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Vita Skoryk
ScienceRise: Medical Science pp 22-27; https://doi.org/10.15587/2519-4798.2021.241013

Abstract:
The aim of the study. To compare the effectiveness of methylprednisolone, dexamethasone and tocilizumab in patients with severe coronavirus disease. Identify the most appropriate treatment option. Materials and methods. Patients of group 1 (n=20) received for anti-inflammatory purposes tocilizumab at a dose of 600–800 mg. Patients in group 2 (n=82) received pulse therapy with methylprednisolone. Patients in group 3 (n=20) received dexamethasone 6 mg / day. Data are presented as M [25–75]. Statistical analysis of the results was performed using the program "Statistica 10". Significance of differences in indicators was assessed using the nonparametric Wilcoxon test. The results were considered reliable at values of p 0.05). The level of IL-6 in group 1 was 61.8 pg / ml, in group 2 – 64.6 pg / ml, and in group 3 – 46.5 pg / ml without significant differences between groups (p> 0.05). The level of ferritin in all groups exceeded normal values. Conclusions The most favourable result was obtained when using methylprednisolone: it was possible to reduce the mortality rate to 59.8 %. The relative risk of developing VTE was significantly higher in groups 1 and 3 (RR12 6.8 [2.7–16.8] p12 <0.0001, RR23 0.15 [0.06–0.35] p23 <0.0001), which gives grounds to confirm the presence of anticoagulant activity in methylprednisolone
Vira Tseluyko, Tetyana Pylova
ScienceRise: Medical Science pp 10-15; https://doi.org/10.15587/2519-4798.2021.241534

Abstract:
The aim of the study to evaluate the effect of supplementation of basic therapy by ranolazine in patients with INOCA on exercise test parameters and Holter ECG monitoring. Materials and methods. 53 patients with stable coronary heart disease were examined, including 18 men (33.9 %) and 35 (66 %) women, the average age of patients was 57 (±9.68) years. According to the results of coronary angiography all patients had non-obstructive coronary arteries. In addition to physical and laboratory examination, bicycle ergometry, Holter ECG monitoring and echocardiography were included in the examination of patients. Patients were divided into 2 groups: group I - patients who in addition to standard therapy received ranolazine at a dose of 1000 mg twice a day for 6 months, and group II patients with standard coronary heart disease therapy. After 6 months from the beginning of the observation an objective examination, echocardiography, exercise test, Holter ECG monitoring were repeated. Results. The study found that patients receiving ranolazine in addition to standard therapy had a statistically significant increase in exercise duration after 6 months compared with baseline and group II. Before treatment in group I, the duration of the exercise test was 356.51±180.24s, and after treatment 414.32±142.10s (p=0.03). In group II, the duration of the test before treatment was 361.4±160.24 c, and after 380.5±152.2 s (p=0.15). It was also found that the duration of the test differed significantly in group I after treatment of patients from group II after treatment of patients with a standard treatment regimen (p=0.04). According to the results of Holter ECG monitoring in group I found a positive effect of ranolazine on the frequency of ventricular arrhythmias: before treatment n=1142 [30; 2012], after treatment n=729 [23; 1420], while in group II a significant difference between the number of extrasystoles before treatment and after not detected (n=1026 [17; 1920], n=985 [15; 1680], respectively) p=0.18. Conclusions. The addition of ranolazine to the basic therapy of patients with non-obstructive coronary arteries disease helps to increase exercise tolerance (according to the loading stress test) and contributes to a significant reduction in the number of ventricular arrhythmias (according to Holter-ECG) compared with both baseline and group II
Iuliia Lozova, , , Tatiana Pochuеva
ScienceRise: Medical Science pp 32-40; https://doi.org/10.15587/2519-4798.2021.241951

Abstract:
Otitis media is one of the most common infectious diseases of the middle ear in preschool age, but its relationship with vestibular dysfunction remains controversial. The aim of the study was to carry out a comparative analysis of stabilometric indicators of preschool children with suppurative and non-suppurative otitis media. Materials and methods: 22 children with suppurative otitis media and 22 children with non-suppurative otitis media at the age from 4 to 7 years were examined by the method of static stabilometry on the device “MPFI Stabilograph 1” (LLC "ASTER IT", Kharkov, Ukraine). We took into account the indices of variation and distribution of the center of pressure, spectral and correlation indices of the stabilogram, as well as integral indices of stability (length, velocity and angle of postural oscillations) and the quality of the balance function in two sensory states (open and closed eyes), which were calculated in the software providing StabiliS. Results. In children with non-suppurative otitis media, the coordinates of the center-of-pressure corresponded (7.04 [2.16–10.09]; -1.14 [-28.90–9.11]), and with suppurative otitis media – (7.04 [3.30–16.16]; -13.72 [(-25.17)–(-10.30)]) with closed eyes. The averaged figure of the projection of the center-of-pressure in the test with eyes closed is actually represented by a circle in both groups, but with open eyes it is represented by an ellipse, which, in case of non-suppurative otitis media, is stretched along the sagittal axis, and in case of suppurative otitis media, along the frontal axis. In both sensory states, children with non-suppurative otitis media were characterized by large (p≤0.05) values of KurtosisX, Length and lower (p≤0.05) values of CC0X, Pup2Sigma compared with non-purulent otitis media. Conclusions: In preschool age, suppurative otitis media more significantly disrupts the balance function compared with non-suppurative otitis media, which was manifested by a significant decrease in the stability of the main stance and the predictability of oscillatory movements compared with non-suppurative otitis media
Amit Mittal, Manoj Kumar Singh, Rajeev Kumar, Deepti Mandsorwale
ScienceRise: Medical Science pp 48-51; https://doi.org/10.15587/2519-4798.2021.238014

Abstract:
Coronavirus disease 2019 (abbreviated “COVID-19”) is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The cases of COVID-19 infection since then were showing increasing trend in all over the world. The aim: to study the epidemiological distribution and determinants of COVID-19 pandemic. Methods: it is a descriptive study carried out at a tertiary care hospital of India. The population comprised of patients admitted in the hospital. Sample size comprised of all the subjects admitted in the hospital with established COVID 19 +ve cases. The duration of study was April 2020 to June 2020. The study was approved by the Institutional Ethical committee and Informed consent was obtained from each subject before the conduct of the study. Data collection was done by a pre-structured questionnaire. Data entry and analysis was done using SPSS version 20 software. Results: out of total 38 COVID-19 +ve cases, 95 % were male and 5 % female ant the maximum numbers of cases ranges between 36–40 years of age group with the median age of 32 years.53 % of cases were Muslim and 47 % Hindu by religion. The median duration of stay in hospital of all COVID-19 +ve cases was11 day that on further differentiation with co-morbidity was 15 days and 11.5 without any co-morbidity. The median duration taken between 1st sample taken and report provided was 2 days, between 2nd sample taken and report provided 1 day and between 1st and 2nd sample taken was 11 days. Conclusions: present study concluded that middle age persons were affected in majority which may be due to more exposure to public places. Co-morbidities are strong predictors of requirement for admission and duration of stay at hospital
Viktoriia Olkhovska, Zalina Yeloyeva, Yevhen Olkhovskyi
ScienceRise: Medical Science pp 28-31; https://doi.org/10.15587/2519-4798.2021.240151

Abstract:
The aim of the work was to study the characteristics of the response of non-specific protective factors in tonsillitis of streptococcal etiology in children infected and uninfected with HHV-6 infection at different periods of the disease. Materials and research methods. In 78 children aged 3–15 years, inflammation markers and phagocytic activity of peripheral blood neutrophils (PAN) were determined using the nitroblue tetrazolium reduction test. The studies were carried out in the acute period and in the period of convalescence. Mathematical and statistical processing of the data obtained was carried out using Microsoft Excel 2003 and Statistica 6.0 programs. The significance of differences between the mean values was determined using the Student's test (t). Results. It was found that infection of children with HHV-6 leads to a decrease in the functional activity of neutrophils in the onset of streptococcal tonsillitis compared with uninfected patients (p<0.05). Also, the acute period of streptococcal tonsillitis in patients with co-infection is accompanied by a violation of the functional reserve of the oxygen-dependent mechanism of bactericidal neutrophils: minimal opportunities were found in tonsillitis on the background of HHV-6 infection (p<0.05). By the period of convalescence, a decrease in the indicators of the functional activity of neutrophils, increased in the acute period, was recorded, but in children infected with HHV-6, a complete recovery of indicators to the physiological norm did not occur. One of the features of streptococcal tonsillitis in children with HHV-6 infection is an increase in serum gamma globulin level (p˂0.05), lack of significant dynamics of decrease in the ASL-O indicator. Conclusions. The presence of VHL-6t infection in a child with streptococcal tonsillitis adversely affects the state of nonspecific protective factors, in particular PAN. The obtained data must be used to optimize the management of patients at different periods of the disease, including at the stages of dispensary observation
Mariia Ievtushenko, Olena Koshova, Svitlana Kryzhna
ScienceRise: Medical Science pp 41-47; https://doi.org/10.15587/2519-4798.2021.241983

Abstract:
The aim of the research: to experimentally study at the histological and morphological level the degree of the corrective effect of bacterial lysate of the disturbed non-specific defense of the body on the model of periodontitis based on the Central Research Laboratory of the National University of Pharmacy. Materials and methods: prospective study has been conducted on experimental periodontitis in 42 rats for 90 days. The animals were treated with «Respibron» and the reference drug «Imudon». Histological and morphometric studies were carried out according to standard methods. Micropreparations were viewed under a Granum DCM 310 digital video camera. All interventions and euthanasia of animals were carried out in compliance with the European principles. Results: by the end of 90 days of experimental periodontitis at the local level in the homogenate of animal gum tissue compensatory mechanisms are depleted and differed from the norm by 397 times. The dynamics of the studied morphometric and histological parameters of "Respibron" was similar to the "Imudon", but the magnitude of destruction was less pronounced and differed at the end of the experiment by 17.2 times in comparison with the intact control, and in the control group the results improved by 23.1 times. Conclusion: the obtained data from the study indicate a high decompensation of experimental periodontitis. It is characterized by the formation of periodontal pockets and inflammatory bone loss. The magnitude of destruction differed from the norm by 397 times. Applying of bacterial lysates led to the compensation of bacterial dysbiosis, restoration of the tissues of paradont. The therapeutic effect of "Respibron" can be assessed as more powerful in comparison with "Imudon" in terms of the studied morphometric and histological parameters: the magnitude of improvement "Respibron" was 3.72 times higher than the indicators of "Imudon". We should continue the study of experimental periodontitis as mechanisms of development, protection, and restoration of tissues under conditions of pharmacological correction by bacterial lysate "Respibron"
Olga Dubenko, Victoria Anysienkova
ScienceRise: Medical Science pp 16-21; https://doi.org/10.15587/2519-4798.2021.241147

