Medicni perspektivi, 2018;23(1).

        Title of the issue

Content

 2018 Vol. XXIII N 1

Published
2018-03-06

 

THEORETICAL MEDICINE

Tryasak N.S. The role of dendritic cells the in development of atherosclerosis of coronary vessels in the experiment

https://doi.org/10.26641/2307-0404.2018.1.124903

Key words: myocardium, atherosclerosis, dendritic cells, S-100

Abstract. The role of dendritic cells the in development of atherosclerosis of coronary vessels in the experiment. Tryasak N.S. The dynamics of quantitative and qualitative changes of the dendritic cells (DC) of coronary arteries wall at different stages of atherosclerosis development was investigated. Animals received human native low density lipoproteins. Dendritic cells were detected by using polyclonal antibodies S-100 and monoclonal antibodies CD1a (clone O10). A semiquantitative scale from 0 to 3 points was used to determine the intensity of expression of immunohistochemical markers. Histological examination of coronary arteries wall was perfomed by hemothoxylin-eosin, orsein and sudan III. The first increase of the number of dendritic cells was observed at the 10th week after start of experiment, which corresponded to prelipid stage of atherosclerosis. The second increase of the number of dendritic cells was noted at the 13week and was characterized by moderate expression of markers (2 points) and morphologically responded to the stage of lipoidosis. The late stages of the experiment (18-20 week) were characterized by the maximal increase of DC and a high expression of immunohistochemical markers (3 points). 

   

Borzykh N.O. , Strafun S.S. , Savosko S.I. Electrophysiologic research of surgically restored median nerve (experimental study)

https://doi.org/10.26641/2307-0404.2018.1.124905

Key words: median nerve, injury, anastomosis

Abstract. Electrophysiologic research of surgically restored median nerve (experimental study). Borzykh N.O., Strafun S.S. , Savosko S.I. In the experiment the possibility of providing effective regeneration of the injured median nerve in conditions of creation “protected” suture with intact ulnar nerve was studied. Experimental animals were divided into 4 groups: 1) complete neurotomy of the median nerve; 2) complete neurotomy of the median nerve with neurorrhaphy; 3) complete neurotomy of the median nerve and anastomosis creation between the median and the ulnar nerves in the distal site; 4) complete neurotomy of the median nerve and its neurorrhaphy with the anastomosis between the median and the ulnar nerves in the distal site. The histological study was carried out to identify the level of the nerve regeneration, state of the nerve distal segment and electrical conductivity of the surgically restored nerve on day 30 after the trauma. Morphometric and electrophysiological examinations showed that anastomosis creation allows to prevent atrophy and elimination of distal segment of median nerve and activate regenerative process in the injured nerve. The electrical conductivity of the nerve improved. An increased M-response of the forearm muscles was observed in groups with the anastomosis between the median and the ulnar nerves (the level of M-response recovery in the group 2 – 27,1%, group 3 – 18, 9%, group 4 – 84,6%). According to the study results we have made a conclusion that reinnervation of the muscles at an early stage of the median and the ulnar nerves regeneration was realized with the participation of high-threshold myelin nerve fibers.  

  

CLINICAL MEDICINE

Zabida Abdunaser. A.M. Endothelial function, systemic inflammation and cardiac hemodynamics in different age patients with post infarction chronic heart failure

