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L. S. Stryzhak, I. O. Anikin, O. V. Spakhi
Published: 20 August 2021
Pathologia, Volume 18, pp 152-158; https://doi.org/10.14739/2310-1237.2021.2.230342

Abstract:
Exploring new possibilities for the use of methylxanthines to prevent the development of acute kidney injury (AKI) in full-term infants with perinatal asphyxia. Aim: to evaluate the efficacy and safety of methylxanthines in full-term infants for the prevention and conservative treatment of acute kidney injury. Materials and methods. To test the effectiveness of the proposed method of AKI treatment, 38 infants were chosen and divided into 2 groups by random selection. Nursing and intensive care were according to current legislation (Order of the Ministry of Health of Ukraine No. 225 of March 28, 2014). The main group (n = 20) received therapy with caffeine citrate, the comparison group (n = 18) – theophylline. Both of these drugs were used to prevent the development of acute kidney injury – stage II and III according to KDIGO. Results. A significant difference in serum creatinine was found in the main group - the level of serum creatinine was higher than in the comparison group, but did not exceed the physiological norm. GFR on the 3rd day of life was higher with administration of theophylline, but in the group of caffeine did not exceed the reference values of the norm. No differences between urea levels and diuresis rates were found in the groups. The initial results indicate the lack of statistical significance when using various drugs of the methylxanthine group, namely theophylline and caffeine citrate. This is explained by the fact that in the main group 65.00 % (n = 13) of patients had AKI stage 0 according to KDIGO, and 35.00 % (n = 7) had stage I. In the comparison group, 55.56 % (n = 10) and 44.44 % (n = 8), respectively. Stages II and III in both groups of the study did not develop, the obtained data are equivalent – U = 163,00; P = 0,6296. However, the use of caffeine citrate may become a priority due to a better safety profile compared to theophylline. Caffeine is less likely to cause adverse effects in the form of non-pathological bile vomiting and has significantly lower relative risk of non-pathological bile vomiting in infants (RR 0.26 (95 % CI 0.10; 0.66)). Conclusions. Conservative methylxanthine therapy in full-term infants with perinatal asphyxia prevents the development of stages II and III of AKI according to KDIGO. However, it is necessary to continue the collection of material to increase the statistical significance, as well as to study the early and long-term consequences of this therapy.
S. I. Ilchenko, А. О. Фіалковська, K. V. Skriabina
Published: 20 August 2021
Pathologia, Volume 18, pp 189-195; https://doi.org/10.14739/2310-1237.2021.2.225193

Abstract:
The aim is to study the relationship between the level of exhaled nitric oxide (FeNO) and the activity of the fibrogenic cytokine TGF-β1 in blood serum and brush biopsy samples of bronchial mucosa in order to determine their role in the development of irreversible morphological and functional changes in smoking adolescents. Materials and methods. 20 adolescent smokers with chronic bronchitis (CB) (average age – 17.5 ± 0.2 years) were exa­mined. The comparison group consisted of 37 adolescent smokers without respiratory symptoms (average age – 15.9 ± 0.2 years) and 15 healthy adolescents, who never smoked (average age – 15.9 ± 0.4 years). In adolescent smokers the tobacco smoking status was assessed. To confirm active smoking, the nicotine metabolite cotinine was determined in urine. Instrumental methods included spirometry, chest X-ray, tracheobronchoscopy. The FeNO level was measured using a Niox Mino. TGF-β1 level was determined in the blood serum and brush biopsy samples of the bronchial mucosa. Results. The FeNO levels were significantly lower in adolescent smokers with CB in comparison with adolescent smokers without respiratory symptoms (6.1 ± 0.3 ppb versus 8.8 ± 0.6 ppb, P < 0.05). The relationship between the FeNO levels and indicators of the tobacco smoking status has been established in patients with CB and in asymptomatic smokers. There was a significant increase in the TGF-β1 levels in the blood serum in patients with CB compared with asymptomatic smokers (478.7 ± 57.9 pg/ml versus 231.5 ± 23.5 pg/ml, P < 0.05). In smoking adolescents a relationship between a FeNO level and an increased activity of the fibrogenic cytokine TGF-β (r = -0.63; P < 0.05) has been established. In one third of patients the TGF-β1 factor was identified in the bronchial endothelium. The presence of this factor in the bronchial endothelium is a serious prognostic criterion for the risk of developing “inadequate” pneumofibrosis, which can lead to irreversible remodeling processes in the bronchi. Conclusions. Determination of FeNO levels and TGF-β1 in the blood serum in smoking adolescents has a reliable diagnostic value for determining the risk group for the development of irreversible morphological and functional changes in the bronchi and can improve the efficiency of early diagnosis of chronic respiratory pathology.
O. M. Toronchenko, L. О. Miakinkova, D. D. Baklytskyi
Published: 20 August 2021
Pathologia, Volume 18, pp 243-250; https://doi.org/10.14739/2310-1237.2021.2.225044

Abstract:
The article describes a rare clinical case of hyperkalemia backgrounded by type 1 diabetes mellitus with signs of acute cardiovascular insufficiency, arrhythmia and QRST disturbances which was primarily diagnosed as acute coronary syndrome with ST elevation. Coronary angiography excluded pathology of the coronary arteries. Hyperkalemia, as the cause of ECG changes, was suspected in the hospital treatment. Stabilization of the patient’s condition, renewal of heart rhythm and conduction was obtained against the background of infusion support and insulin therapy. The pathogenesis of arrhythmia and QRST complex had a secondary genesis in relation to fluid and electrolyte metabolism disorders, so the restoration of sinus rhythm occurred without usage of antiarrhythmics. The usage of antiarrhythmic drugs according to the guideline of management of patients with ACS can deepen electrolyte shifts and lead to fatal arrhythmias in conditions of insulin deficiency and hyperkalemia. This example illustrates the urgent need to diagnose life-threatening electrolyte changes, namely hyperkalemia, under the guise of acute coronary syndrome, as well as signs of ACS, along with ECG, to pay special attention to the assessment of medical history and clinical data for the correct choice of emergency care and further treatment tactics.
I. I. Yakovtsova, Ya. M. Miroshnichenko, T. M. Chertenko
Published: 20 August 2021
Pathologia, Volume 18, pp 136-141; https://doi.org/10.14739/2310-1237.2021.2.233425

Abstract:
Aim: to clarify the prognostic value of cytoplasmic p16ink4A, VEGF, MMP-9 and Ki-67 expressions in gastrointestinal stromal tumors (GISTs) and connection of different levels of these markers expression with aggressive transformation of GISTs. Materials and methods. Our study included 36 samples of primary tumors and 10 relapses of GIST and metastases in liver after primary combined treatment (surgery and chemotherapy with imatinib). The immunohistochemical study was performed with 4 primary antibodies: Ki-67, p16ink4A, VEGF and MMP-9. We used formalin fixed and paraffin embedded (FFPE) tissue samples for immunohistochemical study. Results. In our study we showed significant connection between levels of cytoplasmic expression of p16ink4A in primary GISTs and such markers of tumor aggressive behaviour as Ki-67, MMP-9 and VEGF (Fisher’s exact P-value = 0.000753; 0.000101 and 0.000048 respectively). Between cytoplasmic expression of p16ink4A and VEGF and also between p16ink4A and MMP-9 strong direct correlation was found (γ = 0.829, P < 0.05 and rs = 0.961, P < 0.05 respectively). The correlation between expression of Ki-67 and p16ink4A was also direct and strong (rs = 0.754, P < 0.05), but with some exclusions, that’s why this correlation needs further investigation in larger groups with preciser molecular analysis. Analysis of metastatic GISTs samples showed prominent levels of MMP-9 and VEGF expression. Conclusions. Our study has shown very important role of cytoplasmic expression of p16ink4A in GIST as one of the markers of aggressive behavior, which can be used in complex with other markers for more accurate prognosis of GISTs progression. Prominent levels of MMP-9 and VEGF expression in metastatic GISTs can be a marker of resistance to imatinib. So probably evaluation of MMP-9 and VEGF expression can be used as a tool for correct choice of chemotherapy for patients with GISTs.
, T. I. Kordon, S. V. Sushkov, L. A. Drozdova, , O. S. Merezhko, K. O. Bychenko
Published: 20 August 2021
Pathologia, Volume 18, pp 174-182; https://doi.org/10.14739/2310-1237.2021.2.229454

Abstract:
The aim was to study the mechanisms of immunological dysregulation of cytokine and immunoglobulin production, changes in the CD expression of T and B lymphocyte subpopulations in patients with hepatosplenomegaly of different etiology. Materials and methods. We examined 73 patients with liver cirrhosis complicated by portal hypertension, hepatosplenomegaly, and bleeding from phlebectasia. We identified three groups of patients depending on the triggering factors of cirrhosis: the first (I) group – HBV/HCV; the second (II) group – CMV/VEB; the third (III) group – hereditary enzymopathies. The study material was lymphocytes and blood serum. We used the methods of ELISA, immunofluorescence and flow cytometry. Results. An increase in the concentration of IgA and IgM was revealed against the background of normal number of CD22+ B lymphocytes with HBV/HCV (I group), high level of IgM and their producers, B lymphocytes, with CMV/VEB (II group), in group III with hereditary enzymopathies, the concentration of all immunoglobulins was normal with an increased content of B lymphocytes. Multidirectional changes in the content of cytokines were revealed: in group I the synthesis of anti-inflammatory cytokines IL-4, IL-10 and in group II – pro-inflammatory IL-1β, INF-γ, TNF-α dominated; in group III the concentration of IL-6 and vascular growth factor (VEGF) was maximally increased. The number of activated CD3+CD4+CD25+ T cells was reduced in groups I and II – by 2.3 and 2.0 times respectively, in group III – increased by 1.2 times. The number of regulatory T lymphocytes CD3+CD4+CD25+CD127neg was reduced by half in I and II groups. Expression of co-stimulatory molecules CD3+CD4+CD28+ was low in all groups and the maximum decrease was in group III. In patients with HCV/HBV, an increase in the expression of the late activation marker of lymphocytes CD3+HLA-DR+ by an average of 63 % was noted. Conclusions. The revealed immune disorders in hepatosplenomegaly of different etiology are characterized by multidirectional changes. Approaches to the treatment of these patients should be complex, taking into account the trigger factors that cause dysregulation of immune responses, which leads to further destruction, and focuses at remodeling target organs.
V. V. Hryhorovskyi, S. Mahomedov, M. P. Hrytsai, V. P. Tsokalo, T. A. Kuzub, L. V. Polishchuk, A. V. Hryhorovska
Published: 20 August 2021
Pathologia, Volume 18, pp 218-228; https://doi.org/10.14739/2310-1237.2021.2.237156

Abstract:
Aim. Research aim was to find statistical differences of biochemical indicators of blood and morphometric indicators of crural tissue lesion and relationships between them in patients with traumatic osteomyelitis of the tibia with trophic disturbances in extremity. Material and methods. The work material includes data from 28 patients with traumatic osteomyelitis which was combined with trophic tissue disturbances of different manifestation degree. The levels of procalcitonin, lactate dehydrogenase and acetylcholinesterase of blood serum were estimated. In crural tissues quantitative biochemical, gradual morphometric indicators, frequencies of occurrence of different manifestation degree cases and relationships “clinic – biochemistry – pathomorphology” were defined histologically. Results. Average values of procalcitonin, lactate dehydrogenase and acetylcholinesterase in patients with traumatic osteomyelitis of the tibia, combined with trophic disturbances in crural tissues, are significantly higher, than average values of these indicators in intact donors. In the majority of the patients with chronic traumatic osteomyelitis in crural tissues pathological changes were found out, which by clinical estimations are considered as trophic disturbances. They represent a combination of discirculatory, ischemic-necro­tic, exsudative, productive-inflammatory, and also reparative processes which in total create a composite picture of complex lesion and can persist for many years. As closest relations, according to values of association coefficient, concerning certain biochemical indicators, can be noted such clinical indicators: “degree of bone fragments non-consolidation” and “severity of trophic disturbances in bone tissue (by clinical estimation)”, concerning defined morphometric indicators – such biochemical indicators: “level of procalcitonin” and “level of lactate dehydrogenase” in blood serum. Among morphometric lesion indicators the closest relations concerning biochemical indicators were revealed: in bones – “the form of the pathological focus of traumatic osteomyelitis” and “presence of sequesters”, in soft tissues – “exsudative inflammation in internal membrane of a focus capsule”. Conclusions. In chronic traumatic osteomyelitis combined with trophic disturbances of crural tissues, there are relationships between some clinical, biochemical and morphological indicators of the extremity tissues condition. A deviation of metabolism indicators from norm can serve as biochemical markers in definition of severity degree and efficiency of treatment in patients.
T. D. Zadorozhna, Yu. H. Antypkin, T. R. Umanets, А. А. Буратинська, T. M. Archakova, M. I. Kiurdzhiieva, S. M. Kylykhevych
Published: 20 August 2021
Pathologia, Volume 18, pp 159-166; https://doi.org/10.14739/2310-1237.2021.2.237538

