Medicni perspektivi, 2022;27(1)
2022 Vol. XXVII N 1
Key words: analysis, color properties, raster image, microspecimen, computer program
Abstract. Analysis of color properties of raster images of histological microspecimens: own research experience. Ivanova M.D., Myroshnychenko M.S., Khara G.I., Arseniev O.V., Olkhovsky V.O., Grygorian E.K., Fedulenkova Yu.Ya., Kozlov S.V. This study is aimed to develop a computer program to analyze the color properties of raster images of histological microspecimens used in pathological anatomy and forensic medicine. When developing a computer program, we used the system for building client applications – Windows Presentation Foundation (WPF). The system allows you to create applications with visually attractive user interaction capabilities. The programming language is C#, as well as basic graphics capabilities of the .NET Framework system are used. To speed up the display we applied double buffering. In the course of the research, the authors developed a modern computer program «Analysis of color properties of raster images». This program allows you to analyze the color of each individual pixel of a photograph in RGB and Lab color models, comparing the colors and brightness of individual pixels, selecting groups of points and determining statistical characteristics of them. Characteristic points are well distinguishable in the photographs, studied with the program «Analysis of color properties of raster images». This makes it possible to select and automate these properties, using computer recognition algorithms, completely removing human factor’s influence on the analysis results. The computer program «Analysis of color properties of raster images» is of significant scientific and practical interest for specialists both in the field of morphology (pathologists, forensic experts, etc.), and in the field of other biomedical disciplines.
Key words: physians (provisors)-interns, full-time internship training, extramural or practical part of internship training
Abstract. Analysis of expectations and satisfaction of physicians (provisors)-interns in Ukraine at the stage of primary specialization – internship training. Sichkoriz O.Ye., Zimenkovsky A.B., Gutor T.G. The aim of the study is to identify the expectations of physicians (provisors)-interns for postgraduate education and assess their satisfaction with the course of primary specialization (internship). The sociological crossectional study was performed in 2021 by surveying interns of Danylo Halytsky Lviv National Medical University majoring in the following medical specialties: “Medicine” and “Pediatrics”, “Dentistry”, “Pharmacy”. The survey took place in two groups: applicants at the beginning of the internship (n=655) and after completion of the internship (n=623). Statistical methods (which are represented with confidence intervals calculated by the Fisher’s angular transformation method), structural-logical analysis and a systematic approach were used. The study revealed that the most effective form of training in the full-time internship cycle are practical classes and conferences for physicians(provisors)-interns; the least effective form is independent work. The main factors that prevented the interns from mastering the professional knowledge, skills and abilities of the internship cycle are limited opportunities for independent supervision of patients, material and technical equipment of the clinical base of the department and the interns’ own inertia. Certain shortcomings in the organization of the practical part of the internship on the basis of the hospital / pharmacy were established, namely: lack of supervision of patients, lack of practical activities, unsatisfactory material and technical equipment and disinterest of the staff in the training of interns. According to interns, the ideal model of internship should be available, that would provide the optimal amount of theoretical knowledge and relevant practical skills and would be as relevant to the future work of the physician as possible. Applicants emphasize the qualitative component of obtaining postgraduate medical education: the use of new treatment protocols, training in hospital of the third level of medical care, the possibility of doing internships abroad. Such sociological surveys among physians (provisors)-interns on their satisfaction and compliance with expectations are an important component of the development of an optimized Model of postgraduate education of doctors / provisors in Ukraine, which will improve the quality of primary specialization (internship), the ultimate goal of which is health preservation and improvement of the life expectancy of Ukrainian citizens.
Key words: ischemic heart disease, chronic obstructive pulmonary disease, echocardiography, comorbidity, heart failure
Abstract. Remodeling of heart in patients with stable ischemic heart disease combined with chronic obstructive pulmonary disease as a basis for development of heart failure. Kniazieva O.V., Potabashnii V.A., Fesenko V.I. The aim of this study was to determine phenotypes of remodeling of heart and the status of systolic and diastolic function in patients with ischemic heart disease (IHD) combined with chronic obstructive pulmonary disease (COPD) with early symptoms and signs of heart failure (HF). We enrolled 108 males with stable IHD and spirometrically confirmed COPD which preceded the manifestations of IHD – the main group (group 1). As comparison groups 30 males with stable IHD (group 2) and 30 males with COPD (group 3) were examined. Control group included 30 males without IHD and respiratory diseases. All groups were comparable in age, groups 1 and 2 – in the duration of IHD, groups 1 and 3 – in the duration of COPD. The patients of the group 1 were divided into 3 subgroups: subgroup 1 – 45 patients with stable angina, subgroup 2 – 27 patients with postinfarction cardiosclerosis, subgroup 3 –36 patients with combination of stable IHD and arterial hypertension (AH) without history of myocardial infarction. The patients of group 1 had different phenotypes of heart remodeling, which depended on the clinical forms of IHD, the presence of concomitant AH, the severity of bronchial obstruction. The patients of subgroup 1 in 60.0% cases had concentric remodeling and concentric left ventricular hypertrophy (LVH), in 26.7% – normal LV geometry, in all these cases ejection fraction (EF) was preserved. Only in 13.3% of cases eccentric LVH with mildly reduced EF was found. 59.3% of patients in subgroup 2 had eccentric LVH, left atrium dilatation and 55.6% had reduced EF. All patients of subgroup 3 had concentric direction of LV remodeling. The phenotypes of HF with reduced and mildly reduced EF were accompanied by impaired LV diastolic function. In assessing the likelihood of HF with preserved EF the HFA-PEFF score showed better accuracy. Pulmonary hypertension had a mixed cause with predominance of postcapillar component.