https://doi.org/10.26641/2307-0404.2018.1.124918

Kew words: myocardial infarction, endothelial dysfunction, cardiac hemodynamics

Abstract. Endothelial function, systemic inflammation and cardiac hemodynamics in different age patients with post infarction chronic heart failure. Zabida Abdunaser A.M. Heart failure (HF) is a major cause of morbidity and mortality. After myocardial infarction, physiological and anatomical ventricular changes occur, There is also an inflammatory reaction with release of cytokines, growth factors and reactive oxygen species production, which contributes to perpetuate ventricular dysfunction. The study was designed to evaluate the level of inflammatory markers (white blood cells and C-reactive protein), endothelial function and cardiac hemodynamic in different age patients with post infarction heart failure. We divided 45 patients with HF with preserved ejection fraction (HFpEF) with mean age 67,5 [65,5; 71,7] years into two main groups. 1st group: 25 patients with HFpEF and history of myocardial infarction. 2nd group: 20 patients with HFpEF and stable angina (without myocardial infarction in anamnesis). Standard laboratory blood tests for erythrocyte sedimentation rate, C-reactive protein, haematological parameters, lipid profile, glucose, renal and liver function tests, echocardiographic examination, endothelial function estimation were performed. Patients with a history of myocardial infarction had significantly higher levels of left ventricle end diastolic volume, left ventricle end systolic dimension (p<0.05). There was estimated direct correlation between LVEDV, LVESD and age - R=0.68 (p<0.05), R=0.52 (p<0.05). Further analysis of cardiac hemodynamics depending on age revealed significant differences between LVEDV indices in patients with myocardial infarction. A significantly higher level of leukocytes was found in patients with HFpEF with a history of myocardial infarction in both groups (p<0.05). A direct correlation between the leukocyte count and age in patients with HFpEF-R = 0.48 (p< 0.05) was also found. Patients with HFpEF with a history of myocardial infarction had a significantly higher level of CRP, including in the age aspect (p<0.05). A direct correlation between CRP level and age was established in patients with HFpEF - R=0.46 (p<0.05). It was revealed that in the older age groups with myocardial infarction the signs of endothelial dysfunction were significantly more frequent (p<0.05). Reverse correlations were established between the level of endothelium dependent vasodilatation (ESVD) and CRP (R=-0.48, p<0.05), triglycerides (R=-0.45, p<0.05), diastolic blood pressure (R=-0.54, p<0.05). Conclusion: high level of inflammation markers, endothelial dysfunction and changes in cardiac hemodynamics were recorded more often in elderly patients with post infarction heart failure

  

Rosits'ka O.A. Variants of clinical course of ischemic cerebrovascular disease in patients with multifocal vascular lesions

https://doi.org/10.26641/2307-0404.2018.1.124910

Key words: multifocal atherosclerosis, cerebral infarction, transient ischemic attack, dyscirculatory encephalopathy

Abstract. Variants of clinical course of ischemic cerebrovascular disease in patients with multifocal vascular lesions. Rosits'ka O.A. The study included 125 patients aged 40 to 84 years, with multifocal vascular lesions. All patients were divided into three clinical groups, depending on the localization of vascular lesions with stenotic atherosclerosis. According to the correlation analysis, there is a direct correlation between the presence of clinical manifestations of cerebral insufficiency and the age of patients. In multifocal vascular lesions, chronic forms of cerebral ischemia (dyscirculatory encephalopathy) were recorded in 69.2% of patients who had a cerebral infarction, and in 87.0% of patients with TIA in the anamnesis. The most common concomitant pathology in patients with multifocal vascular disease is hypertension of various degrees and stages (92.8% of patients), type 2 diabetes (20.0%). In the study, a direct relationship was established between the degree of hypertension and the acute disorders of cerebral circulation. Infarctions of the brain in patients with multifocal vascular lesions occurred in 72.8%, mainly in the carotid basin, which is 3.2 times higher than the frequency of myocardial infarction in the vertebrobasilar basin. With simultaneous atherosclerotic lesions of the vessels of the brain, heart and lower limbs, there was no TIA as an independent form, but a clinical transition to a cerebral infarction was immediately noted. Repeated heart attacks took place in 28% of patients in the general group, mainly with simultaneous atherosclerotic lesions of the brain and heart vessels (31.0%) or all three basins (26.3%). In atherosclerotic lesions of the vascular basins of the brain and heart, CHD is manifested earlier (58.6%), and in the case of cerebral and lower extremity vessels, ischemia of the lower extremities (73.7%). The time interval between repeated cerebral infarctions was shorter in patients who continued to smoke 4.5 times. 

  

Poslavska O.V., Shponka I.S., Gritsenko P.O., Alekseenko O.A. Morphometric analysis of pancytokeratin-negative neoplastic damages of the lymphatic nodes of the neck

https://doi.org/10.26641/2307-0404.2018.1.124915

Key words: lymph nodes of the neck, immunohistochemistry, morphometry, ImageJ 

Abstract. Morphometric analysis of pancytokeratin-negative neoplastic damages of the lymphatic nodes of the neck. Poslavska O.V., Shponka I.S., Gritsenko P.O., Alekseenko O.A. Patients with a diagnosis of cancer with an unknown primary localization (CUPL) are mostly referred to the category of cancer cohort with the clinical manifestation of lymph nodes enlargement. Cases of CUPL occupy 3-5% of all neoplasia of any localization, and only 20% of them have prognostically better chances as compared to other 80%. Materials and methods. The retrospective study 41 observations of the neoplastic lymph nodes in the neck without other clinical manifestations of primary tumor localization during was performed August 2016 - July 2017. The average age of patients was 47.68±16.41 years (median 46). The aim of the study was to analyze the complex of morphological, morphometric and immu­no­histochemical characteristics of Cytokeratin, Ran negative phenotypes of neoplastic lesions of lymph nodes of the neck for the improvement of diagnostic algorithms. Results. The authors have adjusted the objective parameters of nuclei of tumor cells (area, perimeter, coefficient of "roundness"), in comparison with the size of ordinary lymphocytes, the dependence of the size of the nuclei on morphological characteristics and the immunophenotype of the neoplastic damage of the lymph nodes of the neck has been analyzed.

  

Krishtafor A.A. Prevention and treatment of cognitive disturbances caused by combat trauma with the protection of energy supply of cells by reamberin

https://doi.org/10.26641/2307-0404.2018.1.124919

Key words: cognitive disorders, combat trauma, reamberin 

Abstract. Prevention and treatment of cognitive disturbances caused by combat trauma with the protection of energy supply of cells by reamberin. Krishtafor A.A. Objective: to investigate the state of cognitive functions in victims with combat trauma on the background of reamberin using. We studied 37 patients, injured simultaneously in different parts of the body during fighting, divided into treatment and control groups. The severity of the injury was determined by the ISS and EmTraS scales. The severity of the condition – according to generally accepted clinical and laboratory indicators, as well as by SAPS II scale. Cognitive functions were determined by the CFQ questionnaire (retrospectively the condition before the trauma and 3 months after was determined), MoCA (on day 2, when trans­ferred from the intensive care unit and at discharge from the hospital). Results: It was established that by the severity of the injury and the incoming severity of the somatic state two groups did not differ statistically. The state of cognitive functions before wound in the wounded of both groups was not statistically different and was not beyond the norm. On the second day in the control group, the cognitive functions decreased to the level of dysfunction (82.7±5.0%), while in the main one they did not cross the control limit of 10% of the baseline level (89.0±2.2%). Further dynamics in the reamberin group confirmed its protective properties with respect to cognitive functions, but this effect was not prolonged after the end of therapy. Conclusion: The use of reamberin in the complex intensive care of severe combat trauma can prevent a significant decrease of cognitive functions in the early post-traumatic period, but this effect is of short aftereffect time, therefore, its prolonged usage is necessary for the stable recovery of cognitive functions.

  

Sorokina OYu, Filip Zh.V. A comparative description of dynamics of metabolic response indexes in the phases of burn disease course depending on terms of the onset of surgical intervention

https://doi.org/10.26641/2307-0404.2018.1.124921

Key words: burn disease, metabolic response, surgical intervention

Abstract. A comparative description of dynamics of metabolic response indexes in the phases of burn disease course depending on terms of the onset of surgical intervention. Sorokina O.Yu., Filip Zh.V. A question of possibilities of influence on decline of progressing systemic response on the burn trauma remains open, despite actuality and active study of this problem. The aim of this work was carrying out a comparative description of dynamics of metabolic response indexes in the phases of burn disease (BD) course depending on terms of the beginning of the surgical intervention. Рatients with a thermal trauma were inspected and analyzed in this work. All the patients were estimated for the index of the thermal defeat severity, the percentage of the area of deep burn, a general area of burn, the age of a patient and the presence of respiration system burn. According to these, all the patients were divided into separate groups of research. The 1st group included 46 injured with the index of thermal defeat severity (TDS) from 61 to 90 units. The 2 group included 29 patients with the TDS index over 91 units. According to the terms of surgical intervention, patients of these groups were divided into sub-groups: 1.1 and 2.1, where the first surgical intervention was conducted five days before burn disease; 1.2 and 2.2, where the first surgical intervention was conducted five days after of burn disease. The level of cortisol and glycaemia of blood serum of injured people on different stages of inspection were taken into consideration. The diagnostically-curative program was conducted according to the clinical protocol of medical care to injured with thermal trauma. Estimating the dynamics of cortisol level, there was a considerable increase of it over the first twenty-four hours in both groups, which preserved during an acute period of burn disease. In the patients of the sub-group 2.1, with the TDS index over 91 units, who underwent early surgical tactics, the further activating of a sympathic adrenal system on the 7th day after the burn (an increase in cortisol by 82% compared with the previous indicator) was noted. From the first twenty-four hours after the burn, injured people suffered from a stress-induced hyperglycaemia which developed in all research groups, the latter did not depend on the severity of the burn trauma and did not correlate with the cortisol level of blood serum. With the early surgical treatment of burns, a more rapid normalization of blood glucose level in patients of 1.1 and 2.1 sub-groups on the 5th and 7th day of burn disease accordingly occurred. 

