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Khrystyna Pronyuk, Andriy Vysotskyi
Likarska sprava pp 3-12; doi:10.31640/jvd.5-6.2020(1)

During COVID-19 pandemic Lung ultrasound has rapidly become a tool for diagnosis and monitoring of lung involvement and it’s severity. Accurate evaluation of lung pathologic entities at the bedside, especially in critically ill patients, and those on mechanical ventilation, remains problematic. CT should not be frequently repeated and is not available everywhere, especially for critically ill patients. Limitations of bedside chest X-ray have been well described and lead to poor-quality X-ray films with low sensitivity.The lung ultrasound has been shown to be a useful tool in intensive care patients with adult respiratory distress syndrome (ARDS) and can be used forassessing severity of lung involvement in COVID-19. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. There have been shown that lung ultrasound can predict the deterioration of the patient's conditionand can be used for risk stratification and clinical decision making, reducethe use of both chest x‐rays and computer tomography, what is very important especially in limited resources settings.
E. I. Dubrovskyi, B. V. Dons’Koi
Likarska sprava pp 3-8; doi:10.31640/jvd.3-4.2020(1)

Introduction. This article is devoted to determining the level of protective antibodies of the patients at the early and further stages after being suffered from COVID-19. Materials and methods. On the first stage of the research 66 patients of different age and gender were examined. All patients, with no exception, had positive PCR results on COVID-19. All patients were relatively divided into two age groups: from 18 to 39 (n = 39) and from 40 to 65 (n = 27). The light form of disease was detected in 40 patients, the moderate form – in 15 and the severe one – in other 3 patients. 8 people were ill without symptoms. There were 11 patients hospitalized at the department of infectious diseases of the hospital. Afterwards the level of the antibodies was controlled on the 60th, 90th and 150th day after the onset. All patients were tested for antibodies to COVID-19 by enzyme-linked immunosorbent assay (ELISA) performed on the equip- ment: enzyme-linked immunosorbent assay Tecan (Austria); PW 40 Microplate Washer (France). ELISA set for serology COVID-19 test system IgG SARS-CoV-2 VitroTest (Ukraine). Results. Analyzing the data obtained via laboratory research, it can be seen that the immune response to COVID-19 was formed in 82 % of the examined patients. The maximum level of antibodies, which remains as such up to 40th day. Results. IgG increases from 12 to 40 days and then has not changed significantly for 60; 90 and 150 days. Only 4 patients had a noticeable decrease on day 150 (however, they still had a positive level). Conclusion. IgG levels in patients with Sars-Cov2 remain high for at least 150 days. The formation of antibodies is not affected by the age difference, neither depends on the severity of the disease.
S. Mostovyi, O. Dynnyk, N. Marunchyn
Likarska sprava pp 16-29; doi:10.31640/jvd.1-2.2020(3)

Aim. To determine the features of microcirculatory dysfunction and in patients with chronic ischemic heart disease, depending on the presence of concomitant diffuse liver disease. Materials and methods. We performed a prospective study on the basis of MC «Doctor Vera», as well as in the diagnostic department of Medbud Clinic between 2009 and 2019. A total of 187 patients were examined. Patients' blood flow was assessed by transthoracic echocardiography, wavelet analysis laser Doppler flowmetry (LDF). Results. In the analysis of indicators of microcirculatory dysfunction in patients with ischemic heart disease, statistically significant deterioration of wavelet analysis laser Doppler flowmetry was determined. In patients with ischemic heart disease and left ventricular ejection fraction < 40 %, indicators of wavelet analysis LDF were significantly lower. We also found that the severity of diffuse liver disease significantly disrupts peripheral blood flow (Р < 0.05). Conclusions. The results of intracardiac hemodynamics, microcirculatory dysfunction were first presented. In patients with isolated ischemic heart disease as the left ventricular EF decreased, a significant decrease in capillary blood flow was observed as a result of deterioration of central hemodynamics, development of atherosclerotic vascular changes, as well as an increase in their vascular tone. We have proved that in the presence of DLD in patients with ischemic heart disease and EF < 40 %, the degree of increase in peripheral resistance and impaired venous outflow were more pronounced due to the depletion of vasoactive substances production, impaired their excretion by hepatocytes due to irreversible morpho-functional changes in liver at the stage of decompensation of HF, severe fibrosis, the formation of regeneration nodes. In patients with LC, the most severe disorders of peripheral blood flow were determined according to the data of the digital capillaroscopy, which testifies to the influence of the degree of liver damage on the state of microcirculation.
P. G. Kravchun, M. O. Korzh, I. P. Dunaeva, F. S. Leontieva, I. V. Gusakov, S. O. Krapivko, V. Yu. Dielievska
Likarska sprava pp 8-15; doi:10.31640/jvd.1-2.2020(2)

A study of carbohydrate and lipid metabolism and immunological examination of patients with periprosthetic infection after knee and hip joint endoprosthetics (n = 16) and osteomyelitis (n = 20) was conducted. The patients with periprosthetic infection were characterized by anemia, eosinophilia, impaired glucose tolerance, cholestasis, predisposition to elevated atherogenesis, increased circulating immune complexes, autoimmune granulocytotoxic antibodies, immunoglobulins IgM, IgG, IgA and sensitization to synovial membrane and Staphylococcus aureus. The patients with osteomyelitis did not develop increased glucose and cholesterine level, but showed increased aminotransferases, thymol test, chondroitinsulfates, decrease of calcium and production of the leukocyte migration inhibition factor (LIF), both non-specific and to the antigens of cartilage tissue and sensitization to Streptococcus and E. coli. In patients with infections of the musculoskeletal system, glucose metabolism disturbances have been associated with the presence of autoimmune lymphocytotoxic antibodies, reduced production of LiF, both non-specific and to the antigens of synovial membrane. Atherogenesis was associated with increased circulating immune complexes, autoimmune lymphocytotoxic and granulocytotoxic antibodies, decreased LIF and sensitization to connective tissue antigens and pathogenic microorganisms, especially to Streptococcus and Proteus. Anemia was associated with increased autoimmune lymphocytotoxic antibodies, delayed-type sensitization to bone and cartilage tissue, to Staphylococcus and sensitization by accelerated type to E. coli and Proteus. Physicians should analyse immunological data while treating and monitoring the patients with connective tissue infections and disturbances of glucose and cholesterine metabolism.
I. I. Smolanka, A. O. Lyashenko, A. D. Loboda, D. E. Ryspaeva, O. M. Ivankova, I. V. Dosenko, I. I. Smolanka (Jun.), O. I. Sydorchuk
Likarska sprava pp 30-35; doi:10.31640/jvd.1-2.2020(4)

Radical surgery of the breast cancer (ВС) with the radical mastectomy often lead to a dysfunction of the upper lymb on the operation side. The symptom complex of disorders is manifested by swelling, numbness, paresthesias, pain syndrome of varying severity, heaviness, convulsions, spasms, and limited mobility. It is called postmastectomy syndrome (PMS). According to literature sources, the incidence of PMS is 60–80 % of all patients undergoing mastectomy. The severity of postmasectomy syndrome in patients with an inflammatory breast cancer (IBC) and locally advanced (non inflammatory) breast cancer (LABC) was compared. It turned out , that majority of patients with IBC had postmastectomy syndrome of the III degree according to Beltran while the patients with LABC (non inflammatory) – II. The limitation of mobility of the upper limb was also more pronounced in the IBC group, while the severity of pain syndrome was the same in both groups.
D. M. Zhelezov, G. S. Manasova, N. V. Kuzmin
Likarska sprava pp 50-56; doi:10.31640/jvd.1-2.2020(7)

In recent years, there has been an increase in the number of operations on the uterus in women of reproductive age with the formation of "uterine scarring syndrome" (USS), which can lead to complicated pregnancy and childbirth. To assess of anatomical and functional features of uterine scar, pregnancy and perinatal outcomes in USS women. A prospective analysis of clinical anamnestic data, pregnancy and childbirth in 398 USS women was conducted; ultrasound and Doppler assessment of morpho-functional status of the uterus using the Accuvix V20 Prestige (Samsung Medison, Republic of Korea) was made. Statistical analysis was performed using Statistica 13.0 (Dell Inc., USA) software. In 74.62 % of 398 women, the scar on the uterus is due to a previous caesarean section (CS), in 24.11 % due to conservative myomectomy (CME), in 1.25 % –because of endoscopic interventions for incomplete uterine septum, in 25.87 % of women it was the result of "small" gynecological surgery. In 97 % of women with a scar on the uterus after the previous CS, there was no "passport of surgery": ultrasound revealed the localization of the scar in the lower uterine segment in 96.48 % of 398, corporate scar – in the remaining 3.51 % of women; ultrasound signs of relative "anatomic" scar failure were noted in 10.80 % of pregnant women. In 48.73 % of women pregnancy was complicated by the threat of abortion or premature birth, in 30.40 % anemia was diagnosed, in 24.87 % of the women under observation placental dysfunction took place. 78.1 % of women had delivery at term, 13.2 % had premature birth, 97.3 % had births CS, and 2.7 % of women had labours through canalis obstetricus. In 1.3 % of women labor was complicated by uterine hypotension, and uterine devascularization procedures was performed. The most common reasons for the formation of USS are cesarean section, conservative myomectomy and various "small" intrauterine operations. Pregnancy with this syndrome is most often complicated by the threat of its termination and childbirth before term, anemia, placental dysfunction and Intrauterine growth retardation . The choice of delivery tactics is conditioned by the totality of hystory, the status of the scar on the uterus, obstetric status and the wishes of the woman herself. It is advisable to look for methods to assess the morpho-functional status of the operated uterus and predict the perinatal consequences of pregnancy in these women at the stage of preconception preparation.
V. S. Prokopchook
Likarska sprava pp 77-80; doi:10.31640/jvd.1-2.2020(11)

30 years have passed since the time when an epidemic of a children's disease with alopecia syndrome broke out in the city of Chernivtsi. The disease has been named «chernivtsi» disease. Fortunately, it passed without serious complications and deaths. Pathology was accompanied by significant diagnostic difficulties and received a wide public response in the Soviet Union. As a result, the «сhernivtsi» disease turned out to be an erased form of scarlet fever with alopecia syndrome. It is not excluded that the epidemic may happen again somewhere. The author believes that the knowledge gained about this disease should not be forgotten and offers to acquaint doctors with personally gained experience.
S. N. Ivaschenko
Likarska sprava pp 72-76; doi:10.31640/jvd.1-2.2020(10)

Introduction. This article presents some results of the application a special method of physical education designed for children and adolescents with health deviations. Purpose of the study. The purpose of this study was to estimate level of effectiveness of modern teaching programs aimed at developing all basic physical qualities of young persons. Materials and methods. During the work with this contingent of persons the following scientific methods were used: study of medical documentation of persons with health disorders, methods of pedagogical examination and pedagogical experiment, physical examination of research participants, questionnaires, interviews, testing of physical qualities in dynamics and methods of statistical processing. Results and discussion. Considering the fact that in Ukraine, as in many other countries of the world, the number of children and adolescents with certain health deviations is gradually increasing, the problem of formation the state’s strategic human reserve arises nowadays. In order to perform the functions in the process of labor within the industrial or agricultural sector successfully, an able – bodied person must demonstrate certain physical qualities (endurance, strength, dexterity, coordination of movements, etc.). In addition, these qualities are extremely important for people serving in the ranks of state power structures. The data of statistical studies indicate that in most cases the level of development all basic physical qualities in those individuals who had deviations in their health in childhood and adolescence is significantly lower than the level of development those qualities in practically healthy individuals. But in the vast majority of cases, by means of using a special technique of rehabilitation and preventive training, it is possible to achieve the correction (partial or complete) of those health disorders that occurred in these people in childhood and adolescence. And in other cases, it is possible to achieve such level of development all basic physical qualities of these people that are necessary for work or serve successfully, despite the existence of diseases or pathological conditions. Conclusions. Based on the data obtained in the course of this study, the following conclusions can be drawn: 1. Today (both in our country and in many other countries) there is a tendency to gradually increase the number of young people with disabilities. 2. In the vast majority of cases, the scale of manifestations of health disorders in young people can be significantly reduced by the systematic use of special rehabilitation and prevention programs. 3. The contingent of the population, including persons with functional disabilities, is an important reserve, which after the application of appropriate special measures can be used to replenish the strategic human resources of the state.
I. S. Lembryk, O. V. Tymoshchuk
Likarska sprava pp 36-41; doi:10.31640/jvd.1-2.2020(5)

Introduction. During the last twenty-five years the occurrence of obesity in children and teenagers has increased significantly. Materials and methods. 110 adolescents of 12–17 years old, with alimentary-constitutional obesity and involvement of pancreas and without its injury, as compared to the 30 healthy children of control group, were examined. The research provided determination of the sizes and elasticity of pancreas. The detection of the total cholesterol, high density lipoproteins and leptin level was carried out. Intensity of clinical symptoms (spastic pain in epigastrium and left subcostal arc; abdominal pain without localization, vomit without relief, general weakness) have been made accordingly to sum of points (from 0 to 3 points). If sum of points makes from 0 to 2 – intensive character of abdominal pain is low, from 3 to 5 points – it is high, from 5 to 10 points – it is very high. Normal level of amylase in a blood serum (Karavey’s method) is 12–32 g/(hour l), аnd diastase in urine – 20–160 g/(hour l). We made a screening test for elastase-I level by ELISA test. Normal activity of this enzyme in feces is 200 мkg/g. We have used sonographic method for detection of pancreatic diseases in obese children due to echo-structure of parotid gland. The analysis and statistical data processing were made by computer program "Statistica 7.0" and MS Excel XP. Research data. Physical inspection of our patients confirms prevalence of І degree over II degree obesity (52.7 % and 47.3 %, respectively; Р < 0.05). We have confirmed valid risk factor of pancreatic lesion in obese children – presence of diabetes mellitus type I in close relatives (80 % and 65 %, χ2 = 2,05; Р < 0.05). The changes of exocrine function of the pancreas in children with the stage II obesity were established. Echographic signs of the pancreas lesion in teenagers with obesity indicate the presence of functional changes: edema of head or entire edema, partial increase of parenchymal echogenicity, insufficient enlargement of the duct of Wirsung.
L. V. Nykyfor, L. M. Rak, M. I. Kosevich
Likarska sprava pp 57-62; doi:10.31640/jvd.1-2.2020(8)

The article presents a clinical case of granular-cellular ovarian tumor (GCTJT) in a girl aged 17 years, which occurred in the practice of the doctors at the gynecological department of a hospital.
N. R. Matkovska
Likarska sprava pp 42-49; doi:10.31640/jvd.1-2.2020(6)

Introduction. The urgency of the problem of liver cirrhosis (LC) is caused by the increase in morbidity, prevalence, life-threatening complications, disability and increasing mortality of able-bodied population. The aim of the study was to examine the effect of complex treatment with ademethionine, arginine glutamate and rosuvastatin on changes in the haemostasis systemin patients with alcoholic liver cirrhosis (ALC) in combination with obesity. Research methods. The study included 105 patients diagnosed with ALC in combination with obesity. The assessment of the effectiveness of a three-month treatment regimen with ademethionine, arginine glutamate and rosuvastatin in obese patients with alcoholic liver cirrhosis (ALC) included indicators of synthetic liver function and hemostasis (total protein, albumin, fibrinogen, platelet count, factor Von Willebrand factor, activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), prothrombin index (PI), D-dimer, tissue plasminogen activator (tPA), 1 plasminogen activator (PAI-1), tPA/PAI-1 index, asymmetric dimethylarginine (ADMA)), as well as liver cirrhosis severity (Child-Pugh score) and 3-month MELD mortality score. Results. Decreased levels of total protein, albumin, fibrinogen, PI, platelet count and increased levels of Von Willebrand factor, prothrombin time (PT), APTT, TT, INR, D-dimer, tPA and PAI-1, ADMA were revealed. Such changes worsened with increasing liver cirrhosis decompensation and were accompanied by an increase in the Child-Pugh and MELD scores (P < 0.05). There was a more pronounced increase in levels of PAI-1 than tPA, that was accompanied by a decrease in tPA/PAI-1 index. A number of researchers indicate that an increase in PAI-1 levels can cause a hypercoagulable state, so its increase with a decrease in tPA/PAI-1 index in patients with ALC in combination with obesity indicates a risk of thrombogenic conditions. This is also evidenced by the increasing number of D-dimers. Therefore, the fibrinolytic/antifibrinolytic factors should be considered in the treatment of such patients to prevent LC complications. Conclusions. The inclusion of ademethionine, arginine glutamate and rosuvastatin in the treatment regimen for 3 months improved the levels of total protein, albumin, fibrinogen, PI, platelet count, Von Willebrand factor, PT, APTT, TT, INR, D-dimer, tPA and PAI-1, ADMA, which was accompanied by a decrease in Child-Pugh severity score and MELD 3-month mortality score.
V. E. Kazmirchuk, A. Yu. Galkin
Likarska sprava pp 3-7; doi:10.31640/jvd.1-2.2020(1)

The article outlines the causes of deaths when using a combination of azithromycin with Plaquenil®. Immunological substantiation of the main factors leading to vascular and pulmonary pathology (triggering angiotensin-converting enzyme and helper aggression in the lungs) is given. An immunotherapy method that eliminates the etiological links of the processes occurring during COVID-19 viremia is proposed. The method of prophylaxis of personnel in contact with patients is to use specific antibodies to coronaviruses found in immunoglobulin with intramuscular injection. A treatment schema for severe patients with COVID-19, SARS-2 is proposed.
K. O. Kalko, S. M. Drogovoz, O. Ya. Mishchenko, L. B. Ivantsyk, K. O. Dehtiarova, М. М. Lukashuk, O. V. Gerush, A. O. Palamar, O. N. Korovenkova, S. I. Shevchenko
Likarska sprava pp 63-71; doi:10.31640/jvd.1-2.2020(9)

