ARCHIVE

Resistant hypertension and chronic kidney disease are closely related from a pathogenetic and clinical point of view. To study the dynamics of functional state of kidneys and as well as to identify the predictors of its improvement, 117 patients with resistant hypertension were examined. Dynamic follow−up of patients included monitoring of antihypertensive therapy, blood pressure, biochemical and humoral parameters during 3, 6 and 36 months of treatment. The findings have shown that a significant long−term improvement in blood pressure control in the patients with chronic kidney disease improves their function and also has a nephroprotective effect in patients without any signs of renal damage. The established prognostic value of the higher initial creatinine content for the improvement of renal function in patients with resistant hypertension is stipulated with a positive effect of antihypertensive therapy on the glomerular filtration rate dynamics. The close association between improved renal function and lower baseline levels of interleukin 6 as well as an active renin in the blood may indicate a role for systemic inflammation and renin−angiotensin−aldosterone system activity in the renal dysfunction development. Prolonged improvement in blood pressure control in the patients with resistant hypertension without diabetes is associated with a stable level of urinary albumin excretion, whereas in patients with diabetes, an albuminuria increases over time. The study concluded that independent predictors of improved renal function in patients with resistant hypertension are higher baseline creatinine and lower glomerular filtration rate, lower concentrations of interleukin 6, active renin and plasma potassium.

Modern clinical diagnostics has standards and medical systems for the diagnosis of hypertension, advanced information technology. Mathematical models of the relationship between systolic blood pressure and psychological indices of hypochondria and depression have been described. Methods of mathematical statistics were applied as follows: factor, cluster, discriminant, regression analyzes, Markov chains, polynomial splines and neural networks, they were implemented in software products, such as NeuroModelDBPM, "Monitoring", VerMed. The presented model of interaction of systolic arterial pressure, Hs−hypochondria, D−depression confirms an importance of these states at an initial stage of arterial hypertension and allows the allocation of four options of psychosomatic relations in patients: organ and system somatic defeats of psychosomatic character, somaticized psychiatric reactions, reactions of exogenous type. It has been shown that disharmonious personality traits, risk factors, disorder of chronobiological structure of blood pressure, left ventricular hypertrophy and its diastolic dysfunction contribute to the formation of nosogeny in hypertension. Their development is hindered by harmonious personality traits, keeping a healthy lifestyle, minimal changes in the chronobiological structure of blood pressure, a slight degree of left ventricular hypertrophy and its diastolic dysfunction. The leading cardiovascular risk factors in patients with hypertension are stress, burdened heredity, low physical activity, carbohydrate abuse, higher education and high socioeconomic status. Nosogeny in hypertension should also be considered as a risk factor, as well as should be taken into account in the stratification of the overall cardiovascular risk and accomplishing a proper adjustments.

The main cardiovascular diseases affect the processes of myocardial remodeling, which further contributes to the formation of systolic or diastolic heart dysfunction. The formation of myocardial dysfunction is primarily associated with left ventricular hypertrophy when under hemodynamic loading, firstly, wall rigidity increases, secondly, myocardial fibrosis is formed. The latter is one of the key factors of the hypertrophic process caused by the accumulation of collagen, which leads to a aggravation of the left ventricle relaxation processes. Cardiac remodeling is defined as a group of molecular, cellular, and interstitial changes that are clinically manifested by alterations in the size, shape, and function of heart as a result of the heart muscle injury. It has been determined that fibrosis is an early morphological sign of injury in patients with left ventricular overload, as well as a factor in the development of diastolic and systolic dysfunctions. Compensatory left ventricular hypertrophy transforms into heart failure due to the fibrosis development. In hypertrophy the content of elastic collagen type III decreases and rigid collagen type I increases. The essential role of the extracellular matrix in myocardial fibrosis formation is emphasized. Cardiac fibrosis is a process of pathological remodeling of the extracellular matrix, which leads to abnormalities in its composition and dysfunction of the heart muscle. The extracellular matrix plays a key role in organogenesis and post−traumatic healing in tissue injuries. The study of intercellular interactions of the extracellular matrix will provide a better understanding of the mechanisms of changes in geometry and function of the heart, and investigation of the activity of matrix components will open new opportunities for targeted therapeutic effects on molecular mechanisms of cardiac remodeling.

Postoperative sternomediastinal infections significantly affect morbidity and mortality, as well as the hospitalization duration and treatment cost for cardiac surgery patients. The use of median sternotomy has a number of complications, primarily infectious, which can occur with the formation of superficial or deep wound infection, diastase and fragmentation of the sternum, and sometimes with destabilization of the chest bony skeleton. The development of sternal osteomyelitis is associated with a significant reduction in long−term survival. The results of treatment for the patients with the sternum osteomyelitis after sternotomies, being at the State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the NAMS of Ukraine" in Kharkiv within the period of 2014−2020, have been analyzed. Diagnosis of patients with osteomyelitis of the sternum comprised fistulography, multispiral computed tomography, ultrasound. The material for the bacterial study was the discharges of a sternal wound. Antibiotic susceptibility of isolated bacterial cultures was studied by disco−diffusion and in agar. There were 32 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. Among antibiotics, the most effective in vitro were lincomycin and especially carbapenems (imipenem). When treating the patients with sternal osteomyelitis, VAC therapy was used, as well as open wound management by dressings depending on the wound process stage. The results of the study suggest that multi−slice computed tomography should be preferred in the diagnosis of osteomyelitis of sternum, which allows the diagnosis verification in 98 % of cases, and the use of ultrasonography is important to monitor the clearance and healing of sternotomy wounds. The use of VAC therapy has helped to reduce the length of hospital stay of patients.