Abstract:
The most common comorbid pathology in children with asthma is gastroesophageal reflux disease (GERD) associated with reflux esophagitis (RE), which ranges from 32 % to 80 %. Histological changes of the esophageal mucosa in RE have been described in adults and children, but there are only isolated studies that describe the morphological features of the esophageal mucosa in combined pathology, taking into account the severity of asthma. The aim is to study the histological and immunohistochemical features of the esophageal mucosa in children with asthma combined with reflux esophagitis. Materials and methods. In 43 children aged 6–17 years with RE and severe asthma (group 1), with mild/moderate asthma (group 2) and without asthma (group 3), mucosal biopsies from the distal and proximal esophagus were examined by histolo­gical and immunohistochemical methods. Immunohistochemical research was performed in serial paraffin sections according to standard protocols using monoclonal antibodies to Ki-67, MMP-9, VEGF, BCL-2, IgE and CD68. Results. In children with asthma combined with RE, the structural changes of the esophageal mucosa differed depending on the severity of asthma. Severe basal epithelial hyperplasia was registered in 92.31 % of children in group 1, and its frequency was significantly different from children in groups 2 and 3. A characteristic feature of children with asthma and reflux eso­phagitis was dyschronosis, which was characterized by foci of hypo- and hypertrophy of basal layer cells (92.31 % of children in group 1 and 37.50 % of children in group 2). Severe elongation of the “papillae” was found only in 38.46 % of children in group 1. Immunohistochemical features of the esophageal mucosa of children with asthma and reflux esophagitis revealed the expression of Ki-67 antigen, IgE and a weak macrophage response (CD68), the severity of which differed from children with reflux esophagitis without asthma. Conclusions. Morphological changes in the esophageal mucosa of children with reflux esophagitis and asthma differ from children with reflux esophagitis without asthma in the presence of severe epithelial damage, dyschronosis of changes, severe elongation of the “papillae”, pronounced cell proliferation (Ki-67) and local IgE expression.
M. Yu. Sliepchenko, S. V. Kuznetsov
Published: 20 August 2021
Pathologia, Volume 18, pp 211-217; https://doi.org/10.14739/2310-1237.2021.2.230336

Abstract:
The aim is to evaluate the effect of cytomegalovirus on clinical and paraclinical as well as immunological parameters in children with rotavirus infection (RVI). Materials and methods. 50 children aged one to three years, patients with moderate and severe intestinal infections of rotavirus etiology were examined. All children were examined for herpes virus infections types 1, 2, 4, 5, 6. Enzyme-linked immunosorbent assay (ELISA) was used to determine the level of specific Ig G and Ig M for herpes viruses types 1, 2, 4, 5, 6, and in the case of a positive test, polymerase chain reaction (PCR) determined the presence of DNA (qualitatively) of these herpesviruses. Group 1 (mono-RVI), which was taken as a reference, included 33 children in whom no infection with any of these viruses of the herpes group was detected. Group 2 included 17 patients who underwent RVI on the background of CMV infection, the presence of infection with other viruses of the herpes group was excluded. Immune response parameters (CD 3+, CD 4+, CD 8+, CD 16+, CD 22+, Ig A, Ig M, Ig G, IL 1β, 4, TNF-α) in the acute period of the disease and in the period of convalescence were analyzed. Qualitative indicators were given in the form of absolute and relative (%) value. Significance of differences was determined using Pearson’s χ2 test (Pearson’s Chi-squared test). Quantitative indicators were given in the form of median (Me) and values of lower (LQ) and upper (UQ) quartiles. The significance of differences in quantitative indicators in two unrelated groups was determined using the Mann–Whitney U-test. The threshold value of the confidence level was taken as 0.05. Results. The analysis of the obtained data allows to establish that in the acute period of RVI infection in children with CMV leads to lower figures of temperature reaction, lower vomiting rate, prolongation of hospitalization, along with decrease in leukocytes, CD 16+ (%) cells and immunoregulatory index (CD 4+/CD 8+) against the background of increased levels of monocytes, CD 8+ (%) T-lymphocytes, concentrations of IL-4 and TNF-α. During convalescence, the presence of CMV is associated with an increase in the duration of fever and diarrhea, an increase in monocytes, CD 8+ (%) T cells, concentrations of IL-4, TNF-α and lower figures of immunoregulatory index, CD 16+ (%), CD 22+ (%) T cells and Ig M. Conclusions. Latent cytomegalovirus infection in children with rotavirus gastroenteritis significantly affects a number of clinical and paraclinical as well as immune parameters, which leads to a decrease in the intensity of clinical manifestations in the acute period of the disease and the prolongation of some symptoms during convalescence.
, Н. В. Туманська,
Published: 20 August 2021
Pathologia, Volume 18, pp 142-151; https://doi.org/10.14739/2310-1237.2021.2.237934

Abstract:
Geriatric patients are particularly vulnerable to the development of postoperative complications, one of which is acute kidney injury (AKI). Early diagnosis of AKI is an important component of the effectiveness of its prevention and treatment. It is believed that ultrasound examination of renal blood flow may be a promising method for bedside diagnosis of AKI. The aim is to evaluate the predictive value of renal resistance index (RRI) and semiquantitative renal perfusion (SQP) as methods for early diagnosis of AKI in geriatric patients after urgent abdominal surgery. Materials and methods. A prospective single-center study included 40 patients (72.5 (65; 81.5) y. o.) who were assessed for the risk of development, the presence and stage of AKI, and additionally measured hemodynamic parameters, intra-abdominal pressure (IAP), and abdominal perfusion pressure (APP). Renal resistance index (RRI) and semi-quantitative renal perfusion score (SQP) were determined using Doppler ultrasound (ultrasound probe CH-6, SIEMENS, Acuson Antares). Statistical analysis was performed using the STATISTICA for Windows 13 program (StatSoftInc., No. JPZ804I382130ARCN10-J). Results. In the postoperative period, AKI developed in 26 patients (65%). Compared with patients without AKI, they had a 14% lower level of mean arterial pressure (MAP) (p=0.008), as well as an average of 4 mmHg higher IAP (p=0.005) and significantly lower APP (p=0.0348). Correlation analysis revealed a weak relationship between the values of MAP, IAP, APP and the development of AKI (r=0.34, r=0.41, r=0.392, respectively, p˂0.05). Patients with AKI had a 13.9% higher RRI than patients without AKI (0.75 (0.72; 0.81) r.u. vs 0.66 (0.61; 0.69) r.u., respectively, p=0.000001), however, the degree of SQP of the kidneys did not differ significantly between the groups (p=0.636). The correlation between the RRI and the development of AKI was of moderate strength (r=0.57, p˂0.05). MAP, IAP, and APP were significantly very weakly correlated with RRI (r=0.34; r=0.41, r=0.392, respectively, p˂0.05). ROC analysis showed that RRI>0.71 r.u. is the threshold level for AKI with 87.2% sensitivity and 73.5% specificity, and it has a high predictive value (area under the curve AUC 0.868 (p<0.0001)). Conclusions. High RRI values are associated with AKI in geriatric patients after urgent abdominal surgery. RRI may be a bedside diagnostic tool for AKI, in contrast to renal SQP, which has shown no predictive value.
T. V. Savchuk, S. H. Gychka, I. V. Leshchenko
Published: 20 August 2021
Pathologia, Volume 18, pp 128-135; https://doi.org/10.14739/2310-1237.2021.2.231461

Abstract:
The aim of this research was to study the pathomorphological changes in the placenta in case of coronavirus disease (COVID-19) in the anamnesis during different periods of gestation. Materials and methods. 53 placentas of women with the coronavirus disease (COVID-19) (RNA determination of the SARS-CoV-2) during the pregnancy were studied. The material was divided into the following groups: 1 and 2 – placentas in cases with a negative PCR test in full-term newborns who were born in satisfactory condition and high Apgar score. Group 1 (n = 29) – mother’s history of COVID-19 at 34–39 weeks of gestation; group 2 (n = 17) – mother’s history of COVID-19 at 23-33 weeks of gestation; 3 (n = 7) – placenta in case of antenatal fetal death. Results. Statistically significant differences were revealed between study groups: chorioamnionitis prevailed in group 1 (in 28 cases (96.6 %); confidence interval (CI): 86.4–100.0 %; P1-2 = 0.004); in groups 2 and 3 – arteriosclerosis (in 13 cases (76.5 %); CI: 52.2– 93.9 %; P1-2 = 0.0003 and in 7 cases (100 %); CI: 75.7–100.0 %; P1-3 = 0.001; respectively). COVID-19 was diagnosed in group 1 from 34 to 39 weeks of gestation (median 36.5), group 2 from 23 to 33 weeks (median 28.0), in group 3 from 13 to 32 weeks with a median of 24.5. Antenatal fetal death was observed between 14 and 41 weeks (median 31.4). Conclusions. Pathomorphological changes in the placenta in the coronavirus disease COVID-19 depended on the duration of the post-COVID interval (the time interval from the diagnosis of COVID-19 and the moment of delivery), due to the sequential change in the phases of the inflammatory process: alteration, exudation and proliferation, followed by fibrosis. The formation of acute placental insufficiency in coronavirus disease COVID-19, diagnosed up to 1–6 weeks to delivery, is associated with the development of severe disorders of circulation and acute exudative inflammatory reactions of varying severity. The formation of chronic placental insufficiency is associated with the proliferative stage of inflammation. These changes lead to the development of fibrosis in the wall of arterioles and intervillous space. The most significant structural changes in the placenta, leading to placental insufficiency, were observed in group 2 – at the time of infection in the period from 23–33 weeks of pregnancy. Coronavirus disease COVID-19 in the mother in the second trimester of pregnancy is a risk factor for perinatal losses, which are caused by the changes in the placenta described above with an increase in the duration of the post-COVID interval.
О. Г. Іванько, V. M. Bondarenko
Published: 20 August 2021
Pathologia, Volume 18, pp 196-202; https://doi.org/10.14739/2310-1237.2021.2.229500

Abstract:
Aim. To use the cluster analysis of clinical and laboratory data, characteristic to children aged 6 to 24 months with acute diarrhea, in demonstrating the signs of infectious or functional intestinal disorders. Materials and methods. 56 children admitted to the children’s infectious unit with diarrhea and 31 healthy toddlers of the control group were observed. Anamnesis, laboratory blood and urine tests, microscopy and bacteriological cultures of feces on selective media and tests to identify adeno- and rotaviruses were performed. The presence of Clostridium difficile A/B toxins in the stool, hemoglobin, fecal calprotectin (FC) and the content of undigested fecal carbohydrates also were studied. Results. Children who in their majority have received antibiotics only in 58.9 % of cases were corresponding to the bacterial or viral nature of the disease or the infection was clinically highly probable. Another 41.1 % of patients has experienced non-infectious diarrhea. In 7.1 % of all cases the diarrhea was triggered by an increase of the carbohydrate content in the stool. Diarrhea had the same mechanism in 3.4 % of patients with Giardia lamblia. In 17.9 % of patients the frequent bowel movements were the manifestation of symptomatic (parenteral) diarrhea caused by extraintestinal diseases, and in another 7.1 % the intestinal hypermotility was not explained but resembled irritable bowel syndrome in adults. Additionally, cluster analysis identified 5.4 % of patients with non-infectious diarrhea who had only significantly increased FC corresponding to allergic or immune inflammation in the gut. Conclusions. The classification of patients for the causes of diarrhea became possible due to the microbiological tests and highly informative markers of intestinal health – fecal calprotectin and reducing substances (carbohydrates) in the stool.
M. P. Kopytsia, Yu. V. Rodionova, N. V. Tytarenko, I. M. Kutia, Ya. V. Нilоva
Published: 20 August 2021
Pathologia, Volume 18, pp 229-242; https://doi.org/10.14739/2310-1237.2021.2.235805

Abstract:
Myeloperoxidase is one of the key enzymes involved in oxidative stress and inflammation. Its elevated levels are determined in a wide range of both acute and chronic forms of cardiovascular diseases. The inflammation results in the release of the enzyme from the white blood cells to form products such as hypochlorous acid, which in turn can have a negative effect on the target proteins. Inconsistent evidence on the predictive role of this biomarker in diseases of the circulatory system generates scientific interest and provokes further research in this direction. The aim of this review is to analyze the scientific literature data on myeloperoxidase as a possible clinical use for the diagnosis and risk stratification of patients with саrdiovascular diseases. Materials and methods. Searching and generalization of data from leading specialized sources, which are indexed by scientific databases PubMed, SCOPUS, Web of Science. Results. The results of the studies indicate that myeloperoxidase is actively involved in the pathophysiology of cardiovascular diseases through participation in oxidative stress and inflammation, excessive production of proatherogenic lipoproteins, changes in nitric oxide activity, endothelial dysfunction, and due to the effect on the instability of atherosclerotic plaques. In patients with cardiovascular diseases, including ischemic heart disease, the concentration of the indicated protein is increased and is often associated with a poor prognosis, including an increased risk of mortality. Myeloperoxidase metabolites are often the factors that contribute to cell damage under conditions of ischemia. The review also considers the relationship of the enzyme with the development of restenosis and the effectiveness of revascularization after percutaneous coronary intervention. Conclusions. The presented data mainly define myeloperoxidase as a significant marker for predicting long-term follow-up results and the development of serious adverse cardiovascular events, mortality in patients with cardiovascular disease. At the same time, despite the great achievements in disclosing the complex effects of myeloperoxidase, inconsistency in the available results is noteworthy. This controversy necessitates further research to elucidate and reveal the full clinical potential of myeloperoxidase in patients with cardiovascular pathology.
, O. Ye. Pashkova, K. V. Samoilyk
Published: 20 August 2021
Pathologia, Volume 18, pp 167-173; https://doi.org/10.14739/2310-1237.2021.2.217936