  

Shostakovych-Koretskaya L.R., Lytvyn K.Y., Chykarenko Z.O., Usenko T.V., Logvinenko V.O. Morphological characteristics of brain lesions in HIV positive patients

https://doi.org/10.26641/2307-0404.2018.1.124925

Key words: HIV infection, pathology, morphology, brain, mortality

Abstract. Morphological characteristics of brain lesions in HIV infection. Shostakovych-Koretskaya L.R., Lytvyn K.Y., Chykarenko Z.O., Usenko T.V., Logvinenko V.O. Currently, diseases of the central nervous system are a common cause of death of patients with HIV infection. The article presents results of retrospective analysis of etiotropic structure of 186 lethal cases and typical pathological changes of brain tissue of patients aged 21 to 61 years who had confirmed diagnosis of HIV and died of diseases associated with CNS damage in the Municipal infectious hospital in the city of Dnepr (Ukraine) in the period from 2011 to 2016. The most common causes of death in patients with HIV infection and CNS infection were cerebral tuberculosis (75.0%) including co-infection (n = 35) and meningoencephalitis that developed as a result of yeast fungal (15.6%). In the study of neuropathological processes in the autopsy material of the brain tissue of patients with HIV, various multifocal and diffuse morphological changes have been identified that can be presented in this work in the form of 4 groups: 1) Multiple nonspecific changes associated with both direct action of HIV and co-factors: infection, inflammation, hypoxia, etc., 2) Viral-induced vasculitis with hemorrhages, 3) Subacute aseptic encephalitis, 4) HIV-associated opportunistic infections. General pathomorphological changes in brain tissue are revealed that can cause similarities of clinical manifestations, can complicate differential diagnosis of cerebral lesions of various etiologies, and lead to a divergence of pre and postmortal diagnoses. 

  

Stepanov Yu.M., Chaliy N.V., Simonova O.V. The peculiarities of macroscopic status of the upper gastrointestinal tract mucosa in patients with hepatic and extrahepatic portal hypertension

https://doi.org/10.26641/2307-0404.2018.1.124927

Key words: portal hypertension,  upper parts of the gastrointestinal tract, varicose veins, portal gastropathy

Abstract. The peculiarities of macroscopic status of the upper gastrointestinal tract mucosa in patients with hepatic and extrahepatic portal hypertension. Stepanov Yu.M., Chaliy N.V., Simonova O.V. Identification of endoscopic signs of concomitant pathology of the upper gastrointestinal tract allows to determine the tactics of managing patients with different forms of portal hypertension (PG). The analysis of macroscopic picture of esophagus, stomach and duodenum mucosa was carried out in 104 patients with portal hypertension (88 patients with hepatic  portal hypertension, 46 – with extrahepatic portal hypertension, 16 – without  portal hypertension). The frequency of changes in the esophagus, specific for  gastroesophageal reflux disease did  not differ significantly in the researched groups. The frequency and severity  of varicose veins of the esophagus were diagnosed more often in patients with hepatic form of portal hypertension (OR=10.0, p<0.05). The predominance of different pathological changes of the gastric mucosa in patients with extrahepatic form of portal hypertension was revealed. Portal gastropathy in this group was 5.3 times higher than in patients with hepatic hypertension and 21 times higher than in the III group (without portal hypertension) (p<0.01). There were no significant differences of endoscopic picture of the duodenum  mucosa between the researched groups. 

  

Ivakh V.I. Long-term results of organ-preserving treatment of uterine leiomyoma combined with endometriosis

https://doi.org/10.26641/2307-0404.2018.1.124929

Key words: leiomyoma in combination with endometriosis of the uterus, myomectomy, long-term operation results, tumor recurrences

Abstract. Long-term results of organ-preserving treatment of uterine leiomyoma combined with endometriosis. Ivakh V.I. The analysis of a five-years’ catamnesis of reproductive age women who underwent surgery to remove leiomyoma nodes (myomectomy) is represented in this article. The aim of the study was to determine the incidence of tumor recurrence after myomectomy in women with leiomyoma combined with endometriosis. 82 operated patients, included into rescarch were divided into two groups according to the criterion of the presence or absence of endometriosis of the uterus. Group I included 44 (53.7%) cases of isolated lyomyomyoma surgery, and group II - 38 (46.3%) cases of combination of a similar tumor with endometriosis of the uterus. Myomectomy was performed by the transabdominal way in 43.9%, laparoscopic – in 46.3%, transcervical with a hysteroresectoscope - 11.4% of cases of operative treatment. According to the 5 years observation after the surgery, the recurrence of uterine leiomyoma appeared in 56.1% of women of both groups, while in group II, where the combination of uterine leiomyoma with endometriosis was noted, the frequency of tumor recurrences was significantly higher (71.1%, p<0,05%) than in group I with isolated uterine leiomyoma (43.2%,). Thus, the long-term results of myomectomy in women with uterine leiomyoma are associated with the risk of recurrence of the tumor in almost every second woman, but with the combined pathology of the uterus, these cases have a number of features compared to an isolated tumor – 2.5 times hig­her risk of recurrence in the first year after the operation and by 1.65 times higher frequency of relapse of the leio­myoma within 5 years after the surgery. The authors suggest that these differences evidence that the presence of endo­metriosis of the uterus is an additional factor that initiates the mechanisms of recurrence of the uterine leiomyoma after miomectomy, which should be taken into account in the development of a program of postoperative reproductive health rehabilitation of women with co-pathology of the uterus.

  

Zakharov S.V. Cytokine profile in patients with early latent syphilis

https://doi.org/10.26641/2307-0404.2018.1.124933

Key words: early latent syphilis, interleukin 6, interleukin 10

Abstract. Cytokine profile in patients with early latent syphilis. Zakharov S.V. The purpose of this study was to study the change in the content of the most active cytokines (interleukins 6 and 10) during the formation of the immune response in patients with latent early syphilis, as well as to study the possible relationship between the concentrations of these cytokines and the duration of the disease. In 50 patients with early latent syphilis, the concentration of interleukins 6 and 10 in serum was studied. The serum level of interleukins was studied by the enzyme immunoassay. A statistically significant increase in the concentration of interleukin 6 in the blood of patients with latent syphilis and decrease in the interleukin 10 concentration in comparison with healthy people was established. At the same time, in patients with latent syphilis with term of infection for more than 1 year, interleukin 10 has been expressed, as compared with healthy people and, especially, with patients with syphilis with a duration of infection of up to 1 year. Along with this, a lower degree of increase in the concentration of interleukin 6 in patients with latent syphilis with a duration of infection over 1 year has been established, as compared with patients with latent syphilis with a term of infection up to 1 year, against the background of its increased concentration as compared with a group of healthy individuals.

  

Kolesnyk T.V., Bereznyts’kyy Y.S., Duka R.V., Kolesnik E.L., Kosova H.A., Nadiuk A.V. Dynamics of parameters of elastic-elastic properties of arterial wall in patients with morbid obesity after conduction of bariatric treatment

https://doi.org/10.26641/2307-0404.2018.1.124934

Key words: morbid obesity, arterial wall, elastic properties, surgical treatment

Abstract. Dynamics of parameters of elastic-elastic properties of arterial wall in patients with morbid obesity after conduction of bariatric treatment. Kolesnyk T.V., Bereznyts’kyy Y.S., Duka R.V., Kolesnik E.L., Kosova H.A., Nadiuk A.V. According to the World Health Organization, 2.8 million people die every year from diseases associated with overweight or obesity. Abdominal-visceral form is a serious predictor of mortality from cardiovascular disease. The aim of the work was to evaluate the dynamics of rigidity of the arterial wall in patients with morbid obesity after the administration of bariatric treatment. The study included 22 patients with morbid obesity, 11 women and 11 men (50%). The average age of patients was 41.9 ± 2.38 years. All patients were under the supervision of a multidisciplinary team of State Establishment "Dnepropetrovsk Medical Academy of Health Ministry of Ukraine", which included surgeons, anesthetists, cardiologists and endocrinologists. Weight loss after bariatric treatment of obesity was accompanied by positive changes in the cardiometabolic profile in patients, which was manifested not only by improving blood pressure control, decreasing doses and the number of medications taken, but also reducing the rigidity of the arterial wall, which in turn led to the reduction of the risk of serious cardiovascular events in future.