Determination of dependence of the efficiency and toxicity of drugs on the time of day or season is one of the most promising areas of modern experimental and clinical pharmacology. The aim of the study. Aim is to identify features of daily rhythms of silymarin influence on the state of antioxidant/prooxidant and cytolytic processes (the leading link in the implementation of hepatoprotective activity) with paracetamol in rats under conditions of acute toxic liver damage. Materials and methods. Chronopharmacological action features of silymarin were studied by use of the generic drug "Karsil" as an example (Sopharma, Bulgaria) with paracetamol in rats under conditions of acute toxic liver damage. The state of the processes of POL-AOS was evaluated by the content of TBA-active products (TBA-AP), the content of recovered glutathione, the activity of SOD, catalase in hepatocytes, and the cytolytic processes by the activity of ALT in serum. Results. There was established a certain chronoarchitectonics of the rhythms of the antioxidant protection system and the activity of the processes of peroxidation in rats under physiological conditions, which was not disturbed by paracetamol on the background of acute liver damage (with the exception of level of acrophase catalase activity). The same dynamics and commonality of rhythms occurred on the background of the use of silymarin. The maximum display of silymarin hepatoprotective activity was observed under conditions of its use in the morning (09.00) and in the evening (21.00). Conclusions. The use of silymarin during periods of maximal display of its hepatoprotective activity, in the morning (09.00) and in the evening (21.00) may be the way to increase its bioavailability. Chronopharmacological features of silymarin activity have been established and should be taken into account when to conduct its further chronopharmacological studies.
Yu. М. Dekhtiar, F. I. Kostyev, K. A. Zalyva
Likarska sprava pp 35-40; doi:10.31640/jvd.7-8.2019(5)

Introduction. The basis syndrome Overactive Bladder (OB) is detrusor overactivity (DO) – urodynamic concept that refers to spontaneous or provoked by involuntary detrusor contractions during the filling phase Bladder. Currently, there are two main forms of DO: neurogenic and idiopathic. The purpose was to evaluate the effectiveness of monotherapy with M-anticholinergic Tolterodine tartrate and its combined administration with the cyclic structural analogue of g-aminobutyric acid Gabantin in patients with idiopathic overactive bladder without detrusor overactivity (IOB). Object and methods. Patients were divided into two groups: group A – 31 patients (19 patients with IOB without Urinary Incontinence (UI) and 12 patients with UI and group B – 32 patients (21 patients with IOB without UI and 11 patients with UI). According to the study design, patients in group A were prescribed M-anticholinergic therapy Tolterodine tartra. Patients in group B received combined therapy with Tolterodin tartrate and Gabapentin for a total course for 8 weeks. Results and discussions. Analysis of the results in group A showed that this type of treatment does not lead to significant improvement. However, 3 patients (9.67 %) had a good result, and 7 patients (22.58 %) had a satisfactory result, the rest (21 patients, 67.74 %) had an unsatisfactory result. But among patients in the group B general, a satisfactory result of treatment was noted in 24 (75 %) patients. An unsatisfactory result was observed in 8 (25 %) patients. Conclusions. Monotherapy with M-anticholinergic in patients with IOB and the absence of DO has little effectiveness and is implemented mainly by reducing Pollakiuria. The symptoms of Urgency are resolved moderately (in 22.58 % of patients) and extremely rarely in full (in 9.67 % of patients). The proposed method of treatment by the combined administration of Tolterodine tartrate and Gabapentin allows to achieve a significantly more pronounced clinical effect manifested in a decrease in Pollakiuria by 64.17 %, Nocturia by 82.18 % and Urgency by 81.40% and UI by 80.66 %.
T. V. Morеy, T. M. Solovyova, A. I. Cherepanov
Likarska sprava pp 54-63; doi:10.31640/jvd.7-8.2019(8)

The article is devoted to the research of the formation and functioning of the network of pharmacy establishments in the Kiev province at the end of the XVIII-early 60s. XIX century. The analysis of normative legal acts was carried out, the factors that influenced the opening of pharmacies, their financial situation and the provision of medicines were determined.
V. K. Kazymyrko, L. M. Ivanitska, T. S. Silantieva, V. V. Kutovyi
Likarska sprava pp 3-12; doi:10.31640/jvd.7-8.2019(1)

The paper shows that atherosclerosis results from disturbed cholesterol homeostasis in the body, the development of systemic stromal-vascular lipid-protein dystrophy (or lipidosis, or cholesterolosis) complicated by extracellular focal lipid deposits with a predominant cholesterol in the interstitial tissue of the inner arterial and aortic layer. These deposits are foreign to this body tissue. They induce the development of chronic productive granulomatous inflammation in it – granulomatosis around endogenous foreign bodies. Cholesterol deposition is promoted by a positive cholesterol balance in the body; increased permeability of the endothelium in hemodynamically vulnerable parts of the arteries, where blood components, including LP, infiltrate their wall; a lack of hydrolytic enzymes in the cell lysosomes that could destroy the steroid nucleus of the cholesterol molecule. Being essential for each specific organism (for building membranes, the formation of bile acids, the synthesis of steroid hormones, vitamin D3), cholesterol, if exceeded, can increase the probability of developing atherosclerosis. Genetic mechanisms are implicated in the disturbed lipid protein metabolism in the human body. Hyperlipoproteinemias (HLPs) are known to be the most common metabolic disorders. The dystrophy under consideration results from primary HLP types IIa, IIb, III, IV, V, as well as secondary HLPs in patients with various medical conditions associated with an increase in blood LDL and / or VLDL and/or a decrease in HDL. A reduced cholesterol efflux from peripheral tissues due to a decreased HDL content and the development of lipidosis are seen in diabetes, obesity, physical inactivity, stress, puberty, menopause, hypertriglyceridemia, cigarette smoking, uremia, treatment with anabolic steroids, beta-adrenergic blocking agents, gestagens, and the use of contraceptives. The most pronounced manifestations of dystrophy are characteristic of HLP types IIA, IIb, III, but its moderate development complicated by atherosclerosis also occurs in types IV and V, which are accompanied by increased blood VLDL. Mutations of LDL receptor genes, apoprotein genes lead to the development of stromal vascular dystrophy and atherosclerosis. A number of rare genetic disorders of sterol metabolism accompany impaired metabolism of cholesterol and its esters: hepatic lipase deficiency (with accumulation of VLDL and IDLs); a deficiency in lysosomal hydrolase of cholesterol esters with impaired LDL metabolism (Wolman disease); cholesterol ester accumulation disease; cerebrotendinous xanthomatosis; cerebral cholesterolosis; Toichlander and Hand Schüler Christian syndromes. The main factor contributing to the development of inflammation in the inner vascular wall of arteries and aorta in atherosclerosis is the cyclic hydrocarbonic structure of cholesterol, which cannot be cleaved in the lysosomes of MPs. The leading role of the cyclic hydrocarbonic structure of cholesterol, which is insoluble and indestructible by MPs, in the induction of atherosclerosis-related inflammation is confirmed by the fact of the atherogenic action of cholesterol derivatives having its structure. An important factor in inflammatory morphogenesis is the lipoprotein dyscolloidosis occurring in the arterial intima and the physical and chemical metamorphosis of cholesterol. A colloidal solution, solid crystals of free cholesterol and liquid crystals of cholesterol esters have a pronounced phlogogenic and sclerogenic effect on the interstitial tissue of the arterial intima.
I. V. Kabachna, V. I. Kabachnyy, S. M. Drohovoz
Likarska sprava pp 46-53; doi:10.31640/jvd.7-8.2019(7)

In order to expand the theoretical basis of the purposeful search of analeptics, the awakening and antihypoxic properties of heteroside-21, heteroside-31 (derivatives of sulfur- and nitrogen-containing heterocycles) were studied and the mechanisms of their action were established. Sodium thiopental (42 mg/kg) was used to simulate suppression of the respiratory and vascular centers of the brain. The comparison drugs were – sulfocamphocaine (SCC) with combined analeptic action (20 mg/kg) and the antihypoxic drug piracetam (300 mg/kg). The results were obtained on the models of thiopental anesthesia and normobaric hypoxia with hypercapnia. The analysis of data allowed to count qualitatively and quantitatively the arousing and antihypoxic activity of new substances and classical drugs; their effect on the respiratory center of the brain and behavioral responses of animals; theoretically substantiate, experimentally confirm and establish aerobic, anaerobic and detoxification mechanisms of realization of effects in various conditions; to formulate the theoretical bases of purposeful search of universal analeptics and antihypoxic drugs and offer an instrumental-methodological complex for their experimental reproduction.
L. F. Horzov, V. S. Melnyk, V. V. Horzov
Likarska sprava pp 30-34; doi:10.31640/jvd.7-8.2019(4)

According to state statistics, diseases of the musculoskeletal system in adolescents rank third among the major classes of diseases. The dental system, as a part of the musculoskeletal system, undergoes the same metabolic transformations as the entire bone tissue of the body. The aim of the study was to determine the characteristic disorders of the dental system in adolescents with idiopathic spinal scoliosis, taking into account the anatomical type of lesion. Materials and methods. 225 children aged 12 to 15 years were examined, including 190 (84.4 % ± 3.3 %) girls and 35 (15.6 % ± 2.1 %) boys. All adolescents were registered at a dispensary with an orthopedist-traumatologist. Results and discussion. According to the anatomical type, patients with scoliosis are divided into three groups: Group I - with thoracic spinal deformity; Group II - with thoracolumbar; III group - with lumbar; Group IV - control, almost healthy children without spinal deformities. It was found that the most common type of scoliosis was thoracolumbar scoliosis, observed in 114 patients. In patients of group I, the most common type of tooth closure in the sagittal plane was class II according to Engle. In group II, it was found that distal occlusion is characteristic of 68 people, in 10 revealed mesial occlusion, sagittal gap – in 59 patients. In group III, 13 patients had a neutral bite, and 32 had a distal bite. Sagittal gap was noted in 15 patients, deep bite – in 9. The most characteristic disorders for patients of group IV were distal occlusion 24 %, sagittal gap 16 %, deep occlusion 12 %, shortening of the lower dentition 16 %, oral position of the teeth 12 %. Conclusions. Analysis of the prevalence of dental anomalies in each group leads to the conclusion that regardless of the location of the deformity in the spine in scoliosis for all groups are characterized by the following signs: distal occlusion, sagittal fissure, shortening of the upper dentition, crowding of teeth on the lower jaw, mainly in the front. In the group of almost healthy children without scoliosis, the prevalence of dental anomalies is 2.6 times lower compared with patients with idiopathic adolescent scoliosis.
K. V. Yurko, V. M. Kozko, N. F. Merkulova, О. I. Моhylenets
Likarska sprava pp 41-45; doi:10.31640/jvd.7-8.2019(6)