Among the methods of treatment of acute aortic pathology in many cases, the surgery remains the method of choice. In order to improve the results of treatment for the patients with acute aortic syndrome by reducing the number of acute intraoperative lesions of organs and systems, a study was conducted, wherein there were analyzed the results of surgical treatment of 166 patients with thoracic and / or abdominal aortic lesions. The advantages of the developed and implemented in practice diagnostic and treatment algorithm for such patients in the pre−, intra− and postoperative periods have been considered. Upon admission to clinic, the main tasks were the maximum elucidation of the diagnosis and rapid structuring of surgery, which were started as soon as possible, primarily to control the blood loss. Hardware reinfusion of all blood lost from aortic rupture was mandatory. The most significant systemic complications were determined by cardiac, renal, respiratory and neurological ones. The proposed diagnostic and treatment algorithm has been concluded to be able of reducing the time and increase of the care efficiency for this category of patients. Programmed and systematic prevention of the most common and most dangerous intraoperative complications of acute aortic syndrome prevents their occurrence, reduces severity, improves the treatment outcomes. Intraoperative autohemotransfusion can reduce the total volume of blood loss, volume of infusion of donor drugs, and, consequently, frequency of acute kidney and lung injury in the intra− and early postoperative periods. The overall results of treatment for the patients with acute aortic syndrome largely depend on the experience of medical staff and equipment of a specialized hospital.

Despite the large range of drugs and surgical interventions, there is currently a significant number of patients with angina, in whom the surgery is impossible for various reasons, and drug therapy is not effective enough. In contrast to these methods of treating coronary heart disease and its complications, cell cardiomyoplasty is aimed at creating new cells and stable lineages of normally functioning heart tissue. Autologous bone marrow mesenchymal stem cells are the promising source for such a cardiomyoplasty. To improve the treatment results in the patients suffered from coronary heart disease with refractory angina and heart failure, there was comparatively studied the effect of intravenous administration of autologous mesenchymal bone marrow stem cells on the effectiveness of myocardial remodeling at months 3 and 6, that was assessed by stenocardiography and echocardiography insufficiency, indices of quality of life and tolerance to physical activity. As a result, it was reliably established that the patients receiving autologous cell therapy in combination with traditional methods had a reduced incidence of anginal attacks, decreased functional class of heart failure and angina, improved left ventricular contractile function, improved exercise tolerance and quality of life. Thus, intravenous administration of autologous bone marrow mesenchymal stem cells to patients with chronic ischemic disease, which is manifested in refractory angina and complicated by heart failure is a safe alternative to other treatments and has its advantages. There has been an improvement in the heart pumping function and the life quality of patients.

One of the most relevant and promising areas in the world of oncogynecology, enabling deeper understanding of the etiology and pathogenesis of malignant growth, to study the processes occurring in women, is the study of molecular biological markers, characterizing apoptosis, cell proliferation and angiogenesis. To increase the effectiveness of combined treatment of the patients with endometrial cancer I−II (Т1−2N0M0) stages and prevent the occurrence of local recurrences as well as distant metastases on the basis of investigating the molecular biological features of tumor and their prognostic value, a study based on clinical observations of 125 women was performed. Their treatment included surgery and a postoperative course of remote radiation therapy. The strategy of adjuvant therapy was designed according to the definition of the group of increased risk of cancer recurrence in the patients with negative receptor status (ER, PR) based on the degree of differentiation of endometrial adenocarcinoma (G), depth of tumor invasion into the myometrium and its location in the cavity as well as the level of expression of molecular biological markers (VEGF, Bcl−2, Ki−67). To select the tactics of further treatment, each of the indices was evaluated in points on a scale. Next, the intervals of the total value of S points were set, depending on which the program of combined adjuvant therapy was chosen: up to 6 points the contact radiation therapy was performed, 7−12 points − there was applied a remote in the postoperative period; 13 points − after remote and contact radiation, six more cycles of chemotherapy were added. Analysis of the research results showed that the developed method of combined treatment of patients with endometrial cancer I−II (Т1−2N0M0) stages allows the personalization of the protocol of adjuvant therapy and recurrence prevention.

Among the causes of tubal pregnancy are the main inflammatory diseases of female genital organs, presence of adhesions in the pelvis, which developed as a result of previous laparotomy. The purpose of experimental and clinical studies was to increase the effectiveness of reproductive health in women with advanced tubal pregnancy and to develop new approaches to improve its techniques using endoscopy, anti−adhesion drugs, placental cryoextract, physiotherapy and assisted reproductive technologies. To justify the use of these methods, an experiment was performed in 196 adult female Wistar rats and 90 female BALB / C mice. There were analyzed the data of clinical observations of 518 women for whom different methods of treatment and rehabilitation of reproductive function were used. It was proven that the use of streptodornase with streptokinase in the patients helped to reduce the incidence of adhesions by 1.6 times; polyethylene oxide with carboxymethyl cellulose, streptodornase with streptokinase and cryoextract of the placenta did in 2.2 times; sodium hyaluronate, streptodornase with streptokinase and cryoextract of the placenta increased it in 2.6 times compared with the intraoperatively detected degree of adhesion. To optimize the method of recovering reproductive function in the patients with tubal pregnancy, the use of laparoscopic organ−preserving treatment with intraoperative administration of anti−adhesive drugs as well as a combined physiotherapeutic treatment was advisable. The inclusion of assisted reproductive technologies in the above two−stage treatment of the patients who did not become pregnant naturally contributed to the onset of uterine pregnancy in 64.9−75.7 % of cases, which did not differ significantly from this index in the control group.

Autism spectrum disorders are developