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Medicni perspektivi, 2022;27(3)

     Title of the issue

Content

2022 Vol. XXVII N 3

Published
2022-09-30

THEORETICAL MEDICINE

Sokolova K.V., Stavytskyi V.V., Voskoboinik O.Yu., Podpletnya O.A., Kovalenko S.I. In silico and in vivo screening of triamterene synthetic analogues as promising diuretics

https://doi.org/10.26641/2307-0404.2022.3.265739

In silico and in vivo screening of triamterene synthetic analogues as promising diuretics

     

 

Key words: design, triamterene, pteridines, structural modification, molecular docking, diuretic activity, SAR analysis

Abstract. In silico and in vivo screening of triamterene synthetic analogues as promising diuretics. Sokolova K.V., Stavytskyi V.V., Voskoboinik O.Yu., Podpletnya O.A., Kovalenko S.I. The modification of lead-compound aimed to the increasing of activity, decrement of toxicity or improvement of selectivity is one of the most important methods used for elaboration of novel medications. Natural compounds, approved or investigational drugs or just compounds with proved biological activity could be the lead-compound. Often the chemical modification of lead compounds is directed at the enhancement of ligand-biological target interactions. Abovementioned approach, namely structural modification of known drug triamterene was used for purposeful search for novel diuretics. The preliminary prognostication of ligand-target interactions and affinity levels allow to reduce quantity of experimental animals, synthesis, and pharmacological studies costs. Conducted studies revealed the series of promising 6,7-disubstituted pteridine-2,4(1H,3H)-diones with diuretic activity that comparable with pharmacological effect of triamterene. Aim – purposeful search for promising diuretics among structural analogues of triamterene that includes preliminary in silico studies, synthesis and in vivo screening of novel compounds for diuretic activity. Methods used: organic synthesis, physicochemical methods of analysis of organic compounds (NMR 1H-spectroscopy, chromato-mass spectrometry, elemental analysis). Prediction of affinity for a biological target, prediction of toxicity and lipophilicity of the combinatorial library, which was created on the basis of the drug triamterene, was carried out using computer services. Studies of compounds that affect the excretory function of the kidneys of rats were performed according to the generally accepted method of E.B. Berkhin with water load. Research of the probable mechanism was conducted by flexible molecular docking, as an approach of finding molecules with affinity to a specific biological target. Macromolecular data were downloaded from the Protein Data Bank (PDB) namely, the crystal structures of epithelial sodium channel (ENaC) ((PDB ID – 6WTH). The substantiation of potential diuretics design was conducted by in silico methods (prediction of affinity, ligand-enzyme interactions and pharmacokinetic characteristics). The structural modification of triamterene molecule was carried out by replacing of amino-group in positions 2, 4 and 7 by others “pharmacophore” fragments. Abovementioned transformation is aimed at the changing of ligand-enzyme interactions in active site, lipophility and toxicity. Synthesis of 6,7-disubstituted pteridine-2,4(1H,3H)-diones was conducted by condensation 5,6-diamino-2-oxo-(thioxo-)-2,3-dihydropyrimidin-4(1H)-ones with carbonyl-containing compounds or oxocarboxylic acids.  The further modification of obtained compounds was performed by alkylation, hydrazinolysis and nucleophilic addition/elimination. The structure of obtained compounds was proven by elemental analysis, chromato-mass and 1H NMR-spectral analysis. The studies of synthesized compounds effect on excretion function of kidneys allowed to detect series of promising structural analogues of triamterene that exceed it in pharmacological activity by 27.3-99.0%. The “structure-biological activity” relationship was discussed and perspective of the further search of diuretics among abovementioned compounds were shown. The design of new biologically active compounds with diuretic activity was performed using in silico methodologies and realized by structural modification of the well-known diuretic triamterene. Traditional organic synthesis was used for preparation of target compounds, in vivo experiments were used to detect compounds with significant biological activity. Several effective compounds were identified among pteridines, which exceed the reference drug triamterene in terms of daily diuresis. The obtained results substantiate further purposeful search, in-depth research on experimental pathologies and study of the mechanism of action of potential diuretics among this class of compounds.

Popko S.S. Dynamics of the cellular composition of lymphoid nodules in the lungs of guinea pigs sensitized with ovalbumin

https://doi.org/10.26641/2307-0404.2022.3.265741

Dynamics of the cellular composition of lymphoid nodules in the lungs of guinea pigs sensitized with ovalbumin

     

 

Key words: lymphoid nodule, guinea pig, lung, allergic inflammation, ovalbumin

Abstract. Dynamics of the cellular composition of lymphoid nodules in the lungs of guinea pigs sensitized with ovalbumin. Popko S.S. The article discusses the morphological aspects of the dynamics of the cellular composition of lymphoid nodules in the lungs of guinea pigs as a result of an experimental ovalbumin-induced allergic process. We studied the reactivity of immunocompetent cells of lymphoid formations of the lungs after three times subcutaneous sensitization and subsequent 8-day intranasal aeroallergization with ovalbumin in the early and late stage period of the allergic inflammatory process by microscopic, morphometric and statistical methods. By help of morphometric analysis we demonstrate the general regularity of reactivity of a local specific link of the pulmonary immune system to the action of an allergen, which consists in the elevation of the average amount of immune cells of lymphoid nodules of the lungs, starting from the 30th to the 44th day after the start of the experiment. The maximal coefficient of increase by 5.8 times was observed in counting plasma cells among all types of immunocompetent cells of lymphoid nodules in the lungs during the experiment. It has been statistically proven that the implementation of the ovalbumin-induced allergic inflammatory process in the lungs proceeds according to the humoral type and the duration of its course is not limited by the direct influence of the allergen, it also continues after the end of its action, which is a manifestation of changes in compensatory-adaptive processes in the pulmonary immune system with ovalbumin-induced allergic inflammation.

Bychkova S.V., Stasyshyn A.R., Bychkov M.A. The role of bafilomycin as a therapeutic agent in the modulation of endo-lysosomal store of rat hepatocytes

 

https://doi.org/10.26641/2307-0404.2022.3.265768

The role of bafilomycin as a therapeutic agent in the modulation of endo-lysosomal store of rat hepatocytes

     

 

Key words: аutophаgу, hepatocytes, bаfіlomycіn A1, ATPases, NAAD, Ca2+-store

Abstract. The role of bafilomycin as a therapeutic agent in the modulation of endo-lysosomal store of rat hepatocytes. Bychkova S.V., Stasyshyn A.R., Bychkov M.A. Endo-lysosomal system through the process of autophagy is involved in the pathogenesis of many diseases. Acidification of these organelles is carried out by V-type H+-ATPases, which is inhibited by bafilomycin A1. Endosomes and lysosomes are also important Ca2+-storage in a cell. Nіcotіnіc acіd adenіne dіnucleotіde phosphate (NAADP) releases Cа2+ from endo-lysosomes. The main purpose of the study was to found out the effect of bafilomycin A1 and NAADP on stored Ca2+ and on the ATPase activity of rat hepatocytes. The stored Ca2+ was estimated using chlorotetracycline in permeabilized hepatocytes of rats. ATPase activity was determined by level of orthophosphate spectrophotometrically. It was found that bafilomycin A1 reduces stored Ca2+ in permeabilized hepatocytes of rats in the micromolar range of concentration (20 and 0.04 mkM) and averted the effect of NAADP on calcium content. Lower concentrations of bafilomycin A1 (0.001 mkM) did not alter the content of stored calcium, but prevented the influence of NAADP in permeabilized hepatocytes of rats. In the subcellular fraction of rat liver bafi­lomycin A1 (0.001 mkM) increased Ca2+-ATPase and  basal Mg2+-ATPase activities and reduced Na+/K+-ATPase acti­vity. Preincubation of the subcellular fraction with bafilomycin A1 completely averts any changes in the activity of estimated ATPases by means of NAADP. It was concluded that the bafilomycin-sensitive store in hepatocytes of rats is NAADP-sensitive endo-lysosomal Ca2+-store. Using of bafilomycin A1 may be useful in treating autophagy-depended diseases.

