Ukraine is at the expense of women, which are 3-3.5 times more in number than men, with their characteristic more intensive growth (for 10 years by 3.6% against 0.4% among the adult population in the country). The first three places in the structure belong to the Southeastern region, Kyiv, Western region, the next – Central, Southern, Northeastern regions. Levels of the prevalence of the disease among women (100 thousand) are higher than the average in Ukraine and have a high growth rate (for 10 years by 13.5% from 232.2 to 263.6 against 9.3% from 171.5 to 187.5, respectively). Typical for Ukraine persistent increase in patients with the first diagnosis of chronic cystitis (0.8%, 2.1% and 2.8%, respectively, in the first, second periods and 10 years to 15112 in 2017) is also formed by this category (women's growth was 3.4%, 12.4%, and 5.0%, respectively, to 11.295). A similar situation was also identified in the analysis of the level of morbidity (per 100 thousand). In Ukraine, its growth rate for the last five years was 9.6% against 1.8% for the previous year, for 10 years – 11.9%, and the value reached 43.4 in 2017 against 38.8 in 2008. Among women, its levels are higher than the average in Ukraine (in 2017 – 59.2 against 56.1 in 2008), and the increase was more intense (by 6.2% and 11.3% over the periods; for 10 years – by 11.98%).

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