Medicni perspektivi, 2018;23(3)

     Title of the issue

Content

 2018 Vol. XXIII N 3

Published
2018-11-30

THEORETICAL MEDICINE

Mamchur V.I., Dronov S.N. Synergy of piracetam and aminalon in the cerebroprotective effect of olatropyl

https://doi.org/10.26641/2307-0404.2018.3.147945

Key words: piracetam, gamma-aminobutyric acid, olatropil, synergism

Abstract. Synergy of piracetam and aminalon in the cerebroprotective effect of olatropyl. Mamchur V.I., Dronov S.N. Optimization of pharmacotherapy of neurological and psychosomatic diseases led to the creation of com­bined medicines containing two or more components with different mechanisms of action, differently affecting the pathogenesis and clinical manifestations of specific forms of pathology. Combined drugs that help normalize the central regulatory mechanisms of the development of somatic pathology, improve brain metabolism and hemodynamics, stabilize the cortical-subcortical relationships, the disorders of which lie at the base of many forms of neurological and psychosomatic pathology have been particularly popular in recent years. In this article we propose options for opti­mizing nootropic therapy with olatropyl, which is a combination of two "true" nootropics - gamma-aminobutyric acid (aminalone) and piracetam in one drug form. Such a combination allows one-stage implementation of a complex of multifaceted and diverse effects on the central nervous system characteristic of both piracetam and aminalone, but achieved through fundamentally different mechanisms of action of these agents. The mechanism of action of olatropil demonstrates the pronounced synergism of the monocomponents of the preparation. This combination allows to reduce the therapeutic dosages of each of the active substances by 2 times, which, in turn, leads to a decrease in the incidence and severity of possible side effects; leveling the exciting effect of piracetam and providing higher safety and efficacy. The drug is an effective tool for the therapy of various forms of cerebrovascular pathology, improving cognitive functions, mental activity, psychoemotional status, autonomic functions, favorably affecting the quality of life of patients. The uniqueness of the mechanism of action of olatropil, consisting in the occurrence of the fact of pharmacodynamic synergy in the combined use of piracetam and aminalone in a single dosage form, contributes to the enhancement of positive pharmacological effects and the leveling of a number of negative elements of pharmacodynamics of preparation constituents.

  

CLINICAL MEDICINE

Abdulrahman Ali Hattan, Essa Ali Hattan, Abdulaziz Maree Alqahtani, Omar Saud Alqutaym, Refdan Obeid Alqahtani, Khaled Ghormallah Alzahrani, Abdulrahman Abdullah Al-Otaibi, Omar Mufi Aldwsari, Khalid Mansour Alkhathlan, Mohammed Abdullah Aldossari Impact of Tobacco Smoking on Oral Microbiota – A Case-Control Study

https://doi.org/10.26641/2307-0404.2018.3.147948

Key words: oral microbiota, oral health, impact of tobacco smoking

Abstract. Impact of tobacco smoking on oral microbiota – a case-control study. Abdulrahman Ali Hattan, Essa Ali Hattan, Abdulaziz Maree Alqahtani, Omar Saud Alqutaym, Refdan Obeid Alqahtani, Khaled Ghormallah Alzahrani, Abdulrahman Abdullah Al-Otaibi, Omar Mufi Aldwsari, Khalid Mansour Alkhathlan, Mohammed Abdullah Aldossari. Oral microbiota is a vital part of human microbiota, including bacterial, protozoa, viral and fungal species. Beneficial microbes form biofilms to form a first-line defense against harmful microorganisms. Tobacco smoking is considered a major environmental factor affecting the orodental microbiota. Smokers harbor more pathogenic microbes than non-smokers. In fact, cigarette smoking exposes the oral cavity to a large number of toxicants, perturbing the oral microbial ecology through various mechanisms. In Saudi Arabia, research on the impact of tobacco smoking on oral microbiota is still lacking. Therefore, this case-control study is an important addition to the literature in terms of tobacco use and its effects on oral microbiota and oral hygiene. 130 men were recruited for this study, including 65 smokers and 65 non-smokers. The following parameters were recorded for all 130 participants – age, weight, height and education. The aim of this study was to investigate and compare the effect of tobacco smoking on the oral microbiome of smokers and non-smokers. The majority of the smokers were young adults between the ages of 21 and 30 inclusive (n=27). The results show that excessive microorganism growth was seen in smokers to a greater degree than non-smokers (38.5% of smokers vs. 8.8% of non-smokers). Not surprisingly, a significant majority (85.3%) of non-smokers had moderate microorganism growth compared to only 53.8% of smokers. cigarette smoking facilitates excessive growth of oral microorganisms, predisposing smokers to various periodontal diseases. In fact, smoking perturbs the balance of oral microbiota, producing a viable environment for microbes to cause diseases. Further large scale prospective studies are required to determine the exact mechanism that causes tobacco to affect oral microbiota.