Kozlova Yu.V., Maslak H.S., Abraimova O.E., Koldunov V.V., Khudyakov O.E. State of spatial memory and antioxidant system activity of rats in the dynamics of development of blast-induced traumatic brain injury

 

https://doi.org/10.26641/2307-0404.2022.3.265769

State of spatial memory and antioxidant system activity of rats in the dynamics of development of blast-induced traumatic brain injury

     

 

Key words: blast-induced traumatic brain injury, brain, spatial memory, catalase

Abstract. State of spatial memory and antioxidant system activity of rats in the dynamics of development of blast-induced traumatic brain injury. Kozlova Yu.V., Maslak H.S., Abraimova O.E., Koldunov V.V., Khudyakov O.E. The main purpose of this study was to investigate the changes in spatial memory and catalase activity in dynamics in the blast-induced traumatic brain injury (bTBI). The experiment was carried out on 67 albino male Wistar rats, which were randomly divided into three groups: I group – experimental (n=34), animals were subjected to inhalation anesthesia with halothane, fixed and was simulated blast-induced traumatic brain injury was simulated by generating a shock wave with an overpressure of 26.4±3.6 kPa, II group – sham (n=34), animals which were subjected only to inhalation anesthesia and fixation and III group – intact (n=34). After the study of behavior, euthanasia was performed, blood and brain were taken shelter. Histopathological examination of the brain showed disturbances both of hippocampal neurons and microcirculature. In the dynamics of the post-traumatic period of mild bTBI there was observed a significant (p<0.01) impairment of rats spatial memory in the experimental group, which was established as a prolongation of latent time of the search in the Barnes maze: by 39% – on day 1, by 76% – on day 3, by 65% – on day 7 and by 61% – on day 14 of the study. The analysis of catalase activity revealed a significant decrease of this enzyme activity in blood plasma of the rats in the experimental group in comparison with rats of sham and intact groups: on day 1 – by 35% (p<0.01), on day 3 – by 27% (p<0.01) and by 12% on day 7 of the post-traumatic period (p<0.05), which indicates the involvement of catalase in the reaction of hydrogen peroxide inactivation. Correlation analysis between spatial memory and catalase activity in experimental rats showed a negative relationship of medium degree on day 1 (r=-0.3, p<0.01) and a negative relationship (r=-0.2, p<0.01) of weak degree on day 3 of post-traumatic period, indicating increased formation of free radicals during this period. One-way analysis of variance showed a significant (H1, p<0.01) effect of changes in the catalase activity of rat blood plasma on the state of spatial memory in the Barnes maze during 14 days of the post-traumatic period. It was established that oxidative stress is an important link in pathogenesis of the spatial memory disorders in animals with mild bTBI in the first week of the post-traumatic period.

Degtiar A.V. Morphology of the rat knee joint after intraarticular injection of hydroxymethyl-quinoxaline dioxide

https://doi.org/10.26641/2307-0404.2022.3.265824

Morphology of the rat knee joint after intraarticular injection of hydroxymethyl-quinoxaline dioxide

     

 

Key words: hydroxymethyl-quinoxaline dioxide, experiment, rats, knee joint, histology

Abstract. Morphology of the rat knee joint after intraarticular injection of hydroxymethyl-quinoxaline dioxide. Degtiar A.V. Topical antiseptics are widely used in orthopedics and traumatology. However, studies highlighting the effects of antiseptics during long-term use on joint tissues are limited. In the performed work, the peculiarities of the structure of intra-articular tissues of the knee joint and muscles in rats in two series of experiments were noted: control group (saline injection into the joint) and experimental group (hydroxymethyl-quinoxaline dioxide injection into the joint) daily for 5 days. Histological methods with semi-quantitative assessment of articular cartilage and synovial membrane were used. During the first day after the drug administration, similar reactive changes to the injection of saline and hydroxymethyl-quinoxaline dioxide were observed in the joint tissues of the two groups of rats. The synovial membrane of the capsule was thickened, and synoviocytes were hypertrophied. The articular cartilage contains single cells with dense nuclei only in the superficial parts, but in general, the cytoarchitectonics of articular cartilage was preserved. In 5 days after injection, no statistically significant differences between saline and hydroxymethyl-quinoxaline dioxide were observed for the study periods. According to the studies the safety of long-term use of the drug as an antiseptic for articular tissues was confirmed.

Shulyatnikova T.V., Tumanskiy V.O. Brain aquaporin-4 expression in the rat septic model (immunohistochemical study)

https://doi.org/10.26641/2307-0404.2022.3.265827

Brain aquaporin-4 expression in the rat septic model (immunohistochemical study)

     

 

Key words: sepsis-associated encephalopathy, astroglial reactivity, aquaporin-4

Abstract. Brain aquaporin-4 expression in the rat septic model (immunohistochemical study). Shulyatnikova T.V., Tumanskiy V.O. The study aimed to determine aquaporin-4 expression in different brain regions was performed in Wistar rats subjected to cecal ligation and puncture (CLP) septic model. The immunohistochemical study of aquaporin-4 was carried out in the sensorimotor cortex, white matter, hippocampus, thalamus and caudate nucleus/putamen regions between 20 and 38 h after CLP. From the 12th h after CLP all animals showed the progressive impairment of sepsis signs and therefore, 9 rats were euthanized between 20-38 h (“CLP-B”, non-survived); 11 animals survived up to 48 h (con­stituted “CLP-A”, survived). After operation, CLP-B group displayed regionally-specific dynamic increase in aquaporin-4 level in the brain mostly associated with astroglial capillary endfeet: by 23rd h in the cortex – 234.15%, by 24th h in the thalamus –129.47% and hippocampus – 101.36%, by 30th h in the white matter – 135.31% and by 38 h in the caudate/pu­tamen – 92.85%; with the highest increase in cortex: by 3.34 times. Heterogeneous and heterochronous aquaporin-4 elevation among brain regions indicates territories more and less susceptible for systemic toxic exposure in sepsis as well as points to diverse reactive responsiveness of local astroglial populations during specific time-period after CLP. The higher rates of aquaporin-4 in the cortex of non-survived animals in CLP model reflects the importance of aquaporin-4 increase in the mechanisms of sepsis decompensation.

Astakhov V.M., Batsylyeva O.V., Puz I.V., Shudrikova N.V. Features of the organization of medical and psychological assistance in the situation of perinatal losses (literature review)

https://doi.org/10.26641/2307-0404.2022.3.265829

Features of the organization of medical and psychological assistance in the situation of perinatal losses (literature review)

     

 

Key words: perinatal loss, grief reaction, psycho-emotional state, pregnancy, medical and psychological assistance

Abstract. Features of the organization of medical and psychological assistance in the situation of perinatal losses (literature review). Astakhov V.M., Batsylyeva O.V., Puz I.V., Shudrikova N.V. The article reveals the organiza­tional features of medical and psychological assistance in cases of perinatal losses in modern conditions. The paper presents the peculiarities of perinatal loss, psychological condition of women’s health during the onset of subsequent pregnancy as well as experiences of the women who have lost a child at different stages of pregnancy. The article notes that the majority of pregnant women with a history of perinatal loss are in a state of chronic stress, which can lead to the emergence and development of various medical and psychological complications. The peculiarities of the experience of grief in the situation of perinatal loss, as a serious mental trauma for the woman's psyche were analyzed. It has been substantiated that the experience of perinatal loss is a non-normative crisis in marital relations, and the process of providing psychological assistance should be directed not only to the woman, but also to the married couple as a whole, which will reduce the risk of rupture of relations, promote their harmonization, which can be considered as an effective resource for a constructive experience of the situation of loss. The main tasks of psychologists and medical staff during the organization of medical and psychological assistance for women and married couples experiencing perinatal loss are also revealed. It is crucial to comprehend the feelings women experience in such cases, which makes medical and psychological care more effective in the process of working with those who are through child loss or have had such an experience previously. The conclusion notes the priority of organizing and providing comprehensive medical and psychological assistance not only to women, but also to married couples in a situation of perinatal loss; the need for special training both for medical psychologists, obstetricians and gynecologists to provide complex assistance to women experiencing perinatal losses.

Kryshinska T.Y., Sharun A.V., Zakharov S.V., Stepanskyi D.A. Enghlish-language educational models in medical university

https://doi.org/10.26641/2307-0404.2022.3.265850

Enghlish-language educational models in medical university

     

 

Key words: content and language integrated learning, English as a medium of instruction, higher medical education, foreign language competence

Abstract. Enghlish-language educational models in medical university. Kryshinska T.Y., Sharun A.V., Zakharov S.V., Stepanskyi D.A. The article considers two approaches to training in high medical school: 1) using English as a Medium of Instruction and 2) Content and Language Integrated Learning the emergence of which was related to a wide spread of bilingualism in society, importance of increase in competitiveness of graduates of domestic universities on international labor market. The authors present the models of teaching within the stated approaches which promote the efficiency of professional training of future doctors in solving professional problems on the basis of implementation of foreign language competence. The paper defines the conditions of content and language integrated models implementation into the learning process. In conclusion, it is noted that the integration of subject and language experience contributes to the optimization of foreign language training and  significant improvement of the quality of the educational process. The most pressing issues requiring additional research are identified.

