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A.Ye. Demkovych, Yu.I. Bondarenko, O.O. Fastovets, A.O. Hrad, P.A. Hasiuk, O.V. Denefil
Medicni perspektivi (Medical perspectives), Volume 26, pp 26-32; doi:10.26641/2307-0404.2021.2.234488

The article presents an assessment of the dynamics of changes in the content of the marker of collagenolysis – free oxyproline in the homogeniate of soft tissues and bone in experimental bacterial-immune periodontitis and elucidation of the effect of flavonol quercetin on these indicators. The aim of this study was to determine the role of cytokinogenesis and the effect of flavonol on it in the pathogenesis, development and course of experimental periodontitis. During the experiment, a fragment of the mandible was taken from the animals, from which the soft tissues and bone were carefully separated. The state of collagen was determined by the content of free oxyproline in the soft and bone tissues. The concentration was determined according to the calibration graph and expressed in μmol/g. The results of studies of the indicators of the state of biopolymers of connective tissue structures of periodontium on the 7th, 14th and 30th day of experimental bacterial-immune periodontitis and after its correction with flavonol (from the 7th to the 14th day of the experiment) are presented. The data on the nature of changes in the content of collagen monomers in the process of formation of the inflammatory focus in the periodontal complex are given. During the acute phase of the inflammatory process in rats there was revealed a slight increase in blood free oxyproline in bone homogenate and homogenate of soft periodontal tissues, on the 14th day the dynamics continued to increase, at a later stage of the experiment, namely on the 30th day, increase in bone resorption continued as compared to the 7th and 14th day. During the correction of disorders resulted from the development of this pathological process there was a decrease in the level of free oxyproline in the bone homogenate and homogenate of soft tissues of mandibular periodontium, as compared to the same indicators of animals who did not receive quercetin on the 14th day. The use of flavonol quercetin, which, by affecting immune processes, limited the inflammatory response in periodontal tissues and stabilized collagenolysis processes in periodontal tissues was manifested by a decrease in free oxyproline in bone and soft tissue homogenates of experimental animals.
, V.M. Makhniuk, S.S. Khliestova, N.I. Gumeniuk, H.V. Chaika
Medicni perspektivi (Medical perspectives), Volume 26, pp 188-196; doi:10.26641/2307-0404.2021.2.234733

The article presents the results of theoretical and experimental studies of the degrees of value-motivational, cognitive, emotional, and behavioral components in health care workers of psychiatric health care facilities concerning their health. The degree of risk and value of the personal hygiene of health care workers is determined. The main components and factors that affect the attitude to personal health are revealed. The awareness of the own emotional and cognitive experiences by the medical staff of psychiatric hospitals regarding the preservation and strengthening of their hygiene is analyzed. According to research on the value-motivational component of the medical staff of psychiatric health care concerning the place of personal health in the hierarchy of values in life, it was found that own health is on the second place – 15.2% males, nursing staff (NS), 15.1% females, are psychiatrists and women NS, 14.8% are men psychiatrists. In case of a deterioration of own health both women (35,6%), and men (35,5%) psychiatrists are engaged in self-treatment, the similar tendency is among NS – women NS – 31,3%, men NS – 31, 5%), in 25.8% of cases female psychiatrists and in 23.1% of men NS do not pay attention to the disease at all, which leads to occupational diseases and chronic diseases. At the same time, occupational diseases among doctors and NS do not exceed 10% of the total number of occupational diseases in Ukraine due to self-medication and early treatment. Therefore, the statistics of occupational diseases of health workers in that field are underestimated compared to the actual ones.
, N.M. Rozhkovska, N.M. Kashtalian
Medicni perspektivi (Medical perspectives), Volume 26, pp 80-87; doi:10.26641/2307-0404.2021.2.234521

The last decades showed the worldwide tendency to finding consensus between diagnostics improvement and constant increase of cost of medical services in conditions of restricted financing. The aim of the article was to analyze the diagnostic value of p16 and Ki-67 biomarkers in diagnostics of precancerous diseases of cervix. Data of 80 patients with cervical dysplasia of varying degree who received excisional treatment were analyzed. It was shown that cytological study has a high sensitivity (79.17%) for the diagnosis of CIN 2-3, but low specificity (53.57%). The p16 immunocytochemical biomarker has a high sensitivity for the diagnosis of CIN 2 (0.92; 95% CI: 0.76-0.98) with good specificity (0.78; 95% CI: 0.67-0.82), for the diagnosis of CIN 3 both sensitivity (0.93; 95% CI: 0.82-0.98) and specificity (0.93; 95% CI: 0.82-0.98) is high. The immuno­cytochemical biomarker Ki-67 has a high sensitivity for CIN 2 (0.92; 95% CI: 0.65-0.99), but insufficient specificity (0.62; 95% CI: 0.54-0.64), for the diagnosis of CIN 3 the sensitivity is very high (0.96; 95% CI: 0.80-0.99) as well as specificity (0.78; 95% CI: 0.69-0.81). The combined use of p16 and Ki-67 biomarkers can significantly increase the diagnostic accuracy of the diagnosis of high-grade precancerous pathology of cervix and justify timely surgical intervention. Such an approach for the differential diagnosis of severe dysplasia, on the one hand, may contribute to a decrease in the risk of developing cervical cancer, and on the other hand, it will allow to avoid unnecessary operations and preserve reproductive function of women, reduce the economic costs of treatment.
T.V. Kirieieva, , N.K. Kravchenko, B.O. Basina
Medicni perspektivi (Medical perspectives), Volume 26, pp 197-201; doi:10.26641/2307-0404.2021.2.234734

Venous thromboembolism (pulmonary embolism (PE) and deep vein thrombosis (DVT)) is the third among all cardiovascular syndromes in the world, second only to heart attack and stroke. Estimation of clinical probability of this condition takes into account many factors, including age. But in case of PE probability in young patient data of scales such as Geneva Score (Revised), Wells' criteria for pulmonary embolism, the PERC rule may be misleading. For this group a new influential factor emerges – thrombophilia. The aim of our work was to demonstrate the approach to identifying whom and when to test for genetic predisposition for thrombosis, based on a clinical case of young male with unprovoked episode of PE. Testing patients for thrombophilia is a good way to develop a personalised approach in case of prescribing long-term anticoagulant treatment. Moreover, patient’s awareness about congenital condition helps to increase complience which is crucial, due to the fact that in case of unprovoked pulmonary embolism another episode can occur in up to 50 % of cases during the next 5 years. In addition, further accumulation and analysis of data on the amount of genetic risk factors for thrombosis will expand our understanding of this issue and in the future will allow us to better diagnose and treat this condition.
Irada J. Aliyeva
Medicni perspektivi (Medical perspectives), Volume 26, pp 180-187; doi:10.26641/2307-0404.2021.2.234732

The purpose of this study was to determine dynamics of the levels of type I diabetes mellitus (DM) incidence in the regions with its different incidence. Material from the Azerbaijan Republican and Regional Registers of Diabetes Mellitus were used in this study. All cases of newly diagnosed type 1 DM and documented according to the clinical protocol in 2012-2016 were selected. At the first stage of the study, the rates of diabetes were identified in all administrative-territorial entities. Two groups from administrative-territorial entities were formed for further observation: the first group included regions with high (>80) incidence of type 1 DM, the second group included regions with low (<40) incidence of type 1 DM. At the next stages, changes in type 1 DM incidence were studied and a mean chronological incidence over five years (2012-2016) was determined. Morbidity rate in cities and regions of Azerbaijan in 2012 changed within a range from 5.4 to 294.8. The lowest incidence was observed in three districts: 5.4 in Agjabedi, 5.8 in Jalilabad, 6.1 in Masalli. Very high incidence was observed in Shamkir (294.8) and Khachmaz (278.7) districts. Data from Agdash (30.6) and NAR (32.2) were closer to data from the districts with low incidence. Incidence in Shirvan (81.9) and Yexlakh (171.7) districts was high, but lower than in Shamkir and Khachmaz districts. Type 1 DM incidence has significant interregional differences. Interregional differences in type 1 DM incidence do not depend on the age of the population; age-adjusted incidence of type 1 DM is within a range of 5.0-77.4.
O.M. Smorodska, Yu.V. Moskalenko, I.O. Vynnychenko, O.I. Vynnychenko, V.V. Kostuchenko
Medicni perspektivi (Medical perspectives), Volume 26, pp 4-11; doi:10.26641/2307-0404.2021.2.234379

Tumor molecular profiling in patients with non-small cell lung cancer (NSCLC) is used to identify driver mutations, which lead to premature carcinogenesis in more than 80% of adenocarcinoma cases, including epidermal growth factor receptor (EGFR) mutations. Identification of specific somatic aberrations allows to personalize treatment. Personalization of treatment resulted in improvement of NSCLC outcomes. The aim of our study was to consider scientific data on modern concepts of treatment of patients with non-small cell lung cancer with previously detected oncogenic mutations, especially EGFR mutation. In our study we analyzed scientific papers and data of international scientific literature on the problem of lung cancer treatment. Methods used: scientific research, analytical and generalizing. Different drugs are used in treatment of lung cancer. Choice of treatment scheme depends on type and presence of mutations. Patients with advanced non-small-cell lung cancer and detected mutation in the EGFR can be treated with tyrosine kinase inhibitors (TKIs). Nowadays three first generation drugs are recommended by FDA: afatinib, erlotinib, gefitinib. They showed good clinical benefit. Most patients with metastatic NSCLC typically show disease progression after approximately 9 to 13 months of erlotinib, gefitinib, or afatinib therapy. The first and only commercially available third-generation EGFR TKI is оsimertinib - an oral drug, which selectively inhibits both EGFR-TKI and EGFR T790M resistance mutations. Nowadays scientists are in active investigation of mechanisms of acquired resistance to TKIs, but little is known yet. Clinical success can be observed in patients who were treated with TKIs. EGFR T790M is a mutation that leads to acquired resistance to EGFR TKI therapy. Its incidence is approximately 60% after disease progression on TKI drugs (erlotinib, gefitinib, or aphatinib). Third-generation EGFR TKIs demonstrate high efficacy, but acquired resistance development cannot be avoided. Mechanisms of acquired resistance to these agents are still investigated.
N.O. Saidakova, О.і. Yatsina, V.I. Grodzinsky, V.P. Stus, , V.M. Shiloh, G.E. Коnonova
Medicni perspektivi (Medical perspectives), Volume 26, pp 173-180; doi:10.26641/2307-0404.2021.2.234731