Abstract:
The aim of this study is to evaluate serum level biomarkers of atherosclerosis lipoprotein-associated phospholipase A2 and E-selectin in patients with atherosclerotic carotid stenosis with different clinical manifestation in associated with vascular risk factors. Materials and methods: A total 106 patients with atherosclerotic carotid stenosis (74 men and 32 women, aged from 31 to 74 years, mean 62.6±0.9) were included: with acute ipsilateral atherothrombotic stroke (35), history of stroke and carotid endarterectomy (41) and 30 patients with asymptomatic carotid stenosis. The control group consist of 20 health subjects without cardiovascular disease. All participants underwent duplex sonography. Lipoprotein-associated phospholipase A2 and E-selectin was measured using commercially available (ELISA) kit. Results: The level of lipoprotein-associated phospholipase A2 was in general 55.664±3.537 ng/ml, which was significantly higher (M-W U=10, p=1.023136´10-11 70 % was greater in this group. The level of E-selectin in the study patients was significantly higher (7.653±0.246 pg/ml) than in the control group (3.101±0.503 pg/ml) p<0.05. No association the serum level of lipoprotein-associated phospholipase A2 and E-selectin with common stroke risk factor such as hypercholesterinemia, smoking and body mass index were found, but positive correlation of lipoprotein-associated phospholipase A2 with E-selectin was significant (p=0.00085). Conclusions: Increasing plasma level lipoprotein-associated phospholipase A2 and E-selectin in patients with the carotid atherosclerotic stenosis were observe. Statistically significant correlation between the level of lipoprotein-associated phospholipase A2 and E-selectin were found in symptomatic carotid atherosclerotic stenosis
Marine Georgiyants, Volodymyr Korsunov, , Oleg Loskutov, Nataliia Bohuslavska, Vadim Nikonov, Lidiya Cherkashyna, Oleksiy Oparin, Pavel Nartov, Maksym Holianishchev
ScienceRise: Medical Science pp 4-9; https://doi.org/10.15587/2519-4798.2021.241456

Abstract:
The aim of the research. The aim of this work was to summarize the scientific literature data on the pathogenesis and intensive care of the severe course of coronavirus infection. Materials and methods. Databases such as PubMed, Google Scholar, Scopus and Web Of Science 2020-2021 were used for literary searches. Results. An intense inflammatory response against the SARS-CoV-2 virus in COVID-19 patients causes a cytokine storm and hypercoagulability with the development of acute respiratory distress syndrome (ARDS) and multiple organ failure. Approximately 17 % to 35 % of hospitalized patients with COVID-19 are treated in the intensive care unit, most often due to hypoxemic respiratory failure and the development of ARDS, and between 29 % and 91 % of patients in intensive care units require invasive ventilation. In addition to acute respiratory failure, hospitalized patients may have acute renal failure (9 %), liver dysfunction (19 %), coagulation disorders (10 %–25 %), and septic shock (6 %). More than 75 % of hospitalized patients require additional oxygen therapy. Respiratory support could vary from the need for oxygen supplementation through a nasal catheter to invasive ventilation or extracorporeal membrane oxygenation in patients with the most severe ARDS. The uncontrolled inflammation and coagulation seen in COVID-19 patients is similar to multifactorial ARDS, where a plethora of evidence has demonstrated the ability of long-term corticosteroid therapy (CST) to reduce inflammation-coagulation-fibroproliferation and accelerate recovery. With regard to the assessment of the benefits of therapeutic anticoagulation in patients with elevated D-dimer, the question has not yet been finally resolved, and research devoted to this is still ongoing. Conclusions. The approaches to respiratory, anticoagulant, anti-inflammatory therapy in critically ill patients with COVID-19 require further research to determine the optimal treatment tactics
Mariana Vyshynska
ScienceRise: Medical Science pp 29-34; https://doi.org/10.15587/2519-4798.2021.238094

Abstract:
Coagulopathy remains the leading cause of illness and death in people with severe trauma. The aim was to study the indicators of vascular-platelet hemostasis in severe trauma and to establish changes in the main pathophysiological mechanisms of primary hemostasis that occur in patients with trauma-induced coagulopathy, compared with almost healthy individuals of the same age. Materials and methods. The study included 44 patients aged 19 to 55 years (36.1 [28.7; 43.2] years). The control group included 20 patients of the therapeutic department without preconditions for changes in the hemostasis system, and the main group - 24 patients with diagnosis of “severe trauma” who were treated in the anesthesiology and intensive care department. Results and discussion. We studied indicators of intravascular platelet activation. Patients had a normal number of platelets in the venous blood, but the level of spherocytes and spheroechinocytes increased. On the 3rd day after the injury, number of platelets in the venous blood was normal, however the level of discocytes decreased, and the level of discochinocytes, spheroechinocytes and the sum of active forms of platelets increased. On the fifth day, the level of discochinocytes and active forms of platelets, significantly higher (p<0.05) among patients of the main group, and spherocytes, spheroechinocytes and platelets involved in the aggregates, were significantly lower than in the control group of patients (p<0.05). Conclusions. Indicators of vascular-platelet hemostasis in patients with polytrauma had significant differences from those of the control group. This may be evidence of activation of the vascular-platelet system of the hemostasis system and may be a prerequisite for late thrombotic complications in patients with polytrauma
Oksana Herasymova, Tetiana Filonova
ScienceRise: Medical Science pp 41-45; https://doi.org/10.15587/2519-4798.2021.238132

Abstract:
The aim: to improve the early diagnosis of arrhythmia in combination with gastroesophageal reflux disease (GERD) in children, by studying the risk of connective tissue dysplasia on the occurrence of this pathology. Materials and methods. We examined 100 children aged 8 to 18 years, mean age 13.7±2.7 years, of which 32 children with arrhythmias without combined pathology were group I, 36 children with concomitant GERD - group II and 32 children with GERD without concomitant arrhythmias - group III. Patients underwent clinical and instrumental studies (electrocardiography, Holter daily ECG monitoring, esophagogastroduodenoscopy and pH-metry) and evaluation of phenotypic signs of NDST according to the criteria of T. Milkovskaya-Dimitrova and A. Karkasho. Results. A risk factor for the formation of combined pathology in children in the form of arrhythmia and GERD was identified, namely the next main phenotypic feature of NDST (undifferentiated connective tissue dysplasia) – dysplastic tooth growth. Also, predictors of both an isolated variant of arrhythmia in children and arrhythmia in combination with GERD – high height and scoliotic posture were identified. In this case, the risk factor for an isolated variant of arrhythmia in children, according to the results of the study is asthenic constitution. The severity of NDST in the studied groups was determined. The analysis of the results revealed the absence of a statistically significant relationship between the severity of NDST and study groups, although it should be noted that in children of group III the first degree of NDST was not observed in general. Conclusions. It was found that asthenic constitution, dysplastic tooth growth, tall stature and scoliotic posture are statistically significant risk factors for the development of the studied pathologies. There were no statistically significant differences between the study groups regarding the severity of NDST, but there was a complete lack of detection in children of group III (children with isolated GERD without concomitant arrhythmia) of the first degree of NDST
Vladyslav Bereznyakov, , Sergiy Krasnokutskiy
ScienceRise: Medical Science pp 13-16; https://doi.org/10.15587/2519-4798.2021.237712

Abstract:
The aim of our work was to study the characteristics of the immune status based on the analysis of the cellular, humoral links of immunity and dynamics of immunoglobulins in adults with community-acquired pneumonia (CAP), and their importance in the pathogenesis and prognosis of the disease. Materials and methods. The study was carried out in the period 2017-2020 on the basis of the therapeutic department of the Municipal non-profit enterprise “City Clinical Multidisciplinary Hospital № 25” of Kharkiv City Council. The study involved 20 adult patients with CAP aged 18 to 80 years (mean age 36.5±10.3). The control group consisted of 20 apparently healthy individuals (mean age 39.5±12.5). The study of the immune status of patients was carried out by determining the phagocytic index, the content of lymphocytes, CD3+, CD4+, CD8+, CD16+, CD20+ and the level of immunoglobulins of classes A, G, M in the dynamics of the disease: on the first and tenth days after hospitalization. Results. On the first day of hospitalization, there was a significant imbalance in phagocytosis, T- and B-links of immunity. On the tenth day of treatment, the phagocytic index, the number of CD3+, CD4+, CD8+, CD16+ and CD20+ increased. An increase in Ig M, a decrease in Ig A and Ig G were also noted. Thus, standard therapy for patients with CAP leads to its clinical and radiological resolution, but is not accompanied by the normalization of immunity parameters. Conclusions. The features of immune disorders in patients with CAP were revealed: pneumonia increases the imbalance in the cellular link of immunity, the level of CD3+ and CD4+ decreases, there is no dynamics of the relative amount of CD20+. There are no significant changes in the humoral link of the immune status. For the treatment of patients with CAP, in addition to standard pharmacotherapy, it is necessary to include drugs that stimulate the immune system
Stanislav Kosulin
ScienceRise: Medical Science pp 22-28; https://doi.org/10.15587/2519-4798.2021.237931

Abstract:
Tumor diseases of the BPDZ (biliopancreatoduodenal zone) occupy one of the leading places among the causes of disability and mortality of the population, both according to global and domestic statistics, while in 85–90 % of cases, patients with distal tumor biliary obstruction are detected. The most common symptom of malignant tumors of periampullary localization is OJ(obstructive jaundice), which is found in 86–95 % of patients and becomes the first manifestation of the disease in 65–70 % of cases. Purpose. Optimization of surgical treatment in surgically incurable patients with obstructive blastomatous jaundice. Materials and methods. The study was clinical in nature, it was carried out on the basis of CCH №17 (Kharkov, Ukraine) and the State Institution “Institute of General and Emergency Surgery named after V. I. Zaitsev National Academy of Medical Sciences of Ukraine ") and consisted of two stages. The main task of the first stage was a retrospective assessment of the results of antegrade and retrograde minimally invasive interventions performed in the period from 2006 to 2011 in 122 patients. The main objective of the second stage of the study was to assess the results of surgical treatment of 75 patients with blastomatous breast, who were treated from 2012 to 2019. using the developed treatment algorithm. Results. At the first stage of the study, the effectiveness of endoscopic transpapillary and transhepatic biliary excretion methods in patients with distal malignant obstruction of the gastrointestinal tract was compared, for which patients who underwent minimally invasive interventions were divided into two subgroups: group A (63 observations) biliary excretion, and in group b (59 observations) as biliary decompression antegrade percutaneous-transhepatic methods of drainage of bilious ways were applied. Endoscopic transpapillary surgery showed itself to be, not inferior to open surgery in effectiveness of biliary decompression, instead it has a number of advantages, such as low trauma, relative safety, low complication and mortality. Conclusions. The developed algorithm of bile excretion in incurable patients with blastomatous MF allowed to minimize the number of postoperative complications to 4.0 %, to avoid the development of transient hyperamylasemia and postmanipulation pancreatitis. Endoscopic retrograde methods of RV prosthetics as the final stage of surgical treatment in this category of patients have certain advantages over antegrade methods of external drainage, primarily due to the preservation of the natural passage of bile in the duodenum and better adaptation and tolerability by patients
Vita Skoryk, Volodymyr Korsunov, Tetiana Bocharova, Pavel Nartov, Maslova Valentina
ScienceRise: Medical Science pp 4-12; https://doi.org/10.15587/2519-4798.2021.238093

