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The paper covers investigation of clinical and psychopathological features of bipolar disorder in patients receiving treatment in a psychiatric hospital, and approaches to psychoeducation in complex treatment of this category of patients. As the results of the study, an integrated approach in treatment of BAR, which included psychopharmacotherapy using atypical antipsychotics and mood stabilizers, psychotherapy programs, combined with psychoeducational trainings, lead to restoration of social activity and successful resocialization of the patients. This indicates that psychoeducation not only increases the amount of knowledge and enhances confidence in the fight against the disease, but also solves the problem of reintegration of the patient. According to the results of the follow−up in the study group against a background of complex therapy using psychoeducational intervention stable therapeutic effect that was maintained for 2 years was achieved in 82.2 % of patients, the state remained without changes in 11.1 %. 6.7 % had recurrent disease. In the control group, improvement was observed only in 10 % of patients, 48 % were recommended hospitalization due to recurrent disease. Performance criteria were as follows: stability of remission, rates of hospitalization, quality of life, anxiety levels, improved mental state.

At present psychological aspects of the problem of acute therapeutic profile remain understudied health issues. Coronary artery disease (CAD), myocardial infarction (MI), crisis states in patients with arterial hypertension (AH), transient ischemic attack (TIA) and acute stroke (AS), gastric and duodenal ulcer (GDU) are among the most common diseases. Investigations have shown a high level of affective and neurotic disorder in these patients. The clinical features, dynamics, current and immediate associations with the medical condition are not fully understood, which was the basis of our research, the purpose of which was to identify mental disorders in patients with acute state of therapeutic profile. The study involed 187 patients (65 % men and 35 % women aged 20−60), of them 34 patients with CAD, 37 with MI, 38 with TIA, 39 with hypertension, 39 patients with GDU. The main research method was clinical and psychopathological. Structured analysis allowed identifying four main options of disorders: nosogenic reaction of psychological maladjustment; somatogenic asthenic symptom; reaction of psychological maladjustment; acute stress reactions in patients with severe pain. Stratification of the structure of psychopathological symptoms and signs allowed systematizing them in 4 different manifestations: asthenia; anxiety; subdepressive; somatoform. Thus, clinical and psychopathological study showed that most patients had nonpsychotic disorders. This was the basis for the determining the objects in the psychological adjustment of medical−psychological support of these patients.

Coronary artery disease is a leading cause of death worldwide. Owing to the widespread introduction of reperfusion therapy, antiplatelet drugs and methods of secondary prevention, decline in mortality at myocardial infarction with ST segment elevation (STEMI) has been noted. The article presents the findings of clinical studies on the methods evaluating the effectiveness of reperfusion therapy in patients with STEMI, their informativity and availability. The possibility of carrying out daily real−time 12−channel ECG monitoring with analysis of ST segment dynamics as an available non−invasive method, potentially providing reduction in the time of reperfusion effectiveness evaluation is discussed. This allows early selection of high risk patients who are indicated emergency coronary intervention prior to the manifestation of clinical symptoms of ineffective thrombolytic therapy or infarct−related coronary artery rethrombosis after its successful administration.

Lack of compliance to long−term treatment in patients with cardiovascular disease is one of the main causes of low efficiency of the treatment. According to the findings of the research conducted in 2006−2012 at hospital of SSMU, the factors influencing compliance to therapy of such patients were analyzed in terms of dividing them into conscious and unconscious behavior of the patient, i.e. regularity of therapy separately and its continuation or not at the outpatient stage. In all cases, the survey and/or questioning of the patients were performed on the inpatient stage followed by control calls. The studies showed appropriateness to analyze separately regular intake of drugs, which is influenced by forgetfulness and well−being of the patient, and the fact of its complete termination by the patient. Assessment of the patient's treatment at home should be performed in two ways: based on their replies about continuation of the treatment and comparison of treatment assigned in the hospital, and drugs taken by them after the discharge. For analysis of therapy regularity it is necessary to compare replies of the patients about the frequency of missed doses and objective consideration of the number of issued/returned tablets. Subjective assessment by the patients of their health is an important parameter, which influence on different patients is ambiguous. High estimation by the patient of his/her attending physician is associated with an increased compliance to regular intake of the prescribed drugs.