Abstract:
Aim. To stratify hemodynamic phenotypes in children with diabetes mellitus and their frequency, depending on the duration of the disease. Materials and methods. The study involved 72 children suffering from diabetes, aged 10 to 16 years who were divided into 3 groups. The first group – 22 children with diabetes mellitus up to 1 year. The second group – 24 patients with a disease duration of 1 to 5 years. The third group – 26 children with the disease over 5 years. Control group – 20 children, representative by age and sex. All children underwent daily blood pressure monitoring (ABPM) with the ABPM-04 device (Meditech Ltd, Hungary). Diagnosis of latent hemodynamic disorders was performed by the method of quantitative analysis of the relationships of blood pressure parameters, which involved a linear regression of systolic blood pressure by pulse blood pressure. According to the results of regression, 6 hemodynamic phenotypes were determined, which characterized the individual features of the circulatory system: harmonic, myocardial-insufficient subtype of harmonic, borderline diastolic harmonic, borderline systolic harmonic, dysfunctional diastolic and dysfunctional systolic. According to ABPM results, the ambulatory arterial stiffness index (AASI) was calculated using a linear regression equation. The results were statistically processed using statistics software package Statistica 13.0 (StatSoft Inc., No. JPZ8041382130ARCN10-J). Results. It was found that in the dynamics of diabetes the registration of the harmonic hemodynamic phenotype during the day decreased due to an increase in the proportion of patients with dysfunctional diastolic hemodynamic phenotype. At the same time, in children with diabetes, there was a significant increase in AASI from the first year of the disease with a progressive increase with its dynamics. The highest values of AASI were observed in dysfunctional hemodynamic phenotype. Conclusions. In children with diabetes mellitus observed the formation of disharmonious hemodynamic phenotypes in the dynamics of the disease. In combination with increased vascular stiffness these changes realized in systemic circulatory disorders and the development of a diabetic angiopathy. Detected disorders, apparently, became the risk factors of hypertension. Determination of hemodynamic phenotype in children with diabetes mellitus can be used as screening method for preclinical diagnosis of latent disorders of the cardiovascular system, early treatment and prevention.
A. V. Demchenko, V. V. Biriuk, A. V. Abramov
Published: 20 August 2021
Pathologia, Volume 18, pp 183-188; https://doi.org/10.14739/2310-1237.2021.2.233431

Abstract:
The aim of the study is to investigate activity of markers of oxidative and nitrosative stresses in blood plasma of patients in the I–II stages of Parkinson’s disease (PD) and to determine correlations between their concentrations and severity of non-motor PD symptoms. Materials and methods. 67 patients at I–II PD stages and 20 healthy controls took part in the research. Cognitive functions were examined due to the Montreal Cognitive Assessment test – MoCA test. For the severity of psycho-emotional disorders evaluation the following scales and questionnaires were used: Night Sleep Assessment Questionnaire by A. M. Vein, Zung test for anxiety, apathy Starkstein scale, Boston stress-resistance test, Beck Depression Inventory (BDI-II). We performed ELISA test for determination of glutathione peroxidase (GPx) and glutathione-S-transferase (GST) activities and 3-nitrotyrosine (3-NT) level in blood plasma of participants (Elabscience® kit). Results. The middle age of PD patients and healthy controls was 64.35 ± 1.22 and 66.40 ± 0.70 years, respectively. GPx activity in plasma of patients at І–ІІ PD stages was significantly lower than in healthy controls (P < 0.001) and was higher at the I stage compared to the II PD stage (P = 0.003). Also GPx activity in PD patients with normal cognition was higher than in PD patients with cognitive impairment (P = 0.042). The GST activity in plasma of PD patients with anxiety was significantly lower (P = 0.002) compared to those without anxiety, and 3-NT blood plasma level in PD patients with moderate anxiety was higher than in those without one (P = 0.029). Conclusions. The activity of antioxidant GPx was significantly lower in PD patients at early stages compared to healthy controls, and in PD patients in the II stage of the disease compared to the I stage, and it was significantly lower in PD patients with cognitive impairment. PD patients with moderate anxiety had lower 3-NT levels and GST activity in blood plasma.
, O. V. Romashchenko, V. V. Biloholovska, M. O. Kosiukhno, С. М. Мельников, A. L. Klius
Published: 20 August 2021
Pathologia, Volume 18, pp 203-210; https://doi.org/10.14739/2310-1237.2021.2.214397

Abstract:
Aim. Evaluation of ultrasound diagnostics of paraurethral glands considering their types of location in women of fertile age. Materials and methods. A gynaecological, sexological and ultrasound study of 94 women in the age from 24 to 42 (average age 31.01 ± 6.60) was carried out. Determination of paraurethral glands during ultrasound study was conducted in the format of grey scale (B-mode) using the Doppler colour flow mapping and evaluation of Doppler indices of paraurethral glands both before and after sexual stimu­lation. To optimize the paraurethral glands visual view at the beginning of examination urinary bladder was catheterized and a balloon, filled with gel, was inserted into vagina. Results. The front type of paraurethral glands location was found in the accumulation of glandular tissues in regard to the distal part of urethra in 67 (71.2 %) of the examined, back type – in the area of back urethra in 19 (20.2 %), diffuse type – along urethra in 7 (7.5 %) and absence – in 1 (1.1 %). Paraurethral glands were visualized in the form of clear isoechogenic oval formation with the following dimensions: length – 2.20 ± 0.60 cm, width – 1.52 ± 0.40 cm, thickness – 1.30 ± 0.30 cm, and volume – 4.75 ± 0.50 cm3. The diameter of vessels in the paraurethral glands area was between 0.17 cm and 0.21 cm in calm state and 0.39–0.41 cm – during stimulation. Maximum systolic speed of blood flow (Vps) in calm was 8.9–11.1 cm/sec, while in sexual stimulation it was 13.9–14.1 cm/sec, resistance index (IR) – 0.60–0.62 and 0.63–0.68, respectively, pulsation index (IP) – 1.22–1.44 and 1.61–1.72, respectively. Conclusions. The ultrasound study of vessels of paraurethral glands, when Doppler method is used according to the suggested methodology, gives the opportunity not only to identify its anatomical structure, but also to determine its types. In CDC the increase of diameter of vessels and the optimization of vessels image in the area of paraurethral glands in case of sexual stimulation were marked.
A. V. Khilkovets
Current issues in pharmacy and medicine: science and practice, Volume 14, pp 152-156; https://doi.org/10.14739/2409-2932.2021.2.232334

Abstract:
Heterocyclic compounds are one of the most important branches of modern organic chemistry and are widely used in medicine, pharmacy, agriculture, and in the production of new materials. One of these compounds is 1,2,4-triazole, which has attracted the attention of scientists around the world for many years. The aim of the work is to synthesize new derivatives of 5-(thiophene-3-ylmethyl)-4R-1,2,4-triazole-3-thiols and study their physical-chemical properties, conducting primary pharmacological screening. Materials and methods. Organic synthesis classical methods were used in the study, as well as a complex of physical-chemical analysis methods (1H NMR spectroscopy, elemental analysis, Elisa and chromato-mass spectral studies) were done. Prediction of pharmacological activity was carried out by using the PASS online computer program. Results. Two initial compounds were obtained: 5-(thiophene-3-ylmethyl)-4phenyl-1,2,4-triazole-3-thiol and 5-(thiophene-3-ylmethyl)-4H-1,2,4-triazole-3-thiol. During their further chemical transformation, a number of new corresponding alkyl derivatives were obtained. The structure of the synthesized compounds was confirmed using modern physical-chemical methods of analysis. Based on the results of pharmacological screening, the high activity of the obtained compounds can be predicted. Conclusions. 5-(thiophene-3-ylmethyl)-4H-1,2,4-triazole-3-thiol, 5-(thiophene-3-ylmethyl)-4-phenyl-1,2,4-triazole-3-thiol and a number of their alkyl derivatives were synthesized. The structure and individuality were proved thanks to modern physical and chemical methods of analysis. Having analyzed the results of primary pharmacological screening of a number of obtained compounds, some of them were selected for further study.
M. Yu. Kolesnik, Yа. М. Mykhailovskyi
Zaporozhye Medical Journal, Volume 23, pp 476-479; https://doi.org/10.14739/2310-1210.2021.4.227002

Abstract:
The aim of the study: to establish the frequencies of polymorphisms in VKORC1, CYP2C9 and CYP4F2 genes among residents of the Zaporizhzhia region. Materials and methods. A total of 150 persons (62 male, 88 female) with a median age of 46 years (26; 58) undergoing preventive examination at the Medical Educational and Scientific Center “University Clinic” of Zaporizhzhia State Medical University (ZSMU). The CYP2C9, CYP4F2, VKORC1 genes polymorphisms in atrial fibrillation patients were determined in the Department of Molecular Genetic Studies of the ZSMU Medical Laboratory Center. Amplification of DNA fragments containing polymorphic regions was performed using multiplex real time polymerase chain reaction with Warfarin Pharmacogenetics kits (LLC NPO DNA Technology) in a CFX-96 thermocycler (BioRad) with a fluorescence detection scheme. Results. It was determined that among Zaporizhzhia region residents, the frequencies of CYP2C9*2 genotypes were: C/C – 77.3 %, C/T – 22.7 %, T/T – 0; CYP2C9*3 genotypes: A/A – 88.7 %, A/C – 10.7 %, C/C – 0.6 %; CYP4F2 genotypes: C/C – 56.0 %, C/T – 35.3 %, T/T – 8.7 %; VKORC1 genotypes: G/G – 38.0 %, G/A – 50.0 %, A/A – 12.0 %. There were no statistically significant differences in the distribution of genotype frequencies between males and females and between different age groups. The frequencies of CYP2C9, CYP4F2, VKORC1 genotypes in different populations were compared. Their variability in different geographic regions was established. Conclusions. CYP4F2 and VKORC1 genes polymorphisms are more common in the Zaporizhzhia region, while the prevalence of CYP2C9*2 and CYP2C9*3 genes polymorphisms is much lower. It is necessary to take into account the prevalence of genes polymorphisms that affect warfarin metabolism for each individual population to select its dose by pharmacogenetic testing.
Yu. V. Marushko, N. H. Kostynska, T. V. Hyshchak
Zaporozhye Medical Journal, Volume 23, pp 509-515; https://doi.org/10.14739/2310-1210.2021.4.227348

Abstract:
Hypertension and obesity are important problems among adolescents. In clinical practice, these diseases are often combined and worsen the quality of life, so the study on indicators of tolerance to exercise is of great scientific and practical importance. The aim. To determine the state of tolerance to physical activity among school-age children with stable hypertension depending on body weight. Materials and methods. The study involved 95 children aged from 9 to 18 years who were divided into four groups: the first – 18 patients with normal blood pressure and body weight; the second – 39 with stable hypertension and normal body weight; the third – 20 with normal blood pressure and obesity; the fourth – 18 children with stable hypertension and obesity. Exercise tolerance was examined during cycling ergometry according to the PWC 170 protocol; the maximum myocardial oxygen uptake index – VO2peak (the “gold standard” for determining tolerance) was evaluated. Results. According to the study results, among children with a combination of primary hypertension and obesity, the clinical picture of the condition is characterized by significantly more frequent complaints of dizziness, heart pain, headache and loss of consciousness. The total score of complaints was 5.8 ± 1.9 points in the combined pathology of primary hypertension and obesity group, which is significantly higher (P < 0.01) than that among children with primary hypertension or obesity. In primary hypertension and obesity, there is a decrease in VO2peak, which is most pronounced in the combination of these conditions (up to 26.4 ± 6.7 ml/min/kg among boys and up to 22.7 ± 3.6 ml/min/kg among girls) indicating a significant decrease in exercise tolerance. Conclusions. It has been proven that the combined pathology of primary arterial hypertension and obesity among adolescents greatly worsens the clinical condition of children and significantly reduces exercise tolerance more pronounced than in primary arterial hypertension or obesity.
O. P. Kolesnik, A. I. Shevchenko, A. V. Kadzhoian, O. M. Levyk, D. Ye. Chernyavskyi, В. А. Кузьменко, L. S. Lytvynenko
Zaporozhye Medical Journal, Volume 23, pp 599-604; https://doi.org/10.14739/2310-1210.2021.4.211358

Abstract:
Breast cancer is one of the most widespread malignant neoplasm in Ukraine (20.6 % of all malignant neoplasms). The usual incidence of breast cancer (BC) in women, as of 2019, is 70.3 cases per 100 thousand population. At the moment, BC during pregnancy is rare (only in 0.4 % of all BC cases in women aged 16 to 49 years), the decision on treatment remains difficult for a patient as well as an oncologists. Despite the fact that the treatment of malignant breast disease is usually carried out in non-pregnant women, the problem of tactics for managing patients with different gestation lengths remains unresolved. Thus, the treatment of pregnant women with BC should be guided a multidisciplinary integrated approach to maximize the benefits and minimize the risk to both a mother and a fetus, including the optimal tactics of surgical treatment and chemotherapy. Therapeutic decisions should be based on the stage of disease, tumor morphology, gestational age at diagnosis, and possible pregnancy risks. A promising way of addressing this problem is to conduct more studies to determine the most effective and safest treatment strategies for BC in pregnant women.
B. I. Slonetskyi, М. I. Tutchenko, I. V. Verbytskyi, V. O. Kotsiubenko
Zaporozhye Medical Journal, Volume 23, pp 583-589; https://doi.org/10.14739/2310-1210.2021.4.232565