Abstract:
The aim. Based on the study of the effect of invasive mechanical ventilation and NIV in the CPAP mode on the pathomorphosis of lung damage in patients with HRF caused by SARS-nCoV-2 and deaths in intensive care unit (ICU), determine the safest method of respiratory support. Materials and methods. The study included morphological material from 20 patients with HRF caused by SARS-nCoV-2 (COVID-19) who died in ICU. Group 1 included patients who received non-invasive lung ventilation in CPAP mode through a face mask (n=10), group 2 - patients who underwent invasive ventilation (n=10). The prepared sections, 5 μm thick, were stained according to the Van Gizon method. Photomicrographs were taken using Zeiss ZENliteimaging. Data are presented as M [25-75] and P±Sp. Statistical analysis of the results was performed using the program “Statistica 10”. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test, the parametric Student's test. The results were considered reliable at values of p<0.05. Results The morphological structure of the lungs of patients of group 1 corresponded to the exudative phase of DAD with severe edematous-hemorrhagic syndrome, signs of interstitial pneumonia with desquamation of alveolocytes and the formation of hyaline membranes. In patients of group 2 in the lung tissue there was a picture of the proliferative phase of DAD with signs of interstitial pneumonia, and the development of focal fibrosing alveolitis. Thus, invasive mechanical ventilation, can accelerate the development of irreversible processes in the lungs in the form of fibrosing alveolitis and promote the formation of ventilator-associated pneumonia Conclusions. CPAP NIV is a promising method of respiratory support in patients with ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study
Nataliya Moyseyenko
ScienceRise: Medical Science pp 35-40; https://doi.org/10.15587/2519-4798.2021.237821

Abstract:
Optic neuropathy is a group of diseases of the optic nerve. Using diagnostic techniques such as ophthalmoscopy and perimetry diagnosis are insufficient, as the found abnormalities are not specific for either inflammation or ischemia. Establishing the predominant factor in the pathogenesis of neuropathy is crucial in determining the method of treatment. The aim of the study: to investigate the features of optic nerve damage using optical coherent tomography (OCT) in optic neuropathy in the acute period. Materials and methods: two patients with visual impairment were examined. Result. Patient G. had concomitant rheumatoid arthritis with unregulated Methotrexate therapy. OCT revealed edema of the nerve fibre layer convinced of the predominance of inflammatory neuropathy (atypical neuritis). Pulse therapy with corticosteroids was prescribed, which gave a positive functional effect. A patient O. with pneumonia on the background of Covid-19 with a history of OST showed a decrease in the thickness of the layer of nerve fibres in the lower segment, and in the angio mode – drusen of the optic disc. Conclusions. Thus, the use of OCT for the diagnosis of optic neuropathies in the acute period showed that under conditions of inflammatory lesions is more characteristic of edema and an increase in the thickness of the layer of nerve fibres. In ischemic neuropathy, on the contrary, a decrease in the thickness of nerve fibres is more characteristic, which correlates in location with the localization of scotoma in the field of view. Therefore, the use of OCT of the optic nerve will help in understanding the pathogenesis of forms of optic neuropathy. This will help in the choice of treatment tactics
Yevheniia Lukianets
ScienceRise: Medical Science pp 17-21; https://doi.org/10.15587/2519-4798.2021.238027

Abstract:
Osteoporosis is the fourth most common disease after cardiovascular, cancer and endocrine diseases. With an increase in life expectancy, it becomes one of the main causes of deterioration in health and an increase in mortality. The aim of the study. To identify women with low bone density using ultrasound densitometry and assess the risk of osteoporotic fractures. Materials and methods. The study was based on a survey of 31 women in the Odessa region, the average age of the subjects was 57±9.1 years, the average body weight was 75.74±12.5 kg, height 162.8±0.1 cm, the average BMI was 28.57±4.5. All women were divided into groups by age with a ten-year interval and by densitometry indices. Results. Decrease in bone density was found in 51.6 % of examined women. The lowest BMD was in the age group of 70–79 years, and the largest numbers of respondents with osteopenic changes were at the age of 50–59. A linear correlation was found between BMD and age at the level of significance p=0.007. The linear regression equation is: t=-0.03968 *age+1.268, (r=-0.473). In women with osteopenia, a significant increase in indicators was found for almost all algorithms for assessing the 10-year risk of fractures at p<0.05 (except for FRAX Hiр without BMD (p=0.087)) and a significant decrease in ultrasound densitometry indicators compared with women with normal BMD. Women with fractures had significantly higher scores according to the FRAX Total algorithms without BMD (p=0.002), FRAX Hiр without BMD (p=0.004) and Q-fracture Hiр (p=0.044). Conclusions. Most women had osteopenic manifestations according to ultrasound densitometry. Age significantly correlates with BMD parameters. The numbers of women with changes in the structure of bone tissue increases with age, and, after 70 years, all women have osteopenic manifestations. The algorithms for assessing the 10-year risk of fractures FRAX and Q-Fracture reliably correlate with densitometry indicators. The combination of ultrasound densitometry with algorithms for assessing the risk of osteoporotic fractures significantly increases the diagnosis of osteoporosis
Iryna Yakovtsova, Olexandr Hurov, Vadym Nikonov, Sergii Kursov, Dmytro Hladkykh, Svitlana Danyliuk
ScienceRise: Medical Science pp 45-49; https://doi.org/10.15587/2519-4798.2021.233034

Abstract:
The aim of this study is to establish modern, global trends in the diagnosis of mechanical asphyxia. Materials and methods: search and bibliographic method (theoretical analysis, systematization and classification of library catalogues, printed and electronic sources on mechanical asphyxia) from open anchor databases Scopus preview, Web of Science and using information retrieval systems Google Scholar, Open Ukrainian Citation Index (OUCI), ScienceDirect on the Internet. Results: mechanical asphyxia, as one of the most common types of violent death, ranks first among deaths from mechanical injuries. Its study is of great interest among medical scientists in various fields, especially for resuscitators and forensic experts. Establishing the causes of asphyxia, clinical and morphological manifestations, and the consequences that unfortunately most often lead to death. With the rapid development of society, science is also developing rapidly, and the latest sensitive methods of diagnosing diseases are emerging. However, unfortunately, in the post-Soviet space, the diagnosis of most pathological conditions, including asphyxia, is determined by experience and sensory organs, which are determined using instrumental research methods in compliance with the requirements of evidence-based medicine. Given the peculiarities of the pathophysiological processes of the asphyxiation state and their manifestations in the body, doctors should rely primarily on general knowledge about hypoxic and asphyxiation disorders, which are determined using instrumental research methods in compliance with the requirements of evidence-based medicine. Conclusions: at present, the diagnosis of asphyxia consists of many morphological features. Failure to take into account the state of the body, the presence of chronic diseases, and drug or alcohol intoxication at the time of asphyxiation complicate the diagnosis. Detection of individual clinical manifestations or morphological features does not allow asserting its lifelong origin. Therefore, it is necessary to use modern research methods that should expand the possibilities of forensic diagnosis of the viability of injuries in terms of evidence-based medicine and provide forensic experts with a scientific basis for their results. One such method is immunohistochemical, which is gaining popularity and consolidating its position in the EU, China, Japan and America. In addition, this method is well-established and widespread in morphological studies of differential diagnosis of tumours. Some scientific works prove the expediency of using the immunohistochemical method to solve the problems of forensic expert practice, which is an actual scientific and practical task
Nataliia Cherednichenko, Maryna Kochuieva, Hanna Tymchenko, Yulia Zaikina, Gennadii Kochuiev, Andrii Liashok
ScienceRise: Medical Science pp 9-14; https://doi.org/10.15587/2519-4798.2021.232971

Abstract:
The aim of the study was to investigate the effectiveness of different schemes of basic asthma therapy depending on the polymorphism of the LTC4 gene. Materials and methods. 181 patients with asthma were recruited to participate in the study. All patients included in the study underwent a general clinical study, spirometry, the level of asthma control was determined by Asthma control questionnaire 5 (ACQ-5), by studying the polymorphism of the LTC4 gene, it was determined that patients belong to the A/A, A/C and C/C genotypes. Results. Allelic -444C polymorphism of the LTC4-S gene (rs 730012) had the following genotype frequency among asthma patients: A/A – 77 people (42.6 %), A/C – 73 people (40.3 %) and C/C – 31 people (17.1 %). In groups of patients with genotypes A/A and A/C, during treatment with a low dose of ICS and montelukast, there was a significant improvement in FEV1 and the score according to the ACQ-5 questionnaire (asthma control level). However, in the group of patients with the C/C genotype, there were no significant changes in FEV1 and the score according to the ACQ-5 questionnaire. In the groups of patients with genotypes A/A and C/C on the background of increasing the dose of ICS to medium in a fixed combination with LABA compared with the results of treatment with low-dose ICS and montelukast, there was a significant improvement in FEV1 and asthma control – ACQ- 5. At the same time, in the group of patients with genotype A/C, there were no reliable indicators of FEV1 and ACQ-5 score changes. Conclusions. The frequency of genotypes A/A, A/C and C/C for LTC4S polymorphism in the studied population are 42.6 %, 40.3 % and 17.1 %, respectively. Patients with genotypes A/A and C/C have a significant response to treatment with a low dose of ICS and montelukast in the form of an improvement in FEV1 and ACQ-5 score. Increasing the dose of ICS up to moderate in a fixed combination with β2-LABA in groups of patients with genotypes A/A and C/C leads to a significant improvement in the FEV1, as well as in the asthma control level - ACQ-5
Larysa Strashok, , Natalia Shevchenko, Zalina Yeloyeva, Olga Belousova, Olha Tsodikova
ScienceRise: Medical Science pp 50-55; https://doi.org/10.15587/2519-4798.2021.232478

Abstract:
The relevance of the topic is dictated by the growing prevalence of hepatic steatosis and fibrosis in the pediatric population, which is due to an increase in the number of pathologies of various organs and systems, which may be accompanied by the development of these liver lesions. The aim of the study: to analyze the data of modern sources of scientific literature regarding the prevalence and features of the course of pathology of various organs and systems, which is associated with the development of steatosis and liver fibrosis in the pediatric population. Materials and methods. A systematic search of scientific was carried out using Web of Science, Scopus, PubMed, scientific bases with key words: «hepatic steatosis», «hepatic fibrosis», «non-alcoholic fatty liver disease», «comorbid pathology», «children and adolescents». Conclusions. Currently, the number of children and adolescents who are diagnosed with steatosis and/or fibrosis of the liver is increasing in the world. In particular, the formation of this pathology is associated with the presence of metabolic syndrome and is associated with its main components, such as obesity, hypertension, disorders of carbohydrate and lipid metabolism. More and more studies indicate the role of non-alcoholic fatty liver disease, which is based on steatosis, as a comorbid pathology in systemic, cardiovascular, endocrine diseases, gastrointestinal tract pathology, and genetic disorders. Also, a number of drugs with steatogenic and fibrogenic effects on liver tissue have been established, which are widely used in pediatric practice. It is necessary to monitor the structural and functional state of the liver already in childhood and adolescence for adequate treatment of the underlying disease and prevention of the formation of comorbid pathology
Mykola Ostrovskyi
ScienceRise: Medical Science pp 20-26; https://doi.org/10.15587/2519-4798.2021.232975