Key words: blood lipid spectrum, elastic properties of arteries, chronic pancreatitis, arterial hypertension
Abstract. Blood lipid spectrum and elastic properties of arteries in patients with chronic pancreatitis in combination with arterial hypertension. Filippova A.Yu., Löhr M., Kryvoshei V.V. 110 patients aged 45-65 years with chronic pancreatitis were examined. The first group consisted of patients with a combined course of chronic pancreatitis with arterial hypertension; the second group - patients with chronic pancreatitis without concomitant hypertension. All patients were examined for total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol. Arterial stiffness was determined by the pulse wave velocity. It was found that patients of the 1st group had significantly higher levels of triglycerides (37.2%), low-density lipoprotein cholesterol (13%), total cholesterol (25%), atherogenic ratio (19.6%) and significantly lower levels of high-density lipoprotein cholesterol (15.4%). Correlations between age and the level of atherogenic ratio, low-density lipoprotein cholesterol were established – r=0.35; p<0.01; r=0.37; p<0.01, respectively. The duration of chronic pancreatitis positively correlated with the level of triglycerides, low-density lipoprotein cholesterol – r=0.43; p<0.01; r=0.34; p<0.01, respectively. The level of brachial artery augmentation index was significantly lower by 43% in patients with chronic pancreatitis in combination with arterial hypertension, while the aortic augmentation index was significantly higher by 37.6% (p<0.01). It was found that patients of the 1st group had a significantly higher pulse wave velocity in the carotid-femoral segment compared to the 2nd group – by 7.5% (p<0.01). Significant correlations have been established between the brachial artery augmentation index and age, total cholesterol, atherogenic ratio, high and low density lipoprotein cholesterol, triglycerides, cardiovascular risk level by the SCORE scale in patients with a combined course of chronic pancreatitis with arterial hypertension. Conclusions. Patients with the combination of chronic pancreatitis and hypertension had significantly higher levels of triglycerides, low-density lipoprotein cholesterol and total cholesterol. Changes in the elastic properties of arteries in patients with chronic pancreatitis with comorbid hypertension were characterized by an increase in the augmentation index and the pulse wave velocity in the carotid-femoral segment.
Key words: psychological, COVID-19, health personnel, pandemics, GHQ-28
Abstract. Psychological impact of COVID-19 pandemic on health care workers of tertiary care hospitals. Khan M.J., Jamil B., Haroon M.Z. Healthcare workers (HCWs) are at increased risk of mental health issues when faced with the challenges associated with pandemics. This study was conducted to assess the psychological impact of pandemic on HCWs working in tertiary care hospitals of Khyber-Pakhtunkhwa province of Pakistan. This cross-sectional study was conducted between April & June 2020. By convenience sampling an electronic form of Goldberg General Health Questionnaire was distributed among HCWs of the private sector and public tertiary care hospitals. Data were analyzed using SPSS version 22. Inferential analysis was done. The significant level was considered at p=<0.05. Total of 186 HCWs among which 105 (56.5%) males and 81 (43.5%) females participated in the survey, a mean age of 37.6±9.28 years. The highest prevalence was found for social dysfunction 184 (97.8%) followed by somatization, 169 (92.8%). Significance of difference was found between age group and anxiety (p=0.018), specialty of HCWs with somatization and social dysfunction (p=0.041 and 0.037 respectively). Pandemic poses a significant risk for the mental health of HCWs. During pandemics at its peak, proper mental health support program, personal and family protection assurance is highly recommended for provision of quality care by HCWs
Key words: diabetes mellitus type 2, QTc interval, glycemic variability
Abstract. Definition of the dependence of QTc interval prolongation on glycemic control in patients with type 2 diabetes mellitus. Pertseva N.O., Moshenets K.I. The aim of the study: to assess the impact of glycemic variability on the duration of QTc interval in patients with diabetes mellitus type 2. 68 patients with type 2 diabetes mellitus (DM) and glycosylated hemoglobin (HbA1c) level ≤10% were examined. Of them – 37 (54.4%) men and 31 (45.6%) women. The average age – 46.0 (43.0; 54.0) years, the duration of DM type 2 – 7.0 (5.0; 9.0) years. Patients were divided into 2 groups according to HbA1c level: group 1 (n=31) with HbA1c <7% and group 2 (n=37) with HbA1c ≥7%. The control group consisted of 10 practically healthy people, compared by gender and age. The duration of the QTc interval was calculated automatically by Bazett's formula during 24-hour Holter electrocardiogram (ECG) recordings. Additionally, the percentage of cases of exceeding the QTc threshold over 450 ms (QTc>450) was also calculated. Simultaneously with 24-hour Holter monitoring, the continuous glucose monitoring was performed, using iPro2 system (Medtronic MiniMed, USA). The maximum value of glycemia (Gmax), the minimum value of glycemia (Gmin), as well as indicators of glycemia variability (GV) were analyzed: standard deviation of mean glycemia (SD) and glycemia range (GR). The duration of daily QTc and the value of QTc >450 in patients with type 2 DM were significantly greater compared with the control group (p<0.05) and did not depend on the HbA1c level. In type 2 DM patients without recorded hypoglycemic episodes, the characteristics of QTc did not differ from the results of the control group (p>0.05). At the time of the hypoglycemic episode, the QTc duration in patients with type 2 DM significantly increased compared with the average daily value of QTc in the same patients – 487 (466; 519.5) ms against 436.5 (431; 452) ms (p<0.001). A strong correlation between QTc duration and the presence of hypoglycemia was determined (rs=0.78; p=0.023). QTc duration also correlated with GR (rs=0.23; p=0.016) and SD (rs=0.21; p=0.021). Therefore, it was found that in patients with type 2 diabetes, the prolongation of QTc duration is associated with high glycemic fluctuations and hypoglycemia (p<0.05) regardless of the HbA1c level.