Abstract:
The aim of the work. To analyze the world achievements in modern diagnostic and treatment tactics in patients with strangulated ventral hernias, as well as to outline promising and pragmatic directions for further research. The literature review presents current trends and views on the choice of individual components of the integrated diagnostic approach in patients with strangulated ventral hernias, and focuses on various principles of therapeutic tactics. The need to further improve the examination methods of abdominal organs, anterior abdominal wall, hernia contents (polypositional roentgenoscopy or roentgenography, ultrasound, CT, MRI) is emphasized and prospects of allohernioplasty and videolaparoscopic technologies with an integrated approach in choosing the method for correction or reconstruction of abdominal wall depending on the prognostic risk factors of postoperative complications are substantiated. Comparison of individual priorities of planned hernia surgery provided the opportunity to define the main directions in terms of urgent medical treatment features for patients with strangulated ventral hernias, taking into account a phasal nature of the pathological process and the availability and applicability of various synthetic implants. The literature analysis allowed for enough critical evaluation of the current state of tension-free allohernioplasty – the main fundamental principle of modern urgent surgery for ventral hernias and determining the main pragmatic directions of a selective approach in choosing the therapeutic tactics for patients with infected surgical wound. Conclusions. Urgent surgery of strangulated ventral hernias requires adequate and timely provision of individual and differentiated approaches in choosing the volume and method of surgery. Improvement of methods for predicting and preventing complications in patients with strangulated ventral hernias will expand the indications for the use of advanced types of tension-free hernioplasty.
V. А. Lysenko, V. V. Syvolap
Zaporozhye Medical Journal, Volume 23, pp 462-468; https://doi.org/10.14739/2310-1210.2021.4.229002

Abstract:
Atrial fibrillation (AF) and chronic heart failure (CHF) often coexist due to common pathophysiological mechanisms and risk factors. However, the effect of CHF on heart remodeling in patients with permanent AF has been insufficiently studied. The aim: to study the influence of CHF on changes in structural and geometric parameters and diastolic function of the heart in patients with permanent AF. Materials and methods. The study included 100 patients (men – 60 % (n = 60); women – 40 % (n = 40)) with CHF of ischemic origin and AF, stage II AB, NYHA II-IV FC, and 16 coronary heart disease patients (men – 62.5 % (n = 10), women – 37.5 % (n = 6)) with AF without signs of CHF. Patients were comparable in age (P = 0.267), height (p = 0.406), weight (P = 0.518), body surface area (P = 0.388). Doppler echocardiography was performed on the device Esaote MyLab Eight (Italy) according to standard methods. Results. Patients with AF and signs of CHF were dominated by individuals with eccentric hypertrophy (49 % vs. 19 %; P = 0.0270), and patients with AF without signs of CHF – with eccentric remodeling (0 % vs. 25 %; P = 0.0001). Patients with AF and signs of CHF had significantly higher systolic pressure in the pulmonary artery (54.85 ± 14.23 mm Hg vs. 42.99 ± 11.94 mm Hg; P = 0.028) and pulmonary capillary wedge pressure (PCWP) (12.18 (9.80; 15.33) mm Hg vs. 8.92 (7.62; 10.50) mm Hg; P = 0.005) than patients with AF without signs of CHF, indicating more pronounced pulmonary hypertension and a more significant increase in left atrium pressure. AF patients with signs of CHF demonstrated significantly higher left ventricle end-diastolic pressure (LVEDP), as evidenced by the parameters: E\E’ medial (9.87 ± 5.24 vs. 6.15 ± 1.39; P = 0.001), E/E’ mean (8.38 ± 4.21 vs. 6.06 ± 1.97; P = 0.005), e’ medial (9.96 ± 3.79 cm/s vs. 12.81 ± 3.60 cm/s; P = 0.004). AF patients with signs of CHF had decreased LV EF (55.58 ± 14.65 % vs. 65.44 ± 10.87 %; P = 0.006), systolic velocity of the medial fibrous ring of the mitral valve S (6.92 ± 2.41 cm/s vs. 8.40 ± 2.03 cm/s; P = 0.015), and significantly higher values of TEI RV (0.58 ± 0.16 c. u. vs. 0.48 ± 0.11 c. u.; P = 0.011), but decreased TAPSE values (16.22 ± 4.60 mm vs. 19.54 ± 5.00 mm; P = 0.067), indicating more pronounced systolic dysfunction of both ventricles. Conclusions. Comorbidity of CHF and AF in patients is accompanied by the increased percentage of eccentric hypertrophy (49 %; P = 0.027), more pronounced systolic dysfunction of the left and right ventricles, increased LVEDP, PCWP, systolic pressure in the pulmonary artery, dilation of the inferior vena cava.
O. O. Vorovskyi
Zaporozhye Medical Journal, Volume 23, pp 590-598; https://doi.org/10.14739/2310-1210.2021.4.209522

Abstract:
The aim. Based on the data of the publications of herniologists for the last 5 years to examine the effectiveness and safety of prosthetic materials used in hernioplasty of postoperative ventral hernias. According to surgeons, the incidence of postoperative ventral hernia is up to 20 % of performed laparotomies, and if risk factors are present – up to 70 %. This problem was considered solved by the use of prosthetic mesh that became the standard of surgical approach in hernia repair since a recurrence rate was reduced to 20 %. However, the results of histological examination and body biological responses to an implant showed chronic inflammatory processes due to use of prosthetic material, especially polypropylene, causing purulent-inflammatory complications and intraperitoneal adhesion in 20.0–45.8 %. To prevent adhesion, a special barrier layer was applied on the polypropylene mesh, a process of mesothelial epithelialization (formation of the neoperitoneum) was supposed to occur, thereby reducing the risk of adhesions. A temporary nature of the barrier coating, where adhesion may develop at any time after implantation resulting in complications, has proven to be a potential problem of composite prostheses. There has been an attempt to address the challenge by using biological meshes made of decellularised pig and bovine dermis. However, recurrence rates after repair of hernia using the biological meshes was 6.3–61.0 %, wound infection – 16.0 %. Conclusions. Thus, world publications have proved today that it is impossible to perform adequate hernioplasty of postoperative hernias without the use of prosthetic material. However, complications and recurrences of the disease remain quite high. In order to improve these indicators, a sufficient number of studies were conducted, the effect of various prosthetic meshes on the patient body and on the postoperative wound itself was examined. Nevertheless, all the results are often contradictory, without specific conclusions about the indications for the use of method and type of prosthetic material.
Zaporozhye Medical Journal, Volume 23, pp 485-491; https://doi.org/10.14739/2310-1210.2021.4.233643

Abstract:
The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD). Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified. Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %. Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.
K. V. Rudenko, L. O. Nevmerzhytska, M. V. Kozhanov, M. О. Tregubova,
Zaporozhye Medical Journal, Volume 23, pp 492-502; https://doi.org/10.14739/2310-1210.2021.4.232632

Abstract:
Hypertrophic cardiomyopathy (HCM) – is the most common genetically determined heart disease, characterized by symmetrical or asymmetrical myocardial thickening (≥15 mm), leading to progressive heart failure and a high risk of sudden cardiac death (SCD). Diagnosis, natural course and treatment of HCM have become sources of uncertainty, misunderstanding and debate due to the increasing complexity of diagnosis in clinical practice, international differences in strategic approaches, advances in the treatment of genetic diseases and cardiac imaging. The aim. To amplify the current concept of HCM pathogenesis and mechanisms of the left ventricular outflow tract (LVOT) obstruction as well as to highlight our own results of HCM surgical correction. Materials and methods. A total of 330 HCM patients underwent surgical correction (septal myectomy) in the National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine. The mean age of the patients was 49.7 ± 15.0 years, median – 53; 168 (50.9 %) were male. Results. Surgical correction of HCM significantly improves the quality of life (80 % of patients were in NYHA II functional class after correction), reduces the symptoms of heart failure (93 % of patients had minimal mitral regurgitation after septal myectomy), decreases LVOT systolic pressure gradient (SPG) (the mean SPG was 18.9 ± 8.5 mmHg versus preoperative 93.6 ± 23.2 mmHg) and lowers the high-risk for SCD in the patients (the mean percentage of high-risk group was 3.78 % after correction). Routine CT planning and intraoperative transesophageal echocardiography helps to avoid severe iatrogenic complications and resect the interventricular septum as accurately as possible, completely eliminating LVOT obstruction. Conclusions. Secondary abnormal chordal attachment cutting, papillary muscle realignment and anterior mitral leaflet plication along with septal myectomy allows to fully correct all phenotype of HCM, is the safe and effective procedure as well as the definitive method of this pathology treatment minimizing the risk of disease recurrence.
S. O. Vozianov, A. I. Sahalevych, , F. Z. Haiseniuk, V. V. Kohut, B. V. Dzhuran, M. D. Sosnin
Zaporozhye Medical Journal, Volume 23, pp 575-582; https://doi.org/10.14739/2310-1210.2021.4.226895

Abstract:
Urolithiasis ranks second among urological diseases, after inflammatory processes, and first among surgical interventions in urological hospitals. The problem of this disease treatment is a long-term rehabilitation and disablement, which entails a significant increase in costs and requires changes in the tactics of treatment of patients. Since its introduction until today, percutaneous nephrolithotomy (PCNL) is the standard treatment for nephrolithiasis with a stone size of more than 1.5–2.0 cm. In its standard version, PCNL ends with the placement of nephrostomy catheter through the formed parenchymal channel, but there are techniques of the surgery completion either without nephrostomy catheter with a JJ stent – tubeless PCNL, or without nephrostomy and JJ stent at all – totally tubeless PCNL. However, nowadays, the use of tubeless and totally tubeless techniques is one of the most controversial topics in percutaneous nephrolithotomy in terms of safety and efficacy in their application. Aim. To analyze the results and safety of percutaneous nephrolithotomy by means of tubeless and totally tubeless techniques based on scientific evidence. Analysis of the scientific literature shows that tubeless and totally tubeless PCNL techniques are a safe method of percutaneous surgery and their application reduces pain and analgesic requirements in the postoperative period, shortens the length of postoperative hospital stay, and enhances recovery after surgery in patients, therefore resulting in cost-saving treatment. Conclusions. Tubeless and totally tubeless PCNLs are recommended for widespread use in urological practice, but it is worth to mention that these techniques should be performed in selected patients and by an operating surgeon with significant experience in percutaneous surgery.
O. M. Bilyi, N. A. Mitriaieva, M. V. Krasnoselskyi, L. V. Hrebinyk
Zaporozhye Medical Journal, Volume 23, pp 536-540; https://doi.org/10.14739/2310-1210.2021.4.214070

Abstract:
Secondary edematous breast cancer (SEBC), T4b, has a poor prognosis. The aim of this study is to examine the balance in serum levels of pro-inflammatory (TNFά, IL-8) and anti-inflammatory (IL-4) cytokines in patients with SEBC before special treatment. Materials and methods. A total of 87 patients with breast cancer (BC) were examined before treatment: 42 patients with SEBC in T4bN0-3M0 stage and 45 BC patients in T3-4N1-3M0 stage without edema. The control group consisted of 15 patients with fibroadenomas. The serum levels of cytokines (IL-4, IL-8, TNFά) in the patients was determined using the enzyme-linked immunosorbent assay. Results. In the SEBC patients as compared to the patients without cancer, the serum pro-inflammatory cytokine (IL-8, TNFά) levels were significantly increased and the anti-inflammatory cytokine (IL-4) level was slightly increased in 22 %. In BC without edema, an imbalance was noted in favor of pro-inflammatory cytokines, but in SEBC it was more pronounced (31.6 versus 12.4 and 5.6 versus 3.2, respectively). Conclusions. In the majority of SEBC patients, there is an imbalance in the cytokine profile in favor of the pro-inflammatory cytokines (IL-8, TNFά). SEBC patients with elevated levels of both pro- and anti-inflammatory cytokines before treatment are the highest risk group of tumor progression and metastasis. Inhibition of the IL-8 effects or related CXC chemokines, TNFά, and others may have important consequences for the systemic treatment of SEBC.
S. A. Yermolenko, V. F. Orlovskyi, O. V. Orlovskyi, , I. O. Moiseienko, A. V. Kolnohuz
Zaporozhye Medical Journal, Volume 23, pp 503-508; https://doi.org/10.14739/2310-1210.2021.4.225022

Abstract:
The aim of the study was to investigate the effect of thiazide diuretics on blood pressure (BP) depending on Gly460Trp ADD1 gene polymorphism in arterial hypertension (AH) patients of the Ukrainian population in order to predict their individual treatment efficacy. Material and methods. The study included 232 persons: 120 patients with verified stage II AH and 112 healthy individuals. Restriction fragment length polymerase chain reaction (PCR-RFLP) was used to detect genotype (the Gly460Trp-polymorphic locus of the ADD1 gene). The patients received standard therapy, which included ACE inhibitor – ramipril 5 mg, calcium channel antagonist – amlodipine 5 mg, statin – atorvastatin 20 mg, acetylsalicylic acid 75 mg. The patients were randomized into two groups: group I (60 persons) additionally taking treatment with 1.5 mg of indapamide retard and group II (60 persons) – with 25 mg of hydrochlorothiazide. The dynamic reduction of blood pressure has been assessed every 4 weeks for 2 months. Results. Among 120 patients with AH, 91 persons (75.8 %) were homozygous for the G allele (GG), 26 persons (21.7 %) – heterozygous (GT) and 3 persons (2.5 %) – homozygous for the T allele (TT), while the G allele frequency in patients with hypertension was 0.87, and the T allele – 0.13. 98 healthy individuals (87.5 %) were homozygous for the G allele, 13 individuals (11.6 %) were heterozygous, and 1 person (0.9 %) was homozygous for the T allele. The carrier frequency of the G and T alleles was 0.93 and 0.07, respectively. Allelic distribution indicated the predominance of the G allele carriers by Gly460Trp polymorphism of the ADD1 gene among the Ukrainian population, regardless of whether AH symptoms were present. It is noteworthy that the number of the T allele carriers was 2 times large among symptomatic patients than that among healthy individuals. In patients with the T allele, the hypotensive efficacy of indapamide was almost 3 times higher than that in patients with the G allele. The antihypertensive effect of hydrochlorothiazide in patients with the GT and TT genotypes was 2 times greater than that in the GG genotype carriers depending on the presence of the T allele G460T polymorphism of ADD1 gene in the genotype. Conclusions. Allelic distribution indicates the predominance of the G allele carriers by Gly460Trp ADD1 gene polymorphism among the Ukrainian population, regardless of whether AH symptoms are present. Among patients with AH, the accumulation of the T allele G460T polymorphic marker of the α-adducin gene is 2 times more than that in healthy individuals. Patients carrying the T allele demonstrate 2 times higher hypotensive efficacy of indapamide compared with hydrochlorothiazide.
Zaporozhye Medical Journal, Volume 23, pp 480-484; https://doi.org/10.14739/2310-1210.2021.4.232576

Abstract:
The aim. To evaluate the gender features of structural and functional changes in the heart and levels of copeptin and NTproBNP in patients with acute myocardial infarction (AMI) with concomitant pulmonary hypertension (PH). Materials and methods. 74 patients with AMI and concomitant PH who were treated in the intensive care unit and emergency cardiology for patients with myocardial infarction of the Municipal Non-Profit Enterprise “City Hospital of Emergency and Ambulance” of Zaporizhzhia City Council were examined. The patients were divided into two groups: the first group consisted of 42 male patients (mean age 71.06 ± 2.21 years) and 32 female patients (mean age 76.41 ± 2.32 years). All the patients were examined in the first three days by two-dimensional echocardiography on a device MyLab50 (“Esaote”, Italy). The serum levels of kopeptin and NTproBNP were determined by enzyme-linked immunosorbent assay using a set of reagents Elabscience (USA). Results. There was a trend towards a predominantly anterior AMI in the group of men and lower AMI – in the group of women. Individuals with functional class III and IV heart failure predominated (76.1 %) among the men with AMI and PH. At the same time, there were significantly more persons with III and IV functional class in the group of men than in the group of women (P < 0.05). There was a significant diastolic left ventricular posterior wall thickening in women compared to men (8.4 %; P < 0.05) and a tendency to diastolic interventricular septal thickening in females. There was an upward trend in end-systolic and end-diastolic sizes in the group of men compared to women; however, the differences did not reach the required level of significance. Evaluation of serum copeptin and NTproBNP in patients with AMI and PH revealed significantly higher levels of these indicators in the group of men compared to women (P < 0.05). Conclusions. Men with AMI and PH had more severe heart failure compared to women due to the predominance of patients with functional classes III and IV. Women with AMI and PH demonstrated predominantly concentric type of remodeling in the form of significantly thickened LV posterior wall and the tendency to increase interventricular septum wall thickness, and eccentric hypertrophy in the form of LV dilatation prevailed in men. Men with AMI and PH had significantly higher serum copeptin and NTproBNP levels compared to women.
V. V. Vitomskyi
Zaporozhye Medical Journal, Volume 23, pp 531-535; https://doi.org/10.14739/2310-1210.2021.4.226538

Abstract:
The aim. To compare three respiratory physical therapy techniques and their impact on pulmonary function restoration among cardiac surgery patients in hospital settings. Materials and methods. The study involved 126 patients of both sexes who were admitted for cardiac surgery. All the procedures were performed by sternotomy with cardiopulmonary bypass and cardioplegic arrest. The patients were randomly divided (with a ratio of 1:1:1 by envelope method) into the control group (CG, n = 42), incentive spirometry group (ISG, n = 42) and іnspiratory muscle training group (IMTG, n = 42). The examined patients underwent standardized physical therapy (early mobilization; therapeutic exercises; coughing). The groups varied in respiratory therapy. Patients of the ISG group performed additional respiratory exercises using a Tri-Ball respiratory exerciser (three repetitions of 10 forced, full and rapid inspirations through the respiratory exerciser under the supervision of a physical therapist; besides, they were recommended to perform 3 repetitions with 10 inspirations each hour). Patients of the IMTG group performed additional respiratory exercises using Respironics Threshold IMT breathing exerciser, received explanations and recommendations like patients of the ISG group. The pulmonary function test (PFT) was performed for the patients of all groups before the surgery and on the 7 postoperative day. Results. PFT scores did not differ statistically between the groups of patients before the surgery. The three groups of patients had a negative dynamic of all test indicators, except Tiffeneau index. The analysis of PFT final scores did not confirm a significant difference in the studied indicators among the groups: vital capacity (P = 0.599), forced vital capacity (P = 0.393), forced expiratory volume in one second (P = 0.589), peak expiratory flow (P = 0.326), forced inspiratory vital capacity (P = 0.258), peak inspiratory flow (P = 0.569). Conclusions. Statistical analysis of PFT indicators did not reveal any significant differences among the groups of cardiac surgery patients at the preoperative examination and on the 7 postoperative day, despite the differences in postoperative respiratory physical therapy.
O. V. Hrechana, A. H. Serbin, A. M. Rudnik, I. M. Shevchenko,
Zaporozhye Medical Journal, Volume 23, pp 541-546; https://doi.org/10.14739/2310-1210.2021.4.228765

Abstract:
The data on the composition and amount of amino acids have been analyzed in the raw materials of five legume species. All of them grow in Southern Ukrainian flora (Securigera varia (L.) Lassen, Vicia cracca L., Lupinus luteus L., Melilotus officinalis (L.) Pall., Melilotus albus Medic.) and may be used as a source of amino acids, especially essential, whose resource has to be replenished from the outside. Aim. We have studied and compared the amino acid profile of some species of the Ukrainian South Legumes, and used the multidimensional statistical cluster analysis to construction of histograms based on the amino acids content and composition of such plants as: Securigera varia (L.) Lassen, Vicia cracca L., Lupinus luteus L., Melilotus officinalis (L.) Pall., Melilotus albus Medic. Materials and methods. The raw materials were harvested at the South of Ukraine and were investigated by gas-liquid chromatography. The amino acid analyzer has been used after hydrochloric acid hydrolysis at elevated temperature. Results. 19 amino acids have been identified, of which nine are essential or partially interchangeable. The non-polar amino acid proline is in the lead in terms of quantity among the essential amino acids. Its amount was 6932 mg/100 g and the ability to accumulate it was noted in Melilotus officinalis (2276 mg/100 g). The smallest proline amount was found in Lupinus luteus (388 mg/100 g). The sulfur-containing non-polar amino acid methionine is in the smallest amount in the selected plants (506 mg/100 g). Our attention was drawn to the absence of the polar amino acid glutamine among the non-essential amino acids in some plants. Securigera varia, Vicia cracca, and Melilotus officinalis did not contain glutamine. In this subgroup, the polar aspartic acid was found in the highest amount (6824 mg/100 g) with the highest content in Vicia cracca and the lowest – in Melilotus albus (2660 mg/100 g and 385 mg/100 g, respectively). Conclusions. The analysis of the presence and number of amino acids was the basis for our multidimensional statistical cluster analysis and histograms of the presentation of the amino acid profile of the studied plant members of the family Fabaceae L. In constructing the dendrogram, three clusters were identified, and representatives of one genus (Melilotus L.) were attributed to different clusters which is significant for further chemosystematic studies.
, V. H. Kadzharian
Zaporozhye Medical Journal, Volume 23, pp 469-475; https://doi.org/10.14739/2310-1210.2021.4.232568

Abstract:
The aim. To examine the features of structural and functional changes of the heart in patients with chronic heart failure with preserved left ventricular ejection fraction (CHF pr EF) with excess body weight depending on the presence and form of atrial fibrillation (AF). Materials and methods. The study involved 248 patients with CHF pr EF and excess body weight, the mean age was 65.0 ± 11.0 years, 146 females (58.9 %) and 102 males (41.1 %). The first group included 181 patients without concomitant AF, the mean age was 64.0 ± 11.0 years, 110 females (60.8 %) and 71 males (39.2 %); the second group included 67 patients with AF, the mean age was 67.9 ± 11.3 years, 36 females (53.7 %) and 31 males (46.3 %). Subjects with AF were further divided into subgroups: 7 patients with paroxysmal AF, the mean age – 6.7 ± 10.4 years, 3 females (42.9 %) and 4 males (57.1 %), 12 patients with persistent AF, the mean age – 70.8 ± 10.3 years, 10 females (83.3 %) and 2 males (16.7 %); 48 patients with permanent AF, the mean age – 67.3 ± 11.7 years, 23 females (47.9 %) and 25 males (52.1 %). Results. Patients with concomitant AF had a significantly larger aorta diameter (by 3.0 %), systolic left atrium size (LAs) (by 14.5 %), right atrium size (RA) (by 8.3 %), left ventricle end-diastolic size (LVEDS) (by 7.1 %), left ventricle end-systolic size (LVESS) (by 10.6 %), right ventricle size (RV) (by 13,1 %), mean pulmonary artery pressure (by 20.0 %) and the prevalence of LV eccentric hypertrophy (by 21.0 %; P ˂ 0.001). At the same time, LV wall relative thickness (LV RT) was lower by 6.3 %, LV EF – by 3.4 % and the frequency of LV concentric hypertrophy – by 19.1 % (P ˂ 0.001). In permanent form of AF compared to paroxysmal one, significantly larger LAs (by 10.6 %), RA (by 10.9 %), LV myocardial mass (LV MM) (by 18.1 %) and LV MM index (by 21.1 %) were determined and in contrast to persistent AF, LAs (by 9.8 %), RA (by 11.4 %), LVEDS (by 15.6 %), LVESS (by 15.8 %), RV (by 27, 9 %), LV MM (by 29.8 %), LV MMI (by 14.9 %) were predominant, at the same, LVRT was 12.8 % less. Conclusions. In patients with CHF pr EF and excess body weight, concomitant AF is associated with greater dilatation of the heart cavities, eccentric hypertrophy predominance, decreased LV contractility and pulmonary hypertension. Compared to other forms, permanent AF is characterized by severe structural and functional changes in the heart, maximal manifestations of LV dilatation and hypertrophy.
P. F. Muzychenko, Zh. M. Minchenko, T. I. Havrylenko, , S. V. Demidov, N. O. Ryzhkova, O. A. Pidhaina
Zaporozhye Medical Journal, Volume 23, pp 566-574; https://doi.org/10.14739/2310-1210.2021.4.204886

Abstract:
The aim – based on the analysis of the scientific literature focused on understanding the role of exosomes in the mechanisms of inflammation development and application of stem cells for cellular therapy in different pathological conditions, to identify and substantiate the prospects of using the exosomes as prognostic markers of a disease progression and application of their therapeutic potential in cardiovascular pathology. Global trends in the study of stem cells of different origins from the perspective of morphofunctional, molecular-genetic, cytogenetic, immunogenetic and cytological characteristics contribute significantly the development of regenerative medicine in the context of developing new methodological solutions for the use of stem cells and their components, particularly exosomes, for cell therapy of various pathological conditions. Studies show the indirect effect of exosomes on the immune response activation, coordination of cellular senescence processes and antigen presentation. There are also evidence of their impact on the structural and functional restoration of affected organs and blood vessels. The application potential of exosomes in practical medicine, particularly in the area of new approaches development to synthesize the newer biopharmaceuticals and as markers of multifactorial pathology course in conjunction with studies on the mechanisms of exosome involvement into immune processes is discussed. The study on the exosome-mediated mechanisms of inflammation in atherosclerosis is relevant, given the fact that their main physiological role is to implement the link between immunocompetent cells. Conclusions. Improving knowledge of the molecular biological mechanisms of the exosome influence on immunological processes in patients with cardiovascular pathology allows to expand the range of diagnostic and prognostic criteria for the formation of immuno-inflammatory reactions and endothelial dysfunction and to outline ways to personify the choice of therapeutic programs, which, in turn, can open approaches to develop fundamentally newer pharmaceuticals.
Ya. V. Tielushko, V. I. Pertsov,
Zaporozhye Medical Journal, Volume 23, pp 524-530; https://doi.org/10.14739/2310-1210.2021.4.224124