  

Khrustaleva L.O. Analysis of anxiety level in patients with myocardial revascularization compared with conservative approaches to the treatment of ischemic heart disease

https://doi.org/10.26641/2307-0404.2018.1.124939

Key words: ischemic heart disease, myocardial revascularization, personality and reactive anxiety

Abstract. Analysis of anxiety level in patients with myocardial revascularization compared with conservative approaches to the treatment of ischemic heart disease. Khrustaleva L.O. The aim of the study was a comparative analysis of personal and reactive anxiety in patients with ischemic artery disease within a year, depending on the method of treatment. A survey of 215 patients with ischemic heart disease was conducted in the departments of cardiology, interventional cardiology and cardiac surgery of the MI «Dnepropetrovsk Regional Clinical Center of Cardiology and Cardiosurgery DRC» in 2010 - 2016. All patients underwent invasive coronary angiography and were administered conservative or surgical treatment - aortocoronary bypass grafting or stenting of the coronary arteries. The level of anxiety was determined by the State-Trait Anxiety Inventory (STAI) three times: in the initial stage of treatment, at three months and 1 year after treatment. It is determined that at the initial stage, when the treatment strategy is determined, the level of personal and reactive anxiety is high in most patients. The lowest level of anxiety is observed in patients who are prescribed coronary artery by pass grafting, in the second place - patients waiting for stenting of the coronary arteries, the highest level of anxiety in patients with drug treatment (p<0.001). Three months after the administered treatment, the level of anxiety of patients of different groups still requires additional attention and correction. A year later, patients with surgical revascularization of the myocardium no longer experience significant anxiety. The tendency to a high level of anxiety in patients with non-surgical approach to treatment is traced for a year and requires an additional medical correction of their psycho-emotional state. 

  

Yehudina Ye.D., Syniachenko O.V., Polesova T.R., Chernyshova O.E., Yermolaeva M.V. Disturbance of the muscoloskeletal system in juvenile ankylosing spondylitis and disease developed in the adulthood (involvement
of spine and sacroiliac joints)

https://doi.org/10.26641/2307-0404.2018.1.124942

Key words: ankylosing spondylitis, children, adults, spine, sacroiliac joints

Abstract. Disturbance of the muscoloskeletal system in juvenile ankylosing spondylitis and disease developed in the adulthood (involvement of spine and sacroiliac joints). Yehudina Ye.D., Syniachenko O.V., Polesova T.R., Chernyshova O.E., Yermolaeva M.V. Background. Two forms of ankylosing spondylitis (AS) are distinguished: juvenile and adult, depending on debut age of the disease. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in a pediatric rheumatology. The peculiarities of AS course that onsets in childhood and adulthood are manifested by differences in the nature of a spinal column disturbance. At the same time, the evolution of JAS in adulthood remains unexplored. The goals and objectives of research: to study clinical and X-ray symptoms of spondylopathy and sacroiliitis course, to assess their characteristics in the disease that onset in childhood and adulthood. Material and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21% of cases, moderate and high degree of activity – in 79% of cases, the ІІ-ІІІ stage in 82%, and polyarthritis – in 65%. JAS was detected in 16% of cases (all boys), among them the third stage occurred twice more likely than among the other patients. Results. The clinical and radiologic signs of spondylopathy and sacroiliitis are observed in 95% and 97% of the total number of AS cases, respectively, among all patients with JAS lumbago was detected 4,3 times more frequently, sciatic muscles hypotrophy – 7,8 times, "the string symptom" - 2,9 times", the calcification of the spinal cord - 2,3 times, whereas the prevalence of spinal column injury, the severity of cervico-spondylopathy and sacroiliitis among patients with the disease debut in the adulthood is significantly greater, and the involvement in the process of the lumbar and thoracic spine are detected correspondingly twice as often and by 19%, occurrence of dorsalgia is 4 times as often, the limitation of body lateral bendover by 59%, while there are ambiguous dispersion-correlation links with extraarticular (systemic) manifestations of the disease, and the high prevalence of a peripheral articular syndrome regarding spondylopathy in JAS is a negative prognosis sign, and for the remaining patients there are indices of the Lansbury index and the index of arthro­pathy progression. Conclusion: the onset of AS in adulthood is a risk factor for the severe course of spondylopathy.  