CLINICAL MEDICINE

Kolesnyk T.V., Fursa O.V. Features of the daily profile of blood pressure, taking into account polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension after myocardial infarction

https://doi.org/10.26641/2307-0404.2022.3.265931

Features of the daily profile of blood pressure, taking into account polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension after myocardial infarction

     

 

Key words: arterial hypertension and myocardial infarction, daily blood pressure profiles, angiotensin II type 1 receptor A1166C polymorphism

Abstract. Features of the daily profile of blood pressure, taking into account polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension after myocardial infarction. Kolesnyk T.V., Fursa O.V. The article presents the results of a study of the daily blood pressure profile, taking into account the polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension with past myocardial infarction. The study involved 36 men with stage III hypertension, grade 1-3 arterial hypertension, with past myocardial infarction. The average age in the study group was 57.0 (52.0; 64.0) years, the experience of hypertension was 6.3 (4.0; 15.0) years. The average period after a heart attack was 48.0 (12.0; 144.0) months. The study of the type 1 angiotensin II receptor gene on the DNA-sorb-B test system was carried out by the polymerase chain reaction method with the restriction of products by endonuclease. 24-hour blood pressure monitoring was performed according to the standard method. It was found that, in general, in the group, the levels of systolic and diastolic blood pressure according to the median corresponded to the target ones. But the blood pressure load indicators both for the day and separately during the day and at night exceeded the normal range. In an intergroup analysis, significantly higher blood pressure figures and pressure load indices were registered in patients with the CC genotype of the angiotensin II type 1 receptor gene. In addition, this group of patients showed a high incidence of adverse variants of circadian fluctuations in blood pressure. In accordance to the daily monitoring data, only 13 (34.2%) patients achieved the target level of blood pressure: with the AA genotype – in 6 (15.9%) patients, with the AC genotype – in 6 (15.9%) patients and in 1 (2.6%) patient with CC genotype of the angiotensin II type 1 receptor gene. In 4 (10.5%) patients with the AA genotype and in 3 (7.9%) patients with the AC genotype of the angiotensin II type 1 receptor gene, achievement of the target level of blood pressure was registered in the normal range of blood pressure load indices. In other cases, the target level of arterial pressure was accompanied by an increase in pressure load indices, which indicates incomplete daily control of arterial hypertension.

Koteliukh M.Yu. A model for predicting acute heart failure in patients with acute myocardial infarction by taking into account energy and adipokine metabolism indicators

https://doi.org/10.26641/2307-0404.2022.3.265932

A model for predicting acute heart failure in patients with acute myocardial infarction by taking into account energy and adipokine metabolism indicators

     

 

Key words: adipokine, energy homeostasis, myocardial infarction, heart failure, prognosis

Abstract. A model for predicting acute heart failure in patients with acute myocardial infarction by taking into account energy and adipokine metabolism indicators. Koteliukh M.Yu. Acute heart failure (AHF) is one of the most common complications of acute myocardial infarction (AMI). Currently, adropin, irisin, fatty acid binding protein 4 (FABP 4) and C1q/TNF-binding protein 3 (CTRP 3) are considered to be valid markers of energy homeostasis and the adipokine system in AMI patients. The aim of the study was to predict the development of AHF in AMI patients by taking into account indicators of energy homeostasis and adipokine system using generalized linear mixed model. The study examined 189 patients with acute ST-segment elevation myocardial infarction. Concentrations of adropin, irisin, insulin, FABP4 and CTRP3 were determined by enzyme-linked immunosorbent assay. Fasting capillary blood glucose level was measured by glucoseoxidase method. Insulin resistance (IR) was assessed using homeostasis model assessment of insulin resistance (HOMA-IR). The study identified thrombolysis in myocardial infarction (TIMI) grade before intervention. A generalized linear mixed model was used to develop a method for predicting AHF in AMI patients. The study showed decreased levels of adropin, irisin and CTRP3 and increased levels of FABP4 in AMI patients. A mathematical model for predicting AHF development in AMI patients was proposed. The model consisted of fixed effects, namely, two one-factor indicators (HOMA-IR and systolic blood pressure (BP)), one two-factor indicator (systolic and diastolic BP) and one three-factor indicator (adropin, irisin and CTRP3) and random effects such as four one-factor indicators (FABP4, TIMI Grade Flow, platelets, total cholesterol). The accuracy of predicting the absence of Killip class I AHF was 100%, Killip class II AHF – 0%, Killip class III AHF – 11%, Killip class IV AHF – 82%. It should be noted that systolic BP on day 1 was a strong negative prognostic factor, while HOMA-IR, the combined effect of adropin, irisin and CTRP3, the combined effect of systolic and diastolic BP were positive prognostic factors. Thus, the model showed a very high sensitivity in predicting Killip class IV AHF. The overall accuracy of the model was 89.4%.

Hamid Dahmarde, Faramarz Fazeli. Should renal resistive index be considered as a routine predictor in newly diagnosed acute hydronephrosis in patients with unilateral renal colic?

https://doi.org/10.26641/2307-0404.2022.3.265934

Should renal resistive index be considered as a routine predictor in newly diagnosed acute hydronephrosis in patients with unilateral renal colic?

     

 

Key words: renal resistive index, renal colic, acute hydronephrosis

Abstract. Should renal resistive index be considered as a routine predictor in newly diagnosed acute hydronephrosis in patients with unilateral renal colic? Hamid Dahmarde, Faramarz Fazeli. Urinary tract stones are the most common causes of urinary tract obstruction, leading to patient hospitalization in the emergency room. This study is aimed to evaluate the use of the mean resistance index (mRI) to predict hydronephrosis in patients admitted for acute renal colic. This prospective study was performed on 100 patients who were admitted to the emergency department (ED) with unilateral renal colic (RC) problem. At the first visit, the following was done for all patients: 1. blood was taken from them for laboratory studies; 2. ECG and cardiological test; 3. plain film of the urinary tract; 4. аbdominal US; 5. bilateral color doppler ultrasound (CDUS) with renal RI measurement. Based on the information collected at different times during the experiment, patients were divided into two groups: the group that showed signs of dilatation (group A) and the group with hydronephrosis (group B). The obtained data were analyzed statistically by SPSS version 20. A mRI with a 0.68 cut off value was the most accurate (AUC:0.878), and Sensitive (90%) cut-off value for prediction of  hydronephrosis development among patients presenting with RC and renal stone. This cut-off value also provided the highest positive (94%) and negative (76%) predictive values. CDUS with RI measurement is an easy and non-invasive method that provides useful information about urinary tract obstruction stones in patients with unilateral RC. In our study, this method was able to predict successfully the onset of acute renal dilatation. This was done with different levels of sensitivity, specificity, accuracy and diagnostic efficiency that were higher than ultrasound. Daily use of CDUS in ED can improve ultrasound, especially when other methods are contraindicated. For example, the methods by which the patient is exposed to radiation (pregnancy, allergies, renal failure, etc.) or intravenous injection of contrast agents (urography and CT

Sadullayev A.S., Medvediev M.V. Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis)

 

https://doi.org/10.26641/2307-0404.2022.3.265937

Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis)

     

 

Key words: endometriotic cyst, AMH, Anti-Müllerian hormone, ovarian reserve, laparoscopy, excision of the cyst capsule

Abstract. Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis). Sadullayev A.S., Medvediev M.V. Endometriotic cyst is one of manifestations of the endometriotic process and its incidence among all women with endometriosis varies from 17 to 44%. This chronic process in the ovary is accompanied by persistent inflammation, which leads to fibrosis of the ovarian cortex and loss of follicles. Laparoscopic excision of the endometriotic cyst capsule is by far the mainstay of treatment for cysts of 3 cm or more in diameter. This standard surgical procedure can reduce an ovarian reserve marker such as anti-Müllerian hormone (AMH), raising concerns about reduced fertility after surgery. The aim of the study was to analyze the effect of operative, in particular, laparoscopic cystectomy, on the ovarian reserve in women of fertile age with endometriotic cysts. A retrospective analysis of the data of 202 women with endometriotic cysts who underwent examination, surgery and outpatient observation from 2011 to 2020 was carried out. The analysis was carried out in comparison before and after surgical treatment of all cases. The state of the ovarian reserve was assessed by the level of serum AMH. At baseline, the mean AMH in women with bilateral cysts 1,78 (95% CI 1,62; 1,91) ng/ml was lower than in women with monolateral cysts 2,44 (95% CI 2,18; 2,54) ng/m (p<0.001). When comparing AMH values 6 months after surgery, it was found that in all women the median AMH level significantly decreased by an average of 0,34 (95% CI 0,2-0,48) ng/ml (p<0,001). Laparoscopic excision of the cyst capsule is the main method of treatment of endometriotic cysts, and its minimally invasiveness and acceptability of use in women of fertile age makes it the standard surgical approach. However, the analysis showed that, nevertheless, laparoscopic excision of the endometriotic cyst capsule does not guarantee the safety of the negative effect of this method on the ovarian reserve, both during and after its application, on the contrary, significantly reducing the AMH values in comparison with its levels before surgery.