Background: Actuality of study of infectious mononucleosis (ІМ) is conditioned by high infected of population by the Epstein – Barr virus (EBV), specific virus affinity to the immunocompetent cells, lifelong virus persistence in an organism and often latent process. Methods: Research on the work topic was conducted at the Department of Infectious Diseases of Kharkiv National Medical University. A total of 45 patients with IM (26 men and 19 women) who were hospitalized at the Regional Clinical Hospital in 2018–2019 years were surveyed. The vast majority of patients with IM were young people aged from 18 to 25, of whom 597 % were students. Results: The clinical picture of infectious mononucleosis caused by the Epstein–Barr virus, mainly characterized by manifestations of hepatomegaly, lymphadenopathy, intoxication syndrome and nasopharyngeal tonsillitis. The efficacy of combined use of Valacyclovir and Nuclex in complex therapy of patients with infectious mononucleosis caused by Epstein – Barr virus (EBV) was studied. The use of such therapy was found to promotes regression of clinical symptoms, contribute to normalization of indices of clinical blood tests and lead to a decrease of the number of EVB's DNA copies in the blood serum or complete elimination of virus. Conclusions: Thus, evaluation of the effectiveness of the use of valacyclovir and nuclex in the complex therapy of patients with infectious mononucleosis caused by Epstein–Barr virus, indicates a more significant regression of clinical symptoms, significantly more pronounced positive impact on the indicators of clinical blood analysis and the number of copies of EBV DNA in blood serum than in the comparison group. Obtained results allowed to substantiate the use of complex therapy of valacyclovir and nuclex in patients with IM caused by EBV.
O. V. Onysko, О. О. Korchynska, Stefania Andrashchikova, Sylvia Zhultakova, Alena Shlosserova
Likarska sprava pp 13-21; doi:10.31640/jvd.7-8.2019(2)

Increase in frequency of disorders of women's reproductive function justifies a careful study of the underlying pathological processes. In recent years, increased attention in solving fertility problems is paid to endometrial pathology when chronic endometritis plays an important role. Current worksarefeeding an in-depth study of the etiology and pathogenesis of chronic endometritis. However, results of research pose new questions with an imaginary comprehensive study of this problem. Chronic endometritis is one of the causes of infertility and may play a role in certain complications of pregnancy and childbirth (30.3 % in patients with repeated failures of in vitro fertilization, 9.3 % with recurrent miscarriages, 9.8 % in infertility). Clinically, chronic endometritis is often asymptomatic or accompanied by nonspecific symptoms such as pelvic pain, dyspareunia, abnormal uterine bleeding, and discharges. Previously, scientists considered the uterine cavity as a sterile container. But a team of Spanish scientists sought to test for the presence of intrauterine microflora, which differs from the vaginal. As a result, the study of endometrial fluid and vaginal samples from the same patients revealed different bacterial compositions. Microflora in the intrauterine fluid was classified as Lactobacillus, and women with non-lactobacillary flora of the endometrium had a significantly lower frequency of implantation. At the initial stage of endometrial inflammation is an activation of neutrophils and macrophages, increased cytokines synthesis, extracellular matrix degradation by proteolytic enzymes. Disorders of microcirculation and sclerotic processes in the area of ​​injury lead to the ischemia and tissue hypoxia, which activates the processes of sclerosis and angiogenesis. Chronization of the process increases the expression of chemokines and adhesion molecules, that is lead to migration of B-lymphocytes from the bloodstream and their differentiation into plasma cells, increases the activity of matrix metalloproteinases, changes local expression of estrogen and progesterone receptors. Lack of a pronounced specific clinical picture of chronic endometritis, its later detection causes impaired reproductive function. Untimely diagnosis and treatment of chronic endometritis has significant consequences in terms of the possibility of implantation of a fertilized egg in the programs of assisted reproductive technologies.
V. O. Grukach, O. V. Tkachenko
Likarska sprava pp 64-70; doi:10.31640/jvd.7-8.2019(9)

In the article on the basis of materials from archives of historical literature an attempt is made to analyze the medical provision of socially vulnerable beliefs of the population of Kyiv in the second half of the XIX century at the beginning of the XX century. The charitable support of industrialists is shown charitable societies of medical institutions creating them free hospitals, accommodation shelters. In the work the Tereshchenko family in Kyiv is investigated their contribution to the development of medicine.
A. Stasenko
Likarska sprava pp 22-29; doi:10.31640/jvd.7-8.2019(3)

The aim of the study is to investigate the functional properties of neutrophils in the blood and peritoneal exudate in patients with peritonitis. Materials and methods. The metabolic activity of neutrophils determined in patients with peritonitis and in patients of the control groups in the blood, peritoneal exudate and effusion of the abdominal wall on the 1–2 day of the postoperative period in the Sp and St test with nitro blue tetrazolium (NBT), as well as reserve indicator (RI) of metabolic activity. We studied the percentage of active neutrophils in the phagocytosis –PhI ( index) and the number of absorbed Candida albicans particles on average by one neutrophil –PhN(number). Results and their discussion.The peculiarities of the cellular factors of local protection decreased metabolic activity of neutrophils in the abdominal cavity in the Sp NBT test compared to blood neutrophils and an increased reserve during stimulation. For the comparisons which included the activity of neutrophils abdominal contents in patients with peritonitis versus in control established that neutrophils in the abdominal cavity with peritonitis have a reduced intensity of phagocytosis. Patients with pancreatic peritonitis have inverse correlations between the amount of NBT-positive blood NG in the SP NBT test and IR of blood NG and between the amount of NBT-positive blood NG in the Sp NST test and PhI of blood NG, while patients with abdominal peritonitis do not have correlations between indicators of innate defense of the body. Conclusions. Peritonitis was associated with functional disorders of NG. The leading areas of disorders are significant activation of metabolic processes of NG and inhibition of the phagocytic function of NG blood and peritoneal exudate. Patients with pancreatic peritonitis had inverse correlations between the indicators of the innate defense of the body, while patients with abdominal peritonitis did not have correlations.
T.V. Bogdan, O.V. Savchenko, D.M. Pryadum, A.Y. Yakovenko
Likarska sprava pp 62-70; doi:10.31640/jvd.5-6.2019(7)

Coronary arteries are normally located on the epicardial surface of the heart (surrounded by adipose and loose connective tissue), can "plunge" into the thickness of the myocardium at different depths, and then again "appear" on the surface of the heart. The muscle that covers the intramural segment of the epicardial coronary artery is called the myocardial "bridge" (MB), and the artery extending into the thickness of the myocardium is called the tunnel. MB is the most common congenital pathology of the coronary arteries. MB occurs in about 1/3 of the entire population, but it does not always manifest itself in violation of heart perfusion and related symptoms: angina pectoris, vasospastic angina (Prinzmetalla), acute coronary syndrome, loss of consciousness, ventricular tachycardia, sudden death. This pathology is found in both women and men, but the target group remains in men 25–35 years of age, who experience clinical manifestations mainly during physical activity. According to autopsies, MB is found in 87 %, up to 5 % of them are hemodynamically significant. Among those who died suddenly, 25 % had MB. This topic is relevant because previously diagnosed with MB can prevent the development of the above pathological conditions and save the life of the patient. The article presents data on morphology, pathogenesis, clinical manifestations, diagnosis and treatment of myocardial bridges (MB). The role of this coronary vessel pathology in the emergence of vasospastic angina (Prinzmetal) and sudden cardiac death in young, mainly male patients has been revealed. The pathophysiological role of CO2 levels in the blood and its relationship to the clinical manifestations of the muscular bridges were also analyzed.
O. O. Tolstikova, S. F. Aharkov
Likarska sprava pp 27-39; doi:10.31640/jvd.5-6.2019(3)