The work is based on the materials of official statistical reporting, the analysis of which was carried out for 10 years, divided into two five-year periods (2009-2013 and 2014-2018). Absolute and intensive rates of morbidity and distribution of bladder cancer of the adult population of Ukraine in the regional aspect, taking into account sex were studied, the basic indicators of the prevalence of pathology were analyzed as well. The revealed unfavorable situation is characterized by a steady increase in morbidity and prevalence at a slower pace during 2014-2018. It is noteworthy the high level of morbidity in men, which is growing against the background of its stabilization among women. At the same time, there was noted the tendency in the reduced number of newly diagnosed patients during professional examinations (in 2018-16.9% against 18.0% in 2014) with diagnosis at stages I-II (72.2% vs. 74.79%), wherein every fifth has stage III-IV. With a tendency to increase in the number of registered patients ≥ 5 years (59.1% vs. 56.5%), the death rate did not change significantly within a year from the time of diagnosis (14.7% vs. 15.6%, respectively). In the structure of specialized care, (65% are patients with the first diagnosis), surgical method accounted for 37-40% by years, the combined was second (up to 20% by years), then radiation and chemotherapy, which together did not exceed 5.0%. Areas with high or low relative rates in relation to the average Ukrainian indicators for all parameters studied were identified. In the presence of regional differences, there is a need for in-depth studies of the state of the issue, including the quality and organization of care.
A.O. Pletenetska, ,
Medicni perspektivi (Medical perspectives), Volume 26, pp 166-172; doi:10.26641/2307-0404.2021.2.234730

The peculiarities and specificity of the medical field complicate not only the assessment of quality and timeliness of medical care, but also the correctness of the choice of the method of treatment and diagnosis of the disease. The number of forensic medical examinations in «medical cases» has the tendency to increase, and experts in this case face difficulties with forensic medical assessment of medical care provision. Forensic medical analysis of the medical care provision to patients who died of acute blood loss, based on examinations of different forensic medical bureaus of Ukraine has been analyzed. The aforementioned examinations related to the corpses of people who died as a result of acute blood loss, including shock (150 from the total number of 6129 medical examinations were selected). This cause of a death was chosen as one of the leading causes of death in trauma (including a combination with shock). When evaluating gross medical care defects that were found during the examinations that influenced the result, 40.0% (60) – in the form of improper provision (action) were noted in 10 cases (the case of incorrect diagnosis made by the doctors due to underestimation of examination data), defects in the form of non-provision of medical care (inactivity) – in 83.3% (15 cases). In the statistical analysis of defects in the provision of medical care, the majority of cases were connected with delayed provision of medical care – 41,7%. Defects in cases of blood loss were under the following conditions: a) lack of instrumental research, medical treatment and surgery, b) lack of medical treatment and surgery by indications (each of 3,3%). When considering the reasons that led to defects in cases of blood loss, the isolated underestimation of the examination data was in 16,7% (25), a combination of reasons: a) underestimation of the examination data together with the underestimation of additional research data – 16,7% (25); b) underestimation of the examination data together with the negligent attitude to the patient who had a sloppy appearance – 6,7%. The unprofessional nature of the medical staff was in 16,7% of acute blood loss. When providing medical care in cases of death from acute blood loss, defects in the provision of medical care are made by experienced medical professionals in city hospitals (especially large cities of Ukraine), where there are adequate conditions for the provision of medical care, more qualified specialists of different profiles, and there are protocols for providing medical care in acute blood loss.
S. Akhmedova
Medicni perspektivi (Medical perspectives), Volume 26, pp 160-166; doi:10.26641/2307-0404.2021.2.234726

The results of testing of the improved working classification of superficial mycoses of the skin and its appendages (SMS) in the Republic of Azerbaijan for the period of 2012-2016 are presented. Given the variety of classifications of fungal skin diseases, many years of clinical experience have shown that none of them fully meets the requirements of a practicing physician. The author has developed and improved the classification of mycoses of the skin and its appendages, which will facilitate the diagnosis and the appointment of therapy, since this classification takes into account the tissue and topographic localization of the mycotic process, which greatly facilitates the diagnosis by dermatovenerologists, and will also reveal the true prevalence of mycotic pathology. Based on the traditional form No. 9, among 246 cases of superficial mycoses of the skin and its appendages identified in the city of Baku for the period of 2012-2016, the largest number of patients (79.44±2.6%) were diagnosed with mycoses of the scalp – 32, 52±1.21%, smooth skin mycoses – 30.08%±1.28 multi-colored lichen – 14.80%±1.01, which corresponds to the frequency of occurrence of these forms of SMS at the age of 11-20 years (44.01±3,1%) and 0-10 years (39.08±3.1%), leaders in the age line of groups with SMS in Baku. A reliable statistical difference was revealed in the detection of superficial mycoses of the skin and its appendages in the city of Baku during the study period. Based on the developed working classification, the nosological structure of the incidence of SMS in the city of Baku for the period 2012-2016 is represented by the following – 1919 episodes: mycoses of the scalp – 675 patients (35.17±1.1%); mycoses of smooth skin – 638 patients (33.25±1.1%); multi-colored lichen – 264 patients (13.76±0.8%); combined mycoses of smooth skin and scalp – 134 patients (6.98±0.6%); onychomycoses – 97 patients (5.05±0.5%); purulent-infiltrative form of mycoses – 66 patients (3.44±0.4%); skin candidiasis – 19 patients (0.99±0.2%); feet of the mycoses – 19 patients (0.99±0.2%); inguinal epidermophytosis – 7 patients (0.36±0.1%). The prevalence of nosologies preserved in the largest number of patients (1578 patients – 82.23±0.9%), mycoses of the scalp – 35.17±1.1% (675 patients), smooth skin mycoses – 33.25±1.1% (638 patients), multicolored lichen – 13.76%±0.8 (264 patients). The greatest number of patients with SMS was also detected in the age group of 11-20 years (42.12±3.1%) and 0-10 years (40.32±3.1%). The data of a comparative analysis of the results of the developed and improved classification of superficial mycoses of the skin and its appendages with the data of the traditional reporting form, made it possible to expand the scope of the analyzed nosologies and increase the objectivity of statistical data for assessing the epidemiological situation in the study region.
, O.Y. Savenkov
Medicni perspektivi (Medical perspectives), Volume 26, pp 67-72; doi:10.26641/2307-0404.2021.2.234516

Breast cancer (BC) is one of the most common causes of death in women up to 50 years old. For today the choice of an adequate methods of surgical intervention and the need for an adequate surgical adjuvant therapy, quality of life of patients after surgeryis are important. The aim of our study was to select the volume of surgery for breast cancer using the technique of intraoperative identification of the sentinel lymph node (intraoperative ICG technology) and to evaluate the results of its urgent histological examination. It was shown that the most common method of surgery in patients who underwent intraoperative ICG technology was quadrantectomy, which was performed in 27 cases (54%), rarely subcutaneous mastectomy was performed (30%) and radical mastectomy (by Madden) – 16%. In the control group, priority was given to radical removal of the breast (63.2% of cases); partial resection (by U. Veronesi) was performed in 33.3% of patients, and subcutaneous mastectomy – in 3.5%. Pathomorphological examination of the sentinel lymph node during its intraoperative imaging using ICG-technology established metastatic lesion in 10 of 50 cases (20%) in the main group. The obtained results of the assessment of the regional lymph dissection size in the main group indicate its adequate nature to ensure the radicality of surgical treatment. In our opinion, this is one of the important preliminary conclusions of this study, because to assess the clinical significance of signal lymph node (SLN) analysis as a marker of regional tumor spread, firstly it is necessary to be sured that existing surgical techniques provide radical tumor removal.
A.D. Shkodina, R.M. Grinko, I.I. Starchenko, N.I. Vynnyk, S.M. Sovhyria, V.F. Kyslyi
Medicni perspektivi (Medical perspectives), Volume 26, pp 97-104; doi:10.26641/2307-0404.2021.2.234629

The role of human olfactory bulbs remains one of the most interesting questions concerning work of the brain, because this organ is one in which neurogenesis is continuously generated in post-natal and adult periods. Impaired sense of smell is not a pathology that threatens human life, therefore, often remains unnoticed. However, it can directly affect the quality of life, as it leads to malnutrition and certain problems in interpersonal relationships. The study of the functional structure of the olfactory analyzer plays an important role both in clinical and experimental studies, but the question of its features in humans needs detailed research. The material of the research was 18 pairs of the olfactory bulbs of males and females aged from 30 to 90 years that were received at the Poltava Regional Department of Pathology. In order to objectify the data obtained on micropreparations, the following morphometric indices were determined: the specific gravity of the location of cellular elements; the proportion of mitral neurocytes in the entire cell population; percentage ratio of relative quantity between cellular elements, blood microvessels, fibrillar component and homogeneous eosinophilic structures. Correlation analysis of morphometric indices in the general sample revealed the existence of an inverse communication of average strength between the relative number of homogeneous eosinophilic cells and the relative number of cellular elements and blood microvessels, which in turn indicates the etiopathogenetic mechanisms of the formation of these structures. The conducted research makes it possible to conclude that mitral cells as one of the most differentiated in olfactory bulbs are sensitive to the development of hypoxic states; under the conditions of cerebrovascular pathology, the relative amount of the blood vessels of the microvessels decreases, which leads to the disorder of the trophy of the nervous tissue and as a result can lead to neurocytolysis of mitral cells. Changes in the vascular and cellular com­ponent indicate a different pathogenesis of changes in human olfactory bulbs in these pathologies and suggest that eosinophilic homogeneous cells are the result of apoptotic neurocytolysis against the background of development of hypoxic states.
S.Yu. Shtrygol, I.G. Kapelka, ,
Medicni perspektivi (Medical perspectives), Volume 26, pp 19-25; doi:10.26641/2307-0404.2021.2.234486

The participation of arachidonic acid metabolism products – prostaglandins and leukotrienes – in the process of inflammation is a common pathogenetic link of cold injury and epilepsy. Montelukast is widely used for the treatment of bronchial asthma and allergic rhinitis as a leukotriene receptor blocker. However, the mechanism of action of the drug suggests a wider range of its pharmacological properties and the corresponding scope of application. This study is aimed to determine the effectiveness of montelukast as a potential frigoprotective and anticonvulsant drug. Experiments were performed on 73 white mice weighing 20-22 g on models of acute general cooling and pentylenetetrazol convulsions. Frigoprotective properties were studied at a temperature of –18°C, recording the lifetime. Montelukast ("Singular", 2 mg/kg), acetylsalicylic acid ("Aspirin", 50 mg/kg), celecoxib ("Celebrex", 74 mg/kg), diclofenac sodium ("Voltaren", 14 mg/kg) were administered intragastrically as a suspension in a prophylactic mode, 30 minutes before the cold injury. In the study of anti­convulsant activity, montelukast ("Singular", 4 mg/kg) and sodium valproate ("Depakin", 300 mg/kg) were admi­nistered intragastrically 30 minutes before stimulating convulsions by subcutaneous administration of pentylene­tetrazole (90 mg/kg). The latent period of convulsions, the number of convulsions per 1 animal, % of mice with clonic and tonic paroxysms, the severity of convulsions in points, the duration of the convulsive period, the lifetime of animals and lethality were recorded for an hour. On the model of acute general cooling, montelukast showed a dose-dependent frigoprotective effect at a dose of 2 mg/kg surpassing drugs with proven frigoprotective properties – acetylsalicylic acid and celecoxib. On the model of pentylenetetrazole-induced convulsions, montelukast statistically significantly reduced the integral indicator of anticonvulsant activity – lethality – by 2.57 times. Thus, the experiment proved the significant role of leukotrienes in the pathogenesis of cold injury and epilepsy and justified the feasibility of further study of the frigoprotective and anticonvulsant properties of montelukast – leukotriene receptor blocker a drug as for adjuvant therapy, especially when these pathologies are combined with bronchial asthma and allergic rhinitis.
V.A. Potabashnii, O.V. Kniazieva, O.Ya. Markova
Medicni perspektivi (Medical perspectives), Volume 26, pp 72-79; doi:10.26641/2307-0404.2021.2.234517