Ostafiichuk S.O., Volosovskiy P.R., Prudnikov P.M., Henyk N.I., Makarchuk O.M. Association of hyperemesis gravidarum with the risk of development of small for gestational age fetus

 

https://doi.org/10.26641/2307-0404.2022.3.265938

Association of hyperemesis gravidarum with the risk of development of small for gestational age fetus

     

 

Key words: hyperemesis gravidarum, human chorionic gonadotropin, small for gestational age fetus

Abstract. Association of hyperemesis gravidarum with the risk of development of small for gestational age fetus. Ostafiichuk S.O., Volosovskiy P.R., Prudnikov P.M., Henyk N.I., Makarchuk O.M. The goal of this study was to determine the association of hyperemesis gravidarum with the risk of development small for of fetus gestational age (SGA). Materials and methods. There were studied 327 pregnant women. The main group included 218 women with hyperemesis gravidarum, who were divided into two groups: 140 patients who were first hospitalized with hyperemesis gravidarum in the first trimester (up to 12 weeks of pregnancy) and 78 - who were first hospitalized with hyperemesis gravidarum in the second trimester (12-21 weeks of pregnancy). 109 pregnant women without vomiting were at control group. The diagnosis of SGA fetus was established on the basis of standard ultrasonic fetometry on the ALOKA SSD-1700. Determination of human serum chorionic gonadotropin (HCG) levels was performed at 15-20 weeks and was evaluated as MoM. The results were statistically analyzed using Statistica 10 (Serial Number: STA999K347150-W) and MEDCALC®. Results. In the main group, the SGA fetus was 3.4-fold more frequent compared with pregnant women in the control group (9.6% vs. 2.8%, p<0.05; OR=3.77; 95%CI:1,10-12.92). It was found that hyperemesis gravidarum in the first trimester does not affect the deviation of fetal weight deviations (p>0.05). However, hyperemesis gravidarum in pregnant women in the second trimester increases the risk of developing SGA fetus (OR=6.42; 95%CI 1.75-23.62; p<0.01) compared with control. Pregnant women with HCG≥2.5 MoM were 3.0-fold more likely to be diagnosed SGA fetus than with HCG<2.5 MoM (75.0% vs. 25.0%, p<0.001; OR=9.00; 95%CI:1.42-57.12) and 2.3-fold compared with the development of the normal fetus (75.0% vs. 33.3%, p<0.001; OR=6.00; 95%CI:1.47-24,4). Conclusion. Hyperemesis gravidarum in the second trimester of pregnancy and elevation of HCG level in the second trimester (≥2,5 МоМ) can be seen as markers of placental disfunction and high risk for SGA fetus.

Dynnik V.O., Dynnik O.O., Druzhinina A.E. Role of vitamin D in the formation of abnormal uterine bleeding in the pubertate period

 

https://doi.org/10.26641/2307-0404.2022.3.265940

Role of vitamin D in the formation of abnormal uterine bleeding in the pubertate period

     

 

Key words: abnormal uterine bleeding, vitamin D, hormonal status, adolescent girls

Abstract. Role of vitamin D in the formation of abnormal uterine bleeding in the pubertate period. Dynnik V.O., Dynnik O.O., Druzhinina A.E. The problem of the participation of vitamin D in the pathogenesis of various diseases has been attracted the attention of scientists in recent years. Vitamin D deficiency is regarded as a global problem that increases the risk of many chronic diseases. More recently, the emphasis has shifted to the non-skeletal effects of vitamin D. A lot of literature suggests that vitamin D plays an important role in the regulation of processes in the ovaries that determine female fertility, female reproductive potential. Vitamin D receptor enzymes involved in its metabolism are expressed in both the central and peripheral reproductive organs (hypothalamic-pituitary system, ovaries, uterus, placenta). All of this suggests that vitamin D is involved in the regulation of menstrual function. The aim of the study is to identify the relationships between gonadotropic and steroid hormones with the content of vitamin D in menstrual disorders in adolescent girls by type of abnormal uterine bleeding (AUB). 167 adolescent girls with AUB were examined. The levels of Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), Prolactin (PRL), total estradiol (E2), testosterone (T), cortisol (C), vitamin D were determined. It was revealed that in 92.1% of girls with AUB have a decrease in the level of vitamin D, and 53.9% of them have a sharp reduce of its. A factorial model of the relationship between pituitary-gonadal hormones and vitamin D, on the basis of which it may be assumed that vitamin D makes a significant contribution to the formation of AUB in adolescence. It participates in the mechanisms of stimulation of gonadotropins, affects the activity of sex hormones through the promoters of receptors located both in the hypothalamic-pituitary region and in the periphery in the ovaries. This is evidenced by factor weights, which serve as analogues of the correlation ratios and show the degree of interconnection between the variables in the factors selected. The changes in the content of vitamin D revealed indicate the need and expediency of its determination in the blood of patients with AUB during puberty for early diagnosis of its abnormalities and timely prevention of serious complications in the future.

Nosov S.G., Yuryeva L.М., Shusterman T.Y., Nekrasova O.V. Clinical and pathogenetic prediction of the dynamics of the course of psychoses in epilepsy

https://doi.org/10.26641/2307-0404.2022.3.265945

Clinical and pathogenetic prediction of the dynamics of the course of psychoses in epilepsy

     

 

Key words: epileptic psychoses, prognosis, transient course, paroxysmal course, chronic course, clinical-pathogenetic transformation, treatment

Abstract. Clinical and pathogenetic prediction of the dynamics of the course of psychoses in epilepsy. Nosov S.G., Yuryeva L.М., Shusterman T.Y., Nekrasova O.V. Transient epileptic psychoses in 30-40% of cases turn into psychotic states with a long, paroxysmal or chronic course. The objective of this article is to conduct a systematic analysis of modern literature sources to clarify the factors, clinical and pathogenetic patterns of transformation of transient (short-term) epileptic psychosis into psychotic states with prolonged and chronic course, as well as to identify pathogenetically oriented principles of treatment of such patients. The prognostic value of clinical and neurophysiological factors regarding increasing of the psychotic process duration has been noticed, clinical patterns of transformation of short-term psychosis into long-term (changes in the dynamics and structure of psychosis, features of the relationship with organic personality disorder and dementia in epilepsy, as well as epileptic seizures) have been shown. A number of important neurophysiological pathogenetic mechanisms of increasing the psychosis duration (growing cerebral hypofrontality, temporal localization and regular spread of the epileptic process) have been identified. Pathogenetically oriented principles of treatment tactics of patients with epileptic psychoses have been described and analyzed taking into account the revealed regularities of increasing of their duration.

