2023 Vol. XXVIII N 4

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Medicni perspektivi. 2023. Vol. 28, N 4

2023 Vol. XXVIII N 4

Published
2023-12-22

THEORETICAL MEDICINE

Chernyaeva A.O., Mykytyuk M.R., Karachentsev Yu.I. Analysis of parameters of purine metabolism in patients with diabetes mellitus type 2

https://doi.org/10.26641/2307-0404.2023.4.293972

Abstract

The aim of this research is to comprehensively analyze the current state of purine metabolism as well as assess its features in patients with diabetes mellitus type 2, taking into account the clinical and metabolic polymorphism of the disease. The authors examined 327 patients with diabetes mellitus type 2 (144 men and 183 women), a group of individuals with an average age of 57.8±10.1 years. The average duration of the disease was (9.3±7.3) years. All subjects received oral hypoglycemic therapy. The researchers determined anthropometric indicators, indicators of carbohydrate metabolism, concentration of creatinine, uric acid, parameters of the blood lipid spectrum, purine bases, activity of xanthine oxidase and hypoxanthine-guanine-phosphoribosyltransferase in the blood. In the course of the study the authors verified excretion of uric acid and creatinine renal uric acid, fractional clearance of uric acid, total tubular reabsorption of uric acid and coefficient of complete degradation of purine bases. Using the software complex "Statgraphics Centurion 18.0", we statistically analyzed the obtained data. The research showed that a decrease in assimilation, increased oxidation of purine bases due to the activation of xanthine oxidase, and a decrease in their reutilization by inhibiting the activity of hypoxanthine-guanine-phosphoribosyltransferase cause the high intensity of purine catabolism in patients with diabetes mellitus type 2. Hyperuricemia (28.0%), increased creatinine renal uric acid (62.3%), increased coefficient of complete degradation of purine bases (41.6%), activity of xanthine oxidase (38.8%) and inhibition of hypoxanthine-guanine-phosphoribosyltransferase activity (50.3%) dominate in the structure of disorders of purine bases in patients with diabetes mellitus type 2. We found that more than 50% of the subjects had high concentrations of purine bases in the blood. Purine bases concentrations in the blood of patients with diabetes mellitus type 2 closely correlate with each other and with the activity of xanthine oxidase and do not correlate with the level of uricemia, the level of uricemia does not correlate with the level of uric acid excretion. That is, the concentration of uric acid in the blood of patients with diabetes mellitus type 2 does not objectively reflect its production in the body. Patients with diabetes mellitus type 2 with obesity associate hyperuricemia with significantly lower creatinine renal uric acid and fractional clearance of uric acid as well as activation of the anabolic pathway of purine bases deposition.

Key words: type 2 diabetes, obesity, uric acid, purine metabolism

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Melnychuk I.O., Lyzogub V.H. Plasma amino acids spectrum as an important part of metabolomic pattern in patients with coronary artery disease and atrial fibrillation

https://doi.org/10.26641/2307-0404.2023.4.293976

Abstract

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Krasnoselskyi M.V., Kyrylova O.O., Dubenko O.Ye., Rublova T.V., Pavlichenko Yu.V. Risks of psychological traumatization and stress adaption of medical staff working under war conditions (analytical literature review)

https://doi.org/10.26641/2307-0404.2023.4.293979

Abstract

Medical and psychological consequences of war have a destructive impact on mental health during the hostilities and after their cessation and determine a wide variety of different psychogenic disorders in an individual who was in the territory of hostilities. The purpose of the work is to analyze and summarize scientific literature data on the issue of mental traumatization of the medical staff under the conditions of working during war conflicts. The article is concerned with the analytical literature review, the analysis of experience of studying features of psychoemotional state of the medical workers and people who were in the territory of hostilities, and delivering medical and psychological aid to them. The features of psychological responsiveness of the individuals who participated in war conflicts and possible consequences of mental health damage are described. Scientific data on mental state of medical staff working under the conditions of the war conflict are limited. Most studies are concerned with military personnel and civilians. During war conflicts, medical workers face with chronic stress factors and take their own personal risk that may lead to deterioration of mental health, including post-traumatic stress disorder. International studies have shown that, regardless of the specialty, doctors who are working in stress situations, including war, have an increased risk of depression compared to civil population in general due to high risk of burnout. The incidence of depression among doctors ranges from 11% to 47%. Military medics can suffer severe stress due to the increased risk of death or injuries of other people, and they are also directly or indirectly impacted by a common traumatic reality. The impact of injuries, deaths, sexual assaults, and personal threats jeopardize health of combat nurses who participate in military, humanitarian, and aid missions after natural disasters. As a result, they suffer from unfavorable mental consequences. Compassion fatigue, exhaustion, and post-traumatic stress disorder are common. The importance of medical and psychological aid aimed at decreasing stress and stabilizing psychoemotional state of the medical staff who are working under the conditions of war led to development of a large number of programs in various psychotherapeutic areas that have shown their high effectiveness.

Key words: war conflict, war, mental traumatization, medical staff, coping strategies, distress, adaptation

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Kolkow TT, Spira JL, Morse JS, Grieger TA. Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Mil Med. 2007;172:451-5. doi: https://doi.org/10.7205/milmed.172.5.451
Jones M, Fear NT, Greenberg N, Jones N, Hull L, Hotopf M, et al. Do medical services personnel who deployed to the Iraq war have worse mental health than other deployed personnel? Eur J Public Health. 2008;18(4):422-27. doi: https://doi.org/10.1093/eurpub/ckn031
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Adler AB, Adrian AL, Hemphill M, Scaro NH, Sipos ML, Thomas JL. Professional Stress and Burnout in U.S. Military Medical Personnel Deployed to Afghanistan. Mil Med. 2017;182(3):e1669-e76. doi: https://doi.org/10.7205/MILMED-D-16-00154
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Freedman SA, Tuval Mashiach R. Correction: Shared trauma reality in war: Mental health therapists' experience. Plos One. 2018;13(3):e0194359. doi: https://doi.org/10.1371/journal.pone.0194359
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CLINICAL MEDICINE

Stupnytskyi M.A., Syroyid M.V., Dumchenko O.I., Denysenko N.V., Fedevych Yu.M. Methabolic reaction on the cerebral ischemia during carotid artery surgery

https://doi.org/10.26641/2307-0404.2023.4.294000

Abstract

References

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Bielinskyi M.V., Seredyuk N.M., Vytryhovskiy A.I., Koroliuk V.D. Impact of type 2 diabetes mellitus on low-grade inflammation in patients with ST-elevated myocardial infarction

https://doi.org/10.26641/2307-0404.2023.4.294006

Abstract

Chronic low-grade inflammation has emerged as a hallmark of type 2 diabetes mellitus (T2DM), contributing significantly to the pathogenesis of various cardiovascular diseases, notably ST-elevated myocardial infarction (STEMI). The intricate interplay between inflammation and cardiovascular health in the context of T2DM has been a subject of intensive research in recent years. In particular, the development of various markers of inflammation has provided valuable tools for better understanding the complex relationship between low-grade inflammation and cardiovascular disease in T2DM. Elevated levels of these markers have been consistently associated with increased cardiovascular risk in patients with T2DM, indicating their potential as prognostic indicators. The aim of the study was to investigate the potential association between type 2 diabetes mellitus and low-grade inflammation markers in patients with ST-elevated myocardial infarction through a comparative analysis of systemic immune-inflammation indices, fibronectin, and soluble suppression of tumorogenesis-2 (sST2) levels in ST-elevated myocardial infarction patients with and without type 2 diabetes mellitus. We enrolled 158 patients diagnosed with STEMI who were admitted to the Ivano-Frankivsk Regional Clinical Cardiological Center. The study population was divided into three groups: 1 – consisting of 45 patients with both STEMI and T2DM, and the 2 – consisting of 34 patients with STEMI only, T2DM only group – 69 patients, Control group – 10 healthy patients. In summary, the findings from the study provide compelling evidence to support the notion that patients who suffer from both STEM and T2DM exhibit a more robust inflammatory response and higher platelet count, compared to those with STEMI alone. These results suggest that the presence of T2DM may exacerbate the pro-inflammatory and pro-thrombotic state that is typically associated with STEMI, thereby emphasizing the critical need for early intervention to prevent or mitigate inflammation and platelet activation in this particular patient population. Type 2 diabetes mellitus patients with ST-segment elevation myocardial infarction show higher levels of inflammation markers and fibronectin, indicating greater low-grade inflammation. Elevated levels of soluble suppression of tumorigenicity 2 suggest myocardial remodeling. Targeting low-grade inflammation could be a potential therapy for STEMI in T2DM patients.