  

Kryvopustov M.S. Assessment of quality of life of patients with morbid obesity in a two-stage approach to their surgical treatment

https://doi.org/10.26641/2307-0404.2018.3.147949

Key words: bariatric surgery, morbid obesity, quality of life

Abstract. Assessment of quality of life of patients with morbid obesity in a two-stage approach to their surgical treatment. Kryvopustov M.S. Obesity leads to increased morbidity, disability, mortality and, crucially – decrease in the quality of life. As a tool for analyzing the quality of life, general nonspecific and specific questionnaires, preferring the latter are widely used. 97 patients with morbid obesity of III-IV class of operative-anesthetic risk according to the scale of the American Society of Anaesthesiologists were examined and treated. Two-stage treatment of patients was carried out as follows: in the patients of the main group intragastric balloon was used as the first stage for 6 months, patients of the control group were administered conservative therapy which included diet, physical activity and behavioral therapy. The quality of life was assessed using the Obesity and Weight-Loss Quality-of-Life Instrument (OWLQOL) -17 questionnaire. At the first stage, the mean percent of excess body weight loss % EWL in the main group was 22.69±5.87% being statistically significantly (p<0.001) higher than that obtained in the control group. The index of the total sum of quality-of-life scores increased statistically significantly (p<0.001) in 6 months in the main group of patients, in contrast to the control group. At the second stage, the average percentage of excess body weight loss was 55.27±7.62%. The index of the total sum of quality of life scores increased statistically from 37.43±4.53 before the bariatric operation to 64.91±5.72 12 months after its implementation (p<0.001). The average percentage of loss of excessive body weight at the end of the course of treatment reached 65.28±6.65% on average. Correlation analysis of percentages of excessive body weight loss and quality of life showed a direct average relationship between these indexes (r=0.64, p<0.001).

  

Poslavska О.V., Shponka I.S., Savchenko O.A., Petrova M.Yu. Isolated carcinomatosis of the abdominal cavity in women: the features of immunophenotypes and morphometric parameters

https://doi.org/10.26641/2307-0404.2018.3.147951

Key words: peritoneal carcinomatosis, ovarian cancer, CA125, ImageJ

Abstract. Isolated carcinomatosis of the abdominal cavity in women: the features of immunophenotypes and morphometric parameters. Poslavska О.V., Shponka I.S., Savchenko O.A., Petrova M.Yu. Patients with isolated abdominal carcinomatosis are traditionally treated similarly to patients with ovarian cancer stage III/IV. Despite histological, molecular and clinical similarities, this approach leaves no room for studying the individual biology of this phenotype of cancer of unknown primary localization. In addition, some metastases of gastrointestinal, pancreatic-biliary or endometrial adenocarcinomas simulate the histological and/or immunohistochemical (IHC) characteristics of primary ovarian adenocarcinomas. Over the past three decades, understanding the biology and pathways of intra-abdominal dissemination of tumors, taking into account the protective function of the peritoneal barrier against further tumor spreading, has led many researchers to consider the concept of peritoneal carcinomatosis as a locoregional disease. In the absence of other systemic metastases, new multimodal approaches combining aggressive cytoreductive surgery, intraperitoneal hyperthermia chemotherapy, and systemic chemotherapy are considered promising for improving disease control and increasing survival. Materials and methods. A retrospective analysis of clinical data, histological and IHC characteristics of biopsy material of 24 women with isolated abdominal carcinomatosis at the age of 28 to 81 years (mean 56.29±14.68, median 58.5) and 46 cases of primary ovarian tumors of women at the age of 27 to 76 years (mean 52.17±12.72, median 53.5), was performed to determine differential diagnostic criteria. IHC profile of primary ovarian tumors determined the most specific markers of cytokeratin C7 and CA125 (mucin 16), which in 43 out of 46 (93.48%) and 37 of 46 (80.43%) were respectively positive at least partially. It should be noted that 1 undifferentiated carcinoma was negative for both markers, only for SC7-2 mucinous adenocarcinomas and 1 low-grade, but only for CA125-2 endometrioid, 2 light-celled, 1 undifferentiated carcinoma and 4 low-grade adenocarcinomas (the latter were regarded as primary in exclusion of other localizations on the basis of a complete survey). Receptors to estrogens were determined in 14 of 46 (30.43%) of observations, which indicates their prognostic, and not diagnostic significance. In the group of women with isolated carcinomatosis of the abdominal cavity, SK7 was identified in 21 of 24 (87.5%) observations, CA125 in 16 of 24 (66.67%), all of whom had SC7 immunoreactivity, but only 9 of them demonstrated the presence of estrogen receptors, and 6 – serous phenotype (WT-1+), and 1 – mesothelioma (CK7 +, calretinin +). It should be noted that CA125-partially positive tumor patterns were often mixed with undifferentiated and nopapillary tumor deposits. These women were older than of the entire subgroup (mean 61.4 ± 10.08, median 61), but without significant difference (p>0.05). Conclusions. Only 2/3 of the investigated cases of carcinomatosis without primary localization in women after IHC research can be convincingly attributed to ovarian metastases for the application of appropriate therapy. Other 33.33% percent in our study were divided into 1 - neuroendocrine cancer (Chromogranin +, Synaptophysin +), 3 - colorectal (CK20 + CDX2 +), 2 - moderately and 1 - low-grade carcinomas with doubtful immunophenotypes (CK20+/-CDX2-/+CK7-/+Vimentin -/+), as well as 1 mesothelioma.

  

Rosits'ka O.A. Evaluation of the character of structural and functional changes in cerebral vessels in patients with ischemic cerebrovascular diseases on the background of multifocal lesions

https://doi.org/10.26641/2307-0404.2018.3.147952

Key words: ischemic impairment of cerebral circulation, abnormal deformation of the internal carotid and vertebral artery, stenosing lesions of the internal carotid and vertebral artery

Abstract. Evaluation of the character of structural and functional changes in cerebral vessels in patients with ischemic cerebrovascular diseases on the background of multifocal lesions. Rosits'ka O.A. The hemodynamic consequences of brain damage depend on the state of the autoregulation system of the cerebral circulation, on the severity, prevalence and rate of progression of the atherosclerotic process (one or more basins), changes in the vascular wall, and the features of the anatomical structure of the cerebral vascular system. Most registries cannot determine the cause of stroke in 25-40% of patients - the so-called cryptogenic strokes. Therefore, the question of underestimation of such disorders as tortuosity, extravasal compression, anomaly of development of not only internal carotid arteries, but also vertebral and subclavian arteries in the diagnosis of the effect on the course of cerebral ischemia is raised. In high-risk groups, the effect of pathology in the carotid arteries on the course of cerebral vascular disease is more often compared with the data of similar changes in extracranial vertebral arteries. In the general group of patients with multifocal lesion of the vessels (MFLV), tortuosity of blood vessels were found in the basins of the internal carotid artery (ICA) and vertebral artery (VA), and the frequency of deformations of the vessels of the vertebrobasilar basin predominated over the deformations in the carotid basin. Atherosclerotic lesions of the vessels of the BA (basilar artery) and VA pools were less frequent than the carotid, but more pronounced. Atherosclerotic lesions of the subclavian artery (Left subclavian artery) are significantly more frequent in the group of patients with vascular lesions of the heart, brain and lower limbs. According to the data of the correlation analysis, possible associations of atherosclerotic vascular lesions of the main arteries of the head (MAH) are established, both among them and with other risk factors.

  

Kapustnyk V.A., Kostyuk I.F., Melenevych A.Ya. Dependence of cytokinemia on the clinical course of chronic obstructive pulmonary disease combined with hypertension

https://doi.org/10.26641/2307-0404.2018.3.147953

Key words: chronic obstructive pulmonary disease, hypertension, systemic inflammation, biomarkers, interleukin-18, interleukin-10