Abstract:
Increasing number of lung diseases, unfavorable environmental factors, dissemination of infectious agents in a patient's body result in increased frequency of purulent-septic complications, thereby making the study on methods of their diagnosis and treatment relevant. Aim of the work: to examine the diagnostic value of lung ultrasound (US) and spiral computed tomography (SCT) in the diagnosis of acute abscesses and in determining the tactics of surgical treatment. Materials and methods. A prospective study of 40 cases of acute lung abscesses with diagnostic value of US and SCT examination to choose a surgical method in accordance with the type of acute lung abscess. Results. Male was dominated in the study (82.5 %). The median age was 52 (43.5; 60.0) years. SCT revealed an abscess with sequestration in 9 (22.5 %) of 40 patients, which was confirmed during surgery. A false negative result was obtained in 5 (35.7 %) patients out of 14. Lung US revealed sequestration in 14 (35.0 %) patients: 2 (14.3 %) of them were false positive. Transthoracic drainage was performed in 24 (92.3 %) of 26 patients without sequestration. In 2 (7.7 %) cases – video abscessoscopy (VAS). The median length of hospital stay was 34.5 (29.0; 43.0) days for patients without sequestration and 32.0 (26.0; 35.0) – with sequestration, Р = 0.16. Conclusions. Modern radiation imaging is an effective tool for the diagnosis of lung abscess. The sensitivity and specificity of computed tomography was 64.3 % and 100.0 %, sonography – 85.7 % and 92.3 %, respectively, in the study. The concurrent use of these diagnostic methods increases their information content: sensitivity up to 100.0 %, specificity up to 92.3 %. Video abscessoscopy with sequestrectomy is an effective method of treatment and etiological diagnosis of the process, which allows achieving the length of hospital stay comparable to patients without sequestration: 32.0 (26.0; 35.0) vs 34.5 (29.0; 43.0), Р = 0.16.
V. V. Buheruk, O. B. Voloshyna, І. V. Balashova
Zaporozhye Medical Journal, Volume 23, pp 555-565; https://doi.org/10.14739/2310-1210.2021.4.211033

Abstract:
The aim. To analyze current evidence about etiology, pathogenesis, clinical manifestation, diagnosis, and treatment of patients with COVID-19 associated myocarditis. Multisystem inflammatory syndrome is possible in COVID-19 including inflammatory damage to the myocardium, which may last over several months and worsen the disease outcome. Mechanisms of inflammatory cardiac damage include direct damage by SARS-CoV-2, massive release of cytokines, dysregulation of the renin-angiotensin system. All these factors can aggravate pre-existing overload of the right heart chambers in patients with multifocal pneumonia, thrombosis of coronary arteries and myocardial ischemia. Inflammation of the myocardium manifests with typical symptoms of myocarditis and pericarditis. It can be accompanied by heart failure with rapid decompensation, arrhythmia, acute coronary syndrome or even sudden death. Laboratory findings in COVID-19 associated myocarditis include high levels of CRP, BNP, NT-proBNP, and D-dimer. Transthoracic echocardiography allows for an assessment of the left ventricular dysfunction and diagnosis of a pericardial effusion. Heart MRI according to the Lake Louise Diagnostic Criteria is the most sensitive diagnostic method in acute myocarditis. Medical imaging is indicated only in cases when results obtained can potentially influence the patient management tactics and should be performed according to the shortest protocol due to high risks of virus transmission. Conclusions. ESC experts (2020) do not provide unanimous recommendations for the treatment of SARS-CoV-2 associated myocarditis, considering a lack of the evidence base. Patient management is limited to adequate treatment of heart failure, arrhythmia, acute coronary syndrome, and prevention of thrombotic complications. Ongoing studies are aiming to evaluate potential place of glucocorticoids, intravenous immunoglobulins, antibodies against IL-6 receptor, colchicine in the treatment of COVID-19.
S. M. Rozhko, , I. V. Paliichuk
Zaporozhye Medical Journal, Volume 23, pp 547-554; https://doi.org/10.14739/2310-1210.2021.4.229814

Abstract:
The aim of the work is to conduct a comparative analysis of the biofilm formation by representatives of the oral microflora on the surfaces of basic materials. Materials and methods. The process of biofilm formation was examined on 7 types of basic plastic samples: Polyan, Breflex, Nylon, Protakryl, Vinakryl, Biocryl, which were used for the manufacture of removable prosthetic basis constructions, and SYNMA, which was used for comparison. Biofilm formation was analyzed by the method Y. Zhang (2017) with minor modifications. The test sample was placed in a test tube with 2.0 ml of nutrient broth Brain Heart Infusion to model the biofilm growth of microorganisms (HiMedia Laboratories Pvt. Ltd., India) supplemented with 1 % glucose, pre-inoculated with test strains at a final concentration of 1 × 104 CFU/ml. The strains were cultivated for 24 hours at a temperature of 37 °C under continuous stirring in a shaker MR-1 (SIA BIOS AN, Latvia) at 20 rpm. Evaluation of the biofilm massiveness was performed after gentian violet staining followed by elution of the stain with ethanol and registration of the eluent optical density (OD). The OD was measured with a Synergy™ HTX S1LFTA microplate multimode photometer (BioTek Instruments, Inc., USA) at 595 nm wavelength using Gen5™ Data Analysis Software. The number of viable bacterial cells in the formed biofilms was determined by the method of ten-fold serial dilutions. The obtained results were converted per unit area of the sample tested. Processing of the results was performed using a two-sample t-test with the software package Statistica 13.0 and Microsoft Office Excel, the differences were considered statistically significant at a P value of < 0.05. Statistical analysis of the obtained data was presented as mean values of measurements ± standard deviation for three independent experiments. Results. According to the microbiological analysis results it was found that α-hemolytic streptococci S. oralis and S. sanguinis showed the ability to form biofilms on the surfaces of basic materials, namely Protacryl and Vinacryl, the total biomass of S. sanguinis biofilms was 47.7 % (P < 0.01) and 14.7 % (P > 0.05) greater, respectively, in comparison to a glass slide. Inhibition of biofilm formation processes was observed on the surfaces of Nylon and Biocryl basic materials. S. oralis and S. gordonii showed the highest ability to survive in biofilms. The intensity of C. albicans biofilms formation on Biocryl basic materials, comparative plastics SINMA and Breflex basic materials was greater than on glass slides by 48.3 %, 43.0 % and 34.9 % (P < 0.01), respectively. The least massive C. albicans biofilms were formed on Breflex surfaces and SINMA comparative plastics in comparison to glass slides by 33.6 % and 24.8 % (P < 0.01), respectively. Both Candida strains had the highest level of fungal viability in biofilms on Breflex, Polyan and Protacryl basic materials (P < 0.01), and C. tropicalis biofilms on Biocryl and Vinacryl basic materials (P < 0.05). Integral coefficients indicated the inhibition of the oral microflora ability to form biofilms on the surfaces of basic materials. Conclusions. Oral α-hemolytic and β-hemolytic streptococci have the ability to intensive biofilm growth on the surfaces of the basic materials Protacryl and Vinacryl. Oral Candida albicans form massive biofilms on the surfaces of Biocryl and Vinacryl basic materials and comparative SYNMA plastics. The basic materials Breflex, Nylon and comparative plastics SYNMA are the most inert to biofilm formation by the oral microflora representatives.
Yu. I. Feshchenko, L. O. Yashyna, , M. O. Polianska, S. H. Opimakh, И. В. Зволь, S. M. Moskalenko, H. L. Humeniuk, N. A. Vlasova, L. A. Halai
Zaporozhye Medical Journal, Volume 23, pp 516-523; https://doi.org/10.14739/2310-1210.2021.4.229508

Abstract:
The aim: to compare the efficacy and tolerability of the leukotriene modifier and inhaled corticosteroids in combination with long-acting β2-agonist formoterol in steroid-naive patients with asthma combined with COPD with neutrophilic inflammation. Materials and methods. After obtaining the written consent, 30 patients with asthma combined with COPD and a number of blood neutrophils >4000/μl were randomized (1:1): group I – received a fixed combination of budesonide/formoterol 160/4.5 μg/1 inhalation twice daily as a basic therapy; group II – montelukast 1 tab. (10 mg) once daily and inhalation of formoterol 12 mcg/dose twice daily. The duration of therapy was 12 weeks. General clinical methods, asthma control questionnaires, COPD questionnaire, physical tolerance evaluation (6-minute walk test), pulmonary function tests, quality of life assessment were performed to all the patients before and after the treatment course studied. Results. The combination of budesonide/formoterol improved clinical symptoms – significantly (P < 0.05) increased the total ACT score, decreased the average ACQ score, shortness of breath (mMRC scale), COPD symptoms. PFT indices were improved significantly (P < 0.05), bronchoobstruction at the level of large, medium and small bronchi was significantly reduced. Physical tolerance was significantly improved. There were no statistically significant dynamics of the studied indices in patient group II. The patients of both groups showed a tendency to improve their quality of life. In patients of I group, there was a significant decrease in activity limitations and the total SGRQ score. Conclusions. The combination of inhaled corticosteroid/formoterol has proven to be more effective than the leukotriene modifier or formoterol in steroid-naive patients with asthma combined with COPD and neutrophilic inflammation.
V. I. Kryvenko, M. Yu. Kolesnyk, ,
Zaporozhye Medical Journal, Volume 23, pp 402-410; https://doi.org/10.14739/2310-1210.2021.3.229981

Abstract:
The aim of this work is to evaluate the complex therapeutic effect of Thiotriazolin (anticoagulant, antiplatelet, metabolitotropic, endothelioprotective activity) in patients with post-COVID syndrome in comparison with basic therapy. Materials and methods. The studies involved 30 patients aged between 30 to 60 years with post-COVID syndrome. Of these, 15 persons received basic therapy (antibiotics, anticoagulants, acetylsalicylic acid), and other 15 patients received Thiotriazolin in the form of 200 mg tablets twice a day for 30 days against the background of basic therapy. Inclusion criteria were a positive PCR test for COVID-19; if the PCR test was negative, then the patients were enrolled based on the presence of IgM COVID-19 or IgG COVID-19 (with X-ray confirmed pneumonia). The rate of lung damage is up to 45 %. The patients had the following comorbidities: diabetes mellitus in the stage of compensation, arterial hypertension, ischemic heart disease without heart failure. The results of the study were calculated using the standard statistical package Statistica for Windows 13 (StatSoft Inc., № JPZ804I382130ARCN10-J), аs well as SPSS 16.0, Microsoft Office Excel 2003. Results. The inclusion of Thiotriazolin in the complex basic therapy of post-COVID syndrome led to a significant increase in the effectiveness of basic endothelioprotective, anticoagulant and antiaggregatory therapy and contributed to the prevention of thrombus formation. The administration of Thiotriazolin led to a significant improvement in general clinical parameters in patients with post-COVID syndrome – complaints of tachycardia disappeared, blood pressure was stabilized (without additional correction with antihypertensive drugs), weakness and increased fatigue disappeared. Saturation in 14 (93.4 %) patients increased to 97–98 %. In the control group only 7 (46.7 %) of 15 patients had oxygen saturation at 97–98 % level. Conclusions. The introduction of the drug Thiotriazolin in the form of 200 mg tablets twice a day for 30 days into the complex basic therapy of post-COVID syndrome leads to a significant increase in the basic endothelioprotective, antiaggregatory and anticoagulant therapy and contributes to the prevention of thrombus formation against the background of improving the state of the myocardium and vascular endothelium.
Ye. L. Mykhaliuk, V. V. Syvolap, Ye. Yu. Horokhovskyi, M. S. Potapenko
Zaporozhye Medical Journal, Volume 23, pp 343-347; https://doi.org/10.14739/2310-1210.2021.3.229452

Abstract:
Dynamic examination of athletes is of great interest for sports medicine specialists, as it allows measuring changes in athletes’ functional state in parallel with increasing athletic performance in a one-year training cycle. The aim of the work is to assess dynamic changes in parameters of heart rate variability, central hemodynamics and physical performance in short-distance swimmers during preparatory and competitive periods of the training process. Materials and methods. The swimmers (n = 94) qualified from the second-class sport qualification to Master of Sports of International Class were examined during the preparatory and competitive periods of the training process. Short ECG recordings of 5 minutes were used for the heart rate variability (HRV) analysis according to the International Standard. Results. In the preparatory period, the autonomic equilibrium index had a mean value of 3.104 ± 0.494 1/s2, and in the competitive period – 2.459 ± 0.248 1/s2 (P = 0.295). The initial distribution of athletes depending on the value of autonomic tone, according to the classification proposed by R. M. Bayevskiy, had the following ratio in the preparatory period: 75.0 % / 20.0 % / 5.0 %, vagotonic, normotonic and sympathotonic individuals, respectively, statistically significantly indicating the prevalence of athletes with vagotonia over normotonic individuals (P = 0.0005). In the competitive period, this ratio was 60.0 % / 40.0 % / 0 %. The central hemodynamic indices showed a downward trend as evidenced by a decrease in the cardiac index from 2.954 ± 0.126·l·min-1·m-2 to 2.862 ± 0.088 l‧min-1‧m-2 (Р = 0.510), although these values matched to the eukinetic circulatory type (CT) during both training periods. However, the ratio of hypokinetic, eukinetic and hyperkinetic CT in the preparatory period was 45.0 % / 45.0 % / 10 0 %, and in competitive period – 45.0 % / 55.0 % / 0 %, respectively. The mean value of physical working capacity (PWC170/kg) in the preparatory period was 15.54 ± 0.66 kgm·min-1·kg-1, and in the competitive period it was 18.09 ± 0.53 kgm·min-1·kg-1, making an increase of 16.41 % (Р = 0.0001). The functional state index (FSI) increased significantly by 25.08 % from 5.558 ± 0.322 r. u. to 6.952 ± 0.272 r. u. (Р = 0.00001). The correlation analysis during the preparatory period showed a significant positive correlation between Mo and PWC170/kg (r = 0.46, P = 0.040), ARI and CI (r = 0.50, P = 0.026), IARP and CI (r = 0.53, P = 0.017), stress-index and SI (r = 0.52, P = 0.019) and negative – between Mo and CI (r = -0.56, P = 0.009). In the competitive period, the general tendency of correlation interaction was remained, as evidenced by revealed positive relationships between Mo and FSI (r = 0.53, P = 0.017), ARI and SI (r = 0.51, P = 0.020). Conclusions. Short-distance swimmers in the competitive period had significantly higher level of physical working capacity (by 16.4 %), the functional state index (by 25.1 %), as well as parasympathetic tone of ANS in comparison with the preparatory period. The above-mentioned hemodynamic changes and autonomic balance indicators were associated with the increase in athletic performance: 4 (20 %) swimmers qualified for the title of Master of Sports of Ukraine, 2 (10 %) swimmers – for Candidate Master of Sports, and 2 (10 %) swimmers – for first-class sport qualification.
V. M. Kosenko, I. M. Skyba
Zaporozhye Medical Journal, Volume 23; https://doi.org/10.14739/2310-1210.2021.3.226540