Key words: myocardial infarction, diabetes mellitus, inflammation, atherosclerosis, ST2, fibronectin

References

Vogel B, Claessen BE, Arnold SV, Chan D, Cohen DJ, Giannitsis E, et al. ST-segment elevation myocardial infarction. Nature Reviews Disease Primers. 2019;5(1):1-20. doi: https://doi.org/10.1038/s41572-019-0090-3
Glovaci D, Fan W, Wong ND. Epidemiology of Diabetes Mellitus and Cardiovascular Disease. Curr Cardiol Rep. 2019;21(4):1-8. doi: https://doi.org/10.1007/S11886-019-1107-Y/METRICS
Rotariu D, Babes EE, Tit DM, Moisi M, Bustea C, Stoicescu M, et al. Oxidative stress – Complex pathological issues concerning the hallmark of cardiovascular and metabolic disorders. Biomedicine & Pharmacotherapy. 2022;152:113238. doi: https://doi.org/10.1016/j.biopha.2022.113238
Sharif S, Van der Graaf Y, Cramer MJ, Kapelle LJ, de Borst GJ, Visseren FLJ, et al. Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes. Cardiovasc Diabetol. 2021;20(1):1-8. doi: https://doi.org/10.1186/S12933-021-01409-0
Castro AM, Macedo-de la Concha LE, Pantoja-Meléndez CA. Low-grade inflammation and its relation to obesity and chronic degenerative diseases. Revista Médica del Hospital General de México. 2017;80(2):101-5. doi: https://doi.org/10.1016/j.hgmx.2016.06.011
Ye Z, Hu T, Wang J, Xiao R, Liao X, Liu M, et al. Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and meta-analysis. Front Cardiovasc Med. 2022;9:e933913. doi: https://doi.org/10.3389/FCVM.2022.933913
Zarà M, Campodonico J, Cosentino N, Biondi ML, Amadio P, Milanesi G, et al. Plasma exosome profile in st-elevation myocardial infarction patients with and without out-of-hospital cardiac arrest. Int J Mol Sci. 2021;22(15):8065. doi: https://doi.org/10.3390/IJMS22158065/S1
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: https://doi.org/10.1093/EURHEARTJ/EHX393
Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022;65(12):1925-66. doi: https://doi.org/10.1007/S00125-022-05787-2
Fan W, Wei C, Liu Y, Sun Q, Tian Y, Wang X, et al. The Prognostic Value of Hematologic Inflammatory Markers in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Clinical and Applied Thrombosis/Hemostasis. 2022;28:10760296221146183. doi: https://doi.org/10.1177%2F10760296221146183
Antonov MY, Korobeynikov GV, Khmelnitskaya IV, Kharkovlyuk-Balakina NV. [Mathematical methods of processing and modeling the results of experimental research: a textbook]. Kyiv: Olympic literature; 2021. 216 p. Ukrainian.
Lucci C, Cosentino N, Genovese S, Campodonico J, Milazzo V, De Metrio M, et al. Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial infarction patients with and without diabetes mellitus. Cardiovascular Diabetology. 2020;19(1):1-3. doi: https://doi.org/10.1186/S12933-020-01157-7
Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230. doi: https://doi.org/10.1111/ECI.13230
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Tashchuk VK, Bota RA, Salama MA. [Dynamics of leukocyte inflammatory markers in patients with ST-segment elevation myocardial infarction depending on left ventricular ejection fraction]. Pathology. 2022;19(3):195-200. Ukrainian.
doi: https://doi.org/10.14739/2310-1237.2022.3.267268
Çelik MC, Karayiğit O, Ozkan C, Dolu AK, Kalçık M. Relationship Between Systemic Inflammation Index and No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction. Angiology. 2023;74(4):387-94. doi: https://doi.org/10.1177/00033197221115562
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Zhuravlova MI. [The relationship between calprotectin and parameters of lipid and carbohydrate metabolism, anthropometric and inflammatory parameters in patients with acute myocardial infarction and diabetes mellitus type 2]. Current issues of modern medicine. 2019;19(2):16-8. Ukrainian. doi: https://doi.org/10.31718/2077-1096.19.2.16
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Miakinkova L.O., Yarmola T.I., Pustovoit G.L., Kostrikova Iu.A., Pysana B.O., Talash V.V. Рrevention of contrast-induced nephropathy during interventional treatment of acute coronary syndrome

https://doi.org/10.26641/2307-0404.2023.4.294013

Abstract

The aim of the work was to determine the risk factors of contrast-induced nephropathy in patients with acute coronary syndrome and to evaluate the effectiveness of methods of its prevention. There were examined 62 patients admitted to the interventional cardiology department during 9 months of routine practice with a diagnosis of acute coronary syndrome and concomitant chronic kidney disease. Among them, 56.45% have diabetic nephropathy, 21% – hypertensive nephropathy, 19.35% – chronic pyelonephritis, 3.2% – gouty nephropathy. According to the stages of chronic kidney disease: I stage – 8.1%, II stage – 46.8%, III A stage – 30.6%, III B stage – 14.5% of patients. The control group consisted of 32 patients with acute coronary syndrome without kidney pathology. All patients underwent urgent percutaneous coronary intervention with a water-soluble low-osmolarity radiocontrast medium. The risk of contrast-induced nephropathy was determined according to the Mehran scale. Contrast-induced nephropathy was diagnosed by an increase in serum creatinine by >25% over 24-48 hours. Prevention of contrast-induced nephropathy according to existing recommendations was carried out by prescribing early statin therapy and diuresis-controlled combined hydration in 22 patients with concomitant chronic kidney disease. Mathematical processing was performed using Statistica 8.0 software (StatSoft Inc, USA). Patients with chronic kidney disease had a high and very high risk of contrast-induced nephropathy in 19.4% and 3.2% of cases, among them in 91.6% high, and in 100% – very high-risk contrast-induced nephropathy developed. Patients in the control group had a low to moderate risk, none of them developed contrast-induced nephropathy. It has been shown that the risk of contrast-induced nephropathy depends on the stage of chronic kidney disease and is associated with a decrease in the ejection fraction of the left ventricle (≤40%), acute left ventricle failure of the III and IV classes according to Killip, a decrease in diuresis up to ≤0.6 ml/h/kg in the first 12-24 hours after urgent percutaneous coronary intervention; taking metformin 6-12 hours before the administration of the X-ray contrast medium and the glomerular filtration rate ≤45 ml/min./1.73 m². In patients who underwent prevention of contrast-induced nephropathy in its entirety, its development was not registered.

Key words: contrast-induced nephropathy, urgent percutaneous coronary intervention, acute coronary syndrome, chronic kidney disease

References

Chekalina NI. Resveratrol has a positive effect on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease. Wiad Lek. 2017;70(2,2):286-91.
Chekalina NI, Kazakov YM, Mamontova TV, Vesnina LE, Kaidashev IP. Resveratrol more effectively than quercetin reduces endothelium degeneration and level of necrosis factor α in patients with coronary artery disease. Wiad Lek. 2016;69(3,2):475-9.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention.2019;14(14):1435-534. doi: https://doi.org/10.4244/EIJY19M01_01
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et. al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: https://doi.org/10.1093/eurheartj/ehx393
Shams E, Mayrovitz HN. Contrast-Induced Nephropathy: A Review of Mechanisms and Risks. Cureus. 2021;13(5):e14842. doi: https://doi.org/10.7759/cureus.14842
Yang Y, George KC, Luo R, Cheng Y, Shang W, Ge S, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC 2018;19(1):374. doi: https://doi.org/10.1186/s12882-018-1161-5
Ivanov D. [Contrast-induced nephropathy: searching for new solutions to prevent its development]. POCHKI. 2021;8(3):136-8. doi: https://doi.org/10.22141/2307-1257.8.3.2019.176450
Aksu U, Gulcu O, Aksakal E, Kalkan K, Topcu S. Long-Term Mortality and Contrast-Induced Nephropathy. Angiology.2019;70(8):783. doi: https://doi.org/10.1177/0003319718823628
Maioli M, Toso A, Gallopin M, Leoncini M, Tedeschi D, Micheletti C, et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med (Hagerstown). 2010;11(6):444-9. doi: https://doi.org/10.2459/JCM.0b013e328335227c
Macdonald DB, Hurrell C, Costa AF, McInnes MDF, O'Malley ME, Barrett B, et al. Canadian Association of Radiologists Guidance on Contrast Associated Acute Kidney Injury. Can Assoc Radiol J. 2022;73(3):499-514. doi: https://doi.org/10.1177/08465371221083970
Pustovoyt AL, Yarmola TI, Talash VV, Tkachenko LA, Kostrikova UA. [Studying the Main Issues of Contrast-Induced Nephropathy (Review of Literature)]. JMBS.2018;3(2,11):208-16. doi: https://doi.org/10.26693/jmbs03.02.208
Van der Molen AJ, Reimer P, Dekkers IA, Bongartz G, Bellin MF, Bertolotto M, et al. Post-contrast acute kidney injury. P. 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur 2018;28(7):2856-69. doi: https://doi.org/10.1007/s00330-017-5247-4
Steffens L, Hayes L, Wiebe AZ. Pharmacology of Contrast-In- duced Nephropathy. AACN Advanced Critical 2019;30(2):97-104. doi: https://doi.org/10.4037/aacnacc2019550
Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, et al. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet. 2021;398(10315):1974-83. doi: https://doi.org/1016/S0140-6736(21)02326-6
Antomonov MYu. [Mathematical processing and analysis of biomedical data]. Kyiv: Firma maloho druku; 2006. 558 p. Ukrainian.