  

PREVENTIVE MEDICINE

Slautenko Ye. New tools for assessing health risks for the population caused by air pollution from pig farms

https://doi.org/10.26641/2307-0404.2018.1.124944

Key words: ambient air, modern pig complexes, smell pollution, population surveys, analysis of permission documentation, measurements, mathematical modeling

Abstract. New tools for assessing health risks for the population caused by airpollution from pig farms. Slautenko Ye. With the increase in the number of modern powerful pig complexes in Ukraine, the risks to the health of the population living in a residential area bordering the sanitary protection zones of pig complexes have significantly increased. In addition to the direct influence of chemicals that are present in the emissions, the smell pollution of ambient air being the risk to human health. The aim of the study was to substantiate new tools for assessing the impact of pig farms on public health and improving sanitary and epidemiological expertise. The article presents the materials of the complex hygienic research of the negative influence of atmospheric air pollution, in particular, smell pollution, in one of the modern pig farms with a capacity of 8.2 thousand heads of animals per year carried out by the laboratory of air quality of SI "O.M. Marseev Institute for Public Health" NAMSU. To accomplish these tasks, several stages of the research were carried out: questioning of the population, analysis of design materials and results of some permission documents such as sanitary and epidemiological expertise, in-situ measurements of ambient air and mathematical modeling of the distribution of chemicals on the territory of investigation. Based on the results of the study, the conclusions were drawn about the indirect effects of chemicals with odor properties on the health of the local population; A new tool for the needs of sanitary and epidemiological expertise, based on the method of mathematical modeling is proposed. 

  

SOCIAL MEDICINE

Shostakovych-Koretska L.R., Shevchenko-Makarenko O.P., Shevelova O.V., Tkachenko V.D. Experience of creating register of patients with chronic viral hepatitis in the Dnipropetrovsk region to optimize registration, monitoring and treatment of patients

https://doi.org/10.26641/2307-0404.2018.1.124946

Key words: chronic viral hepatitis B and C, patient register

Abstract. Experience of creating register of patients with chronic viral hepatitis in the Dnipropetrovsk region to optimize registration, monitoring and treatment of patients. Shostakovych-Koretska L.R., Shevchenko-Makarenko O.P., Shevelova O.V., Tkachenko V.D. In the article the authors presented their own experience of creating the register of patients with chronic viral hepatitis adapted for the region conditions, using the research tool created by the staff of the infectious diseases department and the hepatology department of the infectious hospital in 2010, which is used, in the center of health care of patients with viral hepatitis in the Dnepropetrovsk region. The use of the register of patients with chronic liver diseases is an auxiliary tool for improving the monitoring of patients with chronic viral hepatitis, as well as for determining the strategy and the following medical management in the course of the diagnosis of patients. This informative and economic tool can be implemented to monitor health state of patients with chronic viral hepatitis both at the group and individual level on a wider scale.

 

  

Zadorozhna A.G., Makarenko O.V. Pharmacoeconomic evaluation of the modern nasal corticosteroids for the allergic rhinitis treatment

https://doi.org/10.26641/2307-0404.2018.1.124949

Key words: the allergic rhinitis, pharmacoeconomic assessment, nasal corticosteroids, pharmacotherapy

Abstract. Pharmacoeconomic evaluation of the modern nasal corticosteroids for the allergic rhinitis treatment. Zadorozhna A.G., Makarenko O.V. The increase of allergic rhinitis incidence is an actual problem for industrial cities. The literature data on allergic rhinitis incidence in countries of Europe and Ukraine was analyzed. According to different authors, the allergic rhinitis is registered in 12-24% of the inhabitants of the Russian Federation, 26-40% - of the USA, 24-32% - of France, 16% – of the UK, and 19% – of Denmark. There were distinguished three main clinical forms of allergic rhinitis: light, moderate and heavy. General pharmacotherapy principles of the light and moderate forms of allergic rhinitis course are presented in the current article. There were indicated medicines for the first-line therapy of allergic rhinitis group "R01AD" - the medicines acting on the respiratory system, decongestants and other drugs for topical use in diseases of the nasal cavity, corticosteroids. The assortment of nasal corticosteroids is presented by mometasone (13 trade names), beclamethasone (2 trade names), fluticasone propionate (5 trade names). It is also shown that 95.6% of the nasal corticosteroids is imported from 9 countries, mainly from India and Belgium. The Ukrainian spray Forinex produced by Pharmac is the only representative among the R01AD group, but unfortunately, according to pricing range is not a drug of choice among nasal corticosteroids. The received data testify to the risk of inclusion of only imported drugs in the insurance list and the low replacement rate by the Ukrainian drug for treatment of the allergic rhinitis.

  

 

Dytiatkovskyi V.O., Kuliyeva A.A., Bovsunovs`ka K.P. Analysis of atopic diseases incidence among the children population

https://doi.org/10.26641/2307-0404.2018.1.124951

Key words: children, atopic diseases, atopic march, personalization, digestive tract

Abstract. Analysis of atopic diseases incidence among the children population. Dytiatkovskyi V.O., Kuliyeva A.A., Bovsunovs`ka K.P. The paper provides analysis of atopic diseases incidence diagnosed in children. There have been analyzed the associations between genesis of atopic diseases and child`s age, spectrum of cause-significant allergens, presence of digestive tract comorbidities. There have been given the recommendations for personalizing diagnostics and treatment of children having allergy manifestations on the background of the digestive tract diseases. 