Metabolic syndrome (MS) is a growing serious health risk in adults, children and adolescents. The prevalence of metabolic syndrome ranges from 6 to 39 % depending on the criteria used. Multiple data have shown that MS is associated with a 2-fold increase in cardiovascular disorders and a 1.5-fold increase in all cause mortality. To date, there is no single definition regarding MS for children and adolescents. However, most authors agree with the components needed to diagnose such as central obesity, impaired glucose tolerance (or diabetes), hypertension, and dyslipidemia; each of which presents a serious risk of cardiovascular disease. Overweight and obesity are often seen in children and adolescents in the developed and developing countries with a prevalence of 20–35 %. A number of authors have emphasized the need for a modern adapted definition of MS in children and adolescents. For this purpose, it is necessary to take into account age and sex-dependent anthropometric, metabolic and cardiovascular parameters. Recently, a link has been established between metabolic syndrome and non-alcoholic fatty liver disease, as well as hyperuricemia and sleep disorders. According to current data, NAFLD and MS are closely related, so NAFLD is described as a manifestation of MS in the liver, with insulin resistance being the driving force of pathogenesis. A recent study found that 66 % of children with NAFLD confirmed by biopsy had MS, 63 % had hypertriglyceridemia, 45 % had low HDL cholesterol, 40 % had hypertension, and 10 % had impaired glucose tolerance. The correlation between levels of serum uric acid, MS and some of its components in children and adolescents is described. Hyperuricemia triggers endothelial dysfunction via vasodilation caused by insulin action. Obstructive sleep apnea is associated with MS in children and adolescents and is described as one of the components of MS. In 59 % of children with obstructive sleep apnea, signs of metabolic syndrome are noted. Biomarkers, such as adipocytokines, have been the subject of current research as they are implicated in the pathogenesis of MS. Recently, several adipocytokines and inflammatory cytokines have been identified that have significant positive (leptin, hemerin, vaspine, TNFα, IL-6, and IL-8) or Negative (adiponectin) associations with metabolic risk factors. Some may be considered pathophysiological factors that link obesity and its complications, such as insulin resistance and NAFLD. Epigenetics and gestational programming are important issues in addressing MS in children and adolescents. The role of micro-RNA in the diagnosis, stratification and therapy of MS is increasing. Early identification of risk factors, screening for metabolic disorders and the identification of new treatments are the primary goals of reducing morbidity and mortality. Currently, officially accepted approaches to treating children and adolescents with MS are dietary changes and physical activity. Pharmacological therapy and the use of bariatric (metabolic) surgery is a topic of discussion and is recommended for adolescents in some cases of high-risk MS.
V. S. Prokopchook, A. V. Lyckbäck
Likarska sprava pp 3-12; doi:10.31640/jvd.5-6.2019(1)

This is not a play on words, but a key to solving a problem that has been deadlocked. The science of atherosclerosis is still based on the experiments of N. N. Anichkov. It always prioritizes lipid infiltration of vessel's walls. In fact, the lipid infiltration of the vessel's walls is not related to the origin of lipids in atheromas. Their origin is always associated with fatty degeneration of myofibroblasts in places of sclerosis (fibrous plaques), but not with hematogenous infiltration. The key to solving this problem lies in a disclosure of the genesis of sclerotic changes in intima. On the one hand it concerns a primary age sclerosis (compensatory) as well as secondary sclerosis (inflammatory, etc). On the other hand it is important to establish causes of degradation (fatty degeneration) and death of myofibroblasts (the so-called Langgans'cells) in places of sclerosis (fibrous plaques), followed by atheroma formation. We have first showed in vivo (at the cellular level) that a death of myofibroblasts in plaques with following release of lipids occurs due to the fact that these myofibroblasts reach the Heiflik's limit much faster than myofibroblasts on healthy vessels. These occurs due to shortening of telomeres in myofibroblasts that intensively multiply in places of reparative sclerosis. The authors propose replacing the term “atherosclerosis” with “scleroatherosis”, which more accurately reflects the essence of the disease and the sequence of events in its pathogenesis. Considering "scleroarethosis" as a nosological form, two periods of development of the process should be emphasized: the first – sclerotic period (compensatory) and the second – atheromatous (period of decompensation). The second period is accompanied by all manifestations and complications known for scleroatherosis that can't be eliminated. It is no need to spend billions on senseless "purifying” blood vessels and "lowering" cholesterol in blood plasma. It is more important to focus on a healthy lifestyle and, above all, to fight with arterial hypertension as with a main factor of blood vessels' deterioration.
K. M. Lisova, I. V. Kalinovska, O. M. Yuzko
Likarska sprava pp 71-76; doi:10.31640/jvd.5-6.2019(8)

Pregnancy miscarriage is a consequence of many factors. The aim of the study was to analyze the effect of miscarriage gene on embryometric, ultrasound, hormonal, immunological parameters in pregnant women, and to evaluate its prognostic value. The main group includes 31 pregnant women who had clinical signs of miscarriage in current or previous pregnancy. The control group consists of 32 healthy pregnant women whose clinical-paraclinical parameters served as a control to compare the data of the pregnancy survey of the main surveillance group. A general clinical examination and a special obstetrical examination (complaints, anamnesis, general medical examination, obstetric examination), biochemical studies (determination of hormones of the fetoplacental complex in blood serum of pregnant women), ultrasound, immunological studies, histological studies of the placenta, molecular genetic study A1166C polymorphism of the AGTR1 gene were made. In the course of the research, the genetic determinism of miscarriage was discovered. The polymorphism of the A1166C of the AGTR1 gene was considered as a prognostic marker of miscarriage in early gestational term and preeclampsia in the second half of pregnancy. A reliable marker of abortion was the maternal genotype 1166AC for the genome AGTR1. The risk of occurrence of clinical manifestations of abortion increased five times. At simultaneous influence of all prognostic factors the risk of abortion increased 6,25 times. Detection of genetic markers of pregnancy miscarriage will allow early correction of this pathology and prevent perinatal loss.
M. Oros, A. Sabovchyk
Likarska sprava pp 81-87; doi:10.31640/jvd.5-6.2019(10)

We conducted a study including patients with tension type headache (TTH) (n = 60) at the age of 37.2 ± 10.2. The criteria for the International Headache Classification, third edition (beta version) were used. The following outcome measures were compared: EEG, visual analog scale (VAS), hospital anxiety and depression scale (HADS), Beck Depression Inventory (BDI), pulse variation measurement, Wein Scale. 60 patients presenting with TTH were randomly assigned to phenibut (500 mg/day) or selective serotonin reuptake inhibitors (SSRI) for 4 weeks. The findings indicate the potential benefit of phenibut as effective and safe symptomatic therapy in diverse forms of tension type headache.
V. E. Kazmirchuk
Likarska sprava pp 13-26; doi:10.31640/jvd.5-6.2019(2)

Work begins from a large historical background the emergence of the doctrine of immunoglobulins. A brief review of the development of world achievements in the use of immunoglobulin therapy is given. We give the rationale for the treatment of various human diseases in situations of ineffective protocol treatment, the principles of searching for the etiology and making the correct diagnosis. Often a visit to an immunologist is the only hope of the patient in solving the health problem. Several cases from hundreds of patients observed by us are described. All medical professionals working according to the protocols themselves should be referred to the immunologist in cases of lack of diagnosis or ineffective treatment. Treatment of patients should begin with the establishment of an etiological factor in any disease, even in cases of oncology. Until the root cause of the disease has been identified, treatment cannot be effective. The use of immunoglobulin therapy has no contraindications, and its effectiveness and safety are presented in the work.
S. A. Lyalkin, N. O. Verevkina, L. A. Syvak
Likarska sprava pp 46-54; doi:10.31640/jvd.5-6.2019(5)

Treatment of patients with triple negative breast cancer (TNBC) remains one of the most difficult problems in clinical oncology. Despite the negative prognosis for TNBC, there exists the group of patients with better response to the therapy and better prognosis, which proves the heterogenity of TNBC. The aim of the study was to evaluate the predictive role of tumor infiltrative lymphocytes (TIL) and their subpopulations (CD4+, CD8+ and FOXP3) in patients with TNBC. The predictive role of clinical, morphologic and immunohystochemical tumor features on neoadjuvant chemotherapy (NACT) efficacy was assessed in 52 TNBC patients. The risk of incomplete pathomorphologic response after NACT is related with 2 biomarkers: level of TIL and stromal CD4+ lymphocytes. The increase of TIL level decreases of the risk of incomplete pathomorphologic response (P = 0.01), ОR = 0.07 (95 % CІ 0.01–0.55) while standartization on CD4+ level. The high level of TIL at the time of diagnosis significantly decreases the risk of incomplete pathomorphologic response (OR = 0,2; P = 0,02). The group of patients with the ratio of stromal lymphocytes CD4low/CD8low had the eight-fold increase of the risk of incomplete pathomorphologic response comparing with the group with the ratio CD4high/CD8high (ОR = 8,0; Р = 0,03); the patient with the ratio stromal lymphocytes CD8low/ FOXP3low had the almost two-fold increase of the risk of incomplete pathomorphologic response comparing with the group with the ratio CD8high/FOXP3high (ОR = 2,1; Р = 0,03).
V. S. Kopcha, Yu. M. Andreychyn, Ia. I. Iosyk, Yu. V. Kopcha, L. V. Radetska, I. I. Hanberger
Likarska sprava pp 101-105; doi:10.31640/jvd.5.2019(13)

The aim of the study was to describe the diagnosis of HIV infection in a socially orderly person due to clinical evidence. A young socially successful man, on the basis of clinical considerations, underwent respective examination, which allowed diagnosis of HIV infection. The disease was not manifested by typical signs of clinical stage I, but by primary Herpes zoster and recurrent paratonsillar abscess. The wife of the patient was healthy. The hypothetical transmission of the infection was not established. The possibility of HIV infection in socially orderly individuals has been confirmed taking into account relevant clinical indications, first and foremost the episode of Herpes zoster in a young person with no obvious causes of immunodeficiency. Despite the guidelines for a revised clinical classification of HIV infection in adults and adolescents (WHO, 2006), persistent generalized lymphadenopathy is unessential in the clinical stage I and Herpes zoster may be manifested earlier the clinical stage II.
Anna Slifirczyk, Oleksandr Oliynyk
Likarska sprava pp 77-80; doi:10.31640/jvd.5-6.2019(9)

Many researchers of the thyroid pathology consider that the investigation of the epidemiology of thyroid disease in conjunction with the study of the diet are relevant. The question is if the unbalanced diet may worsen the course of hypothyroidism. The purpose of this study was to establish the relationship between the peculiarities of the diet of patients with hypothyroidism and the functional state of the thyroid gland. Methods and materials. It was observed 400 women of Polish nationality aged 19–28 years living in Biala Podlaska district of the Lublin Voivodeship of Poland which consider themselves healthy. The blood levels of free (FT3) and total (T3) triiodothyronine, free (FT4) and total (T4) thyroxin, thyrotropic hormone (TSH) were determined. With the help of questionnaires and food tables, the approximate average amount of proteins, fats and carbohydrates in the daily ration was determined, as well as the average amount consumed daily with iodine. The prevalence of hypothyroidism among surveyed women was 3.5 % and was not significantly different from the values ​​observed in the European Union. Women with reduced thyroid function consumed with food significantly 3.78 times less iodine, 2.97 times (P < 0.001) less salt and 1.47 times (P < 0.001) less protein compared to women with normal thyroid function. In addition, women with hypothyroidism consumed with food 2.25 times (P < 0.001) more products with properties of strumogens. The development of hypothyroidism in the examined women was combined with a reduced intake of iodine and proteins with food products and an increased use of products with the properties of strumogens.
Ismatilla Ydyrysov, Beksultan Yrysov, Kursanbek Kalyev, Keneshbek Yrysov
Likarska sprava pp 106-110; doi:10.31640/jvd.5-6.2019(14)

The article deals with the general description of severe combined traumatic brain injury and organizing special neurosurgical care to patients in Osh Region of Kyrgyz Republic. Material and methods: Among the patients mainly man are dominated – 77.9 %, and man at the age of 20 to 50 (69.9 %), i.e. the most able-bodied part of the society. Results: The main cause of severe combined traumatic brain injury is still a traffic accident (74.3 %). Postsurgical and overall mortality in clinics where there is no full-time neurosurgeon and computed tomography scanner is higher. Most hospitals in Osh Region are still not equipped with computer tomography. The presence in the hospital staff full time neurosurgeon has crucial importance in reducing postsurgical and overall mortality.
S. M. Drogovoz, A. V. Kononenko, H. Zelenkova, K. V. Drogovoz, L. B. Ivatsyk
Likarska sprava pp 88-93; doi:10.31640/jvd.5.2019(11)

Cellulite is not only an aesthetic and cosmetic defect of the skin, but a signal of violations in the body, the cause of which is an incorrect lifestyle. The number of collagen fibers in the connective tissue decreases markedly, peripheral blood supply is disturbed, various hormonal changes occur, and in combination with malnutrition, a sedentary lifestyle, bad habits (smoking, alcohol abuse), sleep disturbance, frequent stress and sudden changes in body weight can first observe the formation of dimples and bulges (“orange peel”), and with the aggravation of the situation due to lymphostasis, there is an accumulation of toxins and gynoid lipodystrophy occurs with age. The main syndromes that characterize cellulitis: lymphostasis, hypoxia, a violation of the relationship between lipogenesis and lipolysis, non-inflammatory changes in subcutaneous fat, fibrodestruction. Cellulite treatment is carried out by complex methods: pharmaco- and physiotherapeutic, including hormone-correcting, lipocorrection, vasoactive, defibrosing, lifting and others. The lack of monotherapy results can be explained by the complexity of the drug penetration into the "cellulite" zones. The absence of effectiveness of monotherapy stimulates the search for new approaches to treatment. One of the effective methods in complex pharmacotherapy is carboxytherapy. Сarboxytherapy application contributes to the normalization of vascular tone and blood rheology, enhances blood circulation and removes venous stasis; improve oxygenation and trophic tissue, stimulate the processes of neovascularization, lipid metabolism, neocollagenogenesis. As a result of these changes subcutaneous fat cells (cellulite) are destroyed, stagnation is eliminated, and skin elasticity and tone are restored.
Z. R. Kocherga, Т. І. Savrun
Likarska sprava pp 55-61; doi:10.31640/jvd.5-6.2019(6)

The influence of genetically determined factors of mutation genetic pressing leads to genetic instability increasing or reducing genom’s sensitivenes to further mutant action, which is of major importance in developing the syndrome of intrauterine growth retardation (IUGR) in newborns. The main markers of genetic instability are the changes in morphological cell characteristics (cytogenetic, cytological, cytodensimetric), polymorphism of genes of xenobiotics detoxication GSTM1 and GSTТ1, changes in enzyme activity of glutathione acid and oxidation protein modification. In order to define the leading factors of destruction of genetic status of newborns with IUGR syndrome a discriminant and correlation analysis was conducted, which determined the links between the genes of xenobiotics detoxication GSTM1 and GSTТ1, by the indices of morphological functional genome state, enzymes activity of glutathione system and oxidation protein modifications and development of IUGR syndrome. The model of the statistic analysis of cytogenic, molecular genetic and biochemical characteristics enables to obtain an objective characteristic of the state of inheritance apparatus of newborns with IGR in comparison with healthy newborns.
S. I. Zbrozhek, V. O. Shapovalova, V. V. Shapovalov (Jr.), V. V. Andrieieva
Likarska sprava pp 111-118; doi:10.31640/jvd.5-6.2019(15)

In the world from 10 to 55% people suffer from chronic pain syndrome. Therefore, timely reduction of pain helps to improve the quality of their life in all areas of activity. To improve the organizational and legal procedure for providing patients with drugs as part of palliative care, a control regime for non-steroidal anti-inflammatory drugs, non-narcotic and narcotic (opioid) analgesics and adjuvant (auxiliary) drugs, which prescribed by doctors for chronic pain syndrome was developed. The research materials were the current regulatory, legislative and instructive documents; statistics of the Ministry of Healthcare of Ukraine; instructions for medical use of medicines, websites of the Verkhovna Rada of Ukraine, the Ministry of Healthcare of Ukraine, the State Expert Center of the Ministry of Healthcare of Ukraine and others. We used documentary, comparative, systemic and regulatory methods of analysis. In the article, based on the analysis of the normative base, analyzed the medical and technological documents concerning the pharmacotherapy of chronic pain syndrome, allocated three classes of medicines. Processed the control regime of non-steroidal medicines, non-narcotic analgesics, narcotic (opioid) analgesics and adjuvant (auxiliary) drugs prescribed by doctors for chronic pain syndrome. Analyzed the normative and legal documents on the procedure for the circulation of narcotic, psychotropic and potent medicines in medical and pharmaceutical healthcare institutions in accordance with the licensed conditions for the conduct of economic activity. Established that the circulation of medicines for pharmacotherapy of chronic pain syndrome within palliative care in medical institutions carried out based on a license for medical practice, and in pharmacy institutions – based on a license for wholesale and retail trade of medicines.
Yu. V. Moskalenko, I. О. Vуnnуchenko, O. M. Smorodska, O. I. Vynnychenko, R. A Moskalenko
Likarska sprava pp 40-45; doi:10.31640/jvd.5-6.2019(4)

Lung cancer is one of the main causes of death from malignant neoplasm all around the world. For the purpose of personalized treatment immunohistochemical determination of specific proteins (biomarkers) presence in tissues and biological fluids is needed. Today management of patients with lung cancer is directly associated with determination of genes mutations: EGFR, ALK, ROS1 and rate of PD-L1 receptors expression. Depending on the PD-L1 expression level blockers of these receptors can be used as the first, supportive and second / third line therapy. As the first line of therapy for patients with high expression level of PD-L1 (≥ 50 % TPS) Pemblizomab is recommended, while for patients with moderate levels (PD-L1 1 – 49% TPS) PD-L1 blockers can be used only as a second / third line of therapy. In numerous clinical trials efficiency and safety of Pemrolizumab, Nivolumab and Atezolizumab have been proved. Testing of Avelumab, Durvalumab, as well as combined drugs – Ipilimumab and Tremilimumb are still going on.
O. V. Khrus
Likarska sprava pp 94-100; doi:10.31640/jvd.5-6.2019(12)

With the help of electron microscopic and morphometric methods, the features of changes in the ultrastructure of periodontal tissues in persons with psychoemotional stresses were studied.It was shown that chronic psychoemotional stress is accompanied in the gum tissue by the development of endothelial and mitochondrial dysfunction with signs of edema and destruction of the capillary endothelium and a violation of the ultrastructure of about 50 % of the mitochondria in the cells.Structural changes were also observed in bone tissue. They testified about the development of destructive processes with the violation of intercellular signaling system and signs of necrotic cells. Such changes in the gum and bone tissues can promote the development of periodontitis in the case of chronic psychoemotional stress and lead to tooth loss.
І. V. Sakhanda, K. L. Kosyachenko, Т. S. Nehoda, A. V. Kabachna, L. L. Davtian, V. V. Gladyshev, I. V. Gladukh
Likarska sprava pp 55-60; doi:10.31640/jvd.4.2019(9)

The number of people with cardiovascular diseases has increased significantly in recent years. According to statistics, diseases of the cardiovascular system occupy one of the first places among other diseases. One of the main pathologies in cardiology is hypertension. Treatment of arterial hypertension for a long period remains an important medico-social and economic task, a heavy financial burden falls on the patient himself or on the health care system, in the case of free distribution of drugs. The group of antihypertensive drugs is one of the most expensive, which raises the question of cost-effective therapy. Clinical and economic research that combines analysis of clinical efficacy and affordability is necessary for evidence-based, rather than empirical, choice of the drug. The most acceptable method of assessing the clinical significance of various drugs is a «cost-effectiveness» analysis. The article is devoted to the conducted pharmacoeconomic research, giving a comparative assessment of various enalapril generics. The objective of the work was to identify and justify the use of the most clinically effective and cost-effective generic drugs enalapril. The methodological basis of the research was the modern concept of marketing research of the drug market, the methodology of system analysis and scientific forecasting of economic phenomen. In the process of research, the methods of system, sociological, economic and statistical analysis, including absentee questionnaires, were used. As a result, sales of cardiovascular drugs on the pharmaceutical market were analyzed, the structure of enalapril generic consumption in health facilities was studied, and a pharmacoeconomic analysis («cost-effectiveness» method) of antihypertensive treatment of enalapril generics was conducted.
L. M. Malanchuk, L. O. Krasnyanska, Z. M. Kuchma, V. M. Martynuik
Likarska sprava pp 46-54; doi:10.31640/jvd.4.2019(8)

The objective of the work was to make a comparative analysis of the result of external genital endometriosis treatment with the use of traditional surgical intervention and hormone therapy together with the use of low-molecular-weight metabolic immune response modifier 5-amino-1,2,3,4-tetrahydrophthalazine-1,4-dione of sodium salt. Materials and methods: the experimental part of the study was previously conducted on 50 female rats which consisted of studying the influence of the immune response modifier on the course of experimentally induced endometriosis in experimental animals, in particular on changes in the estrous cycle. Injection of the immune response modifier caused retrogression of endometrioid heterotopias and normalization of the estrous cycle in the animals. The comparative analysis of the results of external genital endometriosis treatment in 66 women was conducted on the basis of experimental research. 34 women, apart from surgical intervention and hormone therapy, were injected with the immune response modifier 5-amino-1,2,3,4-tetrahydrophthalazine-1,4-dione of sodium salt during the post surgical period. Cellular immunity, T- and B-lymphocytes, and equipment and instrumental methods, such as medical ultrasound of the organs of the lower pelvis and laparoscopy, were used to assess the results of treatment. As a result of the treatment with the use of the immune response modifier the indicators of cells immunity changed, pain severity decreased, menstrual function normalized, relapse frequency reduced, and the overall quality of life for patients improved. Socially significant effect of treatment of external genital endometriosis using metabolic immune response modifier is manifested in implementation of reproductive function ‒ elimination of infertility in 50 % of women during the first year of observation.
P. Herych, I. Popadynets, R. Yatsyshyn, V. Mygovych, V. Kaminskyi
Likarska sprava pp 29-35; doi:10.31640/jvd.4.2019(5)

The objective of the work was to determine the possibility of drug correction of endothelial dysfunction, structural changes in peripheral arteries and the synthesis of end products of nitric oxide metabolism by the use of a combination of roflumilast and quercetin in the baseline therapy. In contrast to the baseline, the use of integrated therapy was followed in 6 months by a probable increase in the initial rate by 18.76 % (0.61 ± 0.04) m/s to (0.75 ± 0.04) m/s (t = 2.47; P < 0.05) and a probable decrease in the initial diameter of the brachial artery to (3.69 ± 0.29) mm (t = 2.49; P < 0.05). Patients of the experimental group have shown a significant increase in mean values of EDVD at the end of in-patient treatment and after 6 months of intensive supportive therapy (t = 2.17; Р < 0.05). The appointment of complex therapy after 6 months showed an increase in concentration in the blood of metabolites of NO in 1,3 times to (10.35 ± 1.89) μmol/l (t = 1.00; P > 0.1) at normal (12.05 ± 2.11) μmol/l. In patients of the index group after six months of the background therapy, IMT index has appeared in 1.07 times lower than the input data and has not reached the level of the control group. The IMT index for patients in the experimental group was considerably lower than the index before treatment (t = 0.31; P > 0.1). Application of complex therapy in patients with severe chronic obstructive pulmonary disease in the exacerbation phase in combination with stable coronary heart disease, stable angina pectoris I–II FK contributes to the restoration of endothelial function, improves structural changes in the peripheral arteries and has a stimulating effect on the synthesis of nitric oxide.
V. M. Nedoborenko, I. P. Kaidashev
Likarska sprava pp 22-28; doi:10.31640/jvd.4.2019(4)

Iron deficiency anemia (IDA) is one of the causes of chronic fatigue with a decrease in the quality of life, impaired cognitive function and poor labor productivity. Obesity as a condition of chronic low-intensity inflammation is one of the factors that increases the risk of anemia and impairs the quality of life in the general population. We drew attention to the high global prevalence of anemia among pregnant women of reproductive age in the world and the prevalence of high body mass index among women compared to men in most countries. The objective of the work was to determine the impact of obesity on clinical features and quality of life of women with ІDA. We analyzed the main markers of ІDA and hematologic indices in women with obesity (n = 30) compared with the control group (n = 10), where there were women with ІDA but without obesity. It was found that there was no statistical difference between these parameters, but nevertheless, the serum ferritin level in obese women was (4.70 ± 2.68) ng/ml compared to (3.50 ± 2.93) ng/ml and had a significant positive correlation with body mass index. The analysis of the questionnaires revealed that obesity is still a significant factor in women with ІDA and obesity, which determines the decrease in quality of life mainly in the physical aspect in the absence of significant influence on the psychosocial components of health.
I. О. Vynnychenko, , M. Yu. Serdyuk, O. А. Ternovenko
Likarska sprava pp 3-7; doi:10.31640/jvd.4.2019(1)

Lung cancer is one of the major causes of death from malignancies. That is why the article devoted to the issue early diagnosis of lung cancer. The objective of the work is to consider the features and prospects of using the most modern methods of diagnosis of lung cancer. The introduction of the latest technologies is essential for quality screening of lung cancer patients. Gradually, there is a growing interest in developing strategies around the world to better assess the risk of human lung cancer, increase screening sensitivity, and reduce costs. The methods of early detection of lung cancer are described in the article: determination of the concentration of volatile organic compounds (LuCID method), endobronchial ultrasound (EBUS method), FISH-marker method, basic principles of the Nano-Nose device. Despite some advances in our country in the diagnosis of lung cancer using common advanced methods of computed tomography and biopsy, the introduction of foreign experience in lung cancer screening is necessary, because the current state-of-the-art methods of diagnosis allow to detect cancer.
S. M. Byshovets,
Likarska sprava pp 36-40; doi:10.31640/jvd.4.2019(6)

In the main group (n = 20; 39.4 years ± 4.1 years; 71.4 kg ± 4.3 kg, I–II ASA) asynchronous intrathecal anaesthesia (AIA) 10 mg of hyperbaric bupivacaine in combination with 0.06 mg of buprenorphine was administered in patients with inguinal hernia repair. The control group (n = 20; 42.6 years ± 0.9 years; 75.4 kg ± 3.6 kg, I–II ASA) received synchronous intrathecal anaesthesia (SIA) 15 mg with isobaric bupivacaine in combination with 0.06 mg of buprenorphine during similar operation. The AIA and SIA provided effective pain relief for operations with long postoperative analgesia. In the AIA group, a hemodynamics was stable due to the lateral rather than bilateral sympathetic block, in contrast to the CIA. Improving the quality of analgesia allowed an early activation and enteral nutrition of patients, as well as a shortened rehabilitation period. An intrathecal administration of bupivacaine supplemented with buprenorphine was characterized by a significantly smaller number of negative side effects compared with the corresponding administration of other opioids.
, H. V. Pavlenko, V. V. Shukhtin, І. N. Shukhtina
Likarska sprava pp 8-15; doi:10.31640/jvd.4.2019(2)

The article is devoted to the study of the state of homeostasis systems in patients with infectious eczema and the establishment of the relationship of the hemostatic system and immune status in the patient’s body. Examination of 108 patients with infectious eczema aged 18 to 65 years living in the southern region of Ukraine showed hypercoagulation changes in the hemostatic system and immune imbalance, which depend on the severity of the disease and play an important pathogenetic role in the onset and progression of this pathology. We have established close pathogenetic mechanisms of the relationship between the immune system and the hemostatic system (changes in the vascular-platelet link are associated with changes in humoral immunity – the content of, circulating immune complexes IgE), and coagulation hemostasis disorders – with indicators of cellular immunity (CD3 +, CD4 +, CD8 +, immunoregulatory index). Identified violations of hemostasis and immune status indicate the need to develop a pathogenetically substantiated method of complex individualized therapy for patients with infectious eczema.
, S. M. Drogovoz, Ya. O. Butko, M. V. Zupanets
Likarska sprava pp 41-45; doi:10.31640/jvd.4.2019(7)