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Shuprovych A.A., Zinych O.V., Kushnareva N.M., Trofymenko O.M., Komisarenko K.P. Study of the association of polymorphisms of the folate cycle enzyme gene with the degree of cognitive and affective disorders in patients in the post-covid period

https://doi.org/10.26641/2307-0404.2023.4.294019

Abstract

Recently, molecular genetic studies have become widespread, and demonstrated the importance of DNA and histone methylation processes in the epigenetic regulation of gene expression. The aim of this study was to detect the association of polymorphisms of the folate cycle enzyme gene methylenetetrahydrofolate reductase (MTHGFR) with the degree of cognitive and affective disorders and the serum level of homocysteine and folic acid in 41 post-covid patients. Hematological and laboratory indices, serum concentration of C-reactive protein, D-dimer, homocysteine and folic acid were determined. MTHGFR polymorphisms for C677T and A1298C mutations were determined by polymerase chain reaction in real time. According to the MTHGFR C677T genotype variant, the examined patients were divided into 3 groups: 1) 21 persons (male/female 10/11) with homozygous CC genotype; 2) 17 ones (male/female 12/5) with heterozygous CT genotype; 3) 3 persons with a recessive homozygous TT genotype (all men). Six months after the end of the acute phase of the coronavirus disease, patients were surveyed using questionnaires to assess the psycho-emotional state: cognitive function, anxiety and depression. No significant difference was found in the average scores of cognitive function, anxiety and depression in patients of group 1 and 2. Individuals of the group 1 C677C, who had an additional recessive homozygous C1298C mutation (group 1a, n=6), were characterized by an elevated level of homocysteine, which showed a high negative correlation with serum folate (r= -0.95). A small group of individuals with the recessive homozygous T677T genotype (group 3, all men) was distinguished by an older age, the presence of cardiovascular diseases, type 2 diabetes (2 cases out of 3), more severe manifestations of COVID-19, which forces us to pay attention to potentially increased risk of complications in such patients and requires further investigation. Correlation relationships between assessments of cognitive function, anxiety, depression and serum levels of homocysteine and folate in patients with different genotypes of MTHGFR C677T were recorded. Therefore, the use of a molecular genetic approach made it possible to pay attention to the possible predisposition to hyperhomocysteinemia in individuals who have a folic acid deficiency, and different combination of alleles of the MTHGFR gene C677T and A1298C.

Key words: methylenetetrahydrofolate reductase, polymorphism, homocysteine, folic acid, neurocognitive complications, post-covid period

References

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Sun J, Jiang X, Zhao M, Ma L, Pei H, Liu N, et al. Association of Methylenetetrahydrofolate Reductase C677T Gene Polymorphisms with Mild Cognitive Impairment Susceptibility: A Systematic Review and Meta-Analysis. Behav 2021;2021:2962792. doi: https://doi.org/10.1155/2021/2962792
Raina JK, Panjaliya RK, Dogra V, Sharma S, Anupriya, Kumar P. Association of МТГФР and MS/MTR gene polymorphisms with congenital heart defects in North Indian population (Jammu and Kashmir): a case-control study encompassing meta-analysis and trial sequential analysis. BMC 2022 Apr 25;22(1):223. doi: https://doi.org/10.1186/s12887-022-03227-z
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Kuryata O.V., Frolova Ye.O., Stadnyk O.I., Semenov V.V. COVID-19 and arterial hypertension: whether normal blood pressure is a sign of a benign course of COVID-19

https://doi.org/10.26641/2307-0404.2023.4.294029

Abstract

References

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Zbitnieva V.O., Voloshyna O.B., Balashova I.V., Zubok E.A., Dukova O.R., Kovalchuk L.I. Peculiarities of ambulatory blood pressure monitoring in patients who have suffered from COVID-19

https://doi.org/10.26641/2307-0404.2023.4.294034

Abstract

Violations of blood pressure control in patients who have had COVID-19 can be due to many pathophysiological factors. Further study of the features of blood pressure (BP) fluctuations in this category of patients will allow to diagnose arterial hypertension (AH) on time, to identify the uncontrolled course of AH and to select the optimal tactics of patients’ management. It was suggested to determine the characteristics of BP fluctuations in patients who have suffered from COVID-19 more than 12 weeks ago, based on the results of ambulatory (daily) blood pressure monitoring. 98 patients (51 men – 52.0%, 47 women – 47.9%) who have had COVID-19 infection more than 12 weeks ago were examined. Patients were divided into 2 groups – with and without a history of AH. The groups of examinees were homogeneous in age and gender. Ambulatory blood pressure monitoring (AM BP) was carried out on the CardioTens apparatus (Meditech, Hungary) according to the standard method. According to the data of AM BP in patients with AH in the anamnesis, who have suffered from COVID-19 more than 12 weeks ago, significantly higher average indicators of daily systolic blood pressure were recorded, and significant violations of the indicators of variability of systolic blood pressure during the day and night periods, pressure load during the day period, as well as a significantly higher degree and the rate of the morning rise in systolic blood pressure. In patients without a history of AH who have suffered from COVID-19 more than 12 weeks ago, in 21.4% cases there was newly diagnosed AH, in 33.3% of cases, increased variability of systolic blood pressure was observed, mainly during the day, in 21.4% of cases, the degree and speed of the morning rise of systolic blood pressure were increased, which indicated the presence of hypertensive reactions to household loads. In patients with a history of AH, in 55.3% of cases there was observed an increase in average blood pressure values per day, during the day and night periods, which was considered as ineffective blood pressure control and required an increase in the doses of previously prescribed antihypertensive drugs or the use of additional antihypertensive drugs in the treatment regimen. In patients with AH in the anamnesis, who have suffered from COVID-19 more than 12 weeks ago, reliable violations of many indicators of AM BP, deterioration of blood pressure control were recorded. In the patients, who did not have AH and who have suffered from COVID-19 more than 12 weeks ago, the presence of a hypertensive reaction to household loads and newly diagnosed AH were odserved.

Key words: ambulatory (daily) blood pressure monitoring, COVID-19, arterial hypertension

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Molchanov R.M., Honcharuk O.O., Khareba G.G., Blyuss O.B., Duka R.V. Segmental ischemia and indocyanine green navigation: impact on perioperative parameters in laparoscopic vs. open partial nephrectomy

https://doi.org/10.26641/2307-0404.2023.4.294040

Abstract

References

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Averin D.I., Zavizion V.F. Metformin as an adjuvant option for systemic treatment of breast cancer

https://doi.org/10.26641/2307-0404.2023.4.294154

Abstract

The modification of the used and development of new treatment regimens significantly improved the overall, recurrence-free survival and quality of life of patients with malignant oncological diseases. Recently, drugs used in non-oncological pathology have been introduced into cancer treatment regimens. This phenomenon is associated with a better understanding of the biology of tumor cells and the mutations that can change this biology. Metformin is actively researched in terms of the treatment of various oncological diseases. For the most part, the modification of the neoadjuvant treatment regimen for early or locally advanced stages of breast cancer results in a less traumatic variant of surgical procedure, thereby increasing recurrence-free survival. The aim is to systematize the data on the possibilities of the antitumor metformin usage for neoadjuvant treatment of breast cancer and to study the results of clinical and morphological effectiveness of the treatment by reviewing the literature. A search of PubMed from February 2023 showed 258 results on the antitumor effects of metformin, of which only 159 were published in the last 5 years. On this subject only four clinical studies were carried out, and only one of them pertained to the implementation of metformin in the systemic treatment of breast cancer. For this review, 55 sources of general and specialized information on anticancer effects of metformin were analyzed. It should be noted that approximately 60% of the study results were published more than 5 years ago and primarily focused on the biological, not clinical aspects of metformin usage. Only one study regarding the implementation of metformin for systemic treatment of breast cancer was carried out by Ukrainian scientists. Currently, there are 2 main hypotheses regarding the antitumor effect of metformin. First one is driven by its impact on the metabolic function of cells and energy deficit. Second – the method of regulating the proliferation of tumor cells involves the PIK3 branch of the regulatory cascade of biological reactions in cancer cells. In addition, metformin reduces the development of resistance in breast cancer cells, thus allowing active chemotherapy agents to act in synergism. However, further studies on the effect of metformin used alone or in combination with standard chemotherapy regimens require a more adequate definition of proto-oncogenic mutations and somatic mutation load. However, it should be considered that more aggressive therapy of oncological diseases can be a nosocomial selector of more aggressive clones of the pool of tumor cells. The main questions are whether metformin can be a targeted drug for the treatment of tumor, whether it is appropriate to use it at the time when the manifestation of evolution disturbances of tumor cell is minimal and homogeneity is maximal.