Ischaemic Heart Disease (IHD) and Chronic Obstructive Pulmonary Disease (COPD) are common diseases that rank highest in the Global Burden of Disease Study (2019). IHD and COPD are often combined, making diagnosis and treatment of patients difficult in actual clinical practice. The aim of the study was to identify problems in the diagnosis and treatment of patients with a combination of chronic IHD and COPD, based on a retrospective analysis of medical records. Patient’s adherence to treatment was also assessed with the Morisky Scale (MMAS-8). The analysis of 108 inpatient charts with a combination of chronic IHD and COPD was carried out. The quality of diagnosis and treatment of IHD was evaluated in accordance with the order of the Ministry of Health of Ukraine N152 dated March 02 2016, considering the recommendations of the European Society of Cardiology (2019). It was found that smoking history was in 23.1% of patients, a body mass index (BMI) was calculated in 51,9%, and a carotid ultrasound examination was carried out in 7.4% of cases. The total cholesterol level was determined in 59.2% of patients, while the level of low-density lipoprotein cholesterol (LDL-C) was determined in only 43.5%. Transthoracic echocardiography (TTE) was performed in 62.9 % of patients, but stress-echocardiography and exercise ECG were not performed. Daily ECG monitoring was performed in 60.2% of cases. The levels of brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) were not detrmined to precise etiology of dyspnea. It was also found that beta-blockers (29.6% of patients), ivabradine (11.1% of patients) and statins (65.7% of patients) are seldom administered to patients with IHD and COPD. The targeted doses of these drugs are not reached. Fixed combinations of long-term bronchodilalarors were insufficiently used in therapy of COPD. However, patients' adherence to basic IHD and COPD therapy is weak. 45.4 % of patients were non-adherent to treatment, 43.5% were medium-adherent, and only 11.1% of patients were adherent to treatment.
D.A. Kulikova, I.N. Safonova, L.I. Chumak, I.N. Poddubnaya, O.S. Protsenko, D.G. Dotsenko
Medicni perspektivi (Medical perspectives), Volume 26, pp 52-58; doi:10.26641/2307-0404.2021.2.234503

The paper presents an analysis of echocardiographic data of patients with PDA having different hemodynamic significance. Presently, the concept of “degree of hemodynamic significance” remains controversial. Criteria for determining the hemodynamic significance of PDA in term infants are not described. In our work, we used a classification of three degrees of hemodynamic significance: non-hemodynamically significant PDA – insignificant, moderately hemodynamically significant – moderately significant and large PDA – hemodynamically significant PDA. Aim – to work out an algorithm for determining the degree of PDA hemodynamic significance for prediction of its further development. The study involved children under 18 years old (80% of them ‒ children under 3 years old) who were examined in the cardiac surgery department of the SI “IGUS n.a.V.T. Zaytsev NAMS of Ukraine” during 2013-2017 yy. Gestational age (from 37 weeks), the presence of left to right PDA shunt, absence of a ASD shunt and other congenital heart defects served as enrollment criteria for the trial. Two prognostic tables were formed with the main criteria for determining hemodynamic significance of PDA by the sum of the signs according to gradations (insignificant, moderately significant and hemodynamically significant) as an outcome of the trial. Based on the determination of the main and additional criteria of hemodynamic significance and the strength of their influence, a diagnostic algorithm is formed for a patient with PDA with the possibility of predicting a further clinical scenario. For determination of hemodynamic significance, an increase in pulmonary gradient with an information index of 1.135 and a prognostic factor of +5.90/-1.75 were dominant, while the left ventricular dilatation located from the A4C with an informational index of 1.020 and a prognostic coefficient of +3.69/-2.50 dominated in determining the degree of hemodynamic significance in the presence of secondary changes. The proposed mechanism for determining the level of hemodynamic significance of PDA for children with borderline changes will predict more precisely the development of the disease, determine the patient’s observation tactics and regulate the decision-making process of surgical intervention.
, I.O. Dudar, Е.к. Krasiuk, А.Yu. Shymova
Medicni perspektivi (Medical perspectives), Volume 26, pp 59-66; doi:10.26641/2307-0404.2021.2.234513

The aim of the study was to establish the frequency and possible predictors of cardiovascular disease (CVD) in chronic kidney disease (CKD) VD stage patients, treated with hemodialysis, based on results of prospective observation. The prospective observational cohort study included 223 patients with CKD V D stage who were treated with hemodialysis (HD) during 2012-2019. The research was carried out in two stages. At the first stage, main demographic, laboratory and clinical characteristics of patients, including the frequency of CVD, at the time of beginning the study were examined. At the second stage, based on prospective studying of the dynamics of the frequency of CV pathology, an assessment of potential predictors of CVD in CKD V D stage patients treated with HD was made. Patients’ characteristics determined at the beginning of the study were used as possible predictors. The average duration of prospective study was 35.5±17.8 months, cumulative – 579.3 patient-years. For determination of prognostic factors of CVD events, ROC-analysis, univariate and multivariate Cox proportional hazard regression analysis were done. The primary endpoint (newly diagnosed CVDs) was assesses at the end of the study. Statistical processing of the obtained results was performed using the MedCalc Statistical Software, version 19.3. During the study period, a significant increase of all CVD frequency by 80% (р<0.001) was stated, more than twice – of coronary artery disease (CAD; р<0.001) and atrial fibrillation (AF; р=0.0039). The incidence rate of CVD and CAD was 9.8 and 9.15 per 100-patient-years, respectively. The primary endpoint was observed in 92 (41.26%) patients: newly diagnosed CAD – in 53 patients, heart failure – in 12 patients, AF – in 9 patients, acute myocardial infarction – in 8 patients, other heart diseases – in 10 patients. Independent predictors on increased CVD risk in chronic kidney disease VD stage patients treated with hemodialysis are: age over 35 years, use of a central venous catheter as a vascular access during HD initiation, history of nasal MRSA collonization. In the other hand, serum albumin level of more than 36,6 g/l was associated with reduced risk.
I.M. Khomenko, O.P. Ivakhno, Ya.V. Pershehuba, N.V. Piven
Medicni perspektivi (Medical perspectives), Volume 26, pp 141-146; doi:10.26641/2307-0404.2021.2.234655

Purpose: scientific substantiation of training of medical personnel for the public health system of Ukraine. During 2017-2020, the Department of Public Health conducted a systematic analysis of public health staffing in Ukraine, developed countries and Europe. For the first time, a model of formation of specialists' competencies for the public health system of Ukraine in the postgraduate education program with a multidisciplinary approach to training is substantiated and developed, which includes such disciplines as epidemiology, hygiene, medical statistics, laboratory diagnostics, information technology, legal law and others. This enables to reveal the tools and methods of system management, improve the availability and quality of work during the formation and development of the industry. The need for medical education for public health specialists who are ready to perform basic operational functions to preserve and strengthen the health of the population of Ukraine has been established. For the first time, methodological approaches to the improvement of higher medical education at the undergraduate and postgraduate levels have been scientifically substantiated, taking into account modern requirements for the functioning of the public health system; competence models of the public health specialist in modern conditions of realization of his activity are created; standards of higher education at the first (bachelor's) and second (master's) levels in the specialty 229 “Public health” in the field of knowledge 22 “Health Care” have been developed.
O.R. Vintoniv, I.R. Popadynets, V.I. Hrodzinskyy, S.V. Melnyk, , I.M. Halipchak
Medicni perspektivi (Medical perspectives), Volume 26, pp 119-125; doi:10.26641/2307-0404.2021.2.234638

In recent years, the requirements for the level of the life quality have increased significantly; an integral part of it is the sexual harmony, which in men largely depends on sexual desire and erectile function. According to the results of modern scientific studies, there is no doubt that erectile dysfunction in men is closely connected with the cardiovascular diseases, obesity, diabetes mellitus and other comorbidities. This problem can also be caused by systematic psycho-emotional overload, deterioration of the environmental conditions, harmful factors of production, uncontrolled use of medicines, inflammatory processes in the genital organs, the growth of somatic diseases. The vast majority of works concerning “male menopause” is reduced to the effectiveness of hormone-replacement therapy in erectile dysfunction, while only few research works are devoted to the study of the connection between somatic pathology and androgen deficiency. There is a negative correlation between total testosterone level and systolic blood pressure. According to the research results of some scientists, it was found that 38% of patients with arterial hypertension had androgen deficiency, confirmed in the laboratory, which is significantly higher than in patients of the same age category with normal blood pressure. These dominant factors exert and increase the influence on each other, which must be taken into account in modern therapeutic practice. The study of the formation of comorbid conditions in men with low levels of androgens is of particular importance, as the knowledge of pathophysiological mechanisms can prevent their development and progression. The aim of this investigation was to study the state of penile vascular blood flow in men with arterial hypertension with erectile dysfunction, using color Doppler imaging with pharmacological induction of erection. The indicators of daily monitoring of arterial pressure and arterial stiffness in men with arterial hypertension of the II degree against the background of androgen deficiency or at normal testosterone levels and ways of correction of erectile dysfunction in these patients were also evaluated.
, I.I. Kniazkova, O.V. Zemlianitsyna, I.P. Dunaieva, I.P. Romanova, O.D. Kurilo, V.M. Sinaiko, N.O. Kravchun
Medicni perspektivi (Medical perspectives), Volume 26, pp 126-134; doi:10.26641/2307-0404.2021.2.234639

The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p<0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.
Medicni perspektivi (Medical perspectives), Volume 26, pp 134-140; doi:10.26641/2307-0404.2021.2.234640