Abstract:
Paclitaxel is an effective chemotherapeutic agent for many cancers, but it has a number of limiting side effects that not only significantly reduce the quality of life of patients, but also limit their further treatment. Peripheral neuropathy is one of these, but there are currently no proven effective druHS for the prevention or treatment of paclitaxel-induced neuropathic pain (PINP) in particular, or chemotherapy-induced peripheral neuropathy (CIPN) in general. 2-ethyl-6-methyl-3-hydroxypyridine succinate (HS) is a derivative of succinic acid with neuroprotective, antihypoxic, membrane-protective, nootropic, sedative effects. The aim of the study was to study the effect of the neuroprotective agent HS on the pathomorphogenesis of the sciatic nerves under conditions of paclitaxel-induced peripheral neuropathy in the experiment. Materials and methods. The experiment was carried out on 80 white rats, which were injected intraperitoneally with paclitaxel (Actavis, Romania), previously dissolved in isotonic saline at a dose of 2 mg / kg of body weight four times every other day until a total dose of 8 mg / kg was reached. Then forty of these animals were injected intraperitoneally with 2-ethyl-6-methyl-3-hydroxypyridine succinate at a dose of 10 mg / kg (the remaining 40 rats received intraperitoneal water for injection). Morphological studies were carried out on the first, seventh, fifteenth, twenty-eighth, sixtieth, ninetieth and one hundred and twentieth days after the last injection of the drug. We investigated the pharmacological potential of HS in the prevention and treatment of CIPN at the level of sciatic nerve (SN) morphology. Results. The maximum value of the average profile area of myelinated nerve fibers with the use of HS is significantly lower than with uncorrected flow, and is (78.12±2.24) μm2 compared to (94.04±1.03) μm2 (p <0.001). The introduction of HS provides a stable content of the value of the ratio of the areas of the axial cylinder and the fiber within 0.39±0.01 (first day) - 0.44±0.01 (ninetieth day), and a rapid recovery of the indicator value to normal values during the final 30 days of the experiment. the maximum value of the index of the profile area of the myelin sheath with the introduction of HS is 1.4 times less than with an uncorrected flow, and is, respectively, (49.01±1.59) μm2 and (69.77±1.87) μm2 (p <0.001). HS provides a more intensive restoration of the indicator of the area of the myelin sheath during the 90th - 120th day of the experiment. Conclusions. Our results allow us to conclude that the introduction of HS creates a protective effect against paclitaxel-induced peripheral neuropathy (PIPN) by acting on both the axial cylinder and the myelin sheath of the heart failure. Due to the known pathophysiological mechanisms of the development of neuropathy, this method can be a promising therapeutic agent for the prevention and treatment of PIPN
, , Suleyman Semih Dedeoglu, Yunus Imren, Ahmet Keskin
ScienceRise: Medical Science pp 27-31; https://doi.org/10.15587/2519-4798.2021.229927

Abstract:
The aim: type 2B clavicle fractures with conoid ligament rupture are considered unstable. Although surgical treatment is recommended as the standard treatment modality for type 2B fractures, there is no consensus about the type of operative treatment. We aimed to evaluate results of surgical treatment with an anatomical distal clavicle plate using CC ligament augmentation. Materials and methods: 15 patients that diagnosed with distal clavicle fractures, who underwent surgery for unstable type 2 fractures. The average patient age was 38 years (range 24–52 years). All patients were male; the right clavicle was injured in 10 patients whereas the left clavicle was injured in 5 cases. Surgical treatment was done with a distal clavicle anatomic locked plate augmentation (ZipTight™) at all cases. The mean follow-up period was 24 months (range, 12–40 months). Results: bony union was achieved at a mean follow-up of 8 weeks (range 6-10 weeks). The mean Constant score was 97 (range, 92–100). There were no complications or no need to second operation. All patients achieved satisfactory full range of shoulder motion. Hardware removal was performed for prominence in one case after the union was completed. Conclusion: the augmented technique reported here, provides early motion, increased stability and anatomic healing compared to other conventional options. We recommend augmentative CC ligament repair techniques over the distal locking anatomic plate for type 2 fractures
Deepti Mandsorwale, Bindu Sharma, Munindra Pratap Singh
ScienceRise: Medical Science pp 4-8; https://doi.org/10.15587/2519-4798.2021.232830

Abstract:
The aim: to assess levels of circulating plasma ox-LDL in various subgroups with different CVD and their relationship with oxidative stress markers, MDA, catalase, and traditional coronary disease risk factors. Material and methods: a total of 215 subjects divided into four groups comprising 54 healthy controls, patients with the SAP were 52 persons, with the UAP 53 ones, and with the AMI there were 56 persons, respectively. Lipid profile parameters (TC, TG, HDL-C, LDL-C, and VLDL-C), plasma MDA, catalase were estimated by kit methods, TBARS method, and colorimetric assay respectively. Plasma Ox-LDL was estimation by competitive ELISA kit method (Mercodia) with the help of specific monoclonal antibody mAb4Eb. Results were present as mean ± SD, significance level at p-values<0.05 with Student’s unpaired t-test. Data analysis was performed by software package SPSS version 17.0. Results: it showed a highly significant (p<0.001) correlation in SAP, UAP, and AMI except for age in the SAP subgroup, moderately significant (p<0.01). Lipid profile except HDL-C was found highly elevated (p<0.001) in subgroups than in healthy controls. HDL-C was higher (p<0.001) in controls with respect to patient subgroups. Comparison of oxidative stress markers (MDA and catalase) and ox-LDH in control with patient’s subgroup indicates highly significant (p<0.001) correlation. The correlation between SAP & UAP was insignificant (p<0.05), SAP with AMI was significant (p<0.05), and UAP & AMI were highly significant (p<0.001). Large interquartile range in SAP subgroup suggesting scattered deviation in the mean value as compared to UAP and AMI showed in the box and whiskers plot and concluded that significantly elevated level of ox-LDL in SAP, UAP, and AMI subgroups indicate its diagnostic importance of CVD. Conclusions: study concluded that significantly elevated level of ox-LDL in SAP, UAP, and AMI subgroups indicate its diagnostic importance of CVD.
Tetiana Pylova
ScienceRise: Medical Science pp 15-19; https://doi.org/10.15587/2519-4798.2021.232642

Abstract:
The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries. Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %. Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042). Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown
Victoria Zabashta, Bogdan Fedak
ScienceRise: Medical Science pp 38-44; https://doi.org/10.15587/2519-4798.2021.232978

Abstract:
It is known that it is possible to affect the extent of myocardial damage and, as a result, mortality only in the first hours of its development. Therapeutic tactics in ACS with elevation of the ST segment involves the restoration of coronary blood flow, the main method is the reperfusion of the coronary artery by systemic thrombolysis or PCI in a specialized hospital. The effectiveness of treatment is inversely related to the time spent. The aim of the study was to examine the opinion of specialists on the feasibility of implementing the items of the protocol of emergency medical care for patients with ACS at the place of call. Materials and methods. During the study the method of expert evaluations, which consisted of gathering information by interviewing experts and summarizing the individual opinions of experts into a general concept was used. The experts were 48 emergency physicians. The method of expert evaluation included the following stages: development of the questionnaire; survey of experts; summary of examination materials; calculation of statistical indicators; interpretation of the obtained results and formulation of conclusions. Results. In order to assess the actions of the emergency team, depending on the need to conduct them for diagnosis and emergency care for patients with ACS at the scene, we calculated the feasibility indexes for each item of the protocol. In the future, we divided the treatment and diagnostic measures for ACS with ST segment elevation according to the level of expediency at the scene into four groups (n): n1 – high level, n2 – sufficient level and n3 – low level and n4 – very low level. According to the results of the ranking, the scope of measures to be implemented by the head of the emergency team at the ACS with elevation of the ST segment on arrival on call, as well as measures that, according to interviewed experts, are not required at this stage and can be carried out during transportation of the patient to a specialized hospital. Conclusions. Based on the results of the calculation of feasibility indices and subsequent ranking of treatment and diagnostic measures for the relevant groups (n1, n2, n3, n4) from 37 items of the study, to assist patients with ACS with ST segment elevation at the scene, it is recommended to perform 16
Inna Torianyk
ScienceRise: Medical Science pp 32-37; https://doi.org/10.15587/2519-4798.2021.232973

Abstract:
Ukraine's enzootic in accordance with natural focal diseases including babesiosis, makes the research undertaken relevant. Aim of the study: to determine the stages in organising the collection of biological materials in the study of the natural prototype of babesiosis. Materials and methods of research. Objects were murine rodents of Muridae family of genera Myodes, Microtus, Apodemus, Sylvaemus of natural habitats of forest-steppe zone of Ukraine, their ectoparasites-carriers of babesiosis - ticks of family Ixodidae. Collection, accumulation and registration of biological materials was carried out in the conditions of scientific expeditions. Regional geography of them concerned Volyn, Zhytomyr, Kyiv, Poltava, Sumy, Kharkiv, Chernihiv regions of Ukraine. Results. A total of 63 wild rodents were captured and used in the study. They were adult mice of both sexes, weighing 45-90 g, belonging to the Muridae family, genera Myodes, Microtus, Apodemus, Sylvaemus. Each group of animals gravitated to a specific geographical area of existence with appropriate attributes of flora and fauna. Collection and recording of those on rodent-feeding animals showed that Ixods differ according to phases of development, blood feeding, sex attributes and species affiliation. Conclusions. Nosological profile of babesiosis as a natural focal obligate-transmissible protozoan blood parasitosis determined methodology of epizootic assessment of area, natural prototype of disease, collection of biological material samples (BMS). BMS collection activities for babesiosis are seasonally dependent. Conducted researches should be focused on 3 links of epizootic or epidemic chain of babesiosis. Invasion by babesia ticks in optimal natural-climatic conditions of development, annual contact with animals led to formation of a latent focus of babesiosis
Oleksandr Belov
ScienceRise: Medical Science pp 33-37; https://doi.org/10.15587/2519-4798.2021.227876

Abstract:
The aim: to establish the features of socio-psychological adaptation in patients with depressive disorders, taking into account age and gender factor. Materials and methods. A clinical and psycho-diagnostic examination of 107 men and 138 women with depressive disorders using the method of diagnosis of socio-psychological adaptation of C. Rogers et R. F. Dymond was done. Results. A low level of socio-psychological adaptation in patients with depressive disorders has been established. There is a tendency to deteriorate socio-psychological adaptation with age, the most pronounced in level of adaptability, emotional comfort, payroll, integrated indicators of adaptation, self-acceptance and emotional comfort in all patients, and in men also in maladaptation, self-acceptance, external control, and women – regarding internality. The rates of lying, acceptance of others and dominance in men and women were highest in the middle age group (30-44 years), and lowest – in the older (over 45 years); this trend is also found in men for internal control and an integrated indicator of acceptance of others, and in women – for the desire for dominance. Differences in the comparison of the older age group with the average were more significant than in the comparison of the younger group (up to 30 years) with the average. Conclusions. Patients with depressive disorders are characterized by a low level of socio-psychological adaptation. In both men and women, the level of socio-psychological adaptation decreases with age, and in men this trend is more pronounced. The most significant deterioration in the state of socio-psychological adaptation in patients with depressive disorders occurs at the age of over 45 years; this trend is also more common in men
, Ihor Tokar, , Valerii Artemenko, Nataliia Semenko
ScienceRise: Medical Science pp 14-16; https://doi.org/10.15587/2519-4798.2021.227862