Abstracts. Dependence of cytokinemia on the clinical course of chronic obstructive pulmonary disease combined with hypertension. Kapustnyk V.A., Kostyuk I.F., Melenevych A.Ya. Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease. The prevalence of COPD continues to increase steadily. 90% of patients with COPD have at least one comorbid pathology. Among concomitant COPD diseases pathologies of the cardiovascular system prevail. The variety of the disease course in patients is the basis for distinguishing COPD patients with similar pathophysiological mechanisms based on analysis of biomarkers. The aim of the study was to analyze the dependence of cytokinemia (interleukin-18 and interleukin-10) on the clinical course of the disease in patients with COPD in combination with hypertension (HT). In total, 100 occupational COPD (GOLD 2, group B) patients in remission were monitored. The main group included 69 patients with COPD in combination with HT stage II, the comparison group - 31 patients with isolated COPD, and the control group - 20 healthy volunteers. All groups were comparable by sex and age. Levels of interleukin-18 (IL-18) and interleukin-10 (IL-10) were significantly higher in COPD patients combined with HT compared to healthy volunteers and isolated COPD. Growth of IL-18/IL-10 ratio is associated with increase in the degree of dyspnea, decrease in exercise tolerance, increase in desaturation during the 6-min walk test, decrease in body mass index, waist and mid-upper arm circumferences, and also more frequent detection of emphysematous changes in chest X-ray. Thus, the IL-18/IL-10 ratio reflects the state of the immune-inflammatory process and has the potential to predict the future risk of developing irreversible pathological changes in the respiratory tract, alveoli and lung vessels with the formation of emphysematous and fibrotic changes.

  

Oprya Y.V. Clinical-diagnostic signs of schizophrenia, comorbid with chronic somatic pathology

https://doi.org/10.26641/2307-0404.2018.3.147954

Key words: clinical-psychopathological signs, diagnostic ratio, schizophrenia, cardiovascular diseases, diabetes mellitus type II, obesity 

Abstract. Clinical-diagnostic signs of schizophrenia, comorbid with chronic somatic pathology. Oprya Y.V. In order to determine the clinical and psychopathological signs of schizophrenia, combined with somatic disorders,186 schizophrenic patients (50 schizophrenic patients with cardiovascular diseases; 42 schizophrenic patients with diabetes type 2, 44 schizophrenic patients with obesity and 50 schizophrenic patients without chronic somatic diseases) were examined. As a research tool the clinico-psychopathological method (analysis of medical history, complaints and condition of the patient) was used, which was supplemented by the scale of positive and negative symptoms (PANSS). In the course of the study, a frequency analysis of socio-demographic data, general clinical characteristics of the endogenous process, as well as features of clinical and psychopathological manifestations of schizophrenia in patients with these somatic diseases were performed in accordance with the procedure of consistent statistical analysis. Specific diagnostic clinical-psychopathological sign-risk markers and anti-risk combinations of schizophrenia with marked variants of somatic disorders have been identified: the duration of psychotic disorder more than 15 years; the presence of depressive symptoms of moderate and higher severity; anxiety higher than moderate; hypochondria ideas of moderate and higher degree; abuse of psychoactive substances in history and emotional alienation above the weak level of expressiveness were established: as the most informative signs of the risk of cardiovascular disorders. The reliable differentiation of the risk of diabetes mellitus type II in patients with schizophrenia is provided by the following features: lack of professional employment; presence of symptoms of moderate and higher levels of excitation; duration of psychotic disorder more than 15 years; and disturbance of attention to a moderate and higher degree of expressiveness. The most informative signs of the risk of obesity in schizophrenia are: lack of professional employment; social isolation; the presence of passive-apathy social isolation of moderate and higher severity.

  

Bilenkyi G.Z., Makarenko O.V. Clinical efficacy and tolerance of sodium hypochlorite combined with taurine on the background of basic therapy in patients with acute pancreatitis

https://doi.org/10.26641/2307-0404.2018.3.147956

Key words: acute pancreatitis, sodium hypochoritis with taurine, clinical efficacy, blood amylase, diastase of urine, side effects 