Such premalignant conditions of prostate cancer (PC) as prostate intraepithelial neoplasia (PIN) are classified between benign and malignant ones. Contemporary evidence wheather PIN develops malignancy is limited and (LGPIN) data present varied results. Morphological and clinical differencies between high (HGPIN) and low grade PIN specimens in the prostate remain unclear. Aim of the work – to determine clinical significance and progression ability of high grade and low grade prostate intraepithelial neoplasia. The results of examination of 276 patients with PIN (152 patients with high grade PIN and 134 patients with low grade PIN) were assessed comparatively. During a 3 year follow-up repeated prostate biopsies were performed with 6 months interval to detect PC. Initial and repeated multifocal transrectal prostate biopsies from 12 samples were performed under transrectal ultrasonic guidance. There were statistically significant differences in PC detection rates between HGPIN and LGPIN. Patients with HGPIN had malignization rate of 42.1% during a 3-year follow-up that was by 33.9% higher than in LGPIN patients. The spread of HGPIN lesions within prostate gland is a malignization risk factor. The mean malignization term of HGPIN is 18 months and of LGPIN – 30 months. Low and high grade PIN are gradual stages of cancerogenesis. PIN grade determines its clinical significance, while LGPIN has low malignization potential, HGPIN possesses morphological and clinical prostate characteristics similar to adenocarcinima.
, D.V. Dobrianskyi, I.P. Tarchenko, A.V. Meliksetian,
Medicni perspektivi (Medical perspectives), Volume 26, pp 45-51; doi:10.26641/2307-0404.2021.2.234499

The modern model of education and the present conditions demand of the teacher to choose the latest teaching methods. The teacher is no longer the main source of information, he should manage education, implementing competence-based study methods. In order to achieve this, the latest teaching methods are introduced in Bogomolets National Medical University with the new lecture frameworks. Changing the lecture style at a medical universities and, in particular, using the modern lecture educational technologies provide important conditions for improving training future doctors. As Bogomolets National Medical University experience shows, this provides opportunity for turning traditional lectures into interactive lessons to increase students’ interest, to provide improved material perception through the dialogue between the lecturer and students. The article presents the results of surveys of 387 students conducted at the Department of Internal Medicine №3, as well as generalized information regarding students’ evaluation of changes in the lecture framework and the implementation of new training methods in Bogomolets National Medical University. According to the survey results, most students are satisfied with the quality of the updated lecture frameworks at the therapeutic departments. The main characteristics of the lectures that teachers need to pay attention to in order to improve the lecture quality have been analyzed separately. In the view of the students, the best features of the lectures are: actuality, availability of material, structure and laconicism, informativeness, interactivity, video footage using, practical orientation of the presentation, illustration and sufficient number of visuals, an opportunity to be engaged in dialogue with lecturer. Students find traditional attendance control useless, the majority of respondents supported free lecture attendance.
V.A. Bocharov, V.V. Bocharova, M.M. Lebediuk, A.A.S. Sarayreh, L.V. Kuts
Medicni perspektivi (Medical perspectives), Volume 26, pp 33-39; doi:10.26641/2307-0404.2021.2.234490

According to the decisions of international scientific forums, the problem of phenomenon of rosacea (acne rosacea), a common dermatosis with numerous unexplained aspects of etiopathogenesis is a promising area of modern medical research. The aim of the study was theoretical substantiation of the essential features of the mechanisms of occurrence, development and clinical manifestations of the first signs of rosacea in women of reproductive age. The use of a systematic analytical methodical approach to assess the data of clinical and laboratory examinations of women with rosacea, conducted in different regions of the world, allowed to establish the originality of such manifestations of dermatosis as the appearance of unexpected rushes to limited areas of the face, accompanied by local redness and local heat areas of the skin differring significantly from similar rushes in other diseases or syndromes (menopause, migraine, etc.). It is established that the peculiarity of the relationship of these clinical characteristics (from English: rush, ruddy, redness, rosacea, reproductive age of women, reaction) allows to indicate the first signs of dermatosis as a phenomenon inherent in this disease Rush-Ruddy-Rosacea-Reproduce-Reaction (abbreviated – «5-R»), the key pathophysiological target of which (as well as the disease as a whole) is a disorder of a set of hierarchically dependent mechanisms of the evolutionarily determined motivational need to ensure reproductive function in women (both at the cellular level and extracellular structures of the ovaries, and at different levels of subcortical formations and centers of the cortex of the cerebral hemispheres). The phenomenon of rosacea rush is closely related to other phenomena of this dermatosis – hypersensitivity of bradykinin receptors, actinic elastosis, development of post erythematous telangiectasia. The prospect of further research on the problem of rosacea is to study the relationship of disorders in the functional systems of molecules of signaling compounds of different classes (hormones, eicosanoids, neuropeptides, kinins, cytokines and others) in the pathogenesis of the disease.
, L.K. Sokolova, , I.K. Churpiy, M.O. Vatseba, V.V. Derpak
Medicni perspektivi (Medical perspectives), Volume 26, pp 88-96; doi:10.26641/2307-0404.2021.2.234627

The aim of the study was to investigate the effect of obesity on the development of cancer of certain localizations in patients with type 2 diabetes mellitus (T2D) and to explain the association mechanisms of obesity in diabetes and cancer. The study included retrospective analysis of first time diagnosed cancer cases in patients with T2D in 2012-2016 in Ivano-Frankivsk region. Analysis of the data was carried out using Statistica 12.0 (StatSoft Inc., USA) program. The data are presented in the tables as M ± SD (M ± standard deviation). Differences between the studied parameters were determined using the ANOVA- test, taking into account the Bonferroni correction. The relationship between the studied data was evaluated using the criterion of chi-square with Yates correction (χ²). The odds ratio (OR), 95% confidence interval, the positive and negative predictive value were calculated to determine the association between two events. The differences were considered significant at p < 0.05. According to the results, 533 cases of the first time diagnosed cancer were detected in patients with T2D. It was found that obesity is inherent in women with breast, uterine, ovarian and colorectal cancer; for men with prostate cancer and with colorectal cancer. According to the criterion of χ², the effect of obesity on the incidence of breast cancer in women (x2=8.46; p<0.05), and prostate cancer (x2=7.02; p<0.05) and colorectal cancer (x2=7.94; p<0.05) in men was proven. OR revealed an increased risk of breast cancer in women [OR=2.06; 95% CI (1.28-3.29); p<0.05], and prostate cancer [OR=2.94; 95% CI (1.37-6.32); p<0.05] and colorectal cancer [OR=2.87; 95% CI (1.42-5.82); p<0.05] in men associated with obesity. Thus, among patients with T2D, obesity increases the risk of breast cancer in women, prostate cancer and colorectal cancer in men. The mechanisms of association of obesity and cancer in patients with T2D are hyperglycemia, hyperinsu­li­nemia, cytokine imbalance, hyperestrogenism (in estrogen-dependent cancer), and intestinal dysbiosis (in colorectal cancer).
B.M. Mirchuk, Y.V. Maksymov
Medicni perspektivi (Medical perspectives), Volume 26, pp 104-110; doi:10.26641/2307-0404.2021.2.234633

In the presence of dentition defects there is a complex of morphological, aesthetic and functional changes that significantly complicate the process of diagnosis and treatment of this pathology. Dentition defects, combined with various dental anomalies and deformations very often impede rational prosthetics and at times make it impossible at all. The aim is to increase the effectiveness of orthodontic treatment of secondary deformations in patients with dentition defects by using primary dental implants as an additional skeletal support. For clinical evaluation of the effectiveness of treatment of secondary deformations in 20 patients with partial dentition defects there was performed orthodontic treatment using a straight arc technique with metal braces of the Roth system and primary detailed one-component implants as an additional skeletal support. On the diagnostic models of the jaws, the meso-distal dimensions of the lost teeth and their possible position in the dentition were determined, the shape of the dentition by methods of Pon and Korkhaus, the position of the teeth in the area of dentition defects was analyzed and the jigs of occlusion according to Andrews were defined. The use of primary dental implants as an additional skeletal support in the area of dentition defects makes it possible to control the rotation of the teeth and at the same time to use orthodontic forces of different intensity during their distal or mesial movement. As a result of orthodontic treatment of secondary deformations, we managed to achieve positive changes in the normalization of angles of dental inclination that limit the defect in patients with dentition defects. Along with the normalization of the angles of dental inclination (torque and angulation) which limit dentition defects we have noticed an increase in the distance between these teeth, which allows to restore dentition defect with dentures, better corresponding to the size of the lost teeth. Important, in our opinion, is the possibility, when using a primary dental implant as an additional skeletal support, to use the technique of segmental braces. The use of primary dental implants in the area of the dentition defect as an additional skeletal support makes it possible to restore angulation and torque of the teeth, which limit the defect, using orthodontic forces of different intensity. As a result of orthodontic treatment of secondary deformations, the distance between teeth limiting dentition defects on the upper jaw increased on average by 2.39 mm (p<0.001) and on the lower jaw – by 2.57 mm (p<0.001).
O.E. Khudiakov Et Al.
Medicni perspektivi (Medical perspectives), Volume 26, pp 208-209; doi:10.26641/2307-0404.2021.2.234736

Doctor of Medical Science, Professor, Honoured Scientist of Ukraine Sukmansky Oleh Ivanovych(to his 90th birthday)
V.V. Povoroznyuk, , M.A. Bystrytska, , V.S. Shapovalov
Medicni perspektivi (Medical perspectives), Volume 26, pp 111-119; doi:10.26641/2307-0404.2021.2.234637

The progressive and generalized loss of skeletal muscle mass and strength leads to sarcopenia in elderly people. A new geriatric syndrome has been revealed – osteosarcopenia (osteosarcoporosis), which combines low bone mineral density with reduced muscle mass, strength and functional activity. The review presents data on the peculiarities of manifestation of these syndromes, the mechanisms of which are multifactorial and continue to be investigated. They are associated with genetic factors, lifestyle – lack of physical activity and malnutrition. The pathogenesis of sarcopenia involves mechanisms of chronic inflammation, changes in endocrine function, disturbance of neuromuscular connections and low reparation level. Sarcopenia correlates with low quality of life, disability, and death. The review analyzes the prevalence of sarcopenia which increases with age. However, there are conflicting results in the populations, which may be related to different clinical conditions, patient area, lifestyle and the use of different assessment criteria. The analysis of sarcopenia prevalence in men and women showed ambiguous results related to the studied population, involvement of different age groups of patients, different evaluation methods. Metabolic disorders in muscular and bone tissues were summarized on the basis of the analysis of the cross-influence of regulatory factors and metabolism products of these tissues; a close metabolic and functional association between them was shown. Fat infiltration of atrophied muscles and bone marrow is common in patients with sarcopenia and osteosarcoporosis, which affects muscle and bone tissue. Lipotoxicity and local inflammation stimulate the biosynthesis of pro-inflammatory cytokines. Literature analysis has shown controversial data on the association of sarcopenia and osteosarcopenia with falls and fractures, but based on meta-analysis data, which include an extensive body of information, it should be noted that individuals with sarcopenia and osteosarcopenia are more at risk of falls and fractures and require special special attention. The most common fracture in osteosarcopenia is the hip fracture.
A.V. Ipatov, N.A. Sanina, I.Y. Khanyukova
Medicni perspektivi (Medical perspectives), Volume 26, pp 153-159; doi:10.26641/2307-0404.2021.2.234722