Abstract:
Hip fractures are a common pathology among patients older 50 years and cause disability, reduced duration and quality of life, even with adequate management and surgery. In the perioperative period, the most common complications leading to the death of patients are cardiovascular disease. about a hip fracture. The aim of our study was to determine the safest method of anesthesia in the context of acute myocardial injury during hip fracture surgery. The objectives of the study were to determine the frequency of postoperative myocardial damage in patients with hip fractures; compare the frequency of MINS with different types of anesthesia: general anesthesia (GA), spinal anesthesia (SA) and compartment psoas block with sciatic nerve block. Materials and methods. Randomized controlled trial was conducted from January 2018 to August 2019 in the medical center “Into-Sana” (Odessa, Ukraine). Patients with planned osteosynthesis of the proximal femur were randomized into 3 groups depending on the method of anesthesia: general anesthesia and postoperative systemic analgesia, spinal anesthesia and postoperative systemic analgesia, prolonged compartment psoas block with sciatic nerve block. Results. The study involved 90 patients. Acute postoperative myocardial injury was diagnosed in 17.6 % of cases. Postoperative elevation of troponins was significantly more often diagnosed in groups of patients with spinal anesthesia and general anesthesia compared to the group in which the psoas block compartment was used in combination with the sciatic nerve block. None of the patients had symptoms of myocardial ischemia and were not diagnosed with myocardial infarction. Hypotension was significantly more common in group 2 spinal anesthesia (OR 9 95 % CI 1.9-47, p=0.004) There was a direct moderate association between the intraoperative hypotension and the development of postoperative myocardial injury (r = 0.5). Conclusions. Prolonged compartment psoas block with sciatic nerve block intraoperatively is the safest method of anesthesia in the context of the development of postoperative myocardial injury. Intraoperative hypotension is associated with postoperative myocardial injury
ScienceRise: Medical Science pp 22-27; https://doi.org/10.15587/2519-4798.2021.228185

Abstract:
The aim: to compare disease-free survival time (DFS) in high-risk non-muscle-invasive bladder cancer patients treated with adjuvant hyperthermic intravesical chemotherapy and standard BCG therapy. Materials and methods: patients were divided into 2 groups. Group 1 (control) included patients who received adjuvant therapy after TURB with BCG vaccine (BCG therapy group; n=50), group 2 (study group) included patients (HIVEC® therapy group; n=46 ), who received adjuvant intravesical chemotherapy using a Combat BRS HIVEC® device for local hyperthermia. Results: median follow-up was 23 months (range 4 - 36). Tumor recurrence was reported in 19 patients receiving intravesical BCG therapy and in 8 patients receiving intravesical hyperthermic chemotherapy. The incidence of DFS in patients receiving chemohyperthermy was statistically higher than in patients receiving BCG therapy (log-rank test result: p=0.029). Conclusions: The method of hyperthermic intravesical chemotherapy significantly increased the 2-year disease-free survival rate - 82.6 % versus 62 % BCG therapy group (p=0.025). Its use in the future will allow increasing the frequency of organ-preserving treatment of patients with primary and recurrent muscular-non-invasive bladder tumors
Asif Mansyrov, Viktor Lytovchenko, Yevgeniy Garyachiy, Andriy Lytovchenko, Olena Miroshnichenko
ScienceRise: Medical Science pp 4-9; https://doi.org/10.15587/2519-4798.2021.227854

Abstract:
The aim: to conduct a comparative study of osteoreparative regeneration, namely in the periosteal and intermediate areas of the cortex, during intramedullary osteosynthesis of the femur of rats with and without reaming of the bone marrow canal. Materials and methods. The work is based on the results of an experimental study conducted on 56 white mature laboratory rats, which simulated diaphyseal fracture of the femur and performed stable nail osteosynthesis with reaming of the bone marrow canal in the first series and without reaming in the second series of the experiment. Histological examination of the specimens was performed on the 7th, 14th, 28th and 90th day after surgery. Results. The procedure of reaming the bone marrow canal reduces the potential reparative capacity of bone tissue in the endosteal area and leads to “distorted” activation of the process of the cortex restructuring. There is a significant activation of osteoclastic resorption. Conclusions. Bone fusion is more active with the use of intramedullary fixator without reaming of the bone marrow canal, because its reaming reduces the manifestations of reparative potentials in the endosteal region and leads to excessive activation of the resorptive process of restructuring the cortex of both endosteal and central part
Marine Georgiyants, Olexii Popsuishapka, Victor Ryndenko, Sergiy Kursov, Volodymyr Babalian, Nataliia Bohuslavska
ScienceRise: Medical Science pp 43-47; https://doi.org/10.15587/2519-4798.2021.228780

Abstract:
The relevance of the topic is due to the prevalence of lower limbs injuries in people of working age, the complexity of the methods of their surgical treatment and the problem of finding the optimal method of anesthesia in terms of efficiency and safety. Objective of the study: to conduct a systematic analysis of modern scientific literature data on the possibility of using anesthesia methods during surgical interventions and in the case of anesthesia for injuries of the lower limbs in people of working age. Materials and methods. A search for scientific sources was carried out in the scientometric databases Scopus and Web of Science, Google Scholar, archives of journals using the keywords "general anesthesia", "regional anesthesia", "injuries of the lower limbs", "young people", "general anesthesia". The search depth was 8 years. Conclusions. The problem of choosing the method of anesthesia during traumatological surgeries in people of working age has no final solution. In general, both general and regional anesthesia can be used, despite their advantages and the possibility of complications in each case. However, in clinical practice over the past decade, general anesthesia is not always the best method of pain relief. But regional methods have less effect on the vital functions of the body, and the use of ultrasound navigation and modern local anesthetics in a minimum sufficient amount makes anesthesia conduction more effective and safe. The disadvantages of regional anesthesia can be avoided by combining it with general anesthesia. However, in the available literature, there are no recommendations on the differentiated choice of the method of anesthesia for surgical interventions on the lower limbs in people of working age and the factors that influence this
Yuriy Yarov
ScienceRise: Medical Science pp 38-42; https://doi.org/10.15587/2519-4798.2021.228287

Abstract:
The usage of the principle of optimal management, namely such effects on complicated forms, when the course of the disease is close to that of uncomplicated course of the disease is very promising in drug therapy of patients with generalized periodontitis. The aim is to study the intensity and duration of the phases of wound healing of the mucosa after spontaneous periodontitis surgery accompanied by normo-, hyper- and hyporeactivity of the body by cytological examination of smear-imprints of wound exudate. Materials and methods: The experiments were performed on 24 adult mongrel dogs divided into three equal groups. In the first group, drugs that disrupt the reactivity of the organism were not used (normoreactivity of the organism). In the second group, the animals were simulated a сondition of hyperreactivity, in the third group – the hyporeactivity of the organism. All the animals with spontaneous periodontitis underwent a patchwork surgery. In the period after surgery, cytological examination was performed on the 1st, 4th, 6th and 9th day of the experiment. Results: It has been revealed that in cases of the normal reactivity of the organism the following periods of cellular reactions during the healing of the gums mucous membrane can be differentiated within the appropriate terms: the period of degenerative-inflammatory changes (1st day), active granulocyte-macrophage reaction (4th day), reparations (6th day) and the period of increase of reparative processes with a decrease in the overall cellular response (9th day). Examination of smear-imprints after surgical treatment in animals with spontaneous periodontitis with hyper- and hyporeactivity of the body allowed to identify the same periods of cellular reactions during the healing of the gingival mucosa, as in cases of normoreaction with hyperreation.Tthe intensity and duration of the wound healing phases differed from those which are typical for normoreactivity of the body: granulocyte-macrophage reaction was more pronounced and lasted longer until the 6th day, so later only on the 9th day there were cellular signs of regeneration. With hyporeaction, the intensity and duration of the wound healing phases differed from those which are typical for normoreactivity of the body: granulocyte reaction occurred later (only on the 6th day) and lasted longer, signs of active regeneration appeared later on the 9th day. Therefore, postoperative wound healing in animals with impaired body reactivity was delayed for 3-4 days. Conclusions: Thus, direct medical correction with transforming intensity and duration of the phases of the wound process which are characteristic for impaired reactivity of the body into the phases which are typical for normoreaction is essential. It provides synchronization of necrotic and reparative processes and creates conditions for normal uncomplicated healing of periodontal soft tissues
Volodymyr Kozko, Maryna Hvozdetska-Shaar, , Kateryna Yurko, Ganna Solomennyk
ScienceRise: Medical Science pp 28-32; https://doi.org/10.15587/2519-4798.2021.228189

Abstract:
It was shown that in HIV-infected patients, pathomorphological changes in the white matter in the form of demyelinization are already observed in the early stages of the disease. The most studied marker of this process is myelin basic protein that can be detected in cerebrospinal fluid or serum immediately after acute myelin breakdown. The aim. To assess the diagnostic value of myelin basic protein content in serum and cerebrospinal fluid of HIV-infected individuals with 4th clinical stage and central nervous system opportunistic infections. Materials and methods. Using ELISA with diagnostic kit “MBP ELISA” (Ansh Labs, USA), we studied the myelin basic protein content in serum and cerebrospinal fluid of 53 HIV-infected patients with 4th clinical stage and central nervous system opportunistic infections depending on its etiology, the outcome of the diseases and according to Glasgow coma scale score. As well correlation analysis with some laboratory and clinical indicators was performed. Results. We found significantly increased myelin basic protein content in both cerebrospinal fluid and serum of HIV-infected patients 4th clinical stage with central nervous system opportunistic infections compared to control (p˂0.01), which indicate the presence of active demyelinization in central nervous system. The highest cerebrospinal fluid myelin basic protein was registered in patients with an unfavourable outcome of the disease, as death or residual neurologic deficit, and patients with cerebral toxoplasmosis. The cerebrospinal fluid myelin basic protein had an association with the size of white matter lesions on magnetic resonance imaging and serum myelin basic protein content. Conclusions. Myelin basic protein detection in cerebrospinal fluid as well as in serum can serve as an additional quantitative marker of myelin disruption, which can be used along with magnetic resonance imaging for the diagnosis improvement and prognosis of central nervous system opportunistic infections in HIV-infected individuals with 4th clinical stage
Stanislav Zaychenko, Ruslan Tkachenko
ScienceRise: Medical Science pp 17-21; https://doi.org/10.15587/2519-4798.2021.228555