The work analyzes the results of treatment of 107 patients at the hospital of V. T. Zaytsev Institute of General and Emergency Surgery who were performed reconstructive and obstructive−reduction surgery on the colon. The complications in the postoperative period accompanied by paresis of the intestine were distinguished and described. Particular attention was paid to prevention and comprehensive treatment of septic complications accompanying any surgical intervention on the colon. It was found out that the use of the developed technique of endolymphatic injection of 1 % solution of serotonin adipinate at a dose of 10 mg per day and antibacterial drugs, taking into account individual sensitivity to them of the microflora through depulped inguinal lymph node intraoperatively and postoperatively improved the results of prevention and treatment of postoperative intestinal paresis and reduced the amount of purulent−septic complications to 5.7 % vs. 20 % in the controls.

Surgical treatment of patients with locally advanced cancer of the pelvic organs, complicated by bleeding, is one of the challenging problems in urgent oncology. In recent years, to improve the results of surgical treatment in this group of patients with the purpose of hemostasis and impact on the tumor process, transarterial chemoembolization (TACE) of the tumor vessels has been performed. In our work, this method of endovascular treatment was used in 43 patients. Complications and deaths after TACE were not noted. TACE efficacy was controlled with US and CT one month after chemoembolization. Due to TACE of the tumor vessels we managed to control acute arterial hemorrhage in 95.0 % patients, to achieve partial regress or stabilization of the tumor processes and to reduce of tumor size in 32.6 % patients. As the final result of regional chemotherapy we managed to increase the resectability of the locoregional pelvic tumors from 18.6 % to 27.9 %. The survival rate in 31 inoperable patients amounted to 80.6 % within 1 year after TACE; in 12 radically operated patients reached 100 % TACE. Within 2 years the survival rate was respectively 48.4% and 72.7%. Three−year survival was achieved in 4 (36.4 %) of the radically operated patients.

Acute gynecological diseases are responsible for 1−26 % of hospitalization to gynecology hospitals. Twisting of uterus appendages occupies the fifth place among urgent gynecological pathology among the patients with acute abdomen. Teenagers with benign tumors and tumorous formations of uterus appendages, women of reproductive age with infertility who underwent hyperstimulation as well as pregnant women suffer from this pathology. The larger the sizes of the ovary, the more probability is its twisting. The clinical picture of ovary twisting is determined by the degree of the circulation disorder. Conservative treatment is possible when ovary twisting is partial. One of the methods of conservative treatment of ovary cyst twisting is abdominal aspiration of the cyst under ultrasound control and changing of the body position representing a wise alternative to surgical intervention during pregnancy. Treatment of total twisting of benign tumors or tumor−like formations is carried out with the use of laparoscopic or laparotomic access. Modern approaches to surgical treatment depend on the findings of the additional methods of research including Doppler ultrasound, computed tomography, magnetic resonance imaging, interleikin−6 testing. The data of the pregnancy outcome in patients with ovary twisting are shown. Thus, ovary twisting is an important problem in gynecology due to the increase of the number of patients with benign tumors and tumor−like formations and their twisting leads to reduction of reproductive function, as a result only 60 % of patients have a timely childbirth. Therefore, development of new methodologies of laparoscopic access and applying of medication aimed at ovarian circulation normalization after twisting elimination is an urgent issue of modern gynecology.

Delivery is considered premature from week 22 to week 37 of pregnancy and ends with the birth of a premature baby. In the world, miscarriage occupies the first place among the causes of perinatal morbidity and mortality due to various causes of miscarriage, infection, injury, congenital malformations of the fetus, psychological, social and other factors. A differentiated approach to management of pregnant women with premature membrane rupture and threat of preterm labor is necessary. Depending on the gestational age, clinical data, laboratory findings, assessment of fetus state, expectant management or labor induction are chosen, the question of the use of tocolytics, antimicrobials, corticosteroids is solved. The question of the time, manner and method of delivery is solved individually in each case by the prenatal consultation. Expert−class artificial ventilation equipment, exogenous surfactants, parenteral nutrition, and the use of breast milk as early as possible with addition of fortifiers play an important role in survival rate improvement. Despite development of new methods of diagnosis and treatment of miscarriage, nursing preterm infants with extremely low birth weight requires a huge effort of obstetricians, anesthesiologists, neonatologists to get a positive result, i.e., survival of these children.

The concentration of vascular endothelial growth factor (VEGF), placenta growth factor (PGF) and their soluble receptor (VEGF−R1) were investigated in the blood serum in the dynamics of physiological pregnancy and intrauterine growth retardation syndrome (IGRS). It was revealed that in women with uncomplicated pregnancy, increase of VEGF concentration decreased with the term of gestation that confirmed preserved compensation capabilities of the fetoplacental system. The level of PGF at the physiological course of gestational process was characterized by rapid growth of concentration by the end of the second trimester and smooth decline in the third trimester, that indicates probability of development of subcompensated placental insufficiency (PI) and high risk of IGRS development. During uncomplicated pregnancy the level of VEGF−R1 remained relatively stable. Along with the change of maintenance of growth factors (GF) the products of their receptors change in the process of gestation development. The changes of VEGF−R1 at pregnancy complicated with IGRS, along with modification of production of corresponding growth factors, increases the possibility of damage of different links in the general chain of angio− and mitogenic effects of PGF and IGRS. Our findings suggest that alteration in the products of GF at IGRS are revealed before the clinical of manifestation of this obstetric complication and can be used as screening markers for diagnosis of fetus growth disorders.

In recent years, increase in the requirements for intellectual development of the child has been observed. Mental retardation is an acute and pressing issue in child psychoneurology. Within a framework of investigation of the role of chronic infections caused by different viruses of herpes family in mental and speech retardation electroencephalograpy (EEG) was performed in 50 children (study group) with this pathology aged 5−7 years. The findings of the main group were compared with the controls (20 children aged 5 to 7 years without cognitive impairment). The aim of the work was to study the features of EEG in children with mental retardation and establishing the influence of chronic herpes infection on bioelectric activity of the brain. It was found out that long−term pathological manifestations of bioelectric activity were observed in all 50 investigated children of the main group. Children with mental retardation compared with the controls had more prominent paroxysmal and cerebral cortical disorders. In children with severe degrees of mental retardation greater representation of epileptiform manifestations was noted. Pathological manifestations of EEG in children with cognitive disorders and persistent active herpes infection occurred more frequently than in children without the signs of activity. The investigation failed to allocate a statistically significant correlation between the EEG findings and the type of herpes infection.

In recent years, mild traumatic brain injury (MTBI) has emerged as a leading public health concern. The study involved 75 patients with sequellae of mild traumatic brain injuries (52 men and 23 women), aged 25−33 years. The duration of the disease was 3−5 years. All patients were examined in standard clinical neurological conditions. The patients were divided into two groups: group 1 included 38 patients (26 men and 12 women), who received palliative treatment consisting of vasoactive drugs, vitamins, light sedation. The course of treatment lasted for 2 months. Group 2 consisted of 37 patients (26 men and 11 women), who received symptomatic therapy and simultaneously the course of neuroprotective therapy with Phenibut at a dose of 250 mg 3 times a day for 2 months. The controls included 30 sex− and age−matched healthy subjects without any TBI. The quality of life in the patients with sequellae of mild traumatic brain injuries was assessed using detection of state and trait anxiety with Spielberger − Hanin Test. Quality of life was evaluated by using the questionnaire MOS SF−36. In the group of patients with brain concussion the quality of life according to the Scale of Pain was 66.3±3.9 before the treatment with metabolic therapy and 82.5±3.6 points after treatment. According to the questionnaire by Spielberger − Hanin, moderate state anxiety and trait anxiety of the patients were registered. The average meaning of state anxiety was 47.5±1.5 points (in the controls − 11.2±2.8 points) and the average value of trait anxiety was 38.2±8.7 points (in the controls − 12.3±1.7 points). After the metabolic treatment, the level of reactive anxiety was 33.5±2.1 points, personal anxiety was 31.4±3.2 points (p > 0.0001). The quality of life reduced according to all scales of SF−36 questionnaire. According to the scale of physical functioning the quality of life was in average 65.2±4.2 points and as to role functioning, it was 65.5±2.5 points before the treatment. After the metabolic treatment, the level of physical functioning of the quality of life was 83.7±3.2 and as to role functioning, it was 79.5±2.1. The impact of pain reduced daily activity to 65.7±1.7 points and the common state of health was evaluated as 66.2±3.8 points. After the metabolic treatment, daily activity was 81.2±1.7 points and the common state of health was evaluated as 82.2±3.8 points. The quality of life according to the scale of social functioning and emotional functioning before the treatment was 63.7±2.5 points and 65.1±1.8 points, respectively. After the metabolic treatment it was 79.8±3.5 points and 85.1±5.1 points, respectively. The mental health of patients with mild traumatic brain injuries was evaluated as 68.3±3.1 points before the treatment and 79.2±2.5 after the metabolic treatment. Integral evaluation of quality of life according to the questionnaire SF−36 showed reduction in quality of life according to the scales of pain intensity, social functioning and mental health. The treatment of patients with sequellae of mild traumatic brain injuries with neurometabolic therapy improves quality of life.

The purpose of the work was to detect structural and clinical variants of night sleep disorder in patients with the history of brain injury at long−term phase of different severity. Electroencephalography (EEG) of night sleep was performed, clinical variants of sleep disorder and clinical syndromes were determined in 100 patients. The patients were divided into three groups (light, moderate and severe) according to brain injury severity. Analysis of EEG demonstrated that sleep stages of the patients of all groups were structurally changed, namely it took from 30 to 90 minutes (normally 10−20 minutes) for the 1st stage. Superficial sleep (2nd stage) lasted from 40 minutes and more (normally 20 minutes). Shortening of deep sleep (the 3rd and the 4th stages) to 5−10 minutes (normally 10−20 minutes) or its absence (hypnoidal state of patients) was registered in the majority of patients. Shortening of fast sleep or its absence was registered in 70 % of the patients. Transitions of superficial and deep sleep stages to waking state, i.e. waking within sleep, have been registered by EEG in 73 % of the patients. Clinical variant of the 1st sleep stage was presomnia, that of superficial, deep and fast sleep was mild insomnia. In conclusion, mild insomnia with vegetovascular dysfunction and liquor hypertension dominated in all groups. Night sleep structure changed in patients with light craniocerebral trauma more significantly than in those with severe and moderate one. This can be explained by the following: functional and adaptation disorders (particularly sleep disorders) take place in a great extent during light craniocerebral trauma, but in case of severe craniocerebral trauma organic changes are more considerable than functional ones. Investigation of manifestations of sleep disorder is prospective in future since it is necessary to solve problems of not only patients rehabilitation but also of further improving the quality of life in the patients.

In 2014 West African countries experience an outbreak of Ebola virus disease (EVD), which is rapidly spreading, but not out of the region, while cases of imported Ebola to other countries have already been registered. The pathogen of this infection is a very dangerous virus from the family of Filoviridae. The virus genome contains a single strain RNA. Replication of the genome undergoes with low accuracy that leads to a high RNA mutation rate thus leading to formation of new virus variants with altered antigenic structure and virulence. Epidemiologically EVD is a natural focal infection. Natural hosts of the virus are infected bats, rodents, primates, antelopes, porcupines, and others. The virus is transmitted from these animals during the contact with them, or their blood or body fluids, organs or discharge, autopsies as well as through contact with contaminated objects, or by food, as example, eating the monkey's brain. There is a possibility of accidental transmission from patients to others through secretions of the nasal mucosa, eyes, damaged skin of healthy people. Frequently health care workers are infected because of their professional activities. Clinically a latent period (incubation) ranges from 2 to 21 days (usually 8−10). The signs and symptoms are characterized by onset of high fever, signs of intoxication, sore throat later joined by abdominal pain, vomiting, melena. At the peak of EVD intoxication symptoms, abdominal pain and melena get worse. Polymorphic rash, hemorrhagic syndrome, conjunctival hyperemia, dehydration and /or toxic shock, join on the 5th−7th day. Various complications associated with bleeding can occur, while mortality reaches 90 %. A specific diagnosis is developed, using the PCR method. Symptomatic treatment must be provided; specific treatment has not been developed yet. The efficacy of ZMapp (monoclonal antibody) has recently been reported. Preventive measures are the same as in other dangerous infections. No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.

The group with initially high cardiovascular risk are HIV−infected. However, there is still no consensus on which clinical factors are predictors of cardiovascular disease. To study the influence of professional risk factors on high blood pressure epidemiological study of the population of the Ferghana Valley was performed, during which a representative sample of 341 HIV−infected patients was investigated. The examination included a survey tool, biochemical and immunological methods. The data on the influence of risk factors on HIV−positive patients with prehypertension, hypertension, high blood pressure were obtained. It was revealed that the most significant risk factors of development of high blood pressure in the examined group of patients were professional (hard work) and social gradient (education, marriage, religion, ethnic status), while gender (male), age, family history are less important.

Pandemic of HIV−infection/AIDS is one of global issues of our time and an important problem of global health. The content of cytokines (proinflammatory cytokines, tumors necrosis factor−α (TNF−α), interleukin−1β (IL−1β), interleukin−2 (IL−2), interleukin−6 (IL−6), interleukin−8 (IL−8) and anti−inflammatory interleukin−10 (IL−10)) was determined in serum of 62 patients, of them 32 with HIV infection and 30 with co−infection HIV/HCV. The age of the patients ranged from 20 to 69 years. Comparison group consisted of 32 healthy age and sex matched individuals. According to the study results, macronutrient content was significantly different in patients of the control group and in patients with HIV infection, chronic hepatitis C and HIV/CHC co−infection. HIV−infected patients showed a significant decrease in IL−6, IL−2, IL−1 and an increase in IL−10 and TNF level. Patients co−infected with HIV/HCV demonstrated a significant decrease in IL−6, IL−2 and an increase in IL−10 and TNF. Patients co−infected with HIV/HCV, compared with HIV−infected patients, showed substantial (40 %) restructuring in the production of cytokines, perhaps influenced by the chronic hepatitis C. When comparing the levels of cytokines in the groups of patients, significant differences were noted in the content of IL−1β and IL−10. The content of IL−1β was 2.9 times higher in patients co−infected with HIV/HCV (p < 0.05), and the level of pro−inflammatory cytokine IL−10 was higher 1.4 times (p < 0.001) in HIV−infected patients. In relation to other inflammatory cytokines, a marked tendency to higher values in patients co−infected with HIV/HCV, compared with the group of HIV−infected patients, namely, IL−8, 1.3 times (p < 0.05), IL −2 in 1.1 times (p > 0.05), TNF 1.9 times (p > 0.05), and IL−6 2.7 times (p > 0.05) was noted.

Anesthetic management of patients with coronary artery disease undergoing surgery remains a pressing issue in modern medicine. The reason for this is the prevalence of the disease, and chronic multiple organ dysfunction syndrome in such patients. Therefore, the risk of perioperative complications is much higher. The basic schemes of total intravenous anesthesia used in patients with ischemic heart disease were described. The main drugs for general anesthesia, which are used in Ukrainian anesthesiology, are intravenous anesthetics, cardioprotective ability of total intravenous anesthesia is still not sufficiently clear and is under investigation. This paper analyzes the impact of different variants of total intravenous anesthesia in patients with coronary artery disease and heart failure in abdominal surgery on myocardial blood flow to select the best option from the TIVA cardiac safety profile by studying the dynamics of hemodynamic, level of biomarkers of myocardial ischemia and complications. The best option TIVA in these patients is the use of total intravenous anesthesia with propofol anesthetic baseline in continuous infusion in combination with subnarcotic doses of ketamine. Revealed that most ischemic myocardial damage and heart failure develop in the early postoperative period, due to the mismatch of the oxygen regime sharply growing metabolic demand emerging from anesthesia. These patients required perioperative monitoring of hemodynamics, ECG, blood glucose, pulse oximetry, capnography, blood gases, electrolytes, hemoglobin, cardiac troponin for early detection of cardiac complications and timely correction.

Intraabdominal hypertension has received much attention in the literature because of its substantial increase results in abdominal compartment syndrome leading to violations of vital body functions. Diabetic ketoacidosis is the cause of secondary abdominal compartment syndrome. The purpose of the work was to study the dynamics of intraabdominal pressure in patients with diabetic ketoacidosis during intensive care. The study involved 85 patients with diabetes mellitus in the stage of decompensation and ketoacidosis. Patients in group 1 (n = 42, mean age 53.5±6.2) underwent traditional treatment, including infusion−metabolic, insulin therapy according to current guidelines. Patients in group 2 (n = 43, mean age 53.5±6.2 years) were performed further enteric oxygenation. Intra−abdominal pressure was measured in the bladder procedure according to Kron І. L. et al. Development of intraabdominal hypertension syndrome is observed in the early stages of decompensation of diabetes before clinical manifestations. The greatest impact on intraabdominal pressure is provided by oxygen supply of the tissues. In the treatment of patients in group 2 revealed more rapid normalization of intra−abdominal pressure and restored the functional state of the intestine, allowing earlier transfer of patients on enteral fluid intake and reduction of the volume of infusion. Intraabdominal hypertension syndrome is an important component of the pathogenesis of diabetic ketoacidosis. Enteric oxygenation improves the functional state of the intestine, reduces intraabdominal pressure and facilitates transfer of patients on enteral nutrition and fluid intake in earlier periods.

The work deals with investigation of interrelation between the character of atherosclerotic involvement of carotid arteries and development of ischemic stroke using Doppler ultrasound findings. The work is based on the findings of ultrasound intracranial Doppler investigation. Different echographic variants of atherosclerotic plaques of the carotid arteries are shown. Their embologenicity was investigated. The findings of the research prove that triplex sonography is a highly informative method of diagnosis of atherosclerotic involvement of carotid and cerebral arteries. Ischemic stroke can be caused both by a critical stenosis and occlusion of carotid arteries as well as moderately pronounced stenosis.

Migraine is one of the most widely spread form of headache. It high incidence and increase of morbidity among young, employable people, as well as difficulties in diagnosis and therapy determine a huge interest to this problem. Therefore, the problem of implementation of up−to−date methods of diagnosis becomes extremely significant for investigation of this pathology. At present such highly informative methods, as magnetic resonance imaging (MRI) and duplex scanning (DS) are used in diagnosis of various types of migraine. The aim of the present work was to investigate the state of the brain matter and cerebral hemodynamics using MRI and DS in patients with various kinds of migraine paroxysms. 104 patients aged 16−45 (41 men and 63 women), of them 59 patients with migraine without aura (group 1) and 45 patients with migraine with aura (group 2), underwent complex examination. The state of hemodynamics was investigated using of ultrasound device "Ultima" PA (RADMIR, Ukraine) and transcranial Doppler device "Angiodin" (BIOSS, Russia). Brain MRI was carried out using "Magnetom Concerto" (Siemens, Germany) and Signa HDe (General Electric, USA). According to MRI findings, structural changes in the white matter were revealed in 17 patients (28.8 %) of group 1 and 24 patients (53.3 %) of group 2. These changes were characterized by foci, hypertensive on T2WI and mainly isointensive on T1WI with the dimensions varying within 3 mm to 12 mm. Most often, these foci were localized in temporal (38.6 %) and frontal (31.4 %) lobes. The patients with migraine without aura had predominantly vasospastic reactions in medial cerebral arteries. The patients with migraine with aura manifested hypoperfusion and asymmetry of flow rate in medial cerebral and vertebral arteries, as well as increase of peripheral resistance in medial cerebral arteries. The both groups also manifested redundant blood filling of external carotid arteries.