Abstract:
Grinspan–Potekaev syndrome is a rare disorder facing dentists in practical activity. That is why the detailed analysis of the disease clinical course peculiarities is important and urgently needed. The aim of the work: to analyze the clinical course of Grinspan–Potekaev syndrome on the buccal mucous membrane using the example of a patient treatment in the dental clinic Denta Plus (Zhytomyr city). Materials and methods. Bibliosemantic method (analysis, correlation, comparison, generalization, systematization of scientific literature on the studied issues), system analysis and logical generalization (for developing the algorithm of diagnostics and treatment), medical documentation analysis of the patient, who sought medical assistance in the dental clinic Denta Plus, were used. Results. The clinical course of Grinspan–Potekaev syndrome on the buccal mucous membrane was described and analyzed. The conducted diagnostic methods allowed to determine the diagnosis, to develop and to apply the complex drug therapy that positively influenced the general well-being, promoted the transformation of erosive-ulcerous form of lichen planus into less aggressive and safer exudative-hyperaemic one. The difficulties during the diagnostic and differential diagnostic stages concerned the fact that typical skin lesions were not observed and the “fern pattern” on the buccal mucous membrane (within the period of exacerbation) was not clear. Besides, the patient did not have any complaints specific to diabetes mellitus, therefore a blood glucose level and glycemic profile were determined only in the process of case follow-up, the patient was further referred to an endocrinologist, who diagnosed type 2 diabetes mellitus. Conclusions. The described case of Grinspan–Potekaev syndrome allowed to analyze the clinical course of the disease in the oral cavity within the exacerbation period and to examine the components of diagnostic and treatment process. The treatment response in Grinspan–Potekaev syndrome (with isolated manifestations of lichen planus on the buccal mucous membrane) depends not only on a dentist competence but also on cooperation between other specialists: dermatologist, oncologist, psychotherapist, family physician, and endocrinologist. Despite the positive clinical effect, the need to follow-up the further course of the disease is associated with the possibility of erosive-ulcerous form of lichen planus relapses and its malignant transformation.
A. A. Zhyvetska-Denysova, V. B. Tkachenko, I. I. Vorobiova
Zaporozhye Medical Journal, Volume 23, pp 348-355; https://doi.org/10.14739/2310-1210.2021.3.208711

Abstract:
Habitual miscarriage is a stressful condition and a significant factor of frustration for married couples. The psycho-emotional state of the pregnant woman affects the course of the subsequent pregnancy and its outcome. Correction of the psychological component of habitual miscarriage is a promising direction for preventing reproductive losses. The aim of the work is to study the psychological components of miscarriage and determine the ways of their correction. Materials and methods. The level of chronic stress was studied in pregnant women with symptoms of miscarriage and a history of habitual reproductive losses (main group) based on indicators of psychoemotional state, the condition of the autonomic nervous system, and the degree of activation of stress-implementing systems. The results were evaluated with the scale PSS, PSM-25 as adapted by N. Ye. Vodopianova, Spielberger–Khanin inventory and the scale by L. D. Malkova, Baevsky index, cortisol content in the blood and urine. The pregnant women with a physiological course of pregnancy and uncomplicated history were included in the control group. Based on the fact that the etiology of habitual miscarriage is multifactorial, and the psychological component is amenable to correction, stress-protective therapy was included in the treatment complex of habitual miscarriage. To assess the effectiveness of treatment, the main group was divided into subgroups: 1 – with psychotherapy, 2 – without psychotherapy. Results. A high level of personal perception of stress, anxiety and asthenia determine the psycho-emotional state of the main group pregnant women, among whom two dominant psycho types were identified: A – a high level of anxiety and low neuropsychic resistance; B – poise and good adaptive ability against the background of stress. Non-drug stress-protective therapy in the complex of miscarriage treatment contributes to: a decrease in psycho-emotional stress in pregnant women with psycho type A – 2.6 times, anxiety level – 1.7 times, asthenia level – 2.3 times; and also: a decrease in similar indicators in pregnant women with psycho type B – 1.6 times, 3.9 times and 2.5 times, respectively (P < 0.05); a decrease in the frequency of premature termination of pregnancy by more than 11 %. Conclusions. The psychological component of miscarriage is a high level of personal perception of stress, anxiety and asthenia. Stress-protective therapy in combination with pathogenetic therapy of miscarriage improves pregnancy outcomes for the mother and the fetus. It is advisable to conduct pregravid training with the participation of a psychologist in women with a history of reproductive losses in order to overcome the psychological component of stress perception, expand adaptive potential, increase neuropsychic stability, and form a positive orientation toward pregnancy and motherhood.
O. A. Bas, N. O. Ivasyk, О. И. Тыравская, A. M. Hertsyk
Zaporozhye Medical Journal, Volume 23, pp 425-434; https://doi.org/10.14739/2310-1210.2021.3.215664

Abstract:
The aim – theoretical review of the use of physical therapy in children with acute lymphoblastic leukemia. The problem of restoring the health of children with acute lymphoblastic leukemia (GLL) is due to the increased incidence of cancer, the duration of special treatment and the development of complications and comorbidities. The main complaints are fatigue, pain, muscle weakness, decreased mobility and endurance, depression, anxiety, mood swings. Pathology of the musculoskeletal system, gastrointestinal tract and endocrine system occur with equal frequency. Today, the main expected therapeutic effect in pediatric oncology should be considered not only the clinical recovery of patients, but also their return to the previous social position in the family, school and community, the restoration of physical, psychological and social health. The problem of physical therapy of children with acute lymphoblastic leukemia was studied by many scientists. According to the literature, physical exercises reduce the fatigue associated with the tumor process, improving the functional capacity of the body and increasing metabolism. There is a positive effect of exercise on muscle strength and flexibility, but there are ambiguous conclusions from different authors on the effect of exercise on cardio-respiratory function in the course of maintenance therapy in children with GLL who have cancer fatigue. Conclusions. An important area of physical therapy in oncology is the use of dosed physical activity, which, according to many researchers, increases the effectiveness of treatment. Recently, the prevailing opinion is that regular physical activity is safe and can have potential benefits for the musculoskeletal, cardiovascular, respiratory and immune systems of pediatric patients with hematological diseases.
И. В. Возная, S. V. Pavlov, O. V. Voznyi
Zaporozhye Medical Journal, Volume 23, pp 388-394; https://doi.org/10.14739/2310-1210.2021.3.229655

Abstract:
The aim was to study the influence of periodontal pocket microecology state on the local nonspecific resistance in steelworkers with generalized periodontitis. Materials and methods. In total, 178 patients were examined. The study group consisted of 126 patients with generalized periodontitis of initial (n = 8), I (n = 32), II (n = 68) and III (n = 18) degree of severity, chronic course, exposed to work-related hazardous agents. The comparison group consisted of 32 patients with periodontitis of initial (n = 5), I (n = 10), II (n = 11) and III (n = 6) degree of severity without exposure to harmful conditions of steel industry. The control group included 20 otherwise healthy individuals. Detection of the main five periodontopathogenic microorganisms in the crevicular fluid was carried out by the polymerase chain reaction method. The levels of lactoferrin and cathelicidin LL-37 were measured by the enzyme-linked immunosorbent assay method. Results. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were less common, than other opportunistic bacteria in both study groups with initial severity of generalized periodontitis. With the disease development, there was a tendency to increase the number of positive samples for all microorganisms. A correlation was found between the microorganism presence in the sample and the severity of periodontal disease. In the patients of clinical groups, the concentration of cathelicidin LL-37 in the oral fluid was reduced. In the study group, a moderate inverse correlation between cathelicidin and Porphyromonas gingivalis as well as a weak inverse correlation between cathelicidin and Prevotella intermedia were revealed. Lactoferrin was correlated directly and moderately with Porphyromonas gingivalis and Prevotella intermedia but weakly - with Treponema denticola. In the comparison group, there were a statistically significant moderate inverse correlation between cathelicidin and Porphyromonas gingivalis as well a direct correlation between lactoferrin and Porphyromonas gingivalis. Correlations between the concentrations of cathelicidin and lactoferrin in the oral fluid and other periodontopathogens were revealed to be weak. Conclusions. The studies have shown significant disruptions of the oral cavity microecology in the patients exposed to harmful effects of steel industry. The correlation between the concentration of antimicrobial peptides and periodontal pathogens in the periodontal pockets has been found.
A. S. Tugushev, O. S. Cherkovska, D. I. Mikhantiev
Zaporozhye Medical Journal, Volume 23, pp 363-369; https://doi.org/10.14739/2310-1210.2021.3.224265

Abstract:
The aim. To assess the hemodynamic parameters of the hepatic and visceral blood flow in patients with compensated and decompensated liver cirrhosis. Materials and methods. 290 patients with liver cirrhosis were examined: 206 had gastrointestinal bleeding, 84 had diuretic-resistant ascites. Ultrasonic scanning, Doppler sonography, esophagogastroduodenoscopy, angiography, radioisotope scintigraphy were performed to assess blood flow in the portal, splenic and superior mesenteric veins and in the hepatic, splenic and superior mesenteric arteries. Results. Change in the hepatic microcirculatory blood flow in the natural course of liver cirrhosis was characterized by decreased portal and increased arterial blood flow, “arterialization” of hepatic blood flow based on scintigraphy. Decompensation of the disease was associated with progressive reduction in both portal and arterial hepatic blood flow, which were correlated with the severity of functional liver disorders regardless of the complication nature. The portal blood flow in the natural course of liver cirrhosis was characterized by 3.5–4.5 times increased volume of visceral blood. Decompensation of the disease was accompanied by a decrease in blood flow in the portal vein as compared to the splenic and superior mesenteric veins by 1.8–2.2 and 1.5–2.7 times, respectively. Arterial blood flow in the natural course of liver cirrhosis was characterized by a relatively increased hepatic arterial flow. The ultrasound criterion of hepatic blood flow “arterialization” was an increase in hepatic-splenic arterial index, which can be used as a sign to differentiate between different forms of portal hypertension. Decompensation of the disease was characterized by an average of 8.2 % decreased arterial blood flow in the hepatic artery compared to the splenic artery in dynamics. Prognostically unfavorable signs were the progression of splenomegaly degree, the increase in the portal vein diameter with the decreased velocity characterizing the increase in congestive index by 2.4–2.6 times, the decrease in the hepatic artery diameter and velocity in it over time.Conclusions. The hepatic and visceral blood flow characteristics should be considered when choosing method of conservative, surgical or minimally invasive treatment of liver cirrhosis complications. Based on the hepatic hemodynamic characteristics, the mismatch between portal perfusion (reduced) and visceral blood flow (increased) is the essence of portal hypertension in liver cirrhosis. Accordingly, the criterion of treatment effectiveness in decompensated liver cirrhosis should be improved portal liver perfusion and (or) reduced volume of visceral blood flow.
, M. O. Kyrychenko, D. M. Ramazanova, M. V. Smiianova, V. Yu. Harbuzova, O. V. Ataman
Zaporozhye Medical Journal, Volume 23, pp 338-342; https://doi.org/10.14739/2310-1210.2021.3.220651