Serdiuk V.M., Ustymenko S.B., Klopotska N.G., Tikhomirova V.V. Effect of orthokeratologic lenses of individual design on visual functions in premature babies with myopia in school age

https://doi.org/10.26641/2307-0404.2022.3.265952

Effect of orthokeratologic lenses of individual design on visual functions in premature babies with myopia in school age

     

 

Key words: customized orthokeratological lenses, myopia, prematurely babies, school-age children

Abstract. Effect of orthokeratologic lenses of individual design on visual functions in premature babies with myopia in school age. Serdiuk V.M., Ustymenko S.B., Klopotska N.G., Tikhomirova V.V. The study included 62 children aged 6 to 14 years with mild to moderate myopia, born at 28-34 weeks of gestation with a birth weight of 970 to 2200 g. Selection criteria: corneal refractive power >46.00 D, no keratoconus or macular degeneration. The main group – 32 children (64 eyes), who were assigned orthokeratologic lenses, the control group – 30 children (60 eyes) – glasses users. Differences between the groups were not significant. Observation period was 3 years. There were no complications. Corrected visual acuity in the main group increased from 0.63±0.08 to 0.98±0.06, in the control – from 0.61±0.05 to 0.73±0.05; p<0.005. Stable restoration of binocular vision was observed in all children of the study group and 83% of children in the control one. Reserves of absolute accommodation in the main group during the observation period increased by 6.7±0.38 D, and in the control group – by 2.3±0.42 D (p<0.001), which is explained by the active use of accommodation by children of the main group. After 3 years of observation in the main group, the anteroposterior size of the eyeball, according to echobiometry data, almost did not change (from 22.32±0.9 to 24.02±1.1 mm, p>0.2), and in the control group, the eye elongation was more pronounced: from 22.45±0.8 to 25.94±0.9 mm (p<0.01). Complete stabilization of myopia was observed in 30 children (93.75%) of the study group. Orthokeratological lenses MoonLens can be used in patients with high corneal curvature; their use in prematurely babies with a high refractive power of the cornea (>46.0 D) allowed to obtain better results of the treatment.

Garibeh E., Bondаr S.А., Tokarchuk N.I., Vyzgha Y.V. Charactirestics of vitamin D level in patients with atopic dermatitis

https://doi.org/10.26641/2307-0404.2022.3.265954

Charactirestics of vitamin D level in patients with atopic dermatitis

     

 

Key words: atopic dermatitis, vitamin D

Abstract. Charactirestics of vitamin D level in patients with atopic dermatitis. Garibeh E., Bondаr S.А., Tokarchuk N.I., Vyzgha Y.V. The peculiarity of the skin is that it acts not only as a place of synthesis of vitamin D, but also as an organ targeted for its biologically active form. The aim of our study was to analyze the level of vitamin D in patients with atopic dermatitis. There were examined 48 people aged between 18 to 55 years; they are residents of Vinnytsia and Vinnytsia region. Serum levels of vitamin D, total IgE and  eosinophilic cationic protein (ECP) were determined in the subjects. The average level of vitamin D in the serum of patients with atopic dermatitis was 19.2 [11.3-25.4] ng/ml, which corresponded to a deficiency. Among those surveyed, vitamin D deficiency was found in 68.4±4.7% (n=26) while vitamin D insufficiency in 31.6±4.5% (n=12). The severe course of the disease prevailed among patients aged 18-40 years (63.33±8.79) % more than in the age group of 41 years and older, (36.67±8.8%, p<0.05; OR=2.98, S=0.53, 95% SI:1.04-8.52). The proportion of people with vitamin D deficiency and moderate severity of atopic dermatitis was 62.5% (n=10) with a median level of 14 [8.3–19] ng/ml, and patients with severe atopic dermatitis made up 90.9% (n=20) (χ²=4.6; p=0.023), in which the median level of vitamin D was 14 [8.3-19] ng/ml. Serum vitamin D levels were in the zone of deficiency in patients with moderate and severe atopic dermatitis. Vitamin D deficiency was significantly more common in the group of patients with elevated levels of allergic inflammation markers. A positive correlation of medium strength between the level of vitamin D and ECP in the serum of patients with atopic dermatitis (rs=0.53, p<0.001), was revealed.

Badiul P.O., Korpusenko O.I., Nor N.M., Korpusenko I.V., Rudenko O.I. Influence of negative pressure on changes in blood supply in donor zones of perforant flaps formation

https://doi.org/10.26641/2307-0404.2022.3.265955

Influence of negative pressure on changes in blood supply in donor zones of perforant flaps formation

     

 

Key words: reconstructive surgery, negative pressure, perforating flaps, donor sites, dynamic thermography, blood supply

Abstract. Influence of negative pressure on changes in blood supply in donor zones of perforant flaps formation. Badiul P.O., Korpusenko O.I., Nor N.M., Korpusenko I.V., Rudenko O.I. Our study is based on the establishment of normative indicators of the effect of negative pressure on the skin of the thigh. To do this, a group of healthy volunteers was examined – 35 people: 17 women and 18 men aged 19 to 58. The study was conducted on the clinical basis of the burn centre in 2020-2021. The local vacuum was created using a negative pressure device “AGAT-Dnepr” by applying a silver-containing polyurethane sponge directly on the front surface of the thigh. The pressure (P) – 110-160 mmHg has been applied for 30 minutes. Tissue perfusion was monitored by laser Doppler flowmetry and thermal imaging research. Measurements were performed before vacuum, immediately after the end of the application of negative pressure, for three days at the same time at a constant temperature. According to the results of the cluster analysis, based on the effect of negative pressure on the thigh skin, patients with three types of reactions were identified – low, medium and high perfusion changes. The perfusion level of tissue volume per unit time increased the most rapidly: in the group of high perfusion by 45.56 (95% CI 42.09-51.96) PU; in the group of average perfusion – by 22.49 (95% CI 19.93-28.99) PU; in the low perfusion group – by 22.43 (95% CI 15.90-25.13) PU. The number of erythrocytes per unit tissue changed at a medium rate: in the high perfusion group by 57.77 (95% CI 53.05-62.48) AU; in the group of average perfusion – by 55.86 (95% CI 49.62-65.06) PU; in the low perfusion group – by 34.85 (95% CI 13.19-53.55) PU. Among those surveyed, 12 people were included in the low perfusion group (34.29%), 16 people in the medium perfusion group (45.71%) and 7 people in the high perfusion group (20.0%). Before VAC-action the ascending level of thigh skin temperature T1 ranged from 28.60 to 32.90°C and averaged 31.46 (95% CI 30.97-31.95)°C. Immediately, after the offset of the negative pressure the area of the fields of local skin temperature rise increased, the average temperature level ranged from 30.60 to 35.0°C and the average T2 was 33.59 (95% CI 33.16-34.01)°C. The temperature rise occurred on average by 2.13 (95% 1.72-2.54)°C, which corresponded to an increase of 6.77% with significant (p<0.001) statistical differences. Only 1 examined had a slight decrease in the tem­perature of the thigh skin from 31.9 to 31.6°C, in the rest of the examined the rise was by 6.4°С maximally, from 28.6 to 35.0°С, there was a temperature rise by 2°С or more degrees among 9 people (25.71%). After 24 hours there was a rise in local body temperature among all examined (100%), after 48 hours – among 25 (71.43%), and after 72 hours – among 21 examined (60.0%). When choosing a donor site of the perforant flaps, we recommend relying on areas which will belong to the group of indicators with high perfusion. According to the analysis, the group of high perfusion will include patients with an initial average level of perfusion in the donor areas per unit time of 15.84 (14.47-17.21) PU, the number of erythrocytes per unit tissue – 58.73 (53.44-64.02) AU and skin temperature – 29.23 (28.65-29.80)°С; to the average according to F rates – 14.36 (13.0-15.73) PU, C rates – 45.37 (39.74-51.0) AU, T rates – 28.17 (27.74-28.60)°С; to the group of low perfusion, respectively, according to F rates – 12.38 (10.74-14.0) PU, C rates – 43.89 (40.18-47.61) AU, T rates – 29.79 (29.17-30.40)°С. In general, the effect of negative pressure contributes to increased perfusion and local microcirculation in tissues, as evidenced by dynamic infrared thermography: increased “hot” skin fields, increased temperature with a temperature gra­dient ∆T2.1=2.13 (95% 1.72-2.54)°C and for indicators of laser Doppler flowmetry – increase in perfusion by 2.42 times (p<0.001).