Abstract:
The aim of the study was to evaluate the influence of different variants of anesthesia, including low-opioid (LOA) and opioid-free anesthesia (OFA), on the dynamics of the inflammatory response during laparoscopic hysterectomy. Materials and methods: 102 patients were randomly allocated into 3 groups: 37 women assigned to receive a standard opioid-based anesthesia (OBA group), 33 women – LOA group and 32 patients – OFA group. In the LOA group, the amount of fentanyl was halved and lidocaine infusion and ketamine were additionally infused during induction. In the OFA group, ketamine, lidocaine and dexmedetomidine were additionally infused instead of fentanyl. Results: Conducting a laparoscopic hysterectomy is accompanied by the activation of the inflammatory process and is manifested by an increase in the content of leukocytes and granulocytes, and a decrease in the number of lymphocytes, which is accompanied by an increase in the leukocyte index of intoxication. These changes were most significant in patients undergoing standard anesthesia. The activation of the inflammatory process is confirmed by an increase in the level of pro-inflammatory IL-6 in all groups from 28.8 % to 92.9 %, and it was most pronounced in patients who underwent LOA. In the same group, the greatest increase in the level of anti-inflammatory IL-10 was also noted, the level of which was 115.4 % higher (p=0.036) than in the control group. An increase in the content of the pro-inflammatory cytokine IL-6 in each group and a parallel increase in anti-inflammatory IL-10 in groups 2 and 3, with a simultaneous decrease in it in group 1 led to a significant increase in the IL-6 / IL-10 ratio in the control group. This indicator was significantly higher than in groups 2 and 3 by 42.3 % (p=0.043) and 52.7 % (p=0.041), respectively, while the IL-6 / IL-10 ratio in these groups was not differed from the initial state. Conclusion: Laparoscopic hysterectomy is accompanied by activation of the inflammatory process and is manifested by an increase in the content of leukocytes and granulocytes and a decrease in the number of lymphocytes, which is accompanied by an increase in the leukocyte index of intoxication. These changes were most significant in patients undergoing standard anesthesia. The use of LOA and OFA is accompanied by a lower activation of the inflammatory response in laparoscopic hysterectomy than in standard anesthesia, but requires further study
Olha Proshchenko, Iryna Ventskivska, Natalia Kamuz, Svitlana Markitanyuk
ScienceRise: Medical Science pp 10-13; https://doi.org/10.15587/2519-4798.2021.228295

Abstract:
The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.
Olena Kuzenko, Yevhen Kuzenko, Yuri Demin
ScienceRise: Medical Science pp 14-20; https://doi.org/10.15587/2519-4798.2021.219921

Abstract:
Chromium galvanic production have leaded to biosphere pollution. Therefore advisable to study of role in the neurodegenerative development in retinal diseases under experimental conditions. The aim is to study the Enterosgel effect on morphological changes in rats retina with Cr(VI) – induced retinopathy. Materials and methods. An experimental study had carried out on 72 outbred white male rats. The rats had divided into 3 groups: I – control group of intact rats (n = 24). Control rats were received drinking water, II group – rats (n = 24), were received drinking water with Cr (VI) (K2Cr2O7) – 0.02 mol/L, III group – animals (n = 24) were received drinking water with K2Cr2O7– 0.02 mol/L and hydrogel methylsilicic acid (Enterosgel) at a dose of 0.8 mg/kg per day as a corrector. The animals had been decapitated under ether anesthesia. The retina had been studied on days 20, 40 and 60 of the experiment. Morphologically and morphometrically they had analyzed. Results. According to histological studies, it has proved that Cr (VI) causes dystrophic and degenerative changes in all rats retina layers. They increase as the duration of the experiment. The use of Enterosgel as a corrective therapy showed positive results in restoring the morphological structure of rats retina. After Enterosgel 20 days using as a corrector of Cr (VI) exposure, there is a barely noticeable swelling of the outer and inner nuclear layers. Other layers of the retina, morphologically, look undamaged. Forty days Enterosgel treatment have outer and inner nuclear layer edema of retina of animals persists but does not increase. It is easy noticeable swelling of the outer and inner layers of mesh, but no signs of damage processes of cell populations nuclear layers. State ganglionic layer and nerve fiber layer entirely satisfactory. These pathological changes are not critical. After 60 days from the beginning of loading of Cr (VI) and application of Enterosgel in the retina of rats there are initial degenerative changes in the photosensory layer. Cystic dilated outer segments of rods and cones were visible throughout, and areas of their fragmentation were observed. Ganglion neurons are not damaged, but their axons appear somewhat thickened and fluffy. But in general, the typical structure of the retina is preserved. Conclusions. Chromium-induced toxicity in rats is characterized by pronounced histological and morphometric changes and retinal thickness, which appear after 20 days, increase by 40 days and acquire maximum transformations after 60 days of the experiment. The use of Enterosgel improves picture morphological structures of the retina in rats under the influence of Cr (VI). The changes were expressed on days 20 and 40, which indicates the presence of protective properties for the retina
Dmytro Zabolotnyi, Oleksii Minaiev
ScienceRise: Medical Science pp 21-28; https://doi.org/10.15587/2519-4798.2021.224604

Abstract:
The aim. To develop a method for endonasal endoscopic dacryocystorhinostomy (EEDCR) and evaluate its effectiveness in monitoring patients in the early postoperative period. Materials and methods. The study group (1st group) consisted of 45 patients with chronic dacryocystitis (CD), who underwent EEDCR according to the developed method, the comparison group (2nd group) included 36 patients who, after performing the developed EEDCR, an implant was installed in the dacryorhinostoma zone. The control group (3rd group) included 28 patients who underwent EEDCR according to the generally accepted method. Patients of groups 1 and 2 were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography of the lacrimal ducts in the preoperative period according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. Reliably the best results of restoring lacrimation function were in subgroups 1A and 1B already from the 3rd day of observation after surgery, as well as in the subsequent periods of observation. The worst values of lacrimation function were recorded in the control clinical group with a statistically significant difference from other groups (p0.05). Results. A method of EEDCR has been developed, a comparative analysis of groups of patients according to the above indicators has been performed when observing patients in the early postoperative period. On the first day after surgery, the mean score of the severity of lacrimation according to the Munk scale significantly decreased in all groups and gradually decreased on the 7th day and after 2 weeks (p0.05). Conclusions. The developed EEDCR method complies with the principles of sparing surgery, is effective in the treatment of patients with CD, while there is a faster rate of recovery of the lacrimal function and mucosa, improves the quality of life of patients
Aleksey Vlasov
ScienceRise: Medical Science pp 49-52; https://doi.org/10.15587/2519-4798.2021.224662

Abstract:
In the presented work, we have assessed the features of peripheral oxygenation in children with congenital malformations of the surgical profile under various types of combined anesthesia. The aim of the study. To assess the state of peripheral oxygenation in newborns and infants with congenital malformations with various types of anesthetic support. Materials and research methods. A retrospective study included 150 newborns and infants with congenital malformations of the surgical profile, depending on the anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). The parameters of pulse oximetry were analyzed: peripheral oxygenation, heart rate. Additionally, the concentration of oxygen in the respiratory mixture of children was taken into account. Research results. Peripheral saturation did not critically decrease at all stages of observation, with the exception of a decrease in the indicator in children of group I compared with group III at the stage of induction into anesthesia (97.79±2.45 versus 98.79±1.63, at p˂0.05, respectively) and at the most painful moment of the operation (96.29±3.47 versus 98.10±2.47, with p˂0.05). At the painful moment of the operation, it was in children of group I that a drop in heart rate was noted compared to group III (127.98±13.77 and 136.10±15.37, respectively, with p˂0.05) and group II (134.02±18.43, at p>0.05) against the background of a decrease in SpO2. Newborns and group I infants required higher oxygen concentrations in the breathing mixture. A significant difference in the indicator is noted between groups I and III at the traumatic stage – 0.47±0.29 and 0.33±0.2, with p˂0.05, respectively, and immediately after the operation – 0.34±0,19 and 0.26±0.13, with p˂0.05, respectively. Conclusions. The expediency and effectiveness of pulse oximetry for children with congenital malformations at all stages of anesthetic support during surgical treatment was confirmed. The risk group for the formation of oxygen deficiency in organs and tissues, the occurrence of pain during the operation were newborns and infants, for whom combined anesthesia was chosen in the form of an inhalation method and regional anesthesia. In the case of the appointment of this type of anesthetic support, it is necessary to more closely monitor the indicators and promptly correct the deterioration of the child's condition
Olga Nedtzvetskaya, Irina Bagmut, Irina Soboleva, Irina Pastukh, Natalia Goncharova
ScienceRise: Medical Science pp 29-33; https://doi.org/10.15587/2519-4798.2021.223486

Abstract:
Modern scientists are increasingly paying attention to the molecular mechanisms of diseases of the visual organ in conditions of anthropogenic pollution. Environmental pollution is mainly due to atmospheric emissions from the metallurgical, automotive, aviation and petrochemical industries, waste from livestock farms and due to the use of mineral fertilizers and pesticides. Ukraine ranks one of the first in Europe in terms of the amount of industrial dirt per capita. The aim of this literature review was to analyze the role of extra- and intracellular protein structures and molecular mechanisms of some pathological processes of the visual organ that occur under the influence of anthropogenic stress on the human body. Material and methods. Scientific publications in foreign and Ukranian journals on relevant topics in the last 5 years, the Internet resources. Research results and their discussion. The literature review expanded the scientific understanding of the role of reparative enzyme (MGMT), vascular endothelial growth factor, Bcl-2 family proteins, p53 and Ki 67 proteins, matrix metalloproteinases in some ophthalmic pathology. Anthropoecological environmental factors have been shown to cause oxidative stress due to mitochondrial dysfunction and apoptosis, which are a component of a complex pathophysiological process in the most common diseases of the visual analyzer. Conclusions. The study of molecular mechanisms of occurrence and progression of diseases of the visual organ with the participation of protein factors makes it possible to expand the understanding of the pathogenetic links of their development in order to predict the course of the pathological process, adequate treatment and prevention
Olena Koreniuk
ScienceRise: Medical Science pp 53-56; https://doi.org/10.15587/2519-4798.2021.224333

Abstract:
The relevance of the problem of recurrent respiratory diseases in children with severe neurological pathology is due to the high frequency, severity of clinical symptoms and the protracted nature of their exacerbations, as well as the tendency to chronicity of the pathological process. The aim of the research was to study the respiratory microbiota to optimize antibacterial therapy of recurrent respiratory diseases. Materials and methods: the 16 children with severe neurological pathology at repeated respiratory diseases were examined. We used a microbiological examination of the upper respiratory tract using a deep smear from the oropharynx to identify a possible causative agent of the disease. Research results: the pronounced imbalance of the respiratory microbiota, corresponding to II and III degrees of dysbiotic disorders, was revealed in the examined children. The feature of the microflora of the upper respiratory tract was the dominance of Pseudomonas aeroginosa, intestinal opportunistic microflora (Klebsiella pneumoniae, Proteus vulgaris) and their frequent combination with Streptococcus pyogenus, Staphylococcus aureus and yeast-like mushrooms of the Сandida genus. The maximum degree of respiratory microbiota disorders was noted in the group of children with congenital malformations of the brain and correlated with the severity of bronchopulmonary diseases. The analysis of the pathogenic microflora sensitivity to antibiotics showed high resistance of the identified microorganisms to most medicines. Conclusions: respiratory pathology in children with neurological disabilities is characterized by a recurrent and chronic bronchitis with a tendency of a protracted course which determines the duration of antibiotic therapy. The use of a non-invasive technique for the respiratory microbiota studying makes it possible to identify suspected pathogens of bronchopulmonary diseases and optimize their treatment
Tamara Pasiieshvili, Natalia Zhelezniakova, Tetiana Bocharova, Lyudmila Pasiyeshvili
ScienceRise: Medical Science pp 4-8; https://doi.org/10.15587/2519-4798.2021.224335