Key words: breast cancer, chemotherapy, metformin, modification, neoadjuvant treatment, luminal type, medical resistance, survive of patient

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Marshtupa V.V., Nasonova T.I. Clinical, neurological, laboratory and neuropsychological features of the course of cerebrovascular diseases in patients infected with SARS-CoV-2

https://doi.org/10.26641/2307-0404.2023.4.294047

Abstract

The rapid global spread of the COVID-19 virus has caused an unprecedented pandemic, in the conditions of which a significant number of pathological consequences of this disease have appeared. In particular, COVID-19 affected the course of cerebrovascular disease, the consequences of which cause disorders of the normal functioning of the brain. Therefore, the aim of the study was to improve the diagnosis of cerebrovascular disease in patients infected with SARS-CoV-2 by studying clinical, neurological, laboratory and neuropsychological indicators. The trial uses Beck's Anxiety Inventory, Hamilton Depression Rating Scale; neuropsychological tests – Mini-Mental State Examination, Montreal Cognitive Assessment; clinical – neurological status; laboratory – complete blood count, erythrocyte sedimentation rate, C-reactive protein, D-dimer, indicators of the blood coagulation system, procalcitonin; polymerase chain reaction, a test for the detection of ribonucleic acid of the COVID-19 virus; statistical. The revealed results indicate deviations from the norm of most indicators in patients infected with SARS-CoV-2 in particular such as leukocytes (t=3.18, p≤0.01), lymphocytes (t=3.83, p≤0.01), band neutrophils (t=2.33, p≤0.05), segmented neutrophils (t=2.29, p≤0.05), erythrocyte sedimentation rate (t=2.17, p≤0.05), platelets (t =2.86, p≤0.01), prothrombin index (t=3.17, p≤0.01), D-dimer (t=2.11, p≤0.05), fibrinogen (t=2 .53, p≤0.05), C-reactive protein (t=2.97, p≤0.01), procalcitonin (t=2.64, p≤0.05). Patients with a history of SARS-CoV-2 had significantly lower indicators of cognitive (t=-2.17, p≤0.05), visuospatial function (t=-2.84, p≤0.01), as well as a higher level of depression (t=2.87, p≤0.01) than patients who did not suffer from COVID-19. No statistical differences were found in terms of anxiety in both groups. A direct correlation was established between the level of leukocytes and cognitive functions (r=0.477, p≤0.01) and also visuospatial function (r=0.591, p≤0.05). An inverse correlation between procalcitonin level and mental status was also established (r=-0.622, p≤0.01). The conducted study proved the statistical significance of clinical-neurological, laboratory and neuropsychological indicators of patients with cerebrovascular disease infected with SARS-CoV-2.

Key words: SARS-CoV-2, COVID-19, cerebrovascular disease, cognitive functions, laboratory markers, anxiety, depression

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Shevchenko O.A., Sheviakov O.V., Kornienko V.V., Burlakova I.A., Slavska Y.A., Zhyhaylo N.I., Vakulik V.V., Ostapenko I.S., Gerasimchuk O.A., Doroshenko E.Y., Prykhodko V.V., Chernihivska S.A., Ivchenko O.M., Tychonovych V.M., Dorogan S.B. Psychophysiological components of the activities of operators of nuclear power plants as a factor of accidents in the conditions of the threat of social catastrophe

https://doi.org/10.26641/2307-0404.2023.4.294160

Abstract

The purpose of the study is to establish the peculiarities of operator’s work and the leading factors of the formation of its psychophysiological tension at nuclear power plants in the conditions of the threat of social catastrophe in connection with military operations. The study was conducted at the Zaporizhzhya and Khmelnytsky nuclear power plants for the period of 2020-2021. To study the dynamics of the psychophysiological state of operators of nuclear power plants, a verbal-communicative diagnostic method was used to collect information about the operators investigated using Google Form and traditional physiological, psychological and psychophysiological methods. The socio-demographic features of the investigated operators of the block control panel were analyzed. It was established that men only (100%) aged 24-49 and with work experience from 4 to 20 years were among the examined. All surveyed operators (41 people) are residents of the city, with completed higher education and are family members. The methods of psychological (reactive anxiety, mood, activity, mood, attention), physiological (cardiography, blood pressure) and psychophysiological (simple sensorimotor and psychophysical) research methods were used to empirically assess the intensity of activity of the operators of the block control panel of nuclear power plants. There were examined operators, while on duty when control errors and pre-accident situations were recorded. It was established that the psychological, physiological and psychophysiological characteristics of these operators are followed by increased reactive anxiety, decreased indicators of well-being, activity, mood, reduction in functional reserves of the cardiorespiratory system, mental and physical capacity. These indicators are considered as criteria for the development of regulatory measures. It is proposed to take into account not only technological factors, but also the psychophysiological features of operators in the dynamics of their manifestation when developing measures for the optimal selection and personnel placement. The complex of methods for researching the functional state of operators can be used to optimize their professional selection and retraining, which can lead to reducing accidents and costs for professional training. The expected effect is an increase in the efficiency and quality of operator’s activity, the productivity and reliability of the performance of production tasks, an increase in professional longevity, a decrease in rate and occupationally-related morbidity of these specialists.

Key words: psychophysiological potential, psychological condition, operators of nuclear power plants, methodical approach, social and medical support, psychophysiological providing

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Shevchenko O.A. Dnipro State Medical University, Dnipro, Ukraine,
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-2295-170X

Sheviakov O.V. Dnipropetrovsk State University of Internal Affairs, Dnipro, Ukraine,
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https://orcid.org/0000-0001-8348-1935

Kornienko V.V. Dnipropetrovsk State University of Internal Affairs, Dnipro, Ukraine,
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https://orcid.org/0000-0002-8043-3046

Burlakova I.A. Dnipropetrovsk State University of Internal Affairs, Dnipro, Ukraine,
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0002-6043-4359

Slavska Y.A. Dnipropetrovsk State University of Internal Affairs, Dnipro, Ukraine,
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https://orcid.org/0000-0003-2498-3323

Zhyhaylo N.I. Ivan Franko National University, Lviv, Ukraine,
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https://orcid.org/0000-0001-5686-2652

Vakulik V.V. Dnipro state agrarian and economic university, Dnipro, Ukraine,
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0001-8773-2287

Ostapenko I.S. Ukrainian State University of Science and Technologies, Dnipro, Ukraine
https://orcid.org/0000-0003-2232-7138

Gerasimchuk O.A. Ukrainian State University of Science and Technologies, Dnipro, Ukraine,
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
https://orcid.org/0000-0003-1412-5288

Doroshenko E.Y. Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine,
e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Prykhodko V.V. Dnipro State Academy of Physical Culture and Sports, Dnipro, Ukraine,
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https://orcid.org/0000-0001-6980-1402

Chernihivska S.A. Dnipro University of Technology, Dnipro, Ukraine
https://orcid.org/0000-0001-7342-438X

Ivchenko O.M. Ukrainian State University of Chemistry and Technology, Dnipro, Ukraine
https://orcid.org/0000-0003-0806-0860

Tychonovych V.M. Kharkiv Trade and Economics College of the State Trade and Economics University, Kharkiv, Ukraine,
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https://orcid.org/0000-0002-0232-3001

Dorogan S.B. Donetsk national medical university, Kropyvnytskyi, Ukraine
https://orcid.org/0000-0002-6920-4461