Key words: cerebellopontine angle, jugular foramen, vestibular schwannoma, glossopharyngeal schwannoma, cranial nerves caudal group schwannoma, diagnosis, clinical picture, cranial nerves
Abstract. Challenges in preoperative diagnosis of glossopharyngeal nerve schwannoma: own findings analysis. Skobska O.E., Sirko A.H., Zemskova O.V., Lisianyi O.M., Popovych I.O., Malyi R.R. Medical history, disease onset, clinical symptoms, and results of neuroimaging of 14 glossopharyngeal schwannoma patients, who were examined and treated in the Subtentorial Neurooncology Department of the State Institution, Romodanov Institute of Neurosurgery of the NAMS of Ukraine (8 patients) and the Neurosurgery Department No. 2 of the Municipal Enterprise, Mechnikov Dnipropetrovsk Regional Clinical Hospital of Dnipropetrovsk Regional Council (6 patients) in 2018 to 2021 have been analyzed in details. The study inclusion criteria were as follows: patient’s age over 18, presence of unilateral primary glossopharyngeal nerve schwannoma. Our study showed that most of clinical signs and symptoms of the glossopharyngeal nerve schwannoma are associated with otolaryngological disorders (such as hearing loss, tinnitus, hoarseness, or dizziness) or cerebellar disorders (such as ataxia, nystagmus, or dizziness). Neuroimaging cerebellopontine angle tumors diagnosis must include brain computed tomography (with mandatory assessment of the state of jugular foramen and internal auditory canal) and IV contrast brain magnetic resonance tomography and inclusion of high-resolution sequences, gradient echo (3D CISS, DRIVE, TRUFFI, B-FFE) with the aim of better visualization and differentiation of various cerebellopontine angle cranial nerves. The study demonstrates the complexity of a reliable preoperative diagnosis when using standard diagnostic tools. Preoperative jugular foramen and cerebellopontine angle tumors diagnosis should be based on a systematic approach and include a comparison of results of comprehensive clinical and instrumental examination and neuroimaging studies.
Key words: combined anal and rectal diseases, radiosurgery technology, electrosurgery technologies
Abstract. Modern technologies in surgical treatment of combined anorectal pathology and their results. Balytskyy V.V., Zakharash M.P., Kuryk O.H. Surgery of combined anal and rectal diseases requires an unconventional tactics and methods of treatment of these pathologies, which provide minimal impact on tissues, preventing postoperative complications. The aim of the study was to conduct a comparative evaluation of the effectiveness of new radiosurgical and electrosurgical technologies in the treatment of combined anal and rectal diseases by analyzing the clinical course of the postoperative period and the impact of these energy devices on the morphostructure of operated tissues. The results of treatment of 747 patients with combined anal and rectal diseases divided into four research groups and control group have been analyzed. In the first research group 169 (22,6%) patients with electrosurgery device “ERBE ICC 200” have been operated on in the second research group – 114 (15,3%) patients with electrosurgery device "EFA", in the third research group – 107 (14,3%) patients – with electrosurgery device "KLS Martin" and in the fourth research group – 245 (32,8%) patients with radiosurgery device "Surgitron". The control group consisted of 112 (14,9%) patients operated with a surgical scalpel. After surgery 30 patients from each study group underwent morphological investigation of rectal and anal tissues for measurement of the thickness of thermal impacts on them, which was performed using an eyepiece-micrometer scale. Due to the minimal and insignificant impact on the tissues during application of electrosurgery devices “KLS Martin”, “EFA” and “ERBE ICC 200”, as well as radiosurgery device "Surgitron", there were detected neither scar anal strictures in any of the four study groups, nor scarring deformities of the pararectal areas, which contributed to the cosmetic nature of the combined operations and caused rapid rehabilitation of patients in the study groups. In the control group in 2 (2%) patients the formation of scar anal stricture was diagnosed, which required conservative (1 patient) and operative (1 patient) measures to eliminate them. Using modern radiosurgery and electrosurgery technologies for treatment of combined anal and rectal diseases reduces the operation duration, volume of bleeding and intensity of the postoperative pain. Application of these above technologies prevents the occurance of anal strictures and scar pararectal deformations.
Key words: central venous thrombosis, aseptic thrombosis of the cavernous sinus, differential diagnostic of thrombosis
Abstract. Peculiarities of the differential diagnosis of different types of cerebral sinus and vein thrombosis in patients with ENT organs involvement. Lamza N.V., Kovtunenko O.V., Morgachova G.K., Tereschenko L.A., Lyschenko D.V., Zaitsev A.V., Fannan A. The paper is devoted to the problems of diagnosis of septic and aseptic forms of central venous thrombosis. The aim of the study was to study the clinical manifestation and lesions of the ear, nose and throat, in patients with aseptic central venous thrombosis in order to increase the efficiency of differential diagnosis of various forms of thrombosis and to determine the tactics of further treatment of patients with this disease. Variants of manifestation of lesions of Lesions of the ear, nose and throat were studied in 14 patients with aseptic central venous thrombosis who were hospitalized for the period from 2016 to 2019, the results of their ophthalmological and neurological examination, as well as laboratory studies are given. It was found that among patients with cerebral venous thrombosis in most cases (82.4%) various changes in otolaryngological status were detected, of which 21.4% of cases – with septic lesions of the ENT organs, 78.6% of cases – with aseptic changes. During the examination, the character of these pathological changes in otolaryngology status in non-purulent lesions of the ENT organs (swelling of the soft tissues of the face, sinus mucosa or their necrosis, dysfunction of the pharyngeal muscular system, neurosensory deafness) were formulated, which could be explained by secondary ischemic tissue changes and impaired venous outflow of the soft tissues of the face. Also, the absence of a primary purulent focus of infection and septic changes in peripheral blood and cerebrospinal fluid in patients with a clinically confirmed diagnosis of CVT, confirmed the aseptic (primary) form of the disease. Patients with aseptic CVT are assigned direct anticoagulant therapy and symptomatic therapy depending on the presence of cerebral and focal neurological symptoms, which is radically different from the therapeutic tactics used by patients with septic CVT. Thus, when conducting a differential diagnosis of different forms of CVT, for the choice of therapeutic strategy, in addition to the standard algorithm of examination of the patient should take into account the nature of changes in otolaryngological status.