Abstract. Clinical efficacy and tolerance of sodium hypochlorite combined with taurine on the background of basic therapy in patients with acute pancreatitis. Bilenkyi G.Z., Makarenko O.V. Acute pancreatitis refers to the most severe urgent diseases of the abdominal cavity. It occupies the third place after acute appendicitis and cholecystitis. The share of acute pancreatitis makes up 5-10% in the urgent pathology of the abdominal cavity organs. At the same time, in each fourth patient aseptic necrotizing pancreatitis develops, the total mortality of which even in specialized clinics of the world remains high (evidence of A, B level) range from 2.1% to 15%. Therefore, the search for new detoxifying agents with high indicators of clinical efficacy is an important trend in modern pharmacology. The purpose of this work was to establish the clinical efficacy and tolerance of the new infusion solution with the working name "Neoreodez", used against the background of basic therapy in patients with acute pancreatitis compared with the group of patients receiving baseline therapy only. A clinical study included 96 patients aged 20 to 65 years (52 men and 44 women) diagnosed with acute pancreatitis. All patients received baseline therapy (spasmolytics, proton pump inhibitors, protease inhibitors, somatostatin, antibiotics). In addition, the patients in the main group were prescribed an experimental infusion solution with the working name "Neoreodez" within 3 days. To evaluate the degree of endogenous intoxication, the method of determining the average mass molecule was used. The estimation was carried out with spectrometry in different modes of X=254 nm and X=280 nm. In addition, at the screening stage a level of malondialdehyde was determined: the latter is a clinical and laboratory marker of oxidative stress and blood pH. It was established, that the clinical efficacy of treatment in the main group of patients receiving the drug "Neoreodez" was 91.6%, which is significantly higher, than the clinical efficacy in the control group – 60.4%. Thus, the hypothesis about higher clinical efficacy of treatment in the main group of patients as compared with the control is confirmed.

  

Khalid Fahad Almalki, Abdullah Mussad Alharbi, Anthony Morgan, Adel Mohammed Bin Sultan, Saud Ayedh Alajmi, Turke Ali Alajmi, Arif Mohammed Alanazi, Mohammed Ibrahim Alsheddi, Ali Abdulaziz Alanzan, Zayed Fahd Al-Dosari Survival Rate of Patients with Cardiothoracic Injuries in Road Traffic Accidents, and their Relationship with ISS, GCS and Blood Transfusions

https://doi.org/10.26641/2307-0404.2018.3.147958

Key words: cardiothoracic injuries, ISS, GCS, blood transfusions

Abstract. Survival Rate of Patients with Cardiothoracic Injuries in Road Traffic Accidents, and their Relationship with ISS, GCS and blood transfusions. Khalid Fahad Almalki, Abdullah Mussad Alharbi, Anthony Morgan, Adel Mohammed Bin Sultan, Saud Ayedh Alajmi, Turke Ali Alajmi, Arif Mohammed Alanazi, Mohammed Ibrahim Alsheddi, Ali Abdulaziz Alanzan, Zayed Fahd Al-Dosari. Severe thoracic trauma is one of the major causes of injury-related mortality. In the United States, thoracic trauma results in one-fourth of all trauma deaths. Globally, cardiothoracic trauma is also a major contributor to mortality. The most common cardiothoracic injuries include rib fractures, thoracic vertebral fractures, haemothorax, pneumothorax, flail chest, and lung contusions. The purpose of the present study was to determine the survival rate of patients with cardiovascular injuries in road traffic accidents and its relationship with ISS, GCS and blood transfusions at King Khalid Hospital. This study is a useful addition to the literature, as research in this topic is lacking. A total of 189 patients were transported to the hospital with cardiothoracic injuries during the study period. Data was gathered regarding age, gender, nationality, vehicle user type, anatomical region injured, Intensive Care Unit (ICU) admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), blood transfusion, treatment and mortality rate. The neurological status was assessed using the GCS score. Injury Severity Scores were calculated to categorize the injury severity. The mean patient age was 31.81 years, with a peak age of between 21–30 years. Males predominated (93.7%) with a male to female ratio of 15:1. Most of the patients were Saudi nationals (61.3%). Overall mortality was 7.9%. Factors that were significantly associated with mortality were head and neck involvement, ICU admission, age (above 60), treatment delivered, and blood transfusions. Cardiothoracic trauma is associated with a high mortality rate, which may depend on the clinical presentation such as GCS, ISS, degree of shock, pattern of injuries, and associated injuries. Immediate management is vital for patients with life-threatening cardiothoracic trauma, as mortality is high if the diagnosis is missed, wrong or left untreated.

  

Yehudina Ye.D., Kalashnykova O.S. Management of patients with pulmonary arterial hypertension against systemic sclerodermia (part 1)

https://doi.org/10.26641/2307-0404.2018.3.147959

Key words: pulmonary arterial hypertension, systemic scleroderma, pharmacological treatment of pulmonary hypertension 

Abstract. Management of patients with pulmonary arterial hypertension against of systemic sclerodermia (part 1). Yehudina Ye.D., Kalashnykova O.S. Pulmonary arterial hypertension (PAH) is a serious condition caused by the damage to the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic scleroderma (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy in these groups are observed, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials.