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Maruta N.O., Fedchenko V.Y., Yavdak I.O., Panko T.V. The impact of biological and psychosocial factors on the formation of mental disorders in patients who have experienced COVID-19 and exposed to the stressors of the SARS-COV-2 pandemic

https://doi.org/10.26641/2307-0404.2023.4.294190

Abstract

The article is devoted to aspects of the formation of clinical manifestations of mental disorders during the COVID-19 pandemic. The goal – to investigate the clinical and anamnestic features and their impact on the formation of psychopathological consequences in patients with first diagnosed mental disorders who have experienced COVID-19 and exposed to the stressors of the SARS-CoV-2 pandemic. 97 patients with first diagnosed mental disorders who have experienced COVID-19 and exposed to the stressors of the SARS-CoV-2 pandemic were examined and made up the main group. The comparison group included 58 people without mental disorders who have experienced COVID-19 and exposed to the stressors of the SARS-CoV-2 pandemic. During the study, a thorough analysis of the anamnesis of the disease was carried out, including information about the experienced coronavirus disease COVID-19, the impact of the stressors of the SARS-COV-2 pandemic, and the features of the initial psychopathological manifestations. Clinical-psychopathological, clinical-amnestic methods using the developed questionnaire containing questions that reflect the impact of the coronavirus disease COVID-19 and the stressors of the SARS-CoV-2 pandemic on the mental health of the general population, classification of COVID-19 by degree of severity, "empirical" percentage visual scale (KT 0-4), and methods of statistical analysis were applied. The obtained data of a comprehensive study made it possible to distinguish among patients with first diagnosed mental disorders 3 subgroups with characteristic differences in the course and conditions of treatment of the experienced coronavirus disease COVID-19, the structure and significance of the stressors of the SARS-COV-2 pandemic, which the patients encountered, initial psychopathological manifestations. It has been established that the psychopathological consequences of the complex impact of the coronavirus disease COVID-19 and the stressors of the SARS-CoV-2 pandemic lead to the formation of first diagnosed mental disorders in individuals from the general population, among whom the most common forms of mental pathology are depressive episodes, neurotic, associated with stress and somatoform disorders and organic mental disorders. The significance of the obtained data lies in the possibility of studying the role of the psychopathological consequences of COVID-19 in the genesis of mental disorders.

Key words: mental disorders, coronavirus disease COVID-19, pandemic, stressors, impact

References

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Merhavy Z.I., Varkey T.C., Kotyk T., Zeitler C. Sexual health preparedness among medical students

https://doi.org/10.26641/2307-0404.2023.4.294193

Abstract

It has been found that many medical students and early career physicians express feelings of being unprepared and undereducated on topics relating to patient sexual health. Based on previous reports on the topic, the quality and quantity of sexual health education in medical school has been minimally improved over the last several years. Aim of the work is to identify possible deficiencies in sexual health preparation within current medical education curriculum among United States allopathic, osteopathic, and Caribbean medical programs. Medical students (n=100) from three different medical program types, including United States allopathic (n=31), United States osteopathic (n=23), and Caribbean allopathic program (n=46), and years of study (1-4), were recruited informally and participated in a 15-question survey regarding their perceptions and experience of sexual health education, training, and preparation at their respective medical school. After obtaining informed consent, students completed this survey through a private form and the data was compared to students of different years, different programs, and different intended specialties. With a sample size of 100 students from three different medical school programs, it was clear that most schools provide some level of sexual health education to students, however, in most cases, the education received was overall perceived as less than adequate by the students. Additionally, it was seen that almost every student indicated a need for their respective institution to provide additional training in both basic sciences as well as in their clinical education to feel more confident in their ability to discuss sexual health priorities with their patients. Current practices in medical education continue to fail to meet student expectations. To create more competent and confident physicians to adequately assist patients in their sexual health needs, more positive curriculum changes need to be made in order to establish a new, higher standard for quality of sexual health care. Small changes at the pre-clinical and clinical level can improve overall student preparedness and confidence when discussing sexual health with patients.

Key words: sexual health, medical education, medical students, sexual education

References

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Biliakov A.M., Erhard N.M. Peculiarities of identification of persons who died during martial law (literature review)

https://doi.org/10.26641/2307-0404.2023.4.294204

Abstract

Identification of dead persons in forensic medical practice is key one during the martial law in Ukraine. Nowadays, when new research methods and modern laboratory and instrumental equipment appear, there is a need to improve forensic diagnostics during the identification of unknown persons. The goal was to establish the peculiarity of the identification of dead persons during martial law, to provide practical recommendations for the selection and extraction of biological material during forensic medical examinations of corpses. The reliability of the results and conclusions is ensured by the use of general scientific empirical and theoretical research methods. With the help of the general scientific methods of research (analysis, synthesis, generalization), scientific and informational literary sources by the subject of research are characterized. The level of problematic issues in the profile information was determined and recommendations for solving problematic aspects related to the identification of dead persons were provided. A systematic approach to solving problematic issues made it possible to formulate conclusions to achieve the set goal. The necessity of training experts in the peculiarities of material selection for further DNA identification is substantiated. The need to provide forensic medical experts with the necessary consumables and equipment, as well as urgent revision of the normative acts regulating their activities, has been proven. The features of identification of putrefied persons are characterized, which consist in the possibility of DNA extraction from smears from the wall of the aorta, the wall of the urinary bladder, brain tissue and intact teeth. It is proven that the identification of dead persons during the martial law is complicated by the influence of the thermal factor, as well as pronounced putrefactive changes. In these cases, bones and teeth as the objects of DNA extraction should be preferential. The relevance and practical significance of the use of innovative technologies for the identification of dead persons during martial law have been established. Some issues of regulatory and legal provision of forensic medical identification of dead persons during martial law, the need to improve the procedure for taking biological samples in criminal proceedings, etc. were raised. Directions for their solution are proposed.

Key words: forensic medical identification of the dead, DNA identification of corpse

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Hurov OM, Antonov AH, Surhai NM, Tatarko SV, Shylan VI, Uzbek TS. [Ways of improving forensic medical identification of a person in difficult conditions]. Sudovo-medychna ekspertyza. 2023;1:16-21. Ukrainian. doi: https://doi.org/10.24061/2707-8728.1.2023.3

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Kushta A.O., Shuvalov S.M. Long-term postoperative regional analgesia of the lower third of the face in patients with tumors of the oral cavity

https://doi.org/10.26641/2307-0404.2023.4.294211

Abstract

Pain has a certain number of physical, psychological and social consequences. Pain is of particular importance in the postoperative period for patients with tumors of the oral cavity and of the oropharynx. The effectiveness of analgesia in the postoperative period is a serious problem in maxillofacial surgery. Postoperative pain is not always removable, sometimes it becomes chronic. Pronounced pain syndrome in the postoperative period is experienced by 40 to 75% of patients, but 50% of patients experience pain of medium and high intensity. The aim of this study was a comparative assessment of the effectiveness of a new alternative method of a long-term postoperative regional analgesia and the use of non-narcotic analgesics in patients with tumors of the oral cavity and oropharynx in the postoperative period. The study was conducted in 48 patients (38 men, 10 women, average age 58,05±12,31 years) with tumors of the oral cavity and oropharynx. Patients were divided into two groups depending on the method of postoperative analgesia. In the main group (22 patients) pain was suppressed by a long-term postoperative regional analgesia. In the control group (26 patients) analgesia was performed with non-narcotic analgesics. To control the effectiveness of analgesia, a visual analog scale was used, the duration of analgesia and the manifestation of dysphagia on the day 1, 3 and 10 after surgical intervention as well as similar effects were assessed. On the day 10 of using a long-term postoperative regional analgesia, a positive trend towards a reduction in pain syndrome was observed (2.0±0.63), in contrast to drugs of general action (p<0.05). Over the course of a long-term postoperative regional analgesia it was noted that analgesic effect increases from blockade to blockade. In 80% of patients of the main group, stage II-IVa the act of swallowing was nearly restored, only in 2 patients 2 degree of dysphagia was observed (p<0.05). The advantage of the proposed method in the adequacy and duration of analgesia was established (p<0.05), as well as a lower frequency of side effects – 9.1% and 23.3%, and restoration of act of swallowing (p<0.05). The technique of long-term postoperative regional analgesia allows reducing the invasiveness of the manipulation.