Abstract:
The aim of the work. To study the effect of concomitant autoimmune thyroiditis (AIT) on the pathomorphological features of lesions of the esophageal mucosa in young patients with gastroesophageal reflux disease (GERD). Material and research methods. The study included 165 individuals. The contingent of the surveyed was students of Kharkov higher educational institutions. The main group consisted of 120 patients with a combined course of GERD and AIT, the comparison group included 65 individuals with an isolated GERD. The morphological form of the GERD was revealed during esophagogastroduodenoscopy (“Fuginon” system). A histomorphological study of the obtained biopsy material from the mucous membrane of the esophagus was carried out. Samples were studied on an Olympus BX-41 microscope. Morphometric study of the esophageal mucosa was performed using the Olympus DP-Soft. Research results. Histological examination of biopsy specimens revealed that the main pathomorphological signs of GERD in both groups were hyperplasia of the basal zone, lengthening of epithelial papillae, leukocyte infiltration, intercellular edema, expansion of the intercellular space, dystrophic changes, submucous fibrosis, the presence of severe inflammatory infiltration in the submucosal layer. Presence of concomitant AIT was associated with a statistically higher frequency of occurrence of certain signs: hyperplasia of the basal layer of the epithelium, elongation of the papillae, epithelial edema, expansion of the intercellular space, dystrophic changes in the epithelium (p
Oleksandr Tkachyshyn
ScienceRise: Medical Science pp 9-13; https://doi.org/10.15587/2519-4798.2021.224387

Abstract:
The aim: to determine the peculiarities of the indices of coagulation hemostasis in patients with the former occurrence of hemorrhagic stroke, developed as a complication of essential hypertension, in comparison to the hypertensive patients without complications. Materials and methods. There were formed 2 groups of patients: the main group and the comparison group. The main group included 20 patients (10 women and 10 men, middle age 52.9±1.7 (M±m) years old) who had undergone hemorrhagic stroke as a complication of essential hypertension 6 months and more previously, had no normalization of blood pressure over this period of time. The comparison group included 20 patients (10 women and 10 men, middle age 52.5±1.7 years old) suffered from essential hypertension without complications. They were matched groups according to key indicators. All the above-mentioned people underwent fasted analysis of venous blood with detection of coagulation hemostasis indices. Results. In the main and the comparison group the indices of coagulation hemostasis were the following ones, respectively: thrombin time 10.6±0.6 and 11.5±0.8 s, international normalized ratio 1.0±0.1 and 1.0±0.1, activated partial thromboplastin time 50.4±2.1 and 44.7±1.8 s (p48 s, XIIa-dependent fibrinolysis 120 %. This information should be taken into account while prescribing the treatment, influencing hemostasis indices, in a category of hypertensive patients after hemorrhagic stroke
Olena Bielykh, Marine Georgiyants, Olena Vysotska, Anna Strashnenko
ScienceRise: Medical Science pp 34-39; https://doi.org/10.15587/2519-4798.2021.224892

Abstract:
The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients. Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated. Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p
Tinglan Zuo, Sergey Solyarik
ScienceRise: Medical Science pp 40-48; https://doi.org/10.15587/2519-4798.2021.224654

Abstract:
The aim. Compare the hemodynamic effects and safety of infusion of the balanced crystalloid solution, sorbitol-based solution, and standard solution (0.9 % sodium chloride). Materials and methods. A prospective randomized clinical trial was carried out, the study included 68 adult patients, who had the active surgical infection, and were in a state of septic shock. A corresponding solution with a volume of 500 ml was used for resuscitation. Hemodynamic and other clinical and laboratory parameters were monitored. Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups before the 45th minute (p>0.05), from the 50th minute to 2 hours they were found only between the NS and Sorb groups (p 0.05). Cardiac output (CO) and oxygen delivery (DO2) did not differ until 35 min (p> 0.05) and up to 40 min (p> 0.05); after 40 min and 45 min, a significant difference was also found between the Sorb and NS groups (p 0.05). Conclusions. In our study, the balanced polyionic solution with 1.9 % sodium lactate and 6 % sorbitol was the most effective and safe infusion solution for the treatment of septic shock, it can be used as a supplement to balanced crystalloid solutions. When using a balanced polyionic solution (Ringer's acetate) with 0.07 % L-malonic acid, the platelet count should be monitored more often
Tetyana Litovchenko, Oleksandr Bilchenko, Vladimir Malakhov, Olga Dubenko, Olga Sukhonosova, Viktoriia Bokatuieva, Marianna Markova, Vadym Nikonov
ScienceRise: Medical Science pp 4-9; https://doi.org/10.15587/2519-4798.2020.217557

Abstract:
Мета – з’ясування ролі вірусних уражень центральної нервової системи (ЦНС) у розвитку епілептичних нападів і епілепсії.Матеріали та методи: аналіз даних наукової літератури. В огляді дискутується роль неепідемічних вірусних енцефалітів та вірусу імунодефіциту людини у розвитку гострих епілептичних нападів і епілепсії, проаналізовано сучасні епідеміологічні дані та фактори ризику.Результати. Показано, що вірусні інфекції часто ускладнюються епілептичними нападами в гострій фазі захворювання (ранніми нападами) і призводять до підвищеного ризику розвитку епілепсії в подальшому. Механізми розвитку ранніх і пізніх судом різні. Виключаючи герпетичний енцефаліт, коли ризик епілепсії за ранніх нападів – до 60 %, ризик розвитку пізніх судом під час інших вірусних енцефалітів достеменно не з’ясовано. Своєчасне лікування вірусної інфекції і ранніх судом може знизити ризик розвитку епілепсії. Лікування епілепсії внаслідок інфекційного ураження ЦНС аналогічне іншим симптоматичним епілепсіям, а протиепілептичний препарат обирається відповідно до семіології нападів. Взаємодія між ним та препаратами протиінфекційної дії може суттєво змінити концентрацію в крові кожного з них, що призведе до зниження ефективності або до токсичності. Це особливо важливо для осіб з інфекцією вірусом імунодефіциту людини, у яких антиретровірусні засоби мають значну взаємодію з протиепілептичними препаратами. Оскільки напади та епілепсія пов’язані з тяжкістю та ускладненнями основної інфекції, рання агресивна терапія запобігає розвитку пізніх судом та епілепсії.Висновки. Інфекції центральної нервової системи (ЦНС) призводять до 15 % всіх випадків вперше виявлених симптоматичних епілептичних нападів. 20-річний ризик непровокованих нападів і епілепсії після інфекцій ЦНС складає від 2,4 % до 22 %. Ризик залежить від етіології інфекції, локалізації ураження і тяжкості; він високий за герпетичних енцефалітів
Aleksey Oparin, Anna Titkova, Kostiantyn Stepanchenko, Vira Tseluyko, Maryna Kochuieva, Oleksii Korzh
ScienceRise: Medical Science pp 10-14; https://doi.org/10.15587/2519-4798.2020.220010

Abstract:
Мета роботи - провести огляд літератури для вивчення найважливіших і складних аспектів у діагностиці та лікуванні гастроезофагеальної рефлюксної хвороби, які трапляються у практиці сімейного лікаря.Результати. Гастроезофагеальна рефлюксна хвороба стає все більш актуальним захворюванням для молодого и працездатного населення, що надає йому не лише медичний, а й економічний аспект. Поєднана патологія, особливо при наявності позастравохідних проявів, значно ускладнює діагностичні заходи. Для покращення діагностики необхідно враховувати не тільки стравохідні, але і позастравохідні прояви, а також нічну симптоматику. Використання ультразвукового методу дослідження шлунку та верхньої третини стравоходу з водним навантаженням може бути перспективним в діагностиці неерозивної форми гастроезофагеальної рефлюксної хвороби. Лікування коморбідної патології також має свої труднощі та потребує комплексного підходу.Висновки. Гастроезофагеальна рефлюксна хвороба є лідером серед шлунково-кишкових звхворювань та мультиморбідних патологій. Значний ріст серед молодих людей може призвести до збільшення кількості ускладнень. Неерозивна форма цього захворювання при наявності позастравохідних проявів та в сполученні з коморбідним перебігом ускладнюють діагностику. При поєднаній патології змінюється клінічна картина, відбувається взаємне обтяження захворювань. Це потребує додаткового вивчення патогенетичних механізмів та разработки на основі цього лікувально-діагностичних заходів
Sergii Estrin, Tetiana Kravchenko, Anton Pechenenko
ScienceRise: Medical Science pp 23-31; https://doi.org/10.15587/2519-4798.2020.220021

Abstract:
Мета: дослідити морфологічні і морфометричні зміни міокарда на тлі клітинної кардіоміопластики при експериментальному інфаркті міокарда.Матеріали та методи: Експеримент виконувався на 142 щурах лінії Вістар-Кайота, вагою 200-220 г, які містилися в умовах віварію відділу експериментальної хірургії ДУ «Інститут невідкладної і відновної хірургії ім. В.К. Гусака НАМН України» в період з 2012 по 2013 рр. Породу Вістар-Кайота використовували тому, що вона є інбредною, що мінімізує реакцію відторгнення, завдяки її генетичної однорідності. Тварини утримувались у віварії в умовах 12-годинного світлового дня, кімнатної температури і доступу до води та їжі at libitum при температурі повітря +20 - +22°С, вологості не більше 50 %, в світловому режимі – день-нічь. Використання тварин в експерименті проводилось відповідно з правилами, регламентованими «Європейською конвенцією по нагляду і захисту хребетних тварин, які використовуються в експериментальних та інших наукових цілях» (Страсбург, 1986), Директиви Ради Європейської Співдружності від 24.11.86 г. та розпорядження МОЗ України №32 від 22.02.88 р.. Індукцію інфаркту міокарда (ІМ) здійснювали за розробленою нами методикою в умовах загального знеболення. Окрему групу становили 20 самців, яких ми використовували в якості донорів мезенхімальних стовбурових клітин (МСК) задля подальшого дослідження по Y-хромосомі хоумінга клітин в організмі. Культивування МСК проводили в суміші живильних середовищ DMEM / F12, 1:1, (Sigma, США). Матеріалом для морфологічних досліджень були ділянки міокарда лабораторних тварин. Для оцінки морфометричних показників виконували гістохімічні методики за прописами, які наведені у вказівках з гістохімії. Імуногістохімічне дослідження проводили на парафінових зрізах, товщиною 5–6 мкм непрямим методом Кунса за методикою Brosman (1979 р.).Результати. Було встановлено, що клітинна кардіоміопластіка значно покращує структуру постінфарктного серця, що проявляється в зменшенні зони рубця і сполучної тканини відповідно, збільшенні кількості судин і відсотка збережених м'язових волокон. Найкращі результати були досягнуті при інтраміокардіальному введенні, що вимагає підтвердження даного факту при клінічному дослідженні.Висновки. Клітинна кардіоміопластіка при будь-якому способі введення клітинного трансплантата позитивно впливає як на морфологічний субстрат серця у вигляді зменшення розмірів рубця при постінфарктному ремоделюванні, збільшення кількості новостворених судин і збільшення відсотка збережених кардіоміоцитів. Це відбувається за рахунок хоумінга МСК в зону ішемії та спільності двох механізмах - безпосереднього диференціювання в клітини ендотелію судин серця, а також за рахунок паракринного ефекту
Nataliia Chuiko
ScienceRise: Medical Science pp 15-22; https://doi.org/10.15587/2519-4798.2020.220202