Abstract:
The risk T2DM development depends on hereditary predisposition. According to the current data, skeleton enhances insulin gene expression in pancreatic β-cells as well as increases insulin sensitivity of adipocytes, myocytes and hepatocytes through the secretion of unOCN.The aim. To analyze the link between rs1800247 SNP and T2DM occurrence depending on the AH presence, as well as association between rs1800247 and systolic, diastolic, pulse, mean blood pressure among patients with diabetes.Materials and Methods. This study included 153 patients with diagnosed T2DM and 311 individuals without any carbohydrate metabolism disorders. Polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) was used for BGLAP rs1800247-genotyping. Logistic regression with interaction term “genotype × AH” was used to estimate the association between BGLAP rs1800247-genotypes and T2DM development under dominant, recessive, over-dominant and additive models of inheritance. Linear regression was performed to investigate the influence of minor C-allele on the arterial blood pressure. All calculations were performed using Statistical Package for the Social Sciences software (SPSS, version 22.0, Chicago, IL, USA). A value of P ˂ 0,05 was considered as significant.Results. No association was found between rs1800247 single nucleotide polymorphism and T2DM development neither in AH patients, nor in subjects without AH (Paint b > 0,05). There was no impact of rs1800247 genotypes on systolic, diastolic, pulse and mean blood pressure among patients with T2DM (P > 0,05).Conclusion. It was found the lack of association between rs1800247 SNP and T2DM development as well as blood pressure parameters. Further studies with extended groups of comparison are needed for the confirmation of results. This research was a part of the scientific project “Molecular-genetic and morphological features of lower limb tissues regeneration under conditions of chronic hyperglycemia” (0117U003926).
V. V. Syvolap, V. A. Lysenko
Zaporozhye Medical Journal, Volume 23, pp 322-330; https://doi.org/10.14739/2310-1210.2021.3.224710

Abstract:
Patients with chronic heart failure (CHF) with left ventricular ejection fraction (LV EF) in the range of 40–55 % form a separate group with “intermediate” or “moderately reduced” LV EF. Since there are a number of additional criteria in echocardiography other than EF for determining LV systolic function (TEI, MAPSE, systolic velocity of the fibrous ring of the mitral valve (S’), E/e’, dP/dt mitral regurgitation, etc.), their use may be helpful in the final identification of systolic dysfunction in CHF patients with LV EF within the “gray area”. The aim of the work – to find out the possibility of using ultrasound parameters of LV systolic function as additional diagnostic criteria for systolic dysfunction and to develop an algorithm for its diagnosis in CHF patients with LV EF within the “gray zone” (40–55 %). Materials and methods. The study included 79 patients (men – n = 49; women – n = 30) with CHF of ischemic origin with LV EF from 40 % to 55 % (main group) who were divided into two subgroups: the first subgroup (n = 40) – patients with LV EF within the “gray area 45–55 %”, the second subgroup (n = 39) – patients with LV EF less than 45 %. The comparison group – 90 patients with coronary heart disease without signs of CHF (men – n = 40, 44.5 %; women – n = 50, 55.5 %). The patient groups were age-, sex-, height-, weight-, body surface area-matched. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy). Results. According to our results, 90 % (71/79) of CHF patients with reduced LV EF had mitral regurgitation. Additional examination of the systolic index dP/dT of less than 1200 mm Hg/s on the flow of mitral regurgitation allowed to classify CHF patients from the “gray area” (LV EF 40–55 %) to the CHF phenotype with reduced LV EF, and that was almost half of patients – 50.6 % (40/79). Cut off points were established for Myocardial Performance Index TEI of the LV >0.56 r. u., the right ventricle >0.51 r. u., decrease in systolic dP/dT ≤1000 mm Hg/s, systolic velocity of the medial (S med ≤7 cm/s) and the lateral (S lat ≤7 cm/s) fibrous ring of the mitral valve, the amplitude of the medial (MAPSE med ≤11.7 mm) and the lateral (MAPSE lat ≤11.1 mm) fibrous ring of the mitral valve. Conclusions. The cohort of CHF patients with “intermediate” LV EF is a heterogeneous group, which includes patients according to one formal criterion – LV EF in the range of 40–55 %. LV EF is a surrogate marker, insufficient for the final determination of the CHF phenotype. Additional criteria for systolic dysfunction include ventricular TEI, dP/dT mitral regurgitation, systolic velocity (S), and amplitude (MAPSE) of the medial and lateral fibrous ring of the mitral valve. In the presence of two or more additional ultrasound criteria for systolic LV dysfunction, CHF patients with LV EF within 40–55 % should be considered as patients with reduced LV EF.
В. П. Мельник, O. V. Panasiuk, H. V. Sadomova-Andrianova, I. V. Antoniuk, I. O. Sliusarchuk, H. Ya. Solonynka
Zaporozhye Medical Journal, Volume 23, pp 395-401; https://doi.org/10.14739/2310-1210.2021.3.224926

Abstract:
The aim of the study was identifying the features of infection in the site, clinical course of the disease, amount and frequency of patient examinations, family doctor communications and treatment of patients with pneumonia caused by SARS-Cov2. Materials and methods. We examined 23 families of 2–6 members (a total of 78), among them 41 patients with SARS-COV-2 pneumonia. The amount of patient examination (PCR, plain X-ray and CT of the thoracic cavity, coagulogram, blood oxygen saturation) and treatment extent (antibacterial, anticoagulant and oxygen therapy) were considered. Results. The contagiousness of the disease in the families of patients was from 33 % to 100%. The thoracic CT overuse: 73.3 % repeated, 33.0 % triple. Family doctors monitored the treatment only in 14.6 % of cases. The antibacterial therapy administration was 2 times more often than necessary; the treatment was changed by patients themselves or their acquaintances. A hospitalization was offered to patients with a decreased blood oxygen saturation of 92 % and below (29.3 %), and only 2 patients agreed to it. In a lack of treatment efficacy, the patients used respiratory fluoroquinolones (levofloxacin, moxifloxacin), meropenem, linezolid, amikacin, which are among the main drugs for the treatment of resistant tuberculosis. Extensive misuse of antibacterial drugs unnecessarily will result in an alarming increase in antibiotic-resistant infections after the COVID-19 pandemic. Conclusions. Pneumonia caused by SARS-COV-2 is a highly contagious disease in a family cluster (33–100 %). Routine administration of antibacterial drugs (especially levofloxacin, moxifloxanemine, meropenem, linezolid, amikacin) for patients with suspected SARS-COV-2 pneumonia by thoracic CT or PCR-confirmed without proven need is not only unnecessary, but even dangerous due to the potential increase in resistance to these drugs, which are the primary in the treatment of resistant tuberculosis. The anamnesis of the disease, oxyhemometry and coagulogram are of great importance when examining a patient with this pathology.
K. V. Humeniuk, I. I. Hangal, K. K. Karpenko
Zaporozhye Medical Journal, Volume 23, pp 375-380; https://doi.org/10.14739/2310-1210.2021.3.223139

Abstract:
Aim: to provide high-quality and full-fledged minimally invasive highly specialized medical care by X-ray endovascular methods, according to modern world standards, for the Armed Forces of Ukraine on all territories of the country and direct participants of combat operations in the context of Joint Forces Operation (JFO) in certain parts of Donetsk and Luhansk regions. Materials and methods. The provision of minimally invasive highly specialized medical care by X-ray endovascular techniques for servicemen of the Armed Forces of Ukraine in the conditions of JFO in certain parts of Luhansk and Donetsk regions and the National Military Medical Clinical Center of Kyiv (NMMCC) in critical internal bleedings, pathology and injuries of the main vessels, acute cardiovascular pathology over a period of 2018–2020 was analyzed: 1038 diagnostic coronary interventions to servicemen with acute coronary syndrome, 346 stenting of coronary arteries in an emergency, 36 – angioplasty of coronary arteries. A total of 296 interventions for pathology of the peripheral vascular system including combat trauma were performed. Transcatheter arterial embolization was performed for 100 patients with internal bleeding. An emergency care mechanism was implemented for patients with acute coronary syndrome in the Joint Forces Operation in certain parts of Donetsk and Luhansk regions. Results. The implementation of these methods of highly specialized care in the Armed Forces of Ukraine allowed to realize the standards of emergency care for acute coronary syndrome, the average time of “door – balloon” was 100 minutes (CI 95 %, 98–103 minutes, P < 0.05). In the conditions of JFO, care for patients with acute coronary syndrome, the interval “door – balloon” takes time from 2 to 12 hours (CI 95 %, 5.5–6.5 hours, P < 0.05), fatalities were absent. At transcatheter arterial embolization, technical success of arterial occlusion was 100 %. In the treatment of main vessels, the length of hospital stay after endovascular interventions was 1–18 days (CI 95 %, 1.96–2.51 days, P < 0.05). The main complications were postpuncture hematoma – 4.73 %, acute occlusion after intervention within 24 hours – 2.36 %, pseudoaneurysm – 0.68 %. Effective recanalization of the main blood flow was achieved in 262 cases (88.51 %). Conclusions. The implementation of X-ray endovascular techniques into the medical service of the Armed Forces of Ukraine allowed for providing high-quality highly specialized medical care directly to participants of Joint Forces Operation in certain parts of Donetsk and Luhansk regions in the shortest possible time.
T. V. Sorokman, M. I. Bachu, O. V. Makarova, N. O. Popeluk
Zaporozhye Medical Journal, Volume 23, pp 356-362; https://doi.org/10.14739/2310-1210.2021.3.226870

Abstract:
The problem of iodine deficiency (ID) and its adverse effects on the Ukrainian population, especially on children, pregnant and lactating women, does not lose its relevance. The aim. To assess the state of iodine status of the Northern Bukovіna population by the level of thyrotropin (TSH) in newborns during the years 2015–2020. Methods. Selective screening analysis to determine the serum level of TSH in newborns during 2015–2020 (a total of 47888 results), median ioduria and survey among pregnant women, determination of urinary iodine, ultrasonographic and hormonal profiles of 199 prepubertal children living in Northern Bukovina were performed. Results. During the analyzed period, there was a positive trend: the median ioduria in pregnant women increased from 89.8 μg/l in 2015 to 140.1 μg/l in 2020, the level of neonatal hyperthyrotropinemia above 5 μIU/l decreased to 5 % in 2020 (P < 0.001), there was an upward trend in the median ioduria among prepubertal children (60.4 ± 9.3 μg/l). The frequency of goiter was different and accounted for 25.3 % among children living in the mountainous area and it was much lower among children living in the plain areas and in Chernivtsi (15.6 % and 13.1 %, respectively, P < 0.05). Thyromegaly among children of the reference group occurred in 15.1 %. 12.3 % of children were characterized by TSH in the range of age standards, which were shifted towards its increase (4.23–5.00 μIU/l). Conclusions. The increase in the median ioduria and the decrease in the frequency of neonatal hyperthyrotropinemia above 5 μIU/l on the background of iodine supply has been found in the pregnant population. The indicator of neonatal hyperthyrotropinemia above 5 μIU/l can be used to assess iodine deficiency only in the population of pregnant women.
I. A. Zhabchenko, , I. S. Lishchenko, O. M. Bondarenko
Zaporozhye Medical Journal, Volume 23; https://doi.org/10.14739/2310-1210.2021.3.203959

Abstract:
Here we summarize uptodate data on the influence of the most significant micro, macroelements, and vitamins, such as magnesium, vitamin D, iron, and folic acid, on the course of pregnancy and childbirth in obese women. The paper considers both domestic and foreign recommendations for correcting nutritional deficiencies to prevent the development of complications from the pregravid stage to the end of lactation. Nowadays, the deficiency of micro-, macroelements and vitamins is an extremely urgent problem, especially in a group of special risk, i.e. overweight and obese women, whose number is steadily growing simultaneously with an increase of the number of pregnant women of 35+ years of age. It is important to consider a woman's body mass index to prescribe the minimum effective dose of the necessary drugs. Timely preventive personalized correction of the micronutrient state can reduce the risks of such major obstetric syndromes as preeclampsia, premature birth, fetal growth retardation, miscarriage, and placental dysfunction.
S. M. Zavhorodnii, M. S. Gatia, М. А. Кубрак, M. B. Danyliuk
Zaporozhye Medical Journal, Volume 23, pp 370-374; https://doi.org/10.14739/2310-1210.2021.3.229724

Abstract:
Nodular toxic goiter (NTG) accounts for 7.3 % to 10.0 % of the goiter population. There are difficulties in the preoperative differential diagnosis between NTG and other thyroid diseases. There is also controversy about the benefits of resection surgery over thyroidectomy in patients with NTG. The aim of the study: a comparative assessment of the diagnosis and treatment results of patients with NTG in the early and late postoperative periods after resection surgery and thyroidectomy. Materials and methods. The study enrolled 51 patients with NTG. The mean age of patients in the group was 51.7 ± 12.9 years. Results. Bilateral multinodular lesions prevailed – 34 (66.7 %) patients. Free T3 level was measured only in 15 (29.4 %) patients, 7 (46.7 %) of them had elevated T3 level. 15 (29.4 %) patients underwent hemithyroidectomy including the isthmus, 2 (3.9 %) had subtotal resection, 34 (66.7 %) patients underwent thyroidectomy. Conclusions. Multinodular bilateral thyroid lesions dominated the structure of NTG – 34 (66.7 %) patients who underwent thyroidectomy. Uninodular and multinodular unilateral pathology was diagnosed only in 17 (33.3 %) patients who underwent organ-preserving surgery. The measurements of free T3 level in patients with NTG allowed the diagnosis of T3-thyrotoxicosis in almost half of patients (46.7 %), which is a diagnostic criterion for detection of functional nodal autonomy. Following the organ-preserving surgery, 17 (33.3 %) patients with NTG required the use of hormone replacement therapy with levothyroxine at a mean dose of 25.0 (25.0; 50.0) mcg/day in the late postoperative period (>1 year).
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