  

Ternavskyi O.P. Investigation of the effect of coagulation with high-energy methods of hemostasis implementation on the resected liver surface (experimental research)

https://doi.org/10.26641/2307-0404.2018.3.147961

Key words: convection-infrared thermosurgical technology, coagulation hemostasis, bipolar electrocoagulation, high-frequency electric welding of living biological tissues, coagulation zone, liver parenchyma, experiment

Abstract. Investigation of the effect of coagulation with high-energy methods of hemostasis implementation on the resected liver surface (experimental research) Ternavskyi O.P. The peculiarity of using high-energy methods to implement hemostasis is in difficulty of comparing the degree of exposure to high temperature with the achievement of the desired effect, at the same time, excessive temperature in the area of impact leads to the formation of a layer of carbonized tissues or their evaporation. In order to analyze the peculiarities of changes in the liver parenchyma after coagulation with high-energy methods of hemostasis, an experiment that provided liver resection with coagulation of the resection surface using convection-infrared thermosurgical technology in a temperature mode of 600°C, bipolar electro-coagulation and high-frequency electric welding of living biological tissues was performed. The study analyzed the results of experimental studies on 25 outbred rabbits of different sex and age, weighing from 3350.0 g to 4180.0 g. Depending on the use of the high-energy coagulation method, 3 groups were formed: group 1 - high-frequency electric welding of living biological tissues; group 2 - bipolar electro-coagulation; group 3 - convection-infrared thermo­surgical technology at a temperature mode of 600°C. The data of histological research were analysed. Statistical analysis was performed using SPSS Statistics. Studies have found that the average trend of the thickness of the disaggregation/disintegration zone is 1936 (1630.83-2523) μm in the 1st group, 648 (508.33-734.33) μm in the 2nd group and 470.6 (453.5-507) μm in the 3rd group. The zone of compacted parenchyma: the 1st group – 2732 (2591.5-2798.5) μm, the second group 4538 (4421.5-4687.5) μm (p=0.001). The results of the study indicate that the use of convection-infrared thermosurgical technology in a temperature mode of 600°C has a less destructive effect on the surrounding tissues as compared with bipolar electrocoagulation and high-frequency electric welding of biological tissues.

  

Shostakovych-Koretska L.R., Shevchenko-Makarenko O.P., Tymofyeyeva L.V., Tkachenko V.D. Problematic issues of the effectiveness of treatment of patients with chronic viral hepatitis C according to the State program and the ways of their solution

https://doi.org/10.26641/2307-0404.2018.3.147962

Key words: chronic viral hepatitis C, direct-acting antivirals, the effectiveness of therapy

Abstract. Problematic issues of the effectiveness of treatment of patients with chronic viral hepatitis C according to the State program and the ways of their solution. Shostakovych-Koretska L.R., Shevchenko-Makarenko O.P., Tymofyeyeva L.V., Tkachenko V.D. The authors present the experience of antiviral treatment of patients with chronic viral hepatitis C (HVHC) within the framework of the State Target Social Program for the Prevention, Diagnosis and Treatment of Viral Hepatitis until 2016 and the local program "Population Health of Dnipropetrovsk Region for 2015-2019". The authors reviewed the treatment regimens that can be used in patients according to the latest recommendations of WHO and international organizations on the study of the liver (EASL, APASL and AASLD). The authors discussed the problematic issues of the effectiveness of treatment regimens containing interferon and ribavirin, as well as interferon-free regimens of therapy. At the first stage of the work, the authors noted the coverage of with antiviral therapy of HVHC patients in the Dnipropetrovsk region, taking into account the patients followed up the Unified electronic registry of patients of adult age with chronic viral hepatitis B, C and B + C. 3875 patients are included in the register, 3334 have HVHC, of them – 2795 patients with viremia. Antiviral therapy was received by 1038 patients with chronic viral hepatitis, including those with HVHC – 912 patients. In 2017, 725 people with HVHC completed antiviral therapy, the coverage of treatment was 21.75% of the total need, based on the number of patients in the Registry. As a result of treatment, 22 patients with the 1st genotype of HCV, had failed therapy with interferon-containing regimens. However, in a detailed analysis, the authors found that in one case there was a reinfection with another HCV genotype. Relapse was determined in 14 (63%) patients, partial virological response in 3 (14%) patients and non-response in 4 (23%) patients. At the second stage of the work, the re-treatment regimen was evaluated in patients with treatment failure after the use of PEG-IFN regimens using interferon-free regimens containing direct-acting antiviral drugs (DAA) for 12 weeks in 21 patients with an average age of 42.4±2.89 years, with the 1st HCV genotype, with an average disease duration of 6.52±1.05 years. There were 14 men with a mean age of 39.67±4.16 years and 9 women with a mean age of 46.22±4.01 years. The level of fibrosis: F1 – 8 people, F2 – 7, F3 – 3 and F4 – 3. 3D treatment regimen was used for retreatment including the following: Ombitasvir / Paritaprevir / Ritonavir + Dasabuvir + Ribavirin (3D+RBV) in 16 patients, moreover, 3 of them had compensated liver cirrhosis. 5 patients with HCV genotype 1 without the presence of liver cirrhosis were given the following scheme: Ledipasvir + Sofosbuvir + Ribavirin (SOF+LDV+RBV). All patients had a sustained virological response (SVR-24) and the effectiveness of the antiviral therapy was rated as 100%. Also two clinical cases of treatment of HVHC in patients with antiviral therapy failure are presented. For further implementation of the WHO strategy for the elimination of viral hepatitis, it is necessary to continue the work on the formation of the Registry of patients with chronic viral hepatitis in order to improve the provision of care to patients in this category. Further study of the issue of personalization of antiviral therapy and minimization of risks that adversely affect its results are required.

  

Borowska-Striuk T. Therapeutic tactics in the hypothalamic syndrome of puberty in girls

https://doi.org/10.26641/2307-0404.2018.3.147963

Key words: hypothalamic syndrome, puberty, menstrual function, treatment

Abstract. Therapeutic tactics in the hypothalamic syndrome of puberty in girls. Borowska-Striuk T. Hypothalamic syndrome of puberty (HSP) is a pathological symptom complex that occurs as a result of dysfunction of hypothalamus, pituitary gland and other endocrine glands during puberty. Purpose – to improve the therapeutic tactics in patients with HSP based on the results of study of the clinical course of the disease, the state of the nervous and endocrine  systems. The study included 125 patients aged 11-17 years with HSP, divided into two clinical groups: 50 patients aged 11-14 years and 75 girls aged 15-17 years. The examination included the collection of anamnesis, anthropometric, general clinical and gynecological examination, the study of hormonal profile, lipid and carbohydrate metabolism, instrumental studies, consultations of a neurologist, endocrinologist. It was found that the formation and course of HSP in girls during puberty occurs against a background of perinatal hypoxic involvement of the central nervous system, early obesity, viral loads, disorders of menstrual function, increased secretion of prolactin, androgens, cortisol and reduced level of estradiol. Neurofunctional research methods confirmed the functional nature of changes in the central nervous system in patients with hypothalamic syndrome of puberty. HSP therapy should be comprehensive and systematic, including normalization of body weight, correction of nutrition, mental and physical activity, sleep, thyroid function, hyperandrogenism, insulin resistance, menstrual cycle. In the follow-up dynamics after 2-3 courses of therapy (on average 6-15 months), restoration of the menstrual cycle was observed in all 25 (100%) patients with secondary amenorrhea and regression of cystic ovarian formations in all 11 (100%) patients. Weight loss was noted in most patients with overweight and obesity in 70 (92.1%) cases.

  

PREVENTIVE MEDICINE

Ruda T.V., Korshun M.M. Hygienic assessment of professional combined risk in case of modern multicomponent pesticides usage on maize and sunflower crops

https://doi.org/10.26641/2307-0404.2018.3.147964

Key words: herbicide, fungicide, oilseeds, combined risk 

Abstract. Hygienic assessment of professional combined risk in case of modern multicomponent pesticides usage on maize and sunflower crops. Ruda T.V., Korshun M.M. The results of the risk assessment of combined hazard effects of diflufenzopyr, dicamba, nicosulfuron (herbicide Kelvin Plus) and azoxystrobin, difenoconazole (fungicide Amistar Gold 250 SC) on workers involved in working with them are presented. The field study on maize and sunflower crops, in which Kelvin Plus and Amistar Gold were used at maximum flow rates of 0,4 kg/ha and 1,0 l/ha, respectively was performed. During ground handling, the working solution consumption was 300 l/ha, while during aviation – 50 l/ha. Air samples of the working area, washings from the skin, stripes on the overalls of workers were selected, followed by the determination of the residual quantities of the active substances under study in the selected samples. Hazard coefficients and indices, based on exposure and permissible inhalation and percutaneous doses (a. s.) were calculated. It has been established that the working conditions of agricultural workers are permissible, since the hazard indices of the harmful combined effect of the pesticides under study are lower than 1. Before carrying out full-scale studies, the coefficients of possible inhalation poisoning were calculated, and it was established that all pesticides under study are of low risk as for this coefficient – 4 class. An assessment of the possible occurrence of acute toxic effects when working with pesticides was made as well, that is, the selectivity coefficients of the action were determined for inhalation and percutaneous effects on humans. It was established that all investigated a. s. at inhalation influence on the person have sufficient selectivity of action, except for azoxystrobin, which has a low selectivity of action; when applied to the skin all the a. s. have sufficient selectivity of action. The use of the tested combined preparations on maize and sunflower crops does not endanger the workers, while observing the established hygienic regulations.