Key words: oral cavity cancer, analgesia, visual analog scale, dysphagia

References

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Lemko O.I., Vantiukh N.V., Reshetar D.V., Lukashchuk S.V. Correction of insulin resistance in patients with chronic obstructive pulmonary disease under the influence of recovery treatment

https://doi.org/10.26641/2307-0404.2023.4.294220

Abstract

According to modern concepts chronic obstructive pulmonary disease (COPD) is accompanied by persistent respiratory symptoms, as well as extrapulmonary systemic manifestations. Insulin resistance and metabolic syndrome belong to the leading causes of comorbidity formation. The aim is to study the possibilities of insulin resistance correction in COPD patients, taking into account the previous COVID-19, under the influence of complex non-pharmacological treatment based on haloaerosoltherapy in connection with the applied treatment complex. Clinical and functional examinations and carbohydrate metabolism investigations were carried out in 115 patients with COPD (GOLD II-III) beyond the acute period before and after the course of recovery treatment. Among them 60 patients were convalescents after COVID-19. The average age of patients was 60,3±1,71 years and duration of COPD – 14,2±0,89 years. A control group 12 practically healthy persons were also examined. The presence of insulin resistance was diagnosed by evaluation of the glucose, insulin, HOMA-IR index and C-peptide levels. Treatment was carried out according to three treatment complexes. The main component of the treatment was the use of haloaerosoltherapy and its combination with singlet oxygen therapy or drinking and inhalation of mineral water. The duration of the course of treatment was 20-21 days. Before treatment the presence of insulin resistance was confirmed in both groups of patients with COPD (without COVID-19 and convalescents after COVID-19). Blood glucose levels were significantly higher in the latter group. After the course of recovery treatment a decrease in insulin resistance was noted, especially in patients who received complex treatment, although complete normalization of the studied indices was not achieved. Thus, insulin resistance is a characteristic, pathogenetically determined metabolic manifestation in COPD, which requires constant monitoring and development of long-term programs of complex clinical management of this contingent of patients, especially beyond the exacerbation period. The use of haloaerosoltherapy, which has a sanative and anti-inflammatory effect and promotes clinical stabilization of COPD, is accompanied by a decrease in the manifestations of insulin resistance. Expressiveness of these changes depend on the applied treatment complex. The most pronounced decrease in insulin resistance in COPD patients was noted in a complex treatment based on haloaerosoltherapy with additional drinking and inhalation use of low-mineralized hydrocarbonate siliceous mineral water.

Key words: COPD, іnsulin resistance, COVID-19, recovery treatment, haloaerosoltherapy

References

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Zhou W, Li C, Cao J, Feng J. Metabolic syndrome prevalence in patients with obstructive sleep apnea syndrome and chronic obstructive pulmonary disease: Relationship with systemic inflammation. Clin Respir J. 2020;14(12):1159-65. doi: https://doi.org/10.1111/crj.13253
Vantyukh NV, Lemko ОІ. [Some aspects of insulin resistance formation in chronic obstructive pulmonary disease]. Problems of Endocrine Pathology. 2022;79(1):51-6. Ukrainian. doi: https://doi.org/10.21856/j-PEP.2022.1.07
Zuberi FF, Bader N, Rasheed T, Zuberi BF. Association between insulin resistance and BMI with FEV1 in non-hypoxemic COPD out-patients. The clinical respiratory 2021;15(5):513-21. doi: https://doi.org/10.1111/crj.13336
Ruan W, Yan C, Zhu H, et al. Downregulated level of insulin in COPD patients during AE: role beyond glucose control? Int J Chron Obstruct Pulmon Dis. 2019;(14):1559-66. doi: https://doi.org/10.2147/COPD.S197164
Dogra M, Jaggi S, Aggarwal D, et al. Role of interleukin-6 and insulin resistance as screening markers for metabolic syndrome in patients of chronic obstructive pulmonary disease. A hospital-based cross-sectional study. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. 2022;92(3):10.4081.6p. doi: https://doi.org/10.4081/monaldi.2021.2024
Machado FVC, Pitta F, Hernandes NA, Bertolini GL. Physiopathological relationship between chronic obstructive pulmonary disease and insulin resistance. Endocrine.2018;61(1):17-22. doi: https://doi.org/10.1007/s12020-018-1554-z
Gómez Antúnez M, Muiño Míguez A, et al. Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2. Int J Chron Obstruct Pulmon Dis. 2021;5:3433-45. doi: https://doi.org/10.2147/COPD.S276692
Reiterer M, Rajan M, Gomez-Banoy N, et al. Hyperglycemia in acute COVID-19 is characterized by insulin resistance and adipose tissue infectivity by SARS-CoV-2. Cell 2021;33(12):2174-88. doi: https://doi.org/10.1016/j.cmet.2021.10.014
Feshchenko YuI, Iashyna LA, Opimakh SG, et al. [Features of lung impairment due to COVID-19 in patients of the first wave of the pandemic (literature review)]. Medicni perspektivi. 2022;27(4):20-6. Ukrainian. doi: https://doi.org/10.26641/2307-0404.2022.4.271118
MalikJA, Ahmed S, Shinde M, et al. The impact of COVID-19 on comorbidities: a review of recent updates for combating it. Saudi J Biol Sci. 2022;29(5):3586-99. doi: https://doi.org/10.1016/j.sjbs.2022.02.006
Lemko O, Lemko I. Haloaerosoltherapy: mechanisms of curative effect and place in the respiratory rehabilitation. Balneo and PRM Research Journal. 2021;12(4):365-75. doi: https://doi.org/10.12680/balneo.2021.464
Lemko OI. Artificial analogies of speleotherapy and their medical use. In: Techniques&Society: Proceedings of the 18th Congress of Speleology. [Internet]. Savoie Mont Blanc; 2022 [cited 2023 Jan 10];6:365-8. Available from: https://uis-speleo.org/wp-content/uploads/2022/09/ACTES_CONGRES_UIS_WEB_VOLUME_6.pdf
Lemko OI, Vantiukh NV, Reshetar DV. [Possibilities of haloaerosoltherapy as respiratory rehabilitation in the correction of insulinresistance in patients with chronic obstructive pulmonary disease]. Ukr Pulmonol J. 2023;31(1):66-71. doi: https://doi.org/10.31215/2306-4927-2023-31-1-66-71
Antuna-Puente B, Disse E, Rabasa-Lhoret R, et al. How can we measure insulin sensitivity/resistance? Diabetes & Metabolism. 2011;37(3):179-88. doi: https://doi.org/10.1016/j.diabet.2011.01.002
Antomonov MYu. [Mathematical processing and analysis of medical and biological data]. 2nd ed. Kyiv: Medinform; 2017. 578 p. Russian.
BirdSR, Hawley Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med. 2017;2(1):e000143. doi: https://doi.org/10.1136/bmjsem-2016-000143
Kumar AS, Maiya AG, Shastry BA, et al. Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine. 2019;62:98-103. doi: https://doi.org/10.1016/j.rehab.2018.11.001
Lemko OI, Lemko IS, Haysak MO. Halotherapy, haloaerosoltherapy: Science and practice. In: Science of Sea Salt: Benefits of Human Health. Dallas, Texas, USA: Taylor Specialty Books, Content Lead: Rajiv Saini; 2022. 243-64 p.
Uysal B, Ulusinan E. The Importance of Halotherapy in the Treatment of COVID-19 Related Diseases. J Clin Exp Invest. 2020;11(4):em00754.7p. doi: https://doi.org/10.29333/jcei/8486
Zabolotna IB, Gushcha SG, Mikhailenko VL. Non-alcoholic fatty liver disease and mineral waters of Ukraine – opportunities of application (experimental-clinical studies). Balneo Research Jornal. 2018;9(3):270-6. doi: http://dx.doi.org/10.12680/balneo.2018.194
Lemko IS, Haysak MO, Dychka LV. Quantitative evaluation of alkalinizing features of natural mineral waters of Transcarpathia. Balneo Research Journal. 2020;11(2):174-9. doi: http://doi.org/10.12680/balneo.2020.336

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Grygus I.M., Nogas A.O., Zdanyuk V.V. Dynamics of movement amplitude indicators in joints of patients with rheumatoid arthritis

https://doi.org/10.26641/2307-0404.2023.4.294222

Abstract

The purpose of the paper is to evaluate the effectiveness of the technology of rehabilitation measures in patients with rheumatoid arthritis according to the dynamics of movements amplitude indicators. Theoretical (analysis and generalization of literary and Internet data), survey, collection of anamnesis, objective examination, anthropometric (goniometry) methods of mathematical statistics. 188 patients with rheumatoid arthritis were examined, of which 156 (83%) were women, 32 (17%) were men, average age was 44.9±7.6 years. The analysis of the goniometric indicators of the joints of hands affected by rheumatoid arthritis after six months of conducted rehabilitation measures showed a significant improvement in the mobility of the radiocarpal joint and hand fingers in the examined patients. In particular, active flexion in the radiocarpal joint significantly increased in patients of the experimental group and was 72.5±6.0º, while in the patients of the control group this indicator was 5.3º less (67.2±5.0º) (р<0.05). A significant result was achieved in restoring flexion of the hand fingers in patients of the experimental group: mobility of the fingers in the metacarpal phalangeal joints was 83.2±3.6º, and in the control group it was 73.4±5.0º, in the proximal interphalangeal joints in patients of the experimental group it was 84.1±3.3º, and in the control group – 67.8±4.8º (р<0.05). Positive dynamics of active movements in the foot and finger joints was also observed in patients of both groups at the end of the study. In the patients of the experimental group, the active dorsiflexion in the ankle joint was 27.7±1.4º, the plantar flexion was 41.3±1.8º, which was significantly better than in patients of the control group in which the observed dorsiflexion was 23.4±1.7º, and plantar flexion – 41.3±1.8º (р<0.05). Accordingly, there was a significant increase in the motor function indicators in the metatarsal phalangeal joints of patients in the experimental group: flexion was up to 37.1±1.4º, extension – up to 39.2±1.0º, compared with the indicators in the control group: flexion – up to 33.5±1.2º, extension – up to 36.2±1.1º (р<0.05). The effectiveness of the developed technology is confirmed by improvement of the results of goniometric indicators in patients of the experimental group compared with the control group.