Key words: asthma, metabolic disorders, obesity
Abstract. Features of carbohydrate metabolism in asthma patients with obesity. Bezditko T.V., Yeryomenko G.V. Asthma (As) and metabolic disturbances are widespread and socially significant states, obesity (Ob) being also one of them. The comorbidity of As and Ob both affects physiological mechanisms of bronchial obstruction syndrome, the course and prognosis of these two diseases and significantly complicates their treatment. A combination of changes in ventilation and a complex architectonics of the bronchi may contribute to worsening control over As. The performed study deals with the problem of early diagnosis and progression of the course in patients with As and Ob comorbidity. The study involved 62 patients with As. Of them, there were 24 cases with the normal body mass (Group I) and 38 cases with As+Ob (Group II). Along with evaluation of respiratory function values and anthropometric examination, all the patients underwent controlling of carbohydrate metabolism. It was found out that As combined with Ob were accompanied by a cascade of metabolic disorders: hyperinsulinemia, insulin resistance, and higher levels of HbA1с and fasting glucose versus the control group (р<0.05). According to correlation analysis data, in Group II negative correlations between values of HOMA-IR and 40≤FEV1<50% (r= -0.53; р<0.05), HOMA-IR and 50%≤FEV1<60% (r= -0.49; р<0.05), insulin level and 40≤FEV1<50% (r= -0.42; р<0.05) as well as a positive correlation between HPMA-IR value and BMI (r=0.39; р<0.05) were revealed. Patients with As, degree 1 Ob and a disorder of FEV1>60% revealed hyperinsulinemia and an increased level of insulin resistance index; this fact can be regarded as a prognostic criterion for an improved diagnosis, prognostication of unfavorable consequences and optimization of treatment approaches. In order to detect carbohydrate metabolic disturbances in patients with As+Ob it is not enough to determine levels of glucose and glycated hemoglobin. The necessity of studying insulin resistance and insulin level for systematization and determination of development of concomitant metabolic disturbances in patients to whom iGCS are prescribed is proved.
Key words: cytochrome P-4503A4, gene polymorphism, hepatotoxicity, tuberculosis
Abstract. Polymorphism of CYP3A4*1G gene as a predictor of the hepatotoxicity of antituberculosis therapy. Poludenko H.O., Antonenko P.B., Antonenko K.O., Makarenko O.V. The risk of anti-tuberculosis (ATB) drug-induced liver injury could be determined by genotype polymorphism of the xenobiotic-metabolizing enzymes. The aim of presented research was the investigation of an impact of CYP3A4*1G polymorphism on liver function in patients with TB during anti-tuberculosis therapy. There were analyzed case histories of 105 patients with newly diagnosed pulmonary TB at Odessa Regional TB Hospital in 2012-2014. We have considered their medical records at the beginning and at the end of inpatient treatment including activity of biochemical indices such as total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutathione transferase (GGT). The genotype CYP3A4*1G, 20230G>A was detected by PCR. At the beginning of the treatment the level of studied biochemical indices was almost the same regardless of CYP3A4*1G genotype. After the conducted in-patient treatment the biochemical indices in fast metabolizers insignificantly increased, while the level of bilirubin dropped by 10.4% (p<0.05). In slow metabolizers after in-patient treatment the serum total bilirubin level increased by 8.0% (p<0.05), the activity of ALT raised by 67.2% (p<0.05), AST – by 37.4% (p>0.05), also the number of the patients with ALT and AST level beyond normal almost doubled. After completion of in-patient treatment in moderate and slow metabolizers serum GGT activity increased by 2.5 times (p<0.05) and 1.3 times (p>0.05) correspondently, among fast metabolizers – on the contrary, the number of the individuals with increased GGT level dropped (p<0.05). Thus in slow metabolizers according to CYP3A4*1G genotype after completion of in-patient stage of anti-TB treatment the level of cytolysis and toxicity indexes was much higher than in fast metabolizers. That is why detection of CYP3A4*1G genotype of TB patients at the beginning of TB treatment could help to recognize a group of the individuals with increased risk of liver injury during therapy.
Key words: endometrial cancer, laparotomy, laparoscopy, surgery, lymph dissection, pelvic, paraaortic, complications
Abstract. Modern aspects of surgical treatment of patients with endometrial cancer (own experience). Movchan O.M., Svintsitskyі V.S. In recent years, endometrial cancer has taken the lead among oncological processes of the female reproductive system. The high prevalence of this disease leads to disability of the working-age population, large socio-economic losses, which determines the relevance of this problem and the search for new methods of screening, diagnostics, optimal selection of treatment, thereby affecting the quality of future life. The choice of the method of treatment of patients depends on the following main factors: age, general condition, reproductive plans of the patient, histological type of tumor, degree of its differentiation, size, localization in the uterine cavity, prevalence of the tumor process. The main treatment for endometrial cancer is surgical treatment. The principles of surgical treatment consist in the individual selection of the volume of surgical intervention, adequate lymphadenectomy, prevention of recurrence and metastases. Lymph node dissection for cancer of the uterine body has always been a controversial issue. Lymphadenectomy is necessary to accurately establish the stage of endometrial cancer. In recent years, the discussion about laparoscopic lymph node dissection in comparison with open access, to what level lymphadenectomy should be performed, how many lymph nodes, frequency of complications, prognosis of patient survival, frequency of relapses has been developing. The article highlights own vision of the role of lymphadenectomy both in laparotomy and in laparoscopy, the importance of the volume of surgical intervention and complications for each type of treatment.