  

SOCIAL MEDICINE

Yeroshkina T.V., Derevyanko D.V. Medical-demographic problems of Ukraine and some ways of their overcoming

https://doi.org/10.26641/2307-0404.2018.3.147966

Key words: dynamics of demographic indicators, depopulation, demographic crisis,ecological catastrophy

Abstract. Medical-demographic problems of Ukraine and some ways of their overcoming. Yeroshkina T.V., Derevyanko D.V. The article covers the main medical and demographic problems of Ukraine: birth-rate decline, growth of mortality; moving of qualified personnel abroad, which led to a decrease in the population over the years of independence by more than 9.5 million people. The total birth rate in Ukraine in 2017 was 10.3 per 1000 people, which is 14.9% lower than in 1991. The lowest birth rate was observed in 2000-2002 (7.8, 7.7, 8.1). Then gradually there is an increase in the indicators in 2012 - 11.4 per 1000 people. The total mortality rate in 2017 is 14.4, which is 11.6% higher than in 1991. According to the analysis period, the lowest mortality rate was registered in 1991 - 12.9%. The most high-speed in the period 2005-2008. (16.6, 16.2, 16.4). The natural increase from -0.8 dropped to-4.1 (more than 5 times). The demographic situation in Ukraine is characterized by depopulation, it is characterized by demographic crisis, the main features of which are adverse changes not only in the number but also in the healthy of population, which is manifested in the decrease in the average life expectancy, the deterioration of the health of children and adolescents, the growth of malformations among newborns, high mortality rates from circulatory system diseases; oncological diseases, injuries, poisonings and other consequences of external causes; men's super mortality. The main causes of these phenomena are the protracted economic crisis, the ecological catastrophe (Chernobyl), the country's being in a state of hybrid war, which led to a sharp decline in living standards, uncertainty of the population in the future deaths of people. We offered some ways to over come the country's demographic crisis.

  

Hopko N.V. Evaluation of influence of factors of life-sustaining activity on the level of morbidity from leptospirosis on the example of the Chernivtsi region

https://doi.org/10.26641/2307-0404.2018.3.147967

Key words: morbidity, leptospirosis, risk factor

Abstract. Evaluation of influence of factors of life-sustaining activity on the level from morbidity of leptospirosis in the example of the Chernivtsi region. Hopko N.V. The relevance of leptospirosis is associated with its wide spread in many countries of the world, an increase in the number of severe forms of the disease, often with a fatal outcome, which determines its high medical, social and economic importance. In modern conditions, it is necessary to evaluate the influence of various factors on the incidence of leptospirosis through the use of a wide arsenal of statistical methods. Preventing epidemic growths is possible through effective preventive and anti-epidemic measures developed on the basis of epidemiological surveillance and risk assessment. In order to determine the relationship between the incidence rates of leptospirosis and the environmental factors, we conducted a study using regression analysis with subsequent correlation analysis. The study used data from the State Institution "Chernivtsi Regional Laboratory Center of the Ministry of Health of Ukraine", as well as data from the State Statistics Service of Ukraine on social factors for 2008-2018. Given the results of multivariate regression analysis, the most significant factors that affect the incidence of leptospirosis were the infection of cattle, pigs, dogs, cats. The influence of migration processes on the incidence of leptospirosis is proved, which should be taken into account in reporting forms for further correlation analysis and optimization of the epidemiological surveillance system. Improving the system of epidemiological surveillance of leptospirosis by identifying elements in the information, diagnostic and management subsystems will facilitate timely intervention to make adequate management decisions.

  

IN MEMORY OF THE SCIENTIST