Key words: rheumatoid arthritis, physical therapy, joints, goniometry, movement amplitude

References

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Nogas AO. [The results of X-ray examination and determination of the tila index in patients with rheumatoid arthritis]. Art of Medicine. 2022;4(24):109-13. Ukrainian. doi: https://doi.org/10.21802/artm.2022.4.24.109
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease Study 2019: systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020:396(10267):2006-17. doi: https://doi.org/10.1016/S0140-6736(20)32340-0
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Grygus I, Nogas A. Resourses use modern aspects of physical rehabilitation of patients with rheumatoid arthritis. In: Pop T, redaktor. Badania naukowe w rehabilitacji. Rzeszów: Wydawnictwo Uniwersytetu Rzeszowskiego; 2014. р. 80-87. ISBN: 9788379960972
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Nogas AO. [Improving the quality of life of patients with rheumatoid arthritis with the help of physical activity]. Rehabilitation & recreation. 2022;13:48-53. Ukrainian. doi: https://doi.org/10.32782/2522-1795.2022.13.6
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Faltová B., Mojžíšová A. The use of art therapy interventions in schools to support schoolchildren in their health and well-being

https://doi.org/10.26641/2307-0404.2023.4.294223

Abstract

The paper explains the importance of art therapy interventions implemented in the school settings to support schoolchildren’s health and well-being. The aim is a literature review as part of a dissertation at the University of South Bohemia in České Budějovice, Czech Republic, which deals with the possibilities for promoting well-being in schoolchildren, meeting their health and psychosocial needs in the context of their school and family environment. The Czech Republic lacks research on the direct implementation of art therapy interventions into the school environment, and the use of art therapy approaches within the Czech school context is unclear. Data for the literature search were obtained from recent Czech and international publications. We used the EDS multi-finder to search for literature sources. The document search was completed for the 2011–2023 period in Czech and English language. Search terms included School based art therapy, art therapy intervention, art therapy and schoolchildren’s mental health, and schoolchildren’s well-being. According to the results of the analysed literature, it is possible to conclude the benefits of art therapy interventions in schools as part of a holistic supportive approach of schools to their pupils and the environment in which they live. Art therapy, as a non-pharmacological medical complementary and alternative therapy, is considered as both prevention and an opportunity to address the acute need to support schoolchildren in their health and well-being. Art therapy interventions in the school setting can offer help in addressing a wide range of problems of schoolchildren, such as mental health issues, uncertainty in forming a child’s identity, overcoming communication difficulties, addictive behaviours, anxiety, depressive moods associated with acute trauma, family conflicts, truancy and school failure. Art therapy interventions in the school setting can boost feelings of safety in the school environment along with comprehensive psychological, educational, and social interventions synthesizing the needs of the child, teacher, parents and other professionals working together to support the health and well-being of schoolchildren.

Key words: art therapy interventions, mental health, well-being, school, schoolchild

References

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PREVENTIVE MEDICINE

Zorina O.V., Surmasheva O.V., Polka O.O., Mavrykin Yе.О. Risk assessment when consuming drinking water treated with chlorine dioxide and risk management in EU countries and Ukraine to protect public health

https://doi.org/10.26641/2307-0404.2023.4.294226

Abstract

The purpose of the work was to conduct a comparative scientific analysis of the main approaches to risk assessment and risk management to prevent the negative impact of drinking water on public health when treating it with chlorine dioxide in EU countries and Ukraine. The main risk to the population's health arising when consuming drinking water, is the risk of its microbiologicall contamination. Microbiological contamination of drinking water corresponds to a high risk, while the formation of disinfection byproducts in drinking water is an average risk. The regulatory documents of all EU countries take into account the requirements of Directive 2020/2184/EU regarding the content of chlorites and chlorates in drinking water when treating it with chlorine dioxide, while in Denmark, Slovakia, Hungary, Spain, and France, a risk-oriented approach to the safety of drinking water forced to introduce stricter standards for these indicators (as mandatory, recommended or those, which can be temporarily raised).The scientific analysis of the regulation of drinking water quality in the EU countries and Ukraine, as well as field studies on the safety and quality of drinking water at the Dnipro water station in the city of Kyiv, allowed to assess the risks of drinking water hazards and became the basis for raising the issue of revising or canceling the unscientific standard for chlorine dioxide in drinking water of the distribution network (≥0.1 mg/l), revising the strict standard for chlorites (≤0.2 mg/l), as well as control of drinking water quality by the content of chlorates following the requirements of European legislation. When appointing the organizers, executors, and decision-makers regarding risk assessment, similar approaches were implemented in various EU countries; in the documents of many countries, there are references to the relevant scientific institutions and the functions assigned to them. Under such conditions, the working programs of production control over drinking water quality and modernization plans can be adapted to the relevant water supply system and modern realities.

Key words: drinking water, chlorine dioxide, chlorites, chlorates, risk assessment

References

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Tsitsifli S, Kanakoudis V. Disinfection Impacts to Drinking Water Safety − A Review. In: Insights on the Water-Energy-Food Nexus. Рroceedings the 3rd EWaS International Conference; 2018 Jun 27-30; Island, Greece; Proceedings. 2018;2(11):603. doi: https://doi.org/10.3390/proceedings2110603
Prokopov VO, Liponetskaia OB, Kulish TV, Sobol VA. [Priming of whiskey with chlorine dioxide for disinfection of water at the Dnipro water supply system in Kyiv. In: Actual nutrition of public health and environmental safety in Ukraine. Сollection of abstracts of reports of the scientific-practical conference]. Kyiv. 2018;18:221-3. Ukrainian.
Novytskyi DYu, Kostyuk VA, Kobylanskyi VYa. [Chlorine dioxide in the aspect of microbiological safety of tap water]. Science Review. 2019;4(21):9-14. Ukrainian. doi: https://doi.org/10.31435/rsglobal_sr/31052019/6487
Özdemir K. Chlorine and chlorine dioxide oxidation of natural organic matter in water treatment plants. Environment Protection Engineering. 2020;46(4): 87-97. doi: https://doi.org/10.37190/epe200407
Mesanagrenou M. [Wаter chlorination as a metod of disinfection]. [Internet]. 2020 [cited 2023 Feb 12]. Greek. Available from: https://www.zythopedia.eu/50
Yu Zhong, Wenhui Gan, Ye Du, et al. Disinfection byproducts and their toxicity in wastewater effluents treated by the mixing oxidant of ClO2/Cl2. Water Research.2019;162:471-81. doi: https://doi.org/10.1016/j.watres.2019.07.012
Prokopov OV, Lypovetska OB, Kulish TV, et al. [Dangerous chlorites in drinking water: formation and removal using chlorine dioxide in water treatment technology]. Environment and health. 2023;1(106):43-50. Ukrainian. doi: https://doi.org/10.32402/dovkil2023.01.043
Meng-Yuan Xu, Yi-Li Lin, Tian-Yang Zhang, et al. Chlorine dioxide-based oxidation processes for water purification: A review. Journal of Hazardous Materials. 2022;436:129195. doi: https://doi.org/10.1016/j.jhazmat.2022.129195
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Jeligova H, Baudisova D, Pumann P, et al. [New legislation and its requirements for risk analysis in the production of drinking water. In: Drinking water: proceedings of the conference]. Czech Budejovice; 2016. p. 125-30. Czech. Available from:
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[DSanPiN 2.2.4-171-10. Hygienic Requirements to Drinking Water for Human Consumption]. Kyiv; 2010. р. 99-129. Ukrainian.
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Lototska-Dudyk U.B., Kuzminov B.P., Chemodurova N.Ye., Turkina V.A. HET-CAM test in evaluation of irritating action of adhesives used in shoe making industry

https://doi.org/10.26641/2307-0404.2023.4.294232

Abstract

The global tendency of the contemporary scientific studies is using alternative biologic models as substitutes of experimental animals. HET-CAM (The Hen's Egg Test on the Chorioallantoie Membrane Assay) is an alternative to in vivo tests involving experimental animals. This test is actively used in different biomedical studies. The aim of our work was to study the irritating potential of adhesives used in shoe making industry in experimental setting using the alternative HET-CAM method. Polyurethane, polychloroprene, rubber and styrene-butadiene adhesives that are widely used in shoe-making industry were studied . HET-CAM test was used for the evaluation of the irritating action of the aforementioned adhesives. All adhesives were applied directly onto the chorioallantoic membrane of chick embryos with reactions and changes (hemorrhages, vascular lysis and coagulation) observed and registered in 30, 120 and 300 seconds after the application of the adhesive. Irritating potential of the adhesives was evaluated according to a calculated irritating index. The most pronounced signs of irritating action were caused by polyurethane adhesives, namely hemorrhages and coagulation (30 sec) – two-component adhesive and hemorrhages (30 sec) and coagulation (120-300 sec) – one-component adhesive. Vascular reactions from application of styrene-butadiene adhesives manifested predominantly with lysis and hemorrhages (30 sec), in some samples these reactions were observed at a later time-point (120-300 sec). Irritating action of rubber adhesives manifested mostly with hemorrhages (30 sec), one observation showed lysis (120 sec). Polychloroprene adhesive caused hemorrhages (30-120 sec) and also lysis (30 sec) in one of the samples. According to the irritating index, polyurethane (one- and two-component) and styrene-butadiene adhesives were estimated to be strong irritants, while rubber and polychloroprene ones cause moderate irritating action. НЕТ-САМ test can be used as a component in the evaluation of evidence of irritating action of shoe adhesives.