  

REVIEW ARTICLES

Timchenko A.S., Zalessky V.N. Bone marrow fibrosis – the basis of mielofibrosis: pathogenesis, prognostication and antifibrogenic targeted strategies

https://doi.org/10.26641/2307-0404.2018.1.124952

Key words: bone marrow fibrosis, myelofibrosis, pathogenesis, cell therapy, targeted strategies 

Abstract. Bone marrow fibrosis – the basis of mielofibrosis: pathogenesis, prognostication and antifibrogenic targeted strategies. Timchenko A.S., Zalessky V.N. Bone marrow fibrosis is a key patological feature and major diagnostic criterion of mielofibrosis. Although bone marrow fibrosis is manifested in a variety of malignant  and non-malignant disease states, the deposition of reticulin and collagen fibrosis in the bone marrow of patients with myelofibrosis is believed to be mediated by the mielofibrosis of hematopoietic stem/progenitor cells, contributing to an impaired microenvironment toward malignant over normal hematopoiesis. The increased expression of pro­inflammatory cytokines, transforming growth factor-β, impaired megakaryocyte function and aberrant JAK-STAT signaling are the peculiarities of pathogenesis of bone marrow fibrosis. Hematopoietic stem cell transplantation remains the only therapeutic approach that reliably results in resolution of  bone marrow fibrosis in patients with mielofibrosis. In the work we review the pathogenesis, biological consequences and prognostic results of impact of bone marrow fibrosis. We discuss the rationale of various anti-fibrogenic treatment strategies targeting at clonal hematopoietic stem/progenitor cells, aberrant signaling pathway, fibrogenic cytokines, and tumor microenvironment.

  

 

Hojouj M.I.M., Bondarenko I.N., Zavizion V.F., Artemenko M.V., Hojouj T.V., Bondarenko Yu.N., Soloviova N.E., Shevchenko Y.A. Breast cancer and body weight index: the role of l-carnitine in prediction of answer to treatment and outcome of tumor in patients with obesity (review of literature)

https://doi.org/10.26641/2307-0404.2018.1.124953

Key words: body mass index (BMI), breast cancer (BC), obesity, overall survival, L-carnitine

Abstract. Breast cancer and body weight index: the role of L-carnitine in prediction of answer to treatment and outcome of tumor in patients with obesity (review of literature). Hojouj M.I.M., Bondarenko I.N., Zavizion V.F., Artemenko M.V., Hojouj T.V., Bondarenko Yu.N., Soloviova N.E., Shevchenko Y.A. Increasing the effectiveness of antitumor therapy in breast cancer patients who take L-carnitine during preoperative systemic antitumor therapy compared with patients receiving standard neoadjuvant systemic antitumor therapy served as a prerequisite for studying possible antitumor mechanisms of L-carnitine. The positive effect of L-carnitine is due to the transfer of palm-n-fatty acid through the inner membrane into the mitochondrial matrix, which contributes to the formation of a significant number of ATP molecules. It has also been shown that L-carnitine can have a double protective effect, enhancing the energy dynamics of the cell and inhibiting the hyperexcitability of the cell membrane, making it an ideal tool for the prevention and treatment of complications of antitumor therapy and concomitant metabolic disorders. This work summarizes the results of epidemiological and clinical studies on the use of L-carnitine in the treatment of breast cancer.

  

PAGES OF HISTORY

 

Semyonova L.S., Klimenko I.N. Anton Chekhov and his literary works as sources of studying humanism in medicine

https://doi.org/10.26641/2307-0404.2018.1.124954

Key words: Chekhov, humanism, literary works, story

Abstract. Anton Chekov and his literary works as sources of studying humanism in medicine. Semyonova L.S., Klimenko I.N. This article is devoted to a well-known doctor and writer A.P. Chekhov. It shows the influence of his doctor's activity on the creative literary process and concept of humanism in his literary works.

  

REVIEWS

 

Volosovets O.P. Review of National Text-Book “Pediatrics” for the students of higher medical educational establishments of the ІІІ-ІV levels of accreditation on specialty “Dentistry”

https://doi.org/10.26641/2307-0404.2018.1.124955