Mahdi Afshari, Iraj Shahramian, Morteza Salarzaei, Hadi Mirzaie, Fateme Parooie.  Opium use and COVID-19 infection, a retrospective  study in Iran

https://doi.org/10.26641/2307-0404.2022.3.265958

Opium use and COVID-19 infection, a retrospective  study in Iran

     

 

Key words: opium, addiction, Covid-19

Abstract. Opium use and COVID-19 infection, a retrospective  study in Iran. Mahdi Afshari, Iraj Shahramian, Morteza Salarzaei, Hadi Mirzaie, Fateme Parooie. The situation of Covid-19 patients with opium consumption has not been comprehensively investigated especially in Iran. This study is aimed to investigate the effect of current opium addiction on the severity and outcome of the Covid-19 infection. During a retrospective cohort study, clinical, demographic and all variables related to the severity and death due to the Corona virus infection were collected from the medical records of patients hospitalized from February 2020 to June 2021 in the study area. The role of current addiction in the severity and outcome of the disease was investigated using Cox, logistic and linear regression models. Of 939 confirmed Covid-19 cases admitted during the study period, 70 (7.5%) patients were currently addicted.  Multivariate reg­ression models showed that current opium addiction significantly increased the chance of endotracheal intubation (OR=2.96, p=0.005) and reduced the mean length of stay in hospital (beta coefficient =-0.42, p<0.0001). However, opium addiction did not change the risk of death (HR= 1.54, p=0.063) or O2 saturation (OR=1, p>0.99). Opium addiction can be associated with the severity of Covid-19 infection, but does not play a considerable role in the mortality of the patients.

Samoilenko A.V., Titovska S.O. Matrix metalloproteinases in the oral fluid as a characteristic of inflammatory-destructive process in periodontal tissues

https://doi.org/10.26641/2307-0404.2022.3.265959

Matrix metalloproteinases in the oral fluid as a characteristic of inflammatory-destructive process in periodontal tissues

     

 

Key words: generalized periodontitis, pathogenesis, diagnosis, matrix metalloproteinases

Abstract. Matrix metalloproteinases in the oral fluid as a characteristic of inflammatory-destructive process in periodontal tissues. Samoilenko A.V., Titovska S.O. The study of the imbalance between the activity of matrix metalloproteinases and their regulation markers in the oral fluid of patients with generalized periodontitis is necessary for creation of effective methods for early diagnosis and preventive treatment of the disease. The aim of the research was to examine the oral fluid of persons with healthy periodontal tissues, patients with chronic diffuse gingivitis and generalized periodontitis for concentrations of matrix metalloproteinases and their inhibitor, anti- and pro-inflammatory cytokines, markers of bone metabolism and to compare obtained results. 90 persons aged 32-45 years were examined, including 30 persons with intact periodontal tissues, 30 patients with chronic diffuse catarrhal gingivitis and generalized periodontitis of the initial degree and 30 ones with chronic generalized periodontitis of I-II degrees. Periodontal status was assessed using clinical indices and bone mineral density according to computed tomography data. The method of enzyme-linked immunosorbent assay (ELISA) was used to determine the concentration of matrix metalloproteinases MMP-2, MMP-3, MMP-8, MMP-9, MMP-13, tissue inhibitor of metalloproteinases TIMP-1, interleukins-1β, -6 and -4, bone metabolism markers – tartrate-resistant acidic phosphatase and bone alkaline phosphatase, osteocalcin in the oral fluid. The initiation of the inflammatory-destructive process in the periodontal tissues was characterized by an increase levels of MMP and pro-inflammatory IL-1β and IL-6 (р<0.05), a decrease in the concentration of TIMP-1 (р>0.05) and anti-inflammatory IL-4 (р<0.05), against the background of the absence of dynamics of bone metabolism markers in the oral fluid. The progression of the process at the І-II degrees of periodontitis was accompanied by a further increase in the concentration of pro-inflammatory interleukins, an increase in the activity of tartrate-resistant acid phosphatase and a decrease in bone alkaline phosphatase and osteocalcin (р<0.05) in the oral fluid, while the content of MMP did not change (р>0.05). The expression of MMP is important for the preventive diagnosis of generalized periodontitis, but it is not indicative for determining the severity of the disease. The imbalance of MMP and TIMP-1 in the early stages of the pathological process indicates the greatest expediency of using MMP inhibitors in the treatment of patients with gingivitis and periodontitis of the initial degree.

PREVENTIVE MEDICINE

Polka N.S., Makhniuk V.M., Chorna V.V., Podolian V.M., Yurchenko S.T. Hygienic assessment of new architectural and planning solutions of buildings of psychiatric health care facilities

https://doi.org/10.26641/2307-0404.2022.3.265960

Hygienic assessment of new architectural and planning solutions of buildings of psychiatric health care facilities

     

 

Key words: psychiatric hospitals, design decisions, multidisciplinary approach, healthcare environment

Abstract. Hygienic assessment of new architectural and planning solutions of buildings of psychiatric health care facilities. Polka N.S., Makhniuk V.M., Chorna V.V., Podolian V.M., Yurchenko S.T. Aim: to conduct a hygienic assessment of new architectural and planning solutions of psychiatric health care facility buildings in Ukraine and give a comparative description of the sanitary standards of the latter in the EU. The study was conducted based on the analysis of State Building Norms (SBN) B.2.2-10:2019 “Buildings and structures. Health care facilities” (draft, final revision), scientific sources of domestic and foreign scientists. A survey of the chief physicians of psychiatric hospitals of Ukraine concerning safe sanitary and hygienic, anti-epidemic conditions for the functioning of psychiatric health care facilities was conducted. We consider it necessary to present more carefully architectural and planning solutions in the relevant section of SBN B.2.2-10:2019 (draft, final revision) or to use the opportunity specified in the introduction to these Norms, and to supplement them with the Manual on the design of psychiatric health care facilities, taking into account the experience of the European Union. To create an appropriate “therapeutic environment” in new domestic mental health care facilities, it is necessary to implement European requirements in the design of these facilities with the involvement of multidisciplinary groups: (from architects to nurses, from construction contractors to patients) and supplement SBN B.2.2-10:2019 “Buildings and structures. Health care Facilities” of Ukraine with a guide for designing facilities of a new type of “Mental Health Centers” as in the Republic of Poland. We have developed and sent to the chief physicians of psychiatric hospitals of Ukraine «Questionnaire for scientific sanitary and epidemiological assessment of the conditions of placement of a psychiatric health care facility”. Based on the analysis of the block of questions on sanitary and antiepidemic and sanitary and hygienic parameters that characterize the buildings of domestic psychiatric hospitals, the location of medical structures and auxiliary units on the land plot, i.e. the design of buildings is determined. In particular, 50% of psychiatric hospitals are housed in combined buildings, 25% have a pavilion system (separate buildings), 12.5% each have a centralized system (all in one building) and a block system. The number of stories of psychiatric hospitals up to 2 is 50%, up to 3 – 37.5% and up to 5 stories in those which have been under construction since 1960 – 12.5%. Analysis of the questionnaire block on the conditions of stay, treatment, rehabilitation of the mentally ill revealed the possibility of organizing occupational therapy in 12.5% of psychiatric hospitals, where special workshops are equipped  and patients can acquire professional skills. Physiotherapy rooms are equipped in 50% of psychiatric hospitals. Low provision of patients with furniture was revealed: 25% of patients partially have proper desk, 75% do not have it; 50% are provided with proper chairs; 62.8% use proper bedside tables and 25% – closets for storing personal clothes.

Dorohan` S.B., Shevchenko A.A., Kulagin A.A., Liashchenko O.V., Lobas V.M., Mikriukova N.G., Kostetsky I.V. Perception of the epidemic risks of the COVID-19 pandemic by the population of Ukraine

https://doi.org/10.26641/2307-0404.2022.3.265962

Perception of the epidemic risks of the COVID-19 pandemic by the population of Ukraine

     

 

Key words: coronavirus infection, epidemic risks, COVID-19, population vigilance, scale of epidemiological vigilance

Abstract. Perception of the epidemic risks of the COVID-19 pandemic by the population of Ukraine. Dorohan` S.B., Shevchenko A.A., Kulagin A.A., Liashchenko O.V., Lobas V.M., Mikriukova N.G., Kostetsky I.V. In the social network Facebook from April 2020 to October 2020 an online survey using the "Google Form" was conducted to study the perception of the COVID-19 pandemic by the residents of Ukraine. The study involved 550 participants residing in the Ukraine-controlled territory and the city of Kyiv. The data are as follows: the coronavirus is considered a serious danger by 33.3±2.0% of respondents and 11.6±1.4% agree with certain doubts (in total – Σ44.9±2.1%); 21.1±1.7% believe that the coronavirus is not serious and 17.3±1.6% believe that it is probably not serious (Σ38,4±2.1%). COVID-19 is recognized as a pandemic by 73.6±1.9% of respondents, of them 45.6±2.1% of respondents completely agree with this statement. Different views towards the severity of the problem show little but reliable correlation with age (rc =0,23; p<0.001), gender (rc =0,21; p<0,001) of the respondents, as well as with the size of the locality where respondents live (rc =0.30; p<0.001). It was revealed that men (47.2±3.6%), persons over 50 years of age (47.5±5.0%) and residents of small towns with a population of 3,000 to 10,0000 residents (47.7±4.3%) are more skeptical about this issue. The majority of respondents have a moderate level of epidemiological vigilance – 299 (54.4±2.1%); this means that a person emphasizes the seriousness and real threats of coronavirus infection, perceives and adheres to the adopted measures, but with certain hesitations. A high level of epidemiological vigilance characterized by confidence in the real situation and the adopted measures is found in 119 (21.6±1.8%) respondents. A low level of epidemiological vigilance is in 121 (22.0±1.8%) res­pon­dents. Only 11 people (2.0±0.6%) have the overall sum of points, which indicates the absence of epidemiological vigilance.