Abstract:
Мета. Визначити стан ендотелію судин головного мозку та роль імунокомпетентних клітин у розвитку ішемічного інсульту на фоні атеросклерозу.Матеріали і методи. Досліджені судини головного мозку 50 померлих з ішемічними інфарктами головного мозку, 50 – з вираженим атеросклерозом судин головного мозку без проявів ЦВЗ та 50 померлих від причин не пов'язаних із ЦВЗ та атеросклерозом (група порівняння). Гістологічні препарати судин фарбували гематоксиліном-еозином, трихромом за Масоном, а також проводили імуногістохімічне дослідження з використанням маркерів CD31/PECAM-1(Endothelial Cell Marker)Ab-1, CD4 (CD4 Ab-8), CD8 (SP 16), CD20 (CD20 Ab-1) CD68 та (CD68/Makrophager Marker Ab-4).Результати. Ендотелій судин головного мозку при ішемічних інсультах та вираженому атеросклерозі набуває структурних змін у вигляді розриву, десквамації і відшарування, утворення скупчень десквамованих ендотеліоцитів. Говорячи про пошкодження ендотелію, не слід думати, що зміни повинні відбуватись на макроскопічному рівні, достатньо ураження ендотелію на клітинному рівні. В розвитку атеросклерозу значне місце посідають імунокомпетентні клітини, адгезія моноцитів на лумінальній поверхні артерій, наявність великої кількості цих клітин під ендотелієм, а більш зрілих макрофагів у глибині інтими, свідчить про поступлення цих клітин з крові в стінку артерії, які активно потенціюють утворення атеросклеротичної бляшки.Висновки. Порушення ендотеліального покриву із зміною морфології ендотеліальних клітин, сприяють розвитку атеросклеротичних бляшок. Лімфоцити і макрофаги складають молекулярну основу багатьох важливих процесів, включаючи запальну реакцію і імунну відповідь
Maryana Sloboda, Taras Pupin
ScienceRise: Medical Science pp 50-53; https://doi.org/10.15587/2519-4798.2020.221130

Abstract:
Розвиток та перебіг захворювань пародонта у осіб молодого віку характеризується в’ялою клінічною симптоматикою, а на початковій стадії протікає безсимптомно, що значно ускладнює його своєчасну діагностику. Тому особливо важливими є пошук методів ранньої діагностики та прогнозування захворювань пародонта, що дозволить проводити раціональну комплексну профілактику. Серед причин виникнення захворювань пародонта основна роль належить мікроорганізмам зубної бляшки, що має важливе діагностичне значення.Мета дослідження. Дослідити склад змішаних мікрокультур бактерій субгінгінгівальної зубної бляшки в осіб молодого віку з різними нозологічними формами захворювань пародонта та оцінити ступінь впливу мікробного фактору на розвиток захворювань пародонта.Матеріали і методи. Вивчений стан мікробіоценозу в субгінгівальній зоні у 104 осіб із захворюваннями пародонта та у 94 осіб з інтактним пародонтом. Для оцінки вираженості впливу типів виділених мікрокультур субгінгівальної зони на розвиток та прогресування захворювань пародонта у осіб молодого віку був застосований метод альтернативного послідовного аналізу Вальда та формули Байєса.Результати. При розвитку запального процесу в тканинах пародонта в більшості випадків виявляли культури, що характеризувалися наявністтю поліморфних грамнегативних бактерій, що розвивались, фіксуючись на твердій фазі, а в рідкій фазі містили кокову мікрофлору (53,01±5,48 %). При розвитку генералізованого пародонтиту виявляли збільшувалася кількість мікрокультур із переважанням грам-негативної мікрофлори з вираженими адгезивними властивостями, що зумовили розвиток цих мікрокультур на твердій фазі (61,9±10,6 %). Розрахунок прогностичних коефіцієнтів показав, що наявність мікрокультур, що розвивались у планктонній фазі, але містили грамнегативні паличкоподібні бактерії та коки мали високий ступінь значення у плані розвитку захворювань пародонта (+7,46). Висновки. При розвитку патологічного процесу в тканинах пародонта, стан мікрофлори змінювався в напрямку збільшення грам-негативної поліморфної мікрофлори з вираженими адгезивними властивостями, які здатні до агрегації (до 53,01 % в хворих з катаральним гінгівітом, до 90,48 % – з генералізованим пародонтитом). Результати підрахунку вираженості впливу типів виділених мікрокультур субгінгівальної зони на розвиток та прогресування захворювань пародонта у осіб молодого віку показали, що прогноз розвитку захворювань пародонта, у чималому ступені, залежить від стану мікробіоценозу субгінгівальної зубної бляшки
Viorika Akimova, Lyubov Lapovets, Nataliia Lapovets, Oksana Tsymbala
ScienceRise: Medical Science pp 32-35; https://doi.org/10.15587/2519-4798.2020.217982

Abstract:
Актуальною проблемою в медицині залишається своєчасна діагностика різних патоморфологічних форм гострого апендициту (ГА), гострого мезаденіту (ГМ) та абдомінального туберкульозу (АТ). Нейтрофільні гранулоцити є першою ланкою неспецифічної імунної відповіді при запаленні, яка реалізується через фагоцитоз та внутрішньоклітинні бактерицидні системи.Метою дослідження було встановити особливості функціонального стану нейтрофільних гранулоцитів у крові хворих на ГА, ГМ та АТ.Матеріали та методи. Обстежено 30 практично здорових, 27 хворих на ГМ, 40 хворих на гострий флегмонозний апендицит; 20 хворих на гострий гангренозний апендицит, 30 хворих на АТ. У крові визначали фагоцитарну активність нейтрофілів у тесті із гранулами латексу, окисно-відновну активність (спонтанний НСТ-тест), визначали катіонні лізососмальні білки у цитохімічному тесті з бром феноловим синім.Результати досліджень. Фагоцитарна активність нейтрофілів у хворих на деструктивні форми ГА та АТ була нижчою, а у групі хворих на ГМ – не відрізнялася від контрольних значень. Фагоцитарний індекс нейтрофілів у хворих на деструктивні форми ГА був у 1,5 рази нижчим (р<0,05), а фагоцитарне число у хворих на гангренозну форму ГА у 1,7 рази нижче від показника у здорових осіб (р<0,05). У хворих на ГМ відсоток НСТ-позитивних нейтрофілів був в 1,3 рази більшим, у хворих на деструктивні форми ГА та АТ – у 2 рази вищим, від показника у групі здорових осіб (р<0,05). Кількість КЛБ-вмісних нейтрофілів, також була вищою при деструктивних формах ГА, а при ГМ та АТ – не відрізнялася від значення у контрольній групі.Висновки. Встановлено, що нейтрофіли периферичної крові за умов гострого деструктивного запалення та абдомінального туберкульозу мають знижену поглинальну здатність з одночасною значною активацією окисно-відновних процесів. Цитохімічні тести на виявлення фагоцитарної та метаболічної активності нейтрофілів крові є доступними та високоінформативними для діагностики і прогнозування перебігу запалення, а також для диференціальної діагностики бактерійних та вірусних захворювань
Elena Klevakina, Ivan Anikin, Olexandr Mykhalchuk
ScienceRise: Medical Science pp 36-40; https://doi.org/10.15587/2519-4798.2020.219263

Abstract:
Мета роботи. Вивчити вплив інвазивної та неінвазивної штучної вентиляції легень у доношених новонароджених з помірною та важкою ГІЕ на мозкову перфузію та центральну гемодинаміку.Матеріали та методи. Для дослідження впливу неінвазивної штучної вентиляції легень на центральну гемодинаміку та мозкову перфузію було обстежено 60 доношених новонароджених з помірною та важкою ГІЕ, тридцятьом з них проводилась рання екстубація трахеї через 72 години після народження та переведення на неінвазивну назальну вентиляцію легень з переміжним позитивним тиском (NIPPV), ще 30 новонароджених склали групу порівняння. Їм проводилась традиційна ШВЛ.Результати. Не знайдено відмінностей між показниками середнього АТ та ЧСС у новонароджених основної та групи порівняння як на першу добу перебування, так і на четверту, коли немовлята основної групи були екстубовані та переведені на нШВЛ, але рівень середнього АТ достовірно збільшувався після переведення дітей основної групи на нШВЛ в порівнянні зі значеннями цього показника в першу добу перебування (p<0,05 ).Дослідження показників центральної гемодинаміки у немовлят основної групи через добу після екстубації та переведення на нШВЛ, не виявило відмінностей в порівнянні з новонародженими групи порівняння. Показники УО, СІ та ФВ лівого шлуночка в основній групі та групі порівняння не відрізнялись.При аналізі впливу неінвазивної вентиляції легень на мозковий кровоток, вірогідних відмінностей між досліджуваними групами також не знайдено.Висновок. Не знайдено статистичної різниці між показниками СІ та ФВ в основній групі та групі порівняння відповідно. Неінвазивна ШВЛ в режимі NIPPV не впливає на показники церебральної перфузії в порівнянні з традиційною ШВЛ та може бути використана в інтенсивній терапії новонароджених з ГІЕ
Aleksey Vlasov
ScienceRise: Medical Science pp 41-44; https://doi.org/10.15587/2519-4798.2020.219945

Abstract:
Новонароджені з природженими вадами розвитку як правило мають обтяжений перинатальний анамнез, а вагітність їх матерів перебігає на тлі важких ускладнень та загострення хронічної патології. У сучасному акушерстві для визначення ступеня ризику перинатальної та материнської патології використовується безліч орієнтовних шкал, зокрема бальна оцінка за шкалою Coopland.Мета. Провести клініко-епідеміологічний аналіз перинатальних і материнських факторів ризику за шкалою A. Coopland і проаналізувати частоту реалізації перинатальної патології у новонароджених з природженими вадами в ранньому неонатальному періоді.Матеріали та методи дослідження. Ретроспективно селективно проаналізовано 88 історій пологів матерів новонароджених з природженими вадами, які отримали хірургічне лікування в неонатальному центрі та проведена бальна оцінка факторів ризику перинатальної та материнської патології за шкалою A. Coopland.Результати дослідження. Виявлено, що матері новонароджених з природженими вадами входили в групи високого (3 - 6 балів) і дуже високого (7 і більш) прогнозованого ризику перинатальної і материнської патології. У групу високого ризику ввійшли 28 (32%) матерів, а 60 жінка (68%) - у групу дуже високого ризику перинатальної і материнської патології.Висновки. У жінок з обтяженим перебігом вагітності, що мають більш 15 балів за шкалою A. Coopland, у 4,7 рази частіше народжувалися діти з реалізацією внутрішньоутробної інфекції, гастроінтестинальними порушеннями, некротизуючим ентероколітом і важкими респіраторними порушеннями у ранньому неонатальному періоді, порівняно з матерями, що народили новонароджених з таким же терміном гестації і групою низького і високого ризику щодо перинатальної і материнської патології
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