Almost every person can felt the pain syndrome; it has different mechanisms of formation, which must be taken into account when determining the principles of treatment. The causes of pain are inflammation, ischemia, hypoxia, oxidative stress, etc. Non-steroidal anti-inflammatory drugs are the most common painkillers, but the problem of expected efficiency and their potential risks is not fully resolved despite their huge assortment. Therefore, the search for alternative effective and safer methods of anelgesia, one of which is carboxytherapy (treatment of CO2). Carbon dioxide (CO2) is an inalienable component of the metabolism and pacemaker of the respiratory processes. The objective of the work was to study the analgesic effect of carboxytherapy (subcutaneous injections of carbon dioxide). For this purpose, we used a combined model of hyperalgesia (with a central component): carrageenan inflammation in combination with a modification of the tail immersion test. The animals (40 rats) used in the experiment were divided into five groups: I – control pathology; II – rats receiving injections of diclofenac sodium comparator at a dose of 8 mg / kg; III – animals that were subcutaneously injected with CO2 into the hind paw at a dose of 0.5 ml; IV – animals that were injected with CO2 into the hind paw at a dose of 1 ml; V – rats that received 4 mg/kg of diclofenac in combination with subcutaneous injection of CO2 into the hind paw at a dose of 1 ml. In the experiment on rats was found that subcutaneous injections of carboxytherapy at a dose of 0.5 ml and 1 ml have analgesic properties (at the level of 18.9 and 31.1 %), but the most perspective method is the complex purpose of analgesics (diclofenac sodium at a dose of 4 mg/kg) and injection of carboxytherapy (at a dose of 1 ml), which helps to reduce the degree of analgesia by 38.7 %, which correlates with the action of diclofenac sodium (at a dose of 8 mg/kg). Thus, the inclusion of carboxytherapy in conventional therapies will enhance the analgesic effect of a traditional drug and improve the safety profile of the latter.
I.V. Linsʹkyy, , O. V. Baranenko, M. O. Ovcharenko, O. M. Lynev, Yu.O. Yevtushenko, Ye.Yu. Verbytsʹkyy, O.S. Samoylova, N. M. Lisna, S. V. Holʹtsova
Likarska sprava pp 16-21; doi:10.31640/jvd.4.2019(3)

As a result of the study, specific mental and behavioral disorders due to alcohol use in ATO participants were determined taking into account the levels and style of alcohol consumption. The relationship between disorders due to alcohol consumption and the consequences of combat psychological trauma is shown. It has been established that, on the whole, the transition from the conditions of a positional war to the conditions of a peaceful life is accompanied by a decrease in alcohol consumption (by individuals independent of it), a decrease in the level of harmful consequences, an improvement in mental status and a slight improvement in the quality of life, however, there are exceptions to this rule, especially with regard to stressful disorders - the level of exposure to a stressful event remains almost unchanged. Neither the army men nor the demobilized military found any adaptive (useful) medium- and long-term effects of alcohol (the transient anxiolytic and hypnotic sedative effects of alcohol have no long-term positive results (as opposed to negative ones). Psychopathological factors that affect disorders due to alcohol consumption remain almost unchanged during the transition from combat conditions to peaceful life, the influence of only certain components changes. Therefore, measures aimed at preventing maladaptation (that is, the formation of new and exacerbation of existing mental and behavioral disorders, including drug addiction) should adhere to the principle of continuity.It is advisable that between specialists and institutions suitable for the hygiene of the military and the demobilized, as high quality communication as possible is maintained along the methodological guidelines for the provision of medical and rehabilitation assistance. A significant level of consumption of psychoactive substances among combatants may indicate an unmet demand for adaptogens (both chemical and non-chemical origin), the use of which would not lead to the negative consequences of alcohol and other surfactants. This is a challenge for modern military psychopharmacology, military psychology and military psychophysiology.
Likarska sprava pp 36-42; doi:10.31640/jvd.3.2019(5)

Preeclampsia remains the main cause of maternal and perinatal morbidity and mortality. It was shown that the developments of complications from the mother and fetus side or their absence in women with preeclampsia have different pathophysiological mechanisms. It is necessary to distinguish two types of hypertensive disorders during pregnancy: the first one is severe preeclampsia, which has an early onset and is accompanied by complications that threaten the life of the mother and child. Second – it is a mild pre-eclampsia, that specificfor the late stages of pregnancy and occurs without significant associated complications. It has been shown that the markers of the propensity to develop obstetric and perinatal complications in pregnant women with preeclampsia are the following gene polymorphisms: 1691 GA in gene factor V Leiden – increases the risk in 2.9 times (95 % CI 1.94–4.33), 20210 GA in prothrombin gene – 2.36 times (95 % CI 1.54–3.6), 20210 AA in prothrombin gene – 3.12 times (95 % CI 2.4–4.0). Pregnancy on the background of these gene polymorphisms is associated with severe pre-eclampsia, early onset and development of life-threatening maternal and fetal complications.
S. I. Kirkilevsky, A. A. Mashukov, V. E. Maksimovsky, A. I. Tkachenko, R. R. Yarema, V. V. Lisachenko, V. V. Pirogov
Likarska sprava pp 11-28; doi:10.31640/jvd.3.2019(3)

Treatment of late stages of the tumor process requires the implementation of increasingly high-tech and complex interventions, aimed at improving the overall and disease-free survival, improving the quality of life of patients. HIPEC technique is a point of growth at which progress in oncology and all medical science can be demonstrated. Among the specialists involved in the implementation of this type of specialized care, there is still no consensus on what traits the malignant process of the peritoneum should be able to use this technique. Intraperitoneal hyperthermic perfusion (HIPEC) is gaining popularity as a method of palliative treatment of patients with common tumors of the abdominal cavity. Using the popular medical virtual search engine PubMed identified 2140 cited publications on the search query "hipec, peritoneal" and 752 cited publications "hipec, peritoneal, CRS", finally the phrase "hipec, cancer, randomized trial" with the clarifying characteristic "Clinical Trial" (excludes review articles) – 30 scientific publications, 10 of them in the last 5 years. All this demonstrates the growing interest to HIPEC around the world. The technique is used mainly for ovarian cancer, mesothelioma, pseudomyxoma of the peritoneum, colorectal cancer, and gastric cancer. It is possible as a combination of surgically performed PE and HIPEC, and HIPEC in mono-mode, in the absence of macroscopically detected carcinoma of the abdominal cavity, but positive washings from the peritoneum in verified cancer. It is performed both during the cytoreductive operation and as the second stage as a component of the Second look procedure, as well as in the adjuvant mode in the absence of carcinomatosis, but of high potential danger of peritoneal dissemination (for example, if the tumor has infiltrated the entire wall of the organ). HIPEC has never become a standard treatment, and multicenter randomized trials are regularly conducted on this topic.
N. V. Cherkova, L. M. Dushik, G. M. Gerasymov, А. О. Dushik
Likarska sprava pp 52-56; doi:10.31640/jvd.3.2019(8)

In an experiment on laboratory animals (84 male rabbits of Shinchilla breed weighing 3 to 3.5 kg), the processes of liver tissue regeneration after cholecystectomy using electrocoagulation, cryoexposure and Harmonic scalpel (HS) at different terms were studied in a comparative aspect. The objective of the work: to study in the experiment histomorphological changes in the gallbladder bed under the influence of monopolar electrocoagulation, low temperatures and ultrasonic scalpel in a comparative aspect at cholecystectomy. Depending on the method of resection of the gallbladder and the method of hemostasis, all animals were divided into three groups. In Group I, after resection of the gallbladder, the animals underwent hemostasis of the gallbladder bed (GBB) with the help of monopolar electrocoagulation. In Group II, hemostasis was performed by the cryogenic treatment of GBB with a laparoscopic cryoapplicator. In group III, after cholecystectomy, the animals underwent hemostasis with HS. The results of the experiment made it possible to compare not only the hemostatic and cholestatic effects of various types of energy, but also to assess the grade of traumatization of the liver parenchyma in the operative intervention zone and the influence of various methods on the quality and terms of the reparative processes. The effectiveness of the HS in achieving final hemostasis with bleeding from GBB in cholecystectomy has been experimentally proven. It is determined that the depth and grade of the dystrophic process is less expressed with ultrasound exposure. The use of HS in the treatment of GBB was a safe and reliable method of stopping parenchymal hemorrhage and bile leakage from the liver parenchyma.
Likarska sprava pp 56-63; doi:10.31640/jvd.3.2019(9)

The peculiarities of construction of the International Carpathian Valeological Innovation System at different levels of its organization were investigated. The expediency of creating territorial production associations is substantiated. The essence of the category of valeological innovation system is covered as a set of interconnected organizations (enterprises) engaged in production and commercialization of valeological innovative products within the boundaries of recreational zones, which may cover the territories of several or one country. The infrastructural components of the valeological innovation system are distinguished, which include recreation parks, recropolises and resorts, recreational business incubators and valeological innovation centers, as well as legal, financial and social institutions providing and maintaining valeological innovation processes.The organizational model of the valeological innovation enterprise is developed. In order to increase the efficiency of the Valeological Innovation Enterprise, the systems of its management were analysed based on the use of systematic, synergistic, homeostatic and intellectual approaches.It has been found that the management object (valeological innovation process) and the management bodies that are part of the valeological innovation enterprise structure are characterized by unlimited development.The feasibility of modelling the International Carpathian Valeological Innovation System by network model is substantiated. This model was formed in the form of a cluster, territorial-hierarchical model as one of the varieties of network models, which can be components of the Carpathian valeological innovation systems of the Carpathian Euroregion countries.
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