Key words: community-acquired pneumonia, complications, bronchoalveolar secretion, cytokines
Abstract. Cytokine profile of bronchoalveolar secretion in prolonged course of community acquired pneumonia. Razumniy R.V. Despite existing studies on pathogenetic role of cytokine (CK) system in lung damage in pneumonia, there are still controversial issues of cytokine-mediated processes that lead to the prolongation of the inflammatory process in lung tissue in this pathology. The article presents the study of the cytokine profile of bronchoalveolar secretion (BAS) in the prolonged course of community-acquired pneumonia (CAP). To achieve the purpose of the research, in patients with prolonged CAP on the first and last 1-2 days of hospital stay the concentration of pro-inflammatory (IL-1β, IL-2, TNFα, IL-6, IL-8) and anti-inflammatory CK (IL-4 and IL-10) in BAS was determined. When studying the cytokine profile of BAS in the acute period of CAP, it was found that patients with a prolonged course of the disease subsequently had an increase in the concentration of pro-inflammatory CK (IL-1β, IL-6, IL-8, TNF-α and IL -2), reduction of anti-inflammatory (IL-4, IL-10) and more significant disproportion of the ratio of their opposition pools (IL-1β/IL-10 and TNF-α/IL-10) in BAS. In the conditions of the generally accepted therapy in patients with prolonged and not prolonged CAP course, various rate of improvement of indicators of CK in BAS is defined. In patients with prolonged CAP, the rate of progress of pro-inflammatory and anti-inflammatory CK was slower. At the time of discharge from the hospital, most patients had an imbalance of pro-inflammatory and anti-inflammatory CK with a predominance of pro-inflammatory activity in the bronchoalveolar space.
Key words: primary open-angle glaucoma, rs1799983 (G894T, Glu298Asp) NOS
Abstract. Influence of rs1799983 (G894T, Glu298Asp) NOS3 on the primary open-angle glaucoma development. Pallikaris I., Serdiuk V.M., Ustymenko S.B., Isaiev O.A. The WHO Global vision detection program and preventing blindness "VISION 2020: the right to Sight" has shown the need to identify the genetic predisposition to glaucoma. It provides new opportunities for diagnosis, early prevention and treatment. The aim of this study was to determine the effect of the rs1799983 polymorphism (G894T, Glu298Asp) of the NOS3 gene on the development of primary open-angle glaucoma (POAG) in patients from the Ukrainian population. The study involved data from 153 patients (153 eyes) with POAG and 47 controls. The age of patients was 65.0±13.1 years. The duration of the disease was 4.9±5.3 years. The real-time polymerase chain reaction (Gene Amp® PCR system 7500 amplifier; USA) was performed in the patients “blood using the TaqMan Mutation Detection Assays Life-Technology test system (USA). The Statistica 10 program (StatSoft, Inc.) was used for statistical processing of the obtained results, USA). The significant increase in the frequency of the minor genotype TA and the T allele was found in POAG compared to the controls. The distribution of genotypes was not associated with the disease (p=0.051). While the effect of alleles was significant: for the T allele, OR=1.806; 95% VI 1.11-2.93 (p=0.016). It was preserved when it was stratified by gender for women (OR=2.00; OR 1.01-3.95; p=0.043). According to the presence of the risk TT genotype rs1799983, POAG developed at the younger age (p<0.001), such patients had significantly higher intra-abdominal pressure, worse perimetry indicators (MD and PSD), lower thickness of nerve fiber layers (RNFL) and ganglion cell complex (GCC), a larger ratio of excavation area to the area of the optic disc (Cup/Disk Area Ratio). The Association of the RS1799983 polymorphism of the NOS3 gene with PVKG was also confirmed in other populations, and the aggravating effect of the minor TT genotype on the phenotype of patients was shown.
Key words: Hepatitis B infection, HBV, Vertical transmission
Abstract. Hepatitis B vertical transfer and its risk factors in pregnant women in the eastern part of Iran. Moghadam M.N., Amirian S., Afshari M., Parooie F., Keikhaie K.R., Shahramian I., Bazi A., Ostadrahimi P., Sheikh M., Mirzaie H., Aminisefat A. One of the main causes of chronic hepatitis is mother to child transfer which is also known as vertical transfer (VT). Although there are several studies regarding the VT mechanism and its risk factors, none of these studies succeeded in explaining this process, completely. We conducted this study aiming at investigating VT mechanism and risk factors in this region. The present study was a descriptive-analytic cross-sectional study on HBS Ag positive pregnant women, which was conducted from March 2018 to March 2020 in Amir-Al-Momenin Hospital in Zabol, Sistan-and-Baluchestan province, Iran. In this study all samples were tested for HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, and HBV-DNA) and anti-HCV by enzyme-linked immunosorbent assay (ELISA). All statistical analyzes were performed using SPSS version 22 software. Totally 43 infants of HBS antigen positive mothers were investigated. HBe antibody and HBe antigen were found in 25 (62.5%) and 2 (5%) of mothers, respectively. There was no significant difference between the newborns with and without hepatitis B infection regarding maternal age (p=0.216), duration of the infection in mother (p=0.892), AST (0.779), AL (0.449) and ALP (0.065). Mothers with positive viral load during pregnancy delivered newborns with positive HBS antigen much more than mothers with negative HBS antigen. However, this difference was not statistically significant (p=0.642). Although positive viral load was more common in neonates delivered from positive viral load mothers, the observed difference was also remained non-significant (p=0.978). Our study provided evidences regarding that demographic, immunologic and clinical characteristics of mothers with hepatitis B infection did not play considerable role in the vertical transmission of the infection to the newborns as well as the severity of the following infection. We also suggested the possibility of placenta acting as a source of infection in VT. Further longitudinal studies with larger sample sizes are needed to show the exact predictors of transmission of the infection from infected mothers to their children.