In order to determine the possibility of using a rehabilitation profile to assess the effectiveness of rehabilitation and develop a methodology for quantifying the effectiveness of rehabilitation measures in the short term in inpatients of the State Institution "Ukrainian State Research Institute of Medical and Social Disability of the Ministry of Health of Ukraine" we created a rehabilitation profile of the patient based on the principles of the International Classification of Functioning, Disability and Health (ICF). There were analyzed rehabilitation profiles of 522 patients with therapeutic pathology, musculoskeletal system diseases, and eye diseases. Rehabilitation of patients was comprehensive, with the use of methods of medical, psychological, and physical rehabilitation. The severity of dysfunctions was assessed by a quantitative scale from 0 to 4 points, where "0" – no issues, and "4" – extremely serious issue. The evaluation was performed twice by members of the multidisciplinary team: at the initial examination of the patient and at the discharge from the clinic. The statistical method and the method of expert evaluations were used to process the research results. The licensed software MS Excel for Windows was used. The study found that the proposed method of assessing the effectiveness of short-term rehabilitation is accurate and objective, it considers the initial functional status of the patient and allows to assess the quality and effectiveness of rehabilitation measures at the patient level and at the institution. Its implementation will provide a unified approach to the provision of rehabilitation services and draw conclusions about the effectiveness of rehabilitation activities of the medical institution differentially, considering the type of pathology, leading limitations of life, severity of disorders, age of patients.
O.V. Kopchak, L.F. Yakovenko, N.S. Marchenko, , E.M. Pavlenko, O.A. Nimenko, I.V. Kroupskaya,
Medicni perspektivi (Medical perspectives), Volume 26, pp 12-18; doi:10.26641/2307-0404.2021.2.234382

Heat shock protein 60 (Hsp60) is considered as one of the possible autoantigens involved in the pathogenesis of a number of chronic diseases including periodontal diseases. The application of hyaluronic acid or hyaluronan (HA) in the treatment of periodontitis has been evaluated in several clinical trials, however, the effect of hyaluronic acid on heat shock protein 60 level in periodontal soft tissues has not been studied. The aim of this work was to evaluate the effect of HA injections on levels of Hsp60 in periodontal tissue of the rats. Samples of periodontal tissue of mandibular incisors of adult male Wistar rats at 10-12 months of age were investigated. Rats were distributed into the control group and the periodontitis group. Visual manifestations of hyperemia of the gums around the incisors were the criterion for selecting animals into the periodontitis group. There were two subgroups in the control group: intact rats (I); intact rats after HA “hyaDENT BG” 1.0 MDa (BioScience GmbH, Germany) treatment (I+“G-1.0”). There were four subgroups in the periodontitis group: rats with periodontitis (P); rats with periodontitis after HA “hyaDENT BG” 1.0 MDa (BioScience GmbH, Germany) treatment (P+“G-1.0”); rats with periodontitis after HA “SERTOBEC” 2.4 MDa (S.C. Rompharm Company S.R.L., Romania) treatment (P+“S-2.4”); rats with periodontitis after HA “SERTOBEC Tendon” 2.4 МDа (S.C. Rompharm Company S.R.L., Romania) treatment (P+“ST-2.4”). There were three animals in each subgroup. Rats were injected 0.05 ml HA in the area of alveolar processus of central incisors once a week, three times. Levels of Hsp60 in total lysates of periodontal tissue were tested by Western blotting method before and after the treatment with HA (one month after the last injection). There was no significant difference between levels of Hsp60 in total lysates of periodontal tissue of intact rats and rats with periodontitis before treatment (p>0.05). Rats with periodontitis showed decreased inflammation in the periodontal tissue after treatment with HA with different molecular weight. Intact rats and rats with periodontitis which were treated with HA “hyaDENT BG” 1.0 MDa showed reduced levels of Hsp60 in total lysates of periodontal tissue comparatively with levels of Hsp60 before treatment (by 15.4 and 10.7 times respectively, p<0.001). Rats with periodontitis which were treated with HA “SERTOBEC” 2.4 MDa or HA “SERTOBEC Tendon” 2.4 MDa also showed reduced levels of Hsp60 in total lysates of periodontal tissue com­paratively with levels of Hsp60 before treatment (by 21.3 and 16.4 times respectively, p<0.001). Rats with pe­riodontitis showed the decrease in inflammation in periodontal tissue after treatment with HA with different molecular weight. Injections of HA has contributed to reduce levels of Hsp60 in periodontal tissue of intact rats and rats with periodontitis.
O.V. Fedosieieva
Medicni perspektivi (Medical perspectives), Volume 26, pp 40-45; doi:10.26641/2307-0404.2021.2.234498

During the individual development and exposure to infectious agents of the organism, the structural components of the thyroid gland can change significantly. In modern research, great importance is attached to the study of mechanisms for maintaining morphological homeostasis of the thyroid gland and ideas about its structural and functional restructuring in response to the body's immune system to various infections. The morpho-functional features of the thyroid gland of newborn animals after prenatal action of thyroid-nonspecific antigen (staphylococcal toxoid) have been experimentally established. In antigen-premiumed rats, the timing of folliculogenesis changes, as well as the size, distribution and immunohistochemical expression of antibodies to thyroglobulin, the functional state of thyrocytes and follicles compared to normal. The detected immuno­histochemical changes indicate signs of morpho-functional immaturity of the organ with hypoactivity elements.
, O.B. Nagorna, N.E. Nesterchuk, A.O. Nogas, P.S. Podoliaka, T.V. Gamma
Medicni perspektivi (Medical perspectives), Volume 26, pp 202-207; doi:10.26641/2307-0404.2021.2.234735

The article deals with the problems of physical therapy in children with multiple sulfatase deficiency (MSD). The purpose of the study presented in the article was to substantiate the need to form a structured, personalized comprehensive rehabilitation program for children with multiple sulfatase deficiency. The objectives of the study were to analyze the literature on the topic of the study, to study the clinical phenotype of multiple sulfatase deficiency and potential complications of this pathology, to justify the use of physical therapy in children with multiple sulfatase deficiency. Research methods: analysis of scientific and methodological sources of domestic and foreign authors, pedagogical observation, collection of anamnestic information of the patient. The publication discusses the clinical phenotype of genetic pathology and possible potential complications of this orphan disease, strategic vectors of an individual rehabilitation program. The description of a clinical case of late infantile form of the disease is presented. The effectiveness of a six-months’ implementation of the physical therapy program is being investigated. For rehabilitation examination of children with MSD, it is proposed to use testing of children with psychomotor disorders. The technique of massage, the appropriateness of verticalization and orthotics, sensory enrichment of the environment of a child with this genetic pathology are revealed. Exercises of therapeutic physical culture are proposed, they will help to maintain postural control, support ability and functioning of arms, legs, hand-eye coordination, and help prevent diseases of the bronchopulmonary system. It is noted that MSD has been insufficiently studied not only from the standpoint of a treatment strategy, diagnostic algorithms for clinical multisystem manifestations, but also requires attention to analyze the effectiveness and efficiency of the system of modern rehabilitation technologies for children with this diagnosis.
H.M. Danylenko, G.M. Cherniakova, T.V. Merkulova, O.H. Avdiievska
Medicni perspektivi (Medical perspectives), Volume 26, pp 147-152; doi:10.26641/2307-0404.2021.2.234661

The aim of the work was to investigate how gender, age and type of activity in summer affects the indicators of physical development (PD) of children. 1054 students (493 boys and 561 girls) aged 7-16 years took part in the study. The PD of children was studied by assessing somatometric and physiometric indi­cators. To assess the impact of the type of activity, a thematic questionnaire "Summer" was used. It was found that the gender and age of children had a significant effect on PD indicators in the summer. The most intense increase in body length oc­curred at the age of 7-12 years, body weight - in 10-14-year-olds, and up to 16 years grouth of two parameters gradually slo­wed down. From the age of 10, children showed a positive increase in lung capacity (LC). In 15-year-old adolescents, a de­c­rease in both indicators (ChC and LC) was found. It was found that 62% of children carried out educational activities in the summer, 24% of those were engaged in business activities, almost 40% of students were participants in hiking trips and 23% of children attended a children's health camp. The chosen type of activity in the summer influenced the indicators of the pu­pils' PD as follows: educational activities were accompanied by a decrease in body length and strength of the left arm, busi­ness activity, hiking trips and staying in a health camp were accompanied by an increased weight gain and an increase in LC.
T.M. Babkina, , O.V. Polishchuk, L.Yu. Hladka
Medicni perspektivi (Medical perspectives), Volume 26; doi:10.26641/2307-0404.2021.1.227711

Quantitative assessment of cavities and heart function is the most common task of echocardiography (EchoCG). It is difficult to overestimate the importance of standardizing EchoCG measurements, because their results influence clinical decisions. In January 2015, the American Society of Echocardiography and the European Association of Cardiovascular Imaging, published an update Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults. Since then, the results of new research using obtained prospective data, on the basis of which in February 2020 the British Society of Echocardiography (BSE) released a new guide. The authors of the recommendations set the goal of creating a simple, practical reference document and guide for everyday use that encourage the holistic interpretation of measurements (no single number should define normality or pathology). Based on these data, we considered the rational component of the updated recommendations, focused on important conceptual changes in the assessment of heart structure and function, provided new terminology for left ventricular function and left atrial size, and a new approach in assessing aortic root, right heart and left atrium. The BSE recommends obtain left ventricular dimensions from the parasternal long-axis window preferentially using 2D imaging. Aortic dimensions should be obtained using the “inner-edge to inner-edge” technique in end-diastole. The BSE suggests that for those Echocg labs that currently use the “leading-edge to leading-edge” technique, it is reasonable to continue doing so for continuity and consistency.
Yu.K. Bolbot, T.A. Bordiі, Ya.V. Vilenskyi
Medicni perspektivi (Medical perspectives), Volume 26, pp 150-155; doi:10.26641/2307-0404.2021.1.227957

Allergic diseases of the respiratory system seriously affect the psychological, physical and social aspects of the live of sick children, morally and financially exhausting members of their families as well. It is known that exacerbations of allergic diseases of the respiratory tract occur due to interaction with numerous triggers, one of which is a respiratory viral infection. At the same time, it is widely known that patients with allergic respiratory diseases are more prone to to acute respiratory infections. One of the reasons for this tendency often is an insufficient activity of non-specific factors of local immunity of the respiratory system – endogenous amphiphilic antimicrobial peptides, in particular the most studied their representatives - the family of defensins and human cathelicidin. Current research proves that these antimicrobial peptides are characterized by broad antiviral, antimicrobial and immunomodulatory activity. The aim of this study was to study the concentrations of local immune factors - human HbD-2 and LL-37 - in the secretion of the mucous membranes of the upper respiratory tract in children with asthma and allergic rhinitis and to clarify their role in protection against respiratory viral infections in this contingent of patients. We performed laboratory and clinical examinations of 76 children aged 7 to 18 years, of whom 24 were diagnosed with allergic rhinitis, 28 children - bronchial asthma, and 24 - bronchial asthma and allergic rhinitis. The control group consisted of 20 healthy children of the appropriate sex and age. In addition to general clinical methods, patterns of respiratory morbidity were analyzed and concentrations of antimicrobial peptides were determined: by ELISA human cathelicidin (LL-37), β-defensin 2 (HbD-2) in the secretion of the upper respiratory tract, statistical analysis was performed. It was found that children with allergic diseases of the respiratory tract are characterized by a higher frequency of acute respiratory infections with more frequent involvement of the lower respiratory tract, which led to an increase in the duration of the disease compared to their healthy peers. In children with allergic rhinitis and bronchial asthma, there was revealed a significant decrease in the concentrations of antimicrobial peptides in the secretion of the upper respiratory tract compared with the control group.
S.I. Ilchenko, A.O. Fialkovska, V.I. Cherhinets, K.V. Skriabina
Medicni perspektivi (Medical perspectives), Volume 26, pp 136-142; doi:10.26641/2307-0404.2021.1.227953