Korshun M.M., Martіianova Y.V. Hygienic assessment of the potential risk for public health caused by groundwater and surface water pollution by pesticides of various chemical classes

 

https://doi.org/10.26641/2307-0404.2022.3.265963

Hygienic assessment of the potential risk for public health caused by groundwater and surface water pollution by pesticides of various chemical classes

     

 

Key words: pesticides, soil, water reservoirs, risk assessment

Abstract. Hygienic assessment of the potential risk for public health caused by groundwater and surface water pollution by pesticides of various chemical classes. Korshun M.M., Martіianova Y.V. The aim of the study was to compare the potential danger for human health caused by pollution in both underground and surface water sources with the fungicide pydiflumetofen and herbicides amicarbazone and bicyclopyrone in a wide range of soil-climatic conditions. Three methods were used: determination of the integral hazard vector (R); predicting the negative impact of pesticides on the health of the population by integral groundwater contamination hazard index (IGCHI), and a comprehensive risk assessment of the negative effects of pesticides on human body, when they are washed out into water (Р). It was found that the highest level of danger for public health due to possible pollution of water sources, is inherent in bicyclopyrone regardless of the soil-climatic conditions and the used assessment method (R=144.6-173.2 – very high potential hazard; IGCHI=12 points – extremely dangerous for humans, 1А class). Pydiflumetofen has a high potential integral vector hazard (R=115.8-137.5) and simultaneously by the value of the IGCHI (7-9 points) can be assessed from dangerous (2 class) to highly dangerous (1B class) for humans, depending on soil-climatic conditions. Amicarbazone by IGCHI (11 points) is extremely dangerous for humans (1A class), and at the same time by the integral vector (R=76.8-122.5) its potential danger varies from medium to high, depending on the soil-climatic conditions. Assessing the risk of the investigated pesticides, based on the comparison between potential exposure and the permissible daily intake it was concluded that the potential risk of adverse effects on public health (P) of all investigated substances is acceptable.

Vinogradov O.O., Guzhva O.I. The Impact of Restrictive Measures to Prevent the Spread of COVID-19 on Students’ Lifestyle

https://doi.org/10.26641/2307-0404.2022.3.265964

The impact of restrictive measures to prevent the spread of COVID-19 on students’ lifestyle

     

 

Key words: COVID-19, restrictive measures, lifestyle, students

Abstract. The impact of restrictive measures to prevent the spread of COVID-19 on students’ lifestyle. Vinogradov O.O., Guzhva O.I. The need to develop effective strategies to overcome the social, economic, physiological and psychological consequences of the COVID-19 pandemic requires targeted research on the impact of restrictive measures on the lifestyle of people of different ages and socio-demographic groups, including youth, as the most able and active population. The article presents the assessment results of the peculiarities of the restrictive measures impact aimed at preventing the spread of acute respiratory disease COVID-19 on the territory of Ukraine on the lifestyle of student youth. The assessment of the general attitude of the respondents to the COVID-19 pandemic, as well as the peculiarities of the lifestyle before and after the introduction of restrictive measures, was conducted by interviewing students using a specially designed questionnaire. The survey involved 86 people (58.1% – women, 41.9% – men) aged 17 to 35. The majority of respondents (79.1%) were urban residents and had a household size ranging from 2 to 4 people (2.7±0.15 people). The results of the survey showed that the majority of students consider COVID-19 a dangerous infection (48.8%), feel anxiety / worry about their own health (58.1%) and the health of their loved ones (83.7%), support the establishment of quarantine (53.5%) and adhere to the recommended preventive measures (97.7%). The majority of students observe the statistics of COVID-19 in Ukraine (79.1%) and the world (81.4%). The most authoritative sources of information for the majority of respondents are official international (53.5%) and official Ukrainian sources (39.5%); however, a significant proportion of respondents also trust unofficial sources of information (23.3%). Most students do not adhere to the regime of self-isolation (51.2%), every day going outside their place of residence, daily contact with an average of 2.7±0.19 people. After the introduction of restrictive measures, the distribution of time for different types of activity has changed. There was a significant increase in time spent by students watching movies and TV series and a decrease in time for walking (p <0.05). The duration of sleep was not changed after the introduction of restrictive measures, however, the time frame of sleep shifted by about an hour – respondents began to fall asleep later on average and wake up later.

SOCIAL MEDICINE

Kyselov S.М., Nazarenko O.V. The impact of systemic changes on quality of care providing in acute myocardial infarction in Ukraine

https://doi.org/10.26641/2307-0404.2022.3.266000

The impact of systemic changes on quality of care providing in acute myocardial infarction in Ukraine

     

 

Key words: acute myocardial infarction, percutaneous coronary interventions, reperfusion therapy, quality of care

Abstract. The impact of systemic changes on quality of care providing in acute myocardial infarction in Ukraine. Kyselov S.М., Nazarenko O.V. For the past 5 years, the system of providing medical care to patients with acute myocardial infarction (AMI) has radically changed in Ukraine. The accession of our country to the European initiative "Stent for Life" contributed to the creation of the national reperfusion network. It ensured the wide availability of medical care for patients with AMI due to the fastest delivery of patients to clinics that provide a 24-hour emergency coronary artery stenting. Nowadays in Ukraine, 42 reperfusion centers are successfully operating 24/7/365 care delivery and more than 50% of patients with AMI undergo primary percutaneous coronary intervention (PCI). Almost 70% of patients are delivered to clinics within the first 6 hours after the onset of AMI symptoms, which corresponds to the obligatory “therapeutic window” for emergency PCI. The average number of primary PCI performed in AMI increased by 4 times in 2018 compared to 2012, reaching 286 procedures per 1 million population. The structure of reperfusion therapy has qualitatively changed in 2016. The total number of reperfusion procedures increased due to a decrease of thrombolytic therapy cases and an increase in the frequency of using the most effective method – primary coronary stenting in patients with STEMI. Systemic changes in the structure of medical care providing to patients with AMI contributed to a decrease in hospital lethality in patients with AMI - from 14,1% in 2012 to 13,81% in 2019.

Naumenko L.Y., Zub T.О., Mametyev A.О. Place of injuries of elbow joint in the structure of primary permanent disability among Ukrainian population

https://doi.org/10.26641/2307-0404.2022.3.266002

Place of injuries of elbow joint in the structure of primary permanent disability among Ukrainian population

     

 

Key words: elbow joint, consequences of injuries, primary permanent disability in Ukraine, population study

Abstract. Place of injuries of elbow joint in the structure of primary permanent disability among Ukrainian population. Naumenko L.Y., Zub T.О., Mametyev A.О. Despite the rapid development of orthopedics consequences of elbow injuries have a significant proportion of unsatisfactory treatment results until now. Owing to comprehend the sources of disability doctors could determine drawbacks of treatment and regulate rehabilitation program for patients with elbow injuries better. The purpose of the study was to investigate the structure of primary permanent disability due to elbow injuries among the Ukrainian population. The study was made on annual reports of Regional centers of medical and social expertise and the Center of medical and social expertise of the city of Kiev for 2018. During the reporting period a disability group due to upper extremity injuries was established totally for 1 211 patients in age over 18 years, among them 195 people had consequences of elbow traumas. That caused an intensive prevalence rate of 6.22 cases per 1 million of adults. Male patients (70.8%) and patients in working age (94.9%) prevailed among people with disability. 10.8% of patients were determined as people with disability without a revision period after the primary examination on medical and social expertise commission. The causes of primary permanent disability were domestic injuries (90.8%), occupational injuries (5.0%), injures during military service and battle injuries (2.1%) and disability since the childhood (2.1%). Structure according to disability groups showed the next distribution: 90.3% – the 3rd group, 9.2% – the 2nd group and 0.5% – the 1st group. Consequences of elbow injuries which led to primary permanent disability were caused by bone fractures (61.5%), elbow contractures and elbow ankyloses (19.0%), injuries of an ulnar nerve (8.7%), traumatic amputation at the elbow level (6.2%), forearm dislocations (3.1%), open wounds of elbow (1.0%), elbow ligaments ruptures (0.5%). Patients registered as disabled with a revision period during the first examination on commission had sufficient rehabilitation potential for restoration of elbow joint function and one of the upper limb in total.