Key words: shoe adhesives, irritating action, the hen's egg test on the chorioallantoie membrane assay, in vitro method

References

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Ignatov I. Review of different types of mountain springs and mineral waters from Bulgaria based on their natural origin and health benefits

https://doi.org/10.26641/2307-0404.2023.4.294236

Abstract

Mineral water has been renowned for its health benefits for over two millennia, with historical records indicating its use for rapid recovery and wound healing, especially among soldiers engaged in military activities. Over time, baths with mineral water became popular for therapeutic purposes. In the 19^th century, analyses revealed that regions with mountains boasted many long-lived individuals and centenarians, with factors such as pure mountain water, fresh air, and quality food potentially contributing to longevity. This publication comprehensively reviews selected natural waters, including mineral and mountain waters. The author conducted extensive studies in Bulgaria from 2012 to 2019 involving 477 long-lived individuals and their brothers and sisters living in mountain and field areas. The investigation assessed their heredity, body weight, health, psychological status, tobacco smoking, physical activity, food, and water consumption. Emphasizing the importance of medical prevention and care, the study sheds light on essential aspects of longevity today. One significant conclusion drawn from this research is the crucial role of balancing certain minerals in both water and food for human health and longevity. These minerals include Calcium (Ca²⁺), Magnesium (Mg²⁺), Sodium (Na⁺), Potassium (K⁺), Zinc (Zn²⁺), and Manganese (Mn²⁺). Furthermore, a detailed analysis of the physicochemical properties of water in longevity zones reveals lower calcium ions (Ca²⁺) levels compared to other regions, ranging from 6 to 20 mg.L^-1. Notably, regions like Nova Scotia, Canada, known for supercentenarians for over 110 years, have water with such calcium levels. Similarly, longevity is observed in areas of Greece characterized by Mediterranean cuisine and mountain water. Water's physicochemical composition is significantly influenced by its natural filtration through rocks, which imbues it with beneficial minerals.

Key words: mineral water, spring mountain water, health, longevity, analyses

References

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SOCIAL MEDICINE

Geanta M., Cucos B., Boata A., Nuta A.C., Nuta F.M., Semenov V.V. The Ukrainian war and the pandemic: the impact on public health and the need for new health digital tools and the next level of intelligence

https://doi.org/10.26641/2307-0404.2023.4.294241

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A CASE FROM PRACTICE

Zhukovskiy V.S., Prokopiv O.V., Trutyak I.R., Pankiv M.V. Lymphoadenopathies caused by Bartonella henselae

https://doi.org/10.26641/2307-0404.2023.4.294276

Abstract

Bartonella henselae is the causative agent of cat scratch disease, the main manifestation of which is lymphadenopathy, but it can manifest as bacillary angiomatosis, injury to internal organs, joints, eyes, heart, kidneys. This disease is often encountered in the practical work of doctors, especially with an atypical form of the course, which occurs in 20% of adult patients. Often the disease is undiagnosed, mimicking lymphadenopathies caused by tumors of soft tissues and bones or other bacterial pathogens. The purpose of the work was to analyze clinical cases of cat scratch disease by the results of inpatient records data based on the leading clinical symptom – lymphadenitis, to summarize literature data related to morbidity, features of the clinical course and treatment of this disease. The description of two clinical cases of cat scratch disease in adult women aged 19 and 59 is given. The typical course of the disease in one of them at the beginning of the disease, was manifested by symptoms of general intoxication, fever, an increase of lymph nodes in the neck and axillary area, which coincided in time with the previously diagnosed bacterial angina. The diagnostic search ended with the set diagnosis and surgical operation three months after the onset of clinical manifestations of the disease. In the second case, a subfebrile body temperature, a painful lymph node in the right axillary area for 3 weeks were the reason to perform an invasive surgery twice for diagnosed bacterial process of unknown etiology. The reasons for late diagnosis and treatment of cat scratch disease in our patients were insufficient collection of epidemiological anamnesis, lack of vigilance of doctors, first of all, surgeons, regarding the clinical manifestations of the disease and late examination to find out the etiological factor of the disease. An elevated titer of IgM antibodies to Bartonella henselae 1:160 and 1:140 in two cases was the basis for confirming cat scratch disease. Based on the results of the literature analysis, an overview of typical and atypical manifestations of cat scratch disease, its diagnosis and treatment is presented. Bartonella henselae infection should be considered in all cases of lymphadenitis of unknown etiology, accompanied by high temperature, intoxication syndrome and a long course. In order to prevent the development of purulent complications and to avoid unreasonable invasive procedures, it is important to make a timely diagnosis and carry out appropriate antibacterial treatment at the initial stage of the manifestation of clinical symptoms of cat scratch disease.

Key words: Bartonella henselae, cat scratch disease, lymphadenitis, complication , atypical manifestations, treatment

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Pokhylko V.I., Cherniavska Y.I., Fishchuk L.Y., Rossokha Z.I., Ievseienkova O.G., Dubitska O.M., Popova O.F., Fastovets M.М., Kaliuzhka O.О., Gorovenko N.G. Leiden mutation (rs6025) in a severe COVID-19 pneumonia patient with Down syndrome: a clinical case

https://doi.org/10.26641/2307-0404.2023.4.294283

Abstract

COVID-19 was first reported in December 2019 in Wuhan (Hubei Province, China). Later, the pandemic of this disease took the world by storm, challenging the medical community. Its clinical manifestations vary from asymptomatic to a severe course that requires hospitalization and intensive therapy with oxygen support. The mortality rate in patients with a severe course of COVID-19 can exceed 50% The majority of fatal cases of COVID-19 were associated with thrombotic events, despite the prophylactic use of anticoagulant therapy. Numerous theoretical overviews and research articles indicate the need for genetic testing in patients with COVID-19 to determine the genetic profile of proteins involved in thrombophilia. According to the researchers, the Leiden mutation (G1691A, rs6025) of the FV gene is one of the promising candidates for testing. The aim of the work was to demonstrate the clinical features of the severe course of COVID-19 in the presence of the Leiden mutation. 58 patients with COVID-19 of the intensive care unit were genotyped. The Leiden mutation in the heterozygous state was found only in one patient, who had Down syndrome. The Leiden mutation was detected with a frequency of 1.72% in the investigated group. The described clinical case clearly showed that individuals with Down syndrome, associated with hereditary thrombophilia are at risk of undesirable clinical consequences in the treatment of COVID-19. The condition of the patient with the Leiden mutation was severe when admitted to the hospital. The score according to the sequential organ failure assessment scale was 2 points. Bilateral multisegmental pneumonia was detected on the X-ray. On the second day after admission, due to the development of acute respiratory distress syndrome and multiple organ failure, the patient was transferred to the intensive care unit, where he received oxygen therapy through a facial mask. Medical treatment was carried out according to the protocol: non-steroidal anti-inflammatory drugs, antibacterial therapy, anticoagulants, sympathomimetics, and glucocorticosteroids. Despite the medical measures taken, progression of respiratory failure, renal failure, and portal hypertension was noted. On the 11th day, the patient developed asystole. Resuscitation measures were unsuccessful. Thus, the described case of a severe course of COVID-19 in a carrier of a heterozygous variant of the Leiden mutation with Down syndrome confirms the recommendations regarding the need for genetic testing for thrombophilia in high-risk groups and the appointment of personalized measures to prevent complications.

Key words: clinical case, COVID-19, Down syndrome, pneumonia, Leiden mutation, rs6025

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