In modern pediatric practice, inhalated hypertonic saline (IHS) is often used for therapeutic and diagnostic purposes. However, the potential development of serious side effects in children is not predicted. The aim of the study was to determine the efficacy and tolerability of IHS of various concentrations in children with cystic fibrosis (CF). The study involved 34 children with CF aged 6 to 18 years (middle age is 13.0±4.4 years). The comparison group consisted of 27 children (middle age is 7.8±2.3 years) without chronic respiratory diseases. The study included three consecutive inhalations. Sterile 0.9% NaCl solution was used for the first inhalation, 3 % NaCl solution – for the second one and 7% NaCl solution – for the third inhalation. For children under 7 years of age, a patented method of obtaining sputum without forced coughing was used. Spirometry was performed before and after each inhalation, and clinical changes were analyzed. It was noted that after inhalation of IHS, the cough in patients became more productive, moist rales were more often heard over the entire surface of the lungs. The activity of induced sputum secretion after inhalation of 3% and 7% NaCl solution did not differ significantly. However, after inhalation of 7% NaCl solution, side effects, such as sore throat, shortness of breath, spastic cough, auscultatory symptoms of bronchospasm were recorded significantly more often compared with lower concentrations of the solution. The decrease in FEV1 was observed in 5.8% of patients after inhalation of 3% NaCl solution and in 11.8% of patients after inhalation of 7% NaCl solution, which was significantly associated with the clinical symptoms of bronchospasm. Inhalation of IHS has an effective mucolytic effect in patients with CF, however, it is necessary to determine the individual sensitivity of the patient to predict a positive therapeutic effect.
N.V. Mynka, Yu.Yu. Kobelyatskyy
Medicni perspektivi (Medical perspectives), Volume 26, pp 128-135; doi:10.26641/2307-0404.2021.1.227950

Various techniques are applied to reduce the severity of postoperative pain and discomfort in patients. The purpose of this research work was to evaluate the effectiveness and safety of Dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. The study included 80 patients who underwent corneal transplantation on the basis of Dnepropetrovsk Regional Clinical Ophthalmologic Hospital. Patients were divided into 2 groups: control (group K) – 30 men and main (group D) – 50 ones. Multicomponent balanced anesthesia was applied in both groups. Sibazone was administered as the sedative medicine in the group K, Dexmedetomedin was administered in the group D. The main criteria for evaluating the research results were hallmarked: hemodynamic stability during surgery, the amount of administered opiates, the severity of intraoperative pain syndrome by evaluating the ANI index (ANI – analgesia nociception index), the severity of postoperative pain syndrome and the frequency of postoperative nausea and vomiting (PONV). Both schemes of anesthesia allowed avoiding pronounced fluctuations in hemodynamic parameters and gas exchange at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group K pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the surgery, while in group D the ANI index did not fall below 50. Statistically significant differences were obtained on minute 1, 2, 5, 6, and 7 of the surgery. The number of episodes of insufficient anesthesia during the most traumatic stage of the surgery in group K was statistically significantly higher than in group D. Analyzing the quality of pain relief in the postoperative period it was determined, that the level of pain on the Visual Analog Scale (VAS) after awakening in both groups was equal to 0. At the next three stages of the study (2 hours, 6 hours after surgery, and the next morning), the level of pain in group K was significantly higher than in group D. In addition, it was determined that the need for narcotic analgesics and the number of episodes of postoperative nausea and vomiting in group K was statistically significantly higher than in group D. These given data allow us to conclude that Dexmedetomedin is the effective adjuvant of the anesthesia for corneal transplantation.
, , V.P. Shkarban, V.I. Trachuk, S.V. Lynnyk
Medicni perspektivi (Medical perspectives), Volume 26, pp 98-105; doi:10.26641/2307-0404.2021.1.227943

Several studies showed that sarcopenia is associated with an increase of postoperative complications, with worse postoperative results in patients with pancreatic cancer. According to European Working Group on Sarcopenia, it is a "progressive and generalized skeletal muscle loss" characterized by both loss of skeletal muscle mass and strength (Cruz-Jentoft AJ et al., 2019). Aim of our work was to evaluate the effect of sarcopenia on the occurrence of postoperative complications after pancreatic resections in patients with pancreatic and periampullary cancer. We performed a retrospective analysis of treatment of 152 patients who underwent radical pancreatic resections. Sarcopenia was determined by preoperative computed tomography using the Hounsfield Unit Average Calculation (HUAC). In our investigation we measured the psoas area and density (Hounsfield Units) at the level of the third lumbar vertebral body (L3). Sarcopenia was diagnosed in 66 (43.4%) patients. Among patients with sarcopenia complications occurred in 41 (62.1%), mortality was 4 (6.1%). In the group of patients without sarcopenia, complications occurred in 29 (33.7%) of 86 patients, mortality was 2 (2.3%). The level of postoperative complications in patients with sarcopenia was significantly higher (c2 =12.1, p=0.0005). Postoperative mortality in patients with sarcopenia was higher without significant difference (c2 =1.3, p=0.24). Sarcopenia significantly affects the level of postoperative complications and its detection can be used to improve the selection of patients before pancreatic resections in patients with pancreatic cancer.
O.M. Kononets, O.V. Tkachenko, O.O. Kamenetska
Medicni perspektivi (Medical perspectives), Volume 26, pp 90-98; doi:10.26641/2307-0404.2021.1.227941

The nervous system, in particular the autonomic one, is well known to constantly regulate the internal functioning of the body, adapting it to changeable external and internal environmental parameters. In particular, there is a close multiple-vector correlation between the nervous system and the kidneys. The aim of this study was to specify the mechanisms, clinical and paraclinical characteristics of the concomitant lesions of the nervous system and the kidneys in patients with acute stroke. This paper presents the case report of 215 patients, aged 70 ± 8.44, who suffered from ischemic stroke. Among them, we examined 144 women and 71 men. The patients underwent a comprehensive examination, including a detailed clinical and neurological check-up (evaluating the patients’ condition severity with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel index on admission and on the 21st day of the disease), laboratory analysis (electrolyte balance, nitrogen metabolism (on admission and on the 21st day of the disease) and instrumental examination (CT scan of the brain, the follow-up brain magnetic resonance imaging). The statistical methods were used to analyze the data. In the 1st day of the disease, all the surveyed patients with right hemispheric carotid stroke and the overwhelming majority of the patients with left hemispheric carotid stroke and ischemic stroke in the vertebrobasilar system had cerebral renal syndrome, represented by renal concentration-filtration dysfunction, accompanied by the reduced glomerular filtration rate. A reliable relationship was found between the renal concentration and filtration function and the right hemispheric ischemic focus in patients with ischemic stroke, the characteristics are to be specified.
T.P. Borysova, O.Yu. Obolonska
Medicni perspektivi (Medical perspectives), Volume 26, pp 156-162; doi:10.26641/2307-0404.2021.1.227960

Premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) have a high risk of developing acute kidney injury (AKI) due to renal hypoperfusion and use of ibuprofen for duct closure. The aim of the study was to evaluate the effect of ibuprofen for the closure of HSPDA on the development of AKI in preterm infants depending on high dose of the drug on the first day of life. 40 preterm infants with HSPDA who were admitted for observation on the first day of life were examined. To close the ductus arteriosus, infants received restrictive therapy. In addition, 32 (80,0%) preterm infants on the first day of life were prescribed ibuprofen: 19 infants – in high dose (20 mg/kg), 13 infants – in standard dose (10 mg/kg). Clinical examination and treatment of preterm infants was carried out according to the generally accepted methods. Echocardiography with Doppler was performed at 5-11 hours of life and then daily to determine the size and hemodynamic significance of patent ductus arteriosus. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. According to the results of the study, it was established that the frequency of AKI on the third and fifth days of life in preterm infants with HSPDA, who received ibuprofen in a high dose (20 mg/kg) on the first day, was 73.7% and 84.2%, respectively, which is 2.2 (OR=5.6; CI: 1,43-21,95; р<0.02) and 2.5 (OR=10.67; CI: 2.31-49.31; р<0.002) times, more often than in infants without such therapy. High dose of ibuprofen on the first day of life in preterm infants with HSPDA are most often associated with the development of stage I AKI on the third or fifth day of life, which was temporary in one third of patients. The use of a high-dose ibuprofen for HSPDA closure on the first day of life in preterm infants was significantly more often associated with foci of infection in the mother, large duct size and furosemide use.
О.о. Vlasov
Medicni perspektivi (Medical perspectives), Volume 26, pp 115-121; doi:10.26641/2307-0404.2021.1.228024

In pediatric anesthesiology in surgical interventions various methods of combined anesthesia with a combination of inhalation, regional, and intravenous anesthesia are used. The provision of high-quality anesthetic support in newborns and infants during surgical treatment of congenital defects is complicated by risk factors, concomitant diseases and different pathology conditions. The study of risk factors and their influence on the functional indices of the child's vital activity in prescribing anesthesia at all stages of the surgical intervention will help prevent complications and deaths in children. Aim – to сonduct a comparative assessment of various types of anesthesia for surgical correction of congenital defects in children and create a predictive model of the association of risk factors and deaths in the selected methods of anesthetic support. The retrospective study included 150 newborns and infants with congenital defects of the surgical profile depending on anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). After identifying and evaluating prognostic variables by simple logistic regression with calculating the odds ratio, stepwise multiple logistic regression analysis was performed and a predictive model of the association of risk factors and deaths with various types of anesthetic management was created. In thoracic operations a combined anesthesia with sevoran and fentanyl was most often used – 20.4%. In abdominal operations, in total anesthetic support with sevoran and regional anesthesia was used– 69.4%, while in urological operations combined total intravenous anesthesia with 2 drugs – 18.4% ranked first. No significant diffe­ren­ces were found between the types of anesthesia in various surgical interventions for congenital pathologies, between the types of surgery and deaths (p = 0.863). To prevent fatalities in various types of surgical intervention and options for anesthetic support of newborns and infants with congenital defects, it is advisable to more closely monitor the cerebral and peripheral oximetry indicators at all stages of treatment and timely correct the impaired condition of the child.
L.O. Shevchyk, N.Ya. Kravets, I.M. Grod
Medicni perspektivi (Medical perspectives), Volume 26, pp 69-77; doi:10.26641/2307-0404.2021.1.227735