Key words: atopic diseases, children, single nucleotide variants, filaggrin, glucocorticoid receptors
Abstract. Single nucleotide variants of filaggrin and glucocorticoid receptors genes in children suffering different phenotypes of atopic diseases. Dityatkovsky V.O., Naumenko N.V., Alifirenko О.O., Pinaeva N.L., Taran S.T., Filatova I.A., Abaturov O.Ye. Currently, there is an apparent need for genotype-associated personalization of the diagnostic process for atopic diseases (AtD) in children: atopic dermatitis (AD), seasonal allergic rhinitis (conjunctivitis – (SAR(C)), perennial allergic rhinitis (conjunctivitis – (PAR(C)) and bronchial asthma (BA) in different phenotype combinations - monotopic and polytopic. The aim of the study was to identify associations of the genotype variants of SNV rs_7927894 of FLG gene, rs10052957 and rs41423247 of NR3C1 gene in children with AD, SAR(C), PAR(C) and/or BA in mono- and polytopic phenotypes. The study recruited 293 children with AD who were divided into 6 phenotypic clusters: monotopic phenotypes: No. 1 – AD (58 patients); No. 2 – SAR(C)/PAR(C) (71 patients); No. 3 – BA (23 patients); polytopic phenotypes: No. 4 – AD+ SAR(C)/PAR(C) (43 patients), No. 5 – BA+SAR(C)/PAR(C) (72 patients), No. 6-AD+BA+SAR(C)+PAR(C) (26 patients). In patients of all 6 clusters buccal swab of the oral mucosa was taken for genotyping the variants: C/C, C/T, T/T SNV rs7927894 of FLG gene; A/A, A/G, G/G SNV rs10052957 and C/C, C/G, G/G SNV rs41423247 of NR3C1 gene. Heterozygous variant C/T SNV rs_7927894 FLG is the most common, directly associated and significantly increases the risk of polytopic AtD phenotypes: AD+SAR(C)/PAR(C) by 2.47 (95% CI 1.14-5.38, p<0.05) times and AD+BA+SAR(C)+PAR(C) – by 3.13 times (95% CI 1.24-7.95, p<0.05) related to monotopic phenotype SAR(C)/PAR(C). The heterozygous variant A/G SNV rs10052957 of the NR3C1 gene is the most common in all AtD phenotypes, except for monotopic BA and polytopic AD+SAR(C)/PAR(C), and significantly, by 0.40 times (95% CI 0.18-0.93, p<0.05) reduces the risk of the polytopic phenotype related to AD. Homozygous variant G/G SNV rs10052957 of the NR3C1 gene is most common in the monotopic phenotype SAR(C)/PAR(C) and polytopic AD+SAR(C)/PAR(C) as well as in AD+BA+SAR(C)/PAR(C) and significantly increases by 2.97 times (95% CI 1.31-6.74, p<0.05) and decreases by 0.45 times (95% CI 0.21-0.97, p<0.05) the risk of developing AD+SAR(C)/PAR(C) related to AD. Heterozygous variant A/G rs10052957 of the NR3C1 gene significantly reduces by 0.40 times (95% CI 0.18-0.93, p<0.05) the risk of polytopic phenotype BA+SAR(C)+PAR(C) related to AD+SAR(C)/PAR(C). Heterozygous variant C/G SNV 41423247 of the NR3C1 gene was the most common and significantly increased by 2.03 times (95% CI 1.01-4.10, p<0.05) the risk of monotopic AD phenotype related to SAR(C)/PAR(C).
Key words: pollen disease, allergic rhinitis, sensitization, molecular allergodiagnostics, allergen-specific immunotherapy
Abstract. Determination of co-sensitization is an important step in improving the effectiveness of allergen-specific immunotherapy in patients with pollen disease. Dityatkovska E.M., Biletska S.V. In order to increase the effectiveness of allergen-specific immunotherapy in patients with pollen disease, the profile of allergen sensitization was determined at the molecular level, performed in 47 patients with clinical manifestations of seasonal rhinoconjunctivitis and perennial allergic rhinitis during a long time period. Allergic examination of patients included history taking, molecular blood tests using ALEX technology to determine the level of specific antibodies class lgE of major and minor components of pollen and household allergens and diagnostic skin tests (pre-test). Assessment of the main clinical manifestations of allergic rhinitis was performed according to the recommendations of the European Association of Allergists and Immunologists. The severity of nasal symptoms was determined by the TNSS scale, and ocular symptoms - by the TOSS scale. Integral assessment of the intensity of clinical symptoms of allergic rhinitis was calculated as the sum of scores by the main symptoms. According to the results of molecular allergy diagnostics, the profile of allergic sensitization in patients with pollen disease was determined, which established the presence of specific lgE - antibodies to major allergy components of ragweed pollen (nAmb a1) – in 91.5±4.1% of patients, wormwood (nArt v3, nArt v1) – in 40.4±7.2%, meadow thyme (rPh1 p1, rPh1 p5b) – in 17.0±5.5%, house dust mites (Der p1, Der p2) – in 29.8±6,7%. Developed on the basis of molecular allergy diagnostics, the profile of allergological sensitization to allergocomponents allows to obtain complete and detailed information on patient sensitization (diagnose a real allergy), cross-reactivity to other allergens, justify the feasibility and predict the effectiveness of allergen-specific immunotherapy.
Key words: chronic catarrhal gingivitis, early inflammation, orthodontic treatment, mouth fluid, forecasting
Abstract. Prognostic model of early inflammation development in periodontal tissues by biochemical parameters of oral fluid in patients with orthodontic appliances. Kovach I.V., Kopchak O.V., Buniatian K.A., Kriachkova L.V., Alieksieienko N.V., Bindiugin O.Yu. One of the main etiological risk factors and pathogenetic mechanisms for the development of inflammatory diseases of the periodontal disease is a bite pathology or dentofacial anomalies. Therefore, in recent years, scientists make attempts to find new markers that would allow to predict the course of the disease at the preclinical stage of its diagnostics, which would allow to take preventive treatment. In recent years, individual proteins of the mouth, which include matrix metalloproteinases (MMP-8), which can hydrolyze the main proteins in extracellular space and lactoferrin, catelitsidine, KLOTHO protein should be considered leading markers. The purpose is to predict the emergence of early inflammation in periodontal tissues in patients with non-removable orthodontic appliance by studying protein content in the oral fluid in the dynamics of treatment. Among the 113 patients surveyed by us, which underwent orthodontic treatment with non-removable appliance, according to clinical and laboratory studies, 82 people (72,57%) had signs of early inflammation of periodontal tissues. All examined young people were students or students of educational institutions who appealed for advice and treatment to a dental clinic. Biochemical studies of oral fluid and their analysis was conducted at the beginning of orthodontic treatment and 3 and 6 months after the delivery of non-removable orthodontic appliance. The oral fluid was collected in the morning, and the quantitative determination of proteins in it was carried out by the IFA method. In order to assess the probability of prognostication of early inflammation in patients with orthodontic appliance, there was made rank correlation analysis with the determination of the correlation coefficients of the disparity (rs), ROC analysis with the determination of Optimal Cut-Off Point (OСР) – the value of the indicator for prediction and simple and multiple logistic regressions with the calculation of the odds ratio and the construction of a prognostic model (logistics regression equation). For the analysis of factors, on the basis of which it is possible to predict early inflammation of periodontal tissues in patients with orthodontic appliance, a correlation analysis was performed, which showed that the largest changes were in the biochemical parameters of the mouth, namely: MMP-8 (rs=0.58; p<0.001), lactoferin (rs=0.45; p<0.001), catelitsidine (rs= -0.59; p<0.001) and KLOTHO protein (rs= -0.58; p<0.001), with which statistically significant correlations were established. ROC analysis was used to evaluate the discriminatory capacity of the markers investigated, which showed the presence of statistically significant correlations with early signs of inflammatory process in periodontal tissues. As a result of the correlation analysis, it has been found that the most significant changes in the inflammatory process in periodontal tissues were in the biochemical parameters of the mouth, such as MMP-8 (rs=0.58; p< 0.001), lactoferin (rs=0.45; p< 0.001), catholicidine (rs= -0.59; p< 0.001) and Klotho protein (rs= -0.58; p< 0.001), with which statistically significant correlations of average force were detected. The chances of patients with non-removable orthodontic appliance for the development of inflammation in the periodontal tissues are increased by 4.2 times.
Key words: nanostructures, surface defects, titanium nanodioxide composite with nanosilver, titanium dioxide nanopowder, acute intraperitoneal toxicity, sensitizing effect, biological activity, anatase
Abstract. Morphological, spectral and toxicological features of new composite material of titanium nanodioxide with nanosilver for use in medicine and biology. Zahornyi M.M., Yavorovsky O.P., Riabovol V.M., Tyschenko N.I., Lobunets T.F., Tomila T.V., Shirokov O.V., Ragulya A.V., Anisimov Ye.M. The results of this study indicate that titanium dioxide nanoparticles (nano-TiO2) possess adsorptive, photocatalytic, bactericidal, virucidal and fungicidal properties, which are used in antibacterial coating, for air and water disinfection. In parallel with studies of the physicochemical characteristics of titanium dioxide, its toxicological assessment was carried out to prevent possible harmful effects on humans and the biosphere objects, followed by an assessment of the nano-TiO2 hazard class. To enhance these useful properties of nano-TiO2, nanopowders of titanium dioxide and a composite of titanium dioxide were synthesized with a silver (nano-TiO2 /Ag) by way of chemical precipitation of metatitanic acid adding silver nitrate to the composite at 500-600°C. It was stated that the synthesized nanostructures have the following characteristics: anatase crystal structure of TiO2 (anatase, rutile, brookite – natural crystalline modifications of TiO2), the size of Ag nanoparticles is 35-40 nm, TiO2 – 13-20 nm. Nanocomposite has surface defects of the crystal lattice (oxygen vacancies, impurities, excess electrons or holes), silver nanoparticles are localized on the surface of anatase TiO2, which increases adsorptive, photocatalytic, biological and specifically antibacterial properties of the composite material nano-TiO2/Ag. According to the parameters of acute intraperitoneal toxicity, the studied nanocomposite anatase nano-TiO2/Ag was classified as a moderately dangerous substance (material). Nano-TiO2 and TiO2/Ag nanocomposites do not cause local irritation to the skin, yet have a mildly irritating effect on the mucous membrane of the eye, and are also characterized by a weak sensitization effect.
Key words: chronic non-infectious diseases, chronicity of pathology, epidemiological surveillance, public health
Abstract. Methodological approaches to epidemiological surveillance of chronic non-infectious diseases. Berdnyk О.V., Аntomonov М.Yu., Polka N.S., Rudnytska О.P. In the context of the constant growth of the burden of chronic non-infectious diseases, surveillance needs in supplementing traditional statistical health indicators with criteria characterizing the processes of chronicity of pathology. Aim: to scientifically substantiate and develop statistical characteristics of chronic non-infectious diseases suitable for surveillance in the public health system. Methods used: bibliographic; statistical (for analyzing materials about the health of the population); mathematical (for constructing formulas and indices); calculational (to calculate indicators of pathology chronicity); epidemiological (to assess the chronicity of diseases of different classes). The initial statistical information was the materials of the Ministry of Health of Ukraine on mortality, general and primary morbidity of the population for six classes of diseases, which include the most common chronic diseases. The proposed set of indicators, which includes both the indices available in the scientific literature and those developed by us, contains the following characteristics: statistical indicators of official reporting, indicators of pathology chronicity, mortality and survival of the population, and the hazard index of chronic diseases, which can be considered an integrated indicator characterizing chronic diseases. Diversified characteristics of chronic non-infectious diseases of different classes of diseases were established, which is reflected, in particular, on the relationship between chronic diseases with preserved and lost viability. For diseases of the musculoskeletal system, one fatal case accounts for more than 9000 cases of chronic diseases with preserved viability; for diseases of the circulatory system, this indicator reaches only 58, and for neoplasms – only 22. This corresponds with the assessment of the hazard index: chronic diseases (respectively, 0.7; 153.7; 328.5 cu). The use of the proposed set of indicators makes it possible to carry out a comparative analysis of the danger of chronicity of diseases of certain classes, to track the change in these processes over time, being an important part of managing the frequency and outcomes of chronic diseases
Key words: quality of medical care, accreditation, licensing, certification, standardization
Abstract. Problems of regulating the quality of medical care in Ukraine and the main directions of their solution. Tolstanov O.K., Krut A.G., Dmitrenko I.A., Gorachuk V.V. Improving the quality of health care remains problem of the day for world health systems. Recognized quality management tools are used in Ukraine. However, a series of studies indicate the need for their improvement.. The aim of this work was to determine the features of the application of international instruments for regulating the quality of medical care and to substantiate the conceptual directions of their improvement in Ukraine. Materials and methods of research used: systemic approach; comparative analysis; bibliosemantic; conceptual modeling; scientific literature sources, including systematic reviews from the PubMed database; domestic legal documents. Main results: unlike international practices, professional activity of doctors is not licensed in Ukraine. The economic activity of health care institutions and individuals-entrepreneurs engaged in medical practice is subject to licensing. Аccreditation standards have not been revised since 2013. Domestic adaptation of clinical guidelines has been suspended for several years. Certification of quality management systems is administratively related to accreditation. All quality management tools are strictly regulated by the Ministry of Health, without the involvement of local governments, public patient organizations and health professionals. Conceptual directions of improvement of tools of quality regulation are offered: adoption of the law on professional licensing of doctors; creation of an independent accreditation agency; updating the content of accreditation standards, supplementing them with patient safety standards in accordance with international criteria; creation of methodological support for accreditation and certification; training of accreditation inspectors; introduction of tracer methodology in order to verify compliance with accreditation standards; resumption of adaptation of international clinical guidelines at the health sector.
Key words: system of medical education, public administration, nursing, strategic development, continuous professional development, health care, reform, medical aid
Abstract. Current state and strategic directions of development of state management of nursing education in Ukraine. Striukov V.V., Grynko T.V., Krupskyi O.P., Vazov R.G. The article presents the results of the study of the current state of public administration and strategic directions of development of nursing education in Ukraine by on the example of Dnipropetrovsk region. The region was chosen because it ranks second in Ukraine in terms of population (first place Donetsk region). The purpose of the study is to determine the strategic prospects for reform and effective development of the medical sector, in particular the education system of health workers on the basis of the study of the current state of public health management. The article has a conceptual nature, so the following research methods were chosen: systematization and generalization; analysis and specification; abstract-logical. An analysis of the scientific database of domestic and foreign researchers found that public administration of the secondary medical education system, including the health care system, is in crisis and is characterized by globality, longevity and complexity. According to the results of statistical processing of primary data, it was found that despite the high level of graduates in the specialty «223 Nursing» of degrees professional junior bachelor and bachelor for five years (from 2016 to 2020) the number of nurses decreased by 21.6004% and this negative trend continues. State management of nursing education was defined as a special type of professional activity, the purpose and result of which is to ensure, support life and dynamic development of the industry whose main mechanisms are: regulatory-legal, coordination, organizational-motivational, educational-pedagogical, economic. The article emphasizes the need to develop strategic directions for the development of public administration in the system of medical education, which would provide medical institutions with highly qualified specialists, taking into account the market of educational services and the needs of society, to create and implement an effective resource mobilization mechanism to meet the needs of medical education, taking into account continuous professional development to train highly qualified professionals.
Key words: health care, reform, Ukraine, dental facilities per capita, dentists per capita, availability of dental care
Abstract. Transformations of the dental industry during the period of independence of Ukraine and their impact on the availability of dental care. Mazur I.P., Lekhan V.N., Rybachuk A.V. The article presents an analysis of the transformations of the dental industry in different periods of development of the health care system from 1991 to 2020 and their impact on the availability of dental care. The materials of the study were regulations, statistics on the infrastructure and human resources of the dental industry in Ukraine. Bibliosemantic, historical, analytical, medical-statistical and biostatistical research methods are used. The article presents an analysis of the number of dental institutions and dentists per capita at different stages of development of the health care system of Ukraine. The transformation of Ukraine’s health care system in 2015-2020 has led to a significant reduction in dental clinics and human resources in the Ministry of Health of Ukraine with a significant increase in the number of private clinics and dentists providing dental care. The share of working dentists in the public health relative to the private sector is declining: in 2017, 72% worked in public institutions and 28% – in private institutions; in 2020 – 59.7% and 40.3% respectively. Ukraine has a developed infrastructure and human resources for dental care. The transformation of the health care system leads to a reduction in the number of dental facilities and staff in the system of Ministry of Health, which is not offset by the intensive development of the private sector and reduces the availability of dental care. The introduction of innovative technologies increases the complexity of the work of dentists and, accordingly, requires an increase in the number of dentists. The policy in the field of dental education does not allow to prepare a sufficient number of dentists for the industry and to compensate for migration processes of labor dental potential to European countries.
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