Franchuk V.V., Mikhaylichenko B.V. Methodology of the performance of forensic medical examination in cases of medical malpractice litigation

https://doi.org/10.26641/2307-0404.2022.3.266003

Methodology of the performance of forensic medical examination in cases of medical malpractice litigation

     

 

Key words: forensic-medical examination, medical malpractice, medical errors, methodology of the performance of forensic medical examination

Abstract. Methodology of the performance of forensic medical examination in cases of medical malpractice litigation. Franchuk V.V., Mikhaylichenko B.V. Forensic medical examination is the main source of evidence in criminal cases related to defects in the provision of medical care. Despite the implementation in Ukraine of the new Criminal Procedural Code and the reform of the law enforcement system, this type of expert activity is not sufficiently regulated up to now. Development of an unified methodology for the organization and conduction of forensic medical examinations in cases of medical malpractice litigation is the goal of the research. On the basis of national legislation, 135 Court decisions and 350 case materials regarding the medical practitioners involved in negligence were investigated, algorithm of the expert commission’s activity is created. The algorithm consists of four sequential stages: preparatory, organizational and informational, analytical and evaluative and final. An acquaintance with the case materials takes place at the preparatory stage. The following problematic issues are normally solved during the 2nd stage of the algorithm: the personnel of the expert commission, an appointed rapporteur, the main disease or injury the claimed patient suffered, the literature data and normative documents that govern the provision of medical care in a particular case. At the analytical and evaluative stage, the features of the pathological process in the victim are clarified, the admitted defects of medical care are established with their expanded expert characteristics. At the final stage, the expert commission draws up an "expert conclusion", in which it states the negative consequences of an admitted defect in medical care, establishes a causal relationship and makes a reasonable conclusion about the main reason for the development of an unfavorable outcome for the patient.

A CASE FROM PRACTICE

Lytvyn K.Yu., Mavrutenkov V.V., Yakunina О.M., Chykarenko Z.O., Bilokon O.O., Turchyn M.O. Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case)

https://doi.org/10.26641/2307-0404.2022.3.266004

Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case)

     

 

Key words: Guillain-Barré syndrome, coronavirus infection, polyneuropathy

Abstract. Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case). Lytvyn K.Yu., Mavrutenkov V.V., Yakunina О.M., Chykarenko Z.O., Bilokon O.O., Turchyn M.O. The new strain of coronavirus SARS CoV-2 can affect any organ and system of the body. The pathogenesis of these lesions is due to both direct damage to body cells by the virus and the development of immunopathological reactions that can lead to demyelinating diseases of the nervous system. The article presents a clinical case of the development of Guillain-Barré syndrome associated with coronavirus disease in a 71-year-old man who developed after infection with a new strain of SARS CoV-2 virus. The man was hospitalized on the seventh day of the disease with complaints of unproductive cough, weakness, fever in the range of 37.5-38.7°C, shortness of breath during exercise. The clinical diagnosis was confirmed by the presence of SARS CoV-2 RNA in the nasopharyngeal secretion. According to digital radiography, the presence of interstitial pneumonia was determined. Against the background of treatment, the condition gradually improved and on the 14th day after the onset of the disease, a negative PCR result (SARS CoV-2 (-) RNA) was obtained. However, on the 16th day of hospital stay (23-24th days of the disease) he was diagnosed with polyneuropathy (Guillain-Barré syndrome), severe tetraparesis. Despite the therapy, the condition gradually deteriorated due to the progression of polyneuropathy. On the 9th day after the onset of neurological symptoms (25th days of illness), on the background of severe neurological deficits, the signs of respiratory and cardiovascular insufficiency developed, which led to the death of the patient. It has been shown that the course of Guillain-Barré syndrome, which developed after infection with a new strain of SARS CoV-2 virus, in this case has a severe course and lethal outcome of the disease. It is necessary to look for clinical predictors that would predict the occurrence of neurological complications in patients with coronavirus disease.

Sydorchuk А.S., Sоrokhan V.D., Bоhachyk N.А., Drahanush А.D., Fеldman I.V., Hrubliak L.V. Clinical case of leptospirosis in a woman against chronic alcohol intoxication

https://doi.org/10.26641/2307-0404.2022.3.266005

Clinical case of leptospirosis in a woman against chronic alcohol intoxication

     

 

Key words: leptospirosis, epidemic anamnesis, occupation, risk factor, alcohol intoxication, blood smears

Abstract. Clinical case of leptospirosis in a woman against chronic alcohol intoxication. Sydorchuk А.S., Sоrokhan V.D., Bоhachyk N.А., Drahanush А.D., Fеldman I.V., Hrubliak L.V. An interesting clinical case of leptospirosis infection in an elderly woman with a professional way of getting infection on the background of alcohol abuse has been described. The authors emphasized the clinical features of this bacterial zoonosis, considered aspects of differential diagnosis of leptospirosis with other common infectious diseases. It has been emphasized on the intricacies of a detailed epidemiological anamnesis taking in order to identify and evaluate biorisk factors for pathogenic leptospira con­tami­nation in a particular occupational environment. It has been pointed out the necessity of a complex laboratory-instrumental investigation in the infectious hospital, since the delay of hospitalization and adequate treatment can worsen the prognosis for a favorable outcome of the clinical case and recovery. Such specific laboratory methods for verifying leptospiras in the blood of patients as a reaction of microagglutination and lysis with a kit of leptospira and bacterioscopic examination of a smear in the dark field are of high sensitivity and specificity and therefore are widely used in clinical practice.

Tkach V.Ye., Voloshynovych M.S., Romanchuk S.M., Girnyk G.Ye., Matkovska N.R., Kozak N.V. Clinical cases of Darier-White follicular dyskeratosis

https://doi.org/10.26641/2307-0404.2022.3.266006

Clinical cases of Darier-White follicular dyskeratosis

     

 

Key words: Darier-White disease, differential diagnosis, dermoscopy, treatment

Abstract. Clinical cases of Darier-White follicular dyskeratosis. Tkach V.Ye., Voloshynovych M.S., Romanchuk S.M., Girnyk G.Ye., Matkovska N.R., Kozak N.V. Follicular dyskeratosis (Darier-White disease) is a hereditary skin disease that is extremely rare in medical practice, so errors in its diagnosis can occur. It was first described in 1889 by two scientists (independently of each other), Ferdinand-Jean Darier and James White. The disease is inherited in an autosomal dominant pattern with variable gene penetrance. The main cause of this pathological process is a mutation of the ATP2A2 gene, located in the long arm of chromosome 12. Both men and women are affected with the same probability, but clinical manifestations are more severe in males. It appears, as a rule, at the age of 20; children under 10 rarely suffer from DAR; people who are over 30 years have very little chance of contracting this disease. Clinical manifestations slowly progress up to the age of 40-50, and gradually disappear in older age. Typical rashes are follicular papules, 0.2-0.5 cm in size, yellow-brown or dark brown in color, covered with dry or oily layers in the form of horny scales. On the surface layers, black dots are visible which are hair follicle funnels. Papules are rounded, dense, flat or spherical, initially isolated, eventually merging into plaques. They are mostly localized on the skin of the limbs, trunk, chest, in the interscapular area, large folds, less often on the neck, scalp, auricles, and in the ear canals. In 20-30 percent of patients, rashes are localized on the mucous membrane of the oral cavity next to the affected skin. More than 90 percent of patients have nail abnormalities, such as erythro- and leukonychia. Other possible manifestations are fragility, splinter hemor­rhages, marked subungual hyperkeratosis, which can be observed on 2-3 nails or affect all nail plates. The dermatoscopy of skin lesions is characterized by the presence of several polygonal, branched, star-shaped or rounded-oval yellow-orange-brown lumps of various sizes, surrounded by a thin whitish halo and pink small-structured areas. The prognosis for recovery is not favorable, the treatment is ineffective. Two cases of Darier-White disease are described in this article.