The purpose of the work was the need to study the change in weight and hematological indicators of the rats as a reaction-response to being in difficult and unfavorable experimental conditions. The biological experiment was conducted in compliance with the normative conditions of keeping the rats, in accordance with ethical standards and recommendations for humanization of work with laboratory animals. In order to accomplish these tasks, rats were divided into two groups: control rats were housed in a spacious cage with comfortable living conditions and experimental animals were housed in a small cage with limited ability to move freely. For the purity of the experiment, the feed ration of animals of two groups was the same. Weight and hematological indicators were determined by conventional methods in physiology. It has been found that improper housing conditions, causing a stressful situation adversely affect the eating activity of the test animals, which explains the weak correlation of the dynamics of the weight of the animals in the control and experimental groups. The analysis of the absolute mass of the internal organs of rats showed their direct dependence on body weight and the correlation of these parameters between animals of both groups. The study found that the quantitative ratios of the main hematological parameters of each of the rodents are strictly different. The tendency to increase of the investigated parameters in the experimental group in comparison with the control one is symptomatic and can be explained by sympathetic-vegetative influences. The amount of hemoglobin is directly correlated with the number of red blood cells. Comparison of the content of hemoglobin, erythrocytes, leukocytes with body weight showed inversely proportional relationship between them. The persistent predominance of leukocytes in the blood of rats in both groups is likely to genetically determined.
, K.M. Shevchenko, L.I. Averkina, P.A. Kobeza
Medicni perspektivi (Medical perspectives), Volume 26, pp 46-53; doi:10.26641/2307-0404.2021.1.227731

Оbjective control of the level of knowledge in medical universities is the basis for guaranteeing the quality of education. There are a lot of examples of universal systems designed to evaluate medical students in different countries, including USMLE, IFOM and others; particularly in Ukraine Krok 1 licensed exam is conducted since 2005. Results of Krok 1 are also used for ranking medical universities at the national level. The purpose of our work was to conduct a comparative analysis of the results of the licensing exam Krok 1, in particular, a histology subtest, among students of specialties 221 “Dentistry” and 222 “Medicine” and different languages of education (Ukrainian, Russian, English) in Dnipropetrovsk medical academy. We have revealed that all the analyzed contingents of students (DMA as well as Ukrainian) in the majority of observation periods from 2014 to 2019 had lower average results on histology compared to average Krok 1 results. This could be explained by low quota of histological tests for students of specialty 222 “Medicine” which is 4-6%, and absence of the threshold level for doing each particular subject. These conditions do not motivate students of the third course to recollect a complicated discipline that ended more than a year ago. Another problem is in the content of anchor questions in Krok 1 booklets: the number of such questions are distributed unevenly among booklets of different years and different languages of study. As a result, students with different languages of study are put in unequal conditions. In addition, the variation in the number of anchor tests from year to year, the lack of a declared quota of such tests disorients students and makes it difficult to develop algorithms for preparing for Krok 1.
I.S. Borуsova
Medicni perspektivi (Medical perspectives), Volume 26, pp 232-238; doi:10.26641/2307-0404.2021.1.228021

The economic burden of disability due to occupational diseases is significant: the economic losses "due to health problems related to work" in the developed world exceed 1,25 trillion US dollars and amount to 4 to 6% of GDP. A large number of employees work in Ukraine in unfavorable conditions. The study analyzes the dynamics of disability due to occupational diseases in Ukraine for the period from 2015 to 2018 using the example of Dnipropetrovsk, Lviv and Donetsk regions. The results of the study proved that the indicators of disability due to occupational diseases in these areas have a pronounced upward trend. It has been determined that the number of injured or aggrieved persons who received occupational diseases in the Dnipropetrovsk, Lviv and Donetsk regions is 78.5% of the total number of those in Ukraine with occupational diseases. The proportion of those who were initially recognized as disabled due to occupational diseases increased in 2015-2018, increased in these areas and amounted in absolute numbers: in the Dnipropetrovsk region – 906 people (2018) against 705 people (2016); in the Lviv region – 273 people against 239 people, respectively; in Donetsk region – 193 people against 108 people, respectively. Primary disability rate for 2015-2018 period increased by 28.5% in Dnepropetrovsk to almost 50% in Donetsk region. The proportion of those who were initially recognized as disabled due to work injury in the Dnipropetrovsk region was 159 people (2018) against 123 people (2016); in the Lviv region: 42 people against 11 people, respectively; in the Donetsk region: 28 people against 11 people, respectively. The rate of primary disability due to work injury also increased by 29.2% in the Dnipropetrovsk region and by 53% in the Donetsk region. The number of persons with disabilities recognized for the first time depended on age and length of service in hazardous conditions. Persons with 10-19 years of work experience in 2015-2018 accounted for 89.2%. According to our data, 50.1% of workers aged 40 to 49 years are recognized as persons with disabilities, 40% – from 50 to 59 years of age. It is important that in 2018 in 5% of cases, an occupational disease caused disability among workers at the age of 39. In 2018 (as in 2016 and in 2017) in Ukraine, the main conditions that resulted in occupational diseases were: imperfection of mechanisms and working tools – 23.9%; the imperfection of the technological process - 19.5% and the ineffectiveness of the personal protective equipment – 13.5% of their total number. In the structure of disability due to occupational diseases, diseases of the musculoskeletal system occupied the 1st place; 2nd place – respiratory diseases; 3rd place – injuries and poisoning.
A.M. Serdiuk, I.O. Chernychenko, O.M. Lytvychenko, V.F. Babii, O.Ye. Kondratenko, D.O. Hlavachek
Medicni perspektivi (Medical perspectives), Volume 26, pp 226-231; doi:10.26641/2307-0404.2021.1.228020

The objective – to study the dynamic changes for the health risk of the population of the industrial center in accordance with the state of atmospheric air pollution with carcinogenic compounds. The assessment of the state of atmospheric air pollution was carried out by us based on the results of physicochemical analysis of samples taken in places attached to the locations of stationary posts of state monitoring. The concentration of identified substances was determined by conventional methods: spectral-luminescent and gas chromatographic. Heavy metal concentrations were determined using data from the Central Geophysical Observatory of the Ministry of Emergency Situations. The calculation of the inhalation load of chemical carcinogens and the risks associated with them (non-carcinogenic and carcinogenic) was carried out in accordance with domestic guidelines. The assessment of dynamic changes in the nature of atmospheric air pollution with a complex of carcinogenic substances was made 5 of them are constantly recorded at levels exceeding hygienic standards. When compared with the reference concentrations, all compounds are characterized by high coefficients, indicating the likelihood of their effect on the body's immune system, respiratory organs, malformations, etc. A high individual carcinogenic risk of the effect of chromium VI and nitrosamines was determined. A total carcinogenic risk is formed at levels of 2.5 – 3.9×10-3, which should be considered as high; this requires development and implementation of preventive measures. On the territory of the industrial center, a high level of air pollution with increased carcinogenic and non-carcinogenic risk is stably registered.
А.і. Foros, Ye.Ya. Kostenko, M.Yu. Goncharuk-Khomyn
Medicni perspektivi (Medical perspectives), Volume 26, pp 217-225; doi:10.26641/2307-0404.2021.1.228019

The number of drug addicts in the world is growing every year. The aim of the study was to assess the dental status of drug-addicted patients with parafunction of the dental-jaw apparatus. We used clinical, analytical, functional and histological research methods. 119 drug-addicted and 110 non-drug-dependent patients aged 18 to 54 were examined. In order to confirm the presence of parafunctions of the dental-jaw apparatus in patients, we conducted an occludogram study, as well as an assessment of the index of parafunctions of the masticatory muscles and the degree of their severity. The structure of tooth tissues was examined by histological method. Examination of drug-addicted patients revealed the presence of numerous carious cavities, secondary adentia, enamel erosion, pathological abrasion, signs of gingivitis and periodontitis, tooth chipping. The prevalence of parafunction of the dental-jaw apparatus, in particular bruxism, in drug-addicted patients is 1.56 times higher than this figure among non-drug addicts. The results of the occludogram and the index of parafunctions of the masticatory muscles differ significantly between the study groups. The mean value of the masticatory muscle parafunction index among drug-addicted patients is 2.06 times significantly higher than the value among non-drug-addicted men and 2.03 times higher among women. Histological examination of the tooth tissues of drug-addicted patients indicates a disorder of the mineralization of both enamel and dentin. Thinning of the peripheral zone of the pulp, which is normally represented by a layer of odontoblasts, which provide regeneration and nutrition of dentin, is more common in persons under 25 years of age. Drug use adversely affects the dental status of patients and the condition of the hard tissues of the tooth.
M.A. Nikolaychuk, L.R. Shostakovych-Koretskaya, I.V. Budayeva, S.V. Biletska
Medicni perspektivi (Medical perspectives), Volume 26, pp 184-190; doi:10.26641/2307-0404.2021.1.228000

According to WHO, about 150-200 million people are currently infected with the HCV virus worldwide. Recently, in the professional literature, the number of publications on the role of vitamin D in patients with viral hepatitis C has increased as vitamin D metabolism occurs with the participation of the liver and its deficiency is associated with an increased risk of infectious diseases. The aim of this study was to investigate the effect of seasonal factor on vitamin D (25 hydroxycalciferol) levels in patients with chronic viral hepatitis C and healthy subjects. The study involved 100 patients in the registry of patients with chronic viral hepatitis in the Dnipropetrovsk region. The prevalence and deficiency of vitamin D in patients with chronic viral hepatitis C and conditionally healthy subjects at different times of the year were determined, which showed the presence or absence of a seasonal effect on serum 25(OH)D level. Patients were divided into two groups, depending on the time of the year (autumn-winter and spring-summer), in which the level of 25 (OH) D was determined. The serum was metabolised by vitamin D, which is synthesized by the liver – 25 hydroxycalciferol (25 (OH) D), an indicator of the supply of vitamin D to the human body. Vitamin D levels were evaluated according to the M.F. Holick classification. According to the level of vitamin D patients were divided into 3 groups (patients with normal level, insufficient (suboptimal) level and vitamin D deficiency). The results of the study showed no effect of seasonal factor on the level of 25 (OH) D in the serum of patients with chronic viral hepatitis C. Vitamin D levels are controlled by the time of the year: in spring and summer this indicator is normal, in autumn and winter – seasonal decrease in vitamin D.
O.V. Burlaka, V.O. Vahnier
Medicni perspektivi (Medical perspectives), Volume 26, pp 105-114; doi:10.26641/2307-0404.2021.1.227944

The aim of the study is to define awareness level and use of different contraception methods by servicewomen in the current armed conflict in the East of Ukraine. Between October 2018 and September 2019, 507 military women serving in the Joint Forces Operation Zone in eastern Ukraine and 100 civilian women from the frontline region participated in the questionnaire-based survey. The survey was focused on the knowledge and use of different methods of contraception and STI preventing by military women in conditions of armed conflict in Donbas. Servicewomen reported using of different methods of contraception in 48.3±4.3% of the cases, which is 1.5 times less than civilian women (RR=1.5; 95% CI: 1.2 – 1.7, p=0.001). Among those who reported using contraception, hormonal methods were chosen by 8.2±3.4% of active duty military women, which is two times less than by civilians (RR=2.1, 95% CI: 1.1-4.1, p=0.03). The low use of effective methods of contraception by active-duty servicewomen according to results survey is one of the reasons for the disruption of female reproductive health during military deployment. The primary reserve of preserving women's health in the current war environment,besides access to modern contraceptives and counseling, is improving the education of military medics in the gender-specific issues of reproductive health and contraception.
, , D.V. Chernov, I.A. Samoilenko
Medicni perspektivi (Medical perspectives), Volume 26, pp 209-217; doi:10.26641/2307-0404.2021.1.228016

The purpose of the work is improvement of the effectiveness of the mandibular fractures treatment in patients with partial or complete adentia by developing and experimentally testing transalveolar osteosynthesis technique. An experimental study was carried out by 3D computer simulation modeling by the final element analysis to assess the efficiency of mandibular fractures fixation at partial or complete adentia using the Ш-shaped plate, which we developed for the transalveolar osteosynthesis method. Calculations of the immobilized fractures for static (own weight) and dynamic (functional) loads were performed according to the author's method, taking into account pronounced resorptive processes in the bone from the beginning of the reparative reaction to assess the rigidity of fragments fixation during the entire period of the fractures healing. Under the conditions of the same three-dimensional model of the mandible, calculations were performed when the fracture was fixed with ordinary linear titanium osseous plates. It is proved that at functional load the new plate provides a compression effect in the fractures region, as evidenced by the negative displacements in the final elements of the mental region according to the results of design load combination 2- 3. The maximum efforts in the screws of the calculation model with a conventional bone plate were 136.955 N, which is almost ten times more than on the model with a Ш-shaped titanium retainer (12.656 N).
, M.R. Gzhegotskyi, , L.P. Kostyshyn, Yu.O. Kulyk
Medicni perspektivi (Medical perspectives), Volume 26, pp 30-39; doi:10.26641/2307-0404.2021.1.227726

This study aimed to investigate the influence of high-frequency whole body vibration (WBV) on metabolic and structural responses of rats' bone tissue under the sedentary lifestyle and obesity. Obesity combined with a sedentary lifestyle can present the potential negative health effects. However, whole body vibration can be used as a means of non-pharmacological correction of bone mineral density. For characterization of bone nanocomposites organisation and prevention of mineral density loss, X-ray diffraction method was used. Markers of bone remodeling in the rats' blood: leptin, osteocalcin, tartarate resistant acid phosphatase 5b, alkaline phosphatase. Using a high-calorie diet and low-mobility model, we proved that bone mineral mass had been decreasing since 8th week. It should be noted that the decrease in the relative amount of crystalline phase (hydroxyapatite) continued throughout the experiment, up to 24 weeks (p<0.05). These structural changes were accompanied by changes in quantitative indicators of the bone remodeling markers. Rats had lower bone mineral density compared to the animals that were on the normal diet and were additionaly affected by WBV. We observed the increase of the crystalline phase volume fraction from 84% to 93% (p<0.05) in group with additional whole body vibration and the decrease of the mineral component in rats with limited mobility and high-calorie diet. Therefore, WBV could improve structural conditions of bone and prevent fat accumulation and obesity-associated biochemical markers in obese rats. This can be an effective method to improve the structural and functional state of the bones while preventing the loss of bone mineral density.
O.V. Zubarenko, T.V. Stoieva, L.I. Koval, G.K. Kopiyka, R.M. Papinko
Medicni perspektivi (Medical perspectives), Volume 26, pp 143-149; doi:10.26641/2307-0404.2021.1.227956

Pneumonia is one of the most severe respiratory pathology forms in children, which contributes significantly to infant mortality. The high risk of chronic bronchopulmonary process and child`s disability, in case of severe and complicated disease, requires careful pathophysiological change's analysis in community-acquired pneumonia (CAP) in children. In particular, for the prediction of these disorders in children with CAP are important the dysmetabolic phenomena study and the specific approaches development. The immediate aim of this work is to study the cellular energy metabolism (CEM) features and to develop approaches for the early bioenergetic disorders diagnostics in conditions of community-acquired pneumonia in adolescents.The aim of the study is to develop approaches for the early diagnosis of shifts in energy metabolism in children aged 14-18 years with CAP. An examination of 41 children aged 14-16 years with the definition of CEM indicators was conducted in order to develop an approach for predicting CEM disorders in community-acquired pneumonia using the method of logistic regression. A logistic regression method was used to develop a method for predicting CEM disorders in children with CAP. The characteristics of CEM in children with CAP were determined. A decrease in the succinate dehydrogenase activity and an increase in the lactate dehydrogenase / succinate dehydrogenase ratio in children with CAP relative to the reference parameters were observed, which indicated an inhibition of the anaerobic energy synthesis pathway. Two mathematical models for predicting CEM disorders in CAP based on logistic regression equations were proposed. The first mathematical model consisted of social and health characteristics and of pneumonia clinical course characteristics. In ROC analysis the area under the curve (AUC) was 0.82, diagnostic specificity – 71%, diagnostic sensitivity – 90%. The second model included only hematological parameters, AUC – 0.78, diagnostic specificity – 69%, diagnostic sensitivity – 81%. Thus, changes in CEM in children with CAP aged 14 – 18 years have been established. Two methods for predicting disorders of CEM in children with CAP have been developed, which can be applied to optimize the treatment of children with CAP aged 14-18 years.
G.S. Dorofeeva
Medicni perspektivi (Medical perspectives), Volume 26, pp 122-128; doi:10.26641/2307-0404.2021.1.227948

Reduction of cognitive functions in the postoperative period is gaining importance in the context of the insurance medicine introduction. Operational stress and anaesthetization are factors which increase the risk of deepening and developing postoperative cognitive dysfunction. The function of short-term memory, attention function, and the speed of psychomotor cognitive reactions are the most vulnerable to the action of general anesthetics. The influence of various methods of anesthesia on cognitive functions in ophthalmic surgery patients after end-to-end keratoplasty has been studied in this research work. Dexmedetomidine was used (the selective agonist of α-adrenoreceptors) as one of the components of multimodal anaesthetization. The sedative effect of this drug is explained by inhibition of neural activity in the blue spot of the brain stem. Dexmedetomidine is known to be used for sedation of patients. It allowed possibility to reduce the amount of fentanyl which was necessary for intra-and post-operative anaesthetization. Our research was conducted on the basis of ME "DRCOH". 78 patients at the age of 18 to 60 years were examined after end-to-end keratoplasty. Non-inclusion criteria: presence of concomitant pathology, neurological diseases, use of psychotropic substances and alcohol 6 months before the study. The study was conducted using neuropsychological testing: the Mini Mental State Examination (MMSE),the Frontal Assessment Battery (FAB), and Luria’s test. Testing was performed before the operation, in 6, 24 hours, 7 and 21 days. Patients were randomized into two groups. The first group – group k (n1=45) included patients who were provided with anaesthetic management according to the following scheme:premedication — ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously, sibazone 10 mg, fentanyl 0.1 mg intramuscularly 40 minutes before intervention. Induction of propofol – 2-2.5 mg/kg fractionally to achieve clinical symptoms of anaesthetization, fentanyl – 0.005% 0.1 mg tracheal intubation after relaxation on the background of atracuriumbenzylate – 0.3-0.6 mg/kg. Maintaining of anaesthetization: oxygen-sevoflurane mixture FiO250-55%, sevoflurane 1,4-1,8 vol.% on exhalation (1-1. 5 WT.) with the flow of no more than 1 l/min. BIS indicators were kept at the level of 30-40, during the surgery, the bolus injection of 0.1 mg of fentanyl was used in the event of hemodynamic reactions. Anaesthetic support was performed using the infusion of dexmedetomidin for 40 minutes, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously in the second group d (n2=33). Induction, relaxation and maintenance of anaesthetization were performed as in the previous group. Intra-operative monitoring of patients in both groups included: non-invasive measurement of blood pressure (BP), heart rate (HR), pulse oximetry, determination of blood gases (oxygen, carbon dioxide and inhaled anesthetic on inhalation and exhalation). Control of the depth of anaesthetization was performed on the basis of BIS and ANI - monitoring. The use of dexmedetomidinu as the component of a multi-modal method of anaesthetizational al lowed obtaining less pronounced POCD, due to the reduction in the number of used drugs. Further use of the combination of highly selective agonists of α2-adrenoreceptors with regional anaesthetization in ophthalmic surgery is the promising method.
I.S. Shponka, L.A. Pesotskaya, H.S. Korolenko, I.O. Hutnik, B.V. Murashevych, V.A. Nikonenko
Medicni perspektivi (Medical perspectives), Volume 26, pp 78-84; doi:10.26641/2307-0404.2021.1.227934

Chronic myelomonocytic leukosis (CMML) is rarely diagnosed and amounts to 1 per 100 thousand of adults per year, more often in men over 60 years. The clinical case of the rare, prolonged course of myelodysplastic chronic myelomonocytic leukosis (MD-CMML) in a middle-aged woman with rapid transformation into acute monocytic leukemia (AMoL-M5в) with the atypical fulminant course is presented. A retrospective analysis of the course of the disease drew attention to the severe vasculitis suffered by the patient 19 years ago, which could be regarded as the debut of CML in the presence of characteristic pathological changes in the hemogram. Non-pronounced clinical manifestations in the form of moderate cervical lymphadenopathy, skin lesions in the form of transient erythema, spotty eruptions over the next 10 years, fit into the clinical picture of MD-CMML. A detailed picture of the disease was observed after viral infection, bronchitis, antibiotic therapy. Absence of significant blastemia and severe inhibition of normal hematopoiesis with expressed extramedular manifestations of the disease in the patient were not typical for the course of AMoL-M5b in this case. The progression of skin lesions was noteworthy, which gave reason for unfavorable prognosis. For several weeks, the spread of erythematous elements was observed throughout the body with itching, not controlled by antihistamines and corticosteroid drugs; the appearance of maculopapular rashes, merging in places; small-point hemorrhages like vasculitis over the entire surface of the skin. Notable was the development of severe hemorrhagic syndrome without severe thrombocytopenia, significant changes in the coagulogram, as a manifestation of early severe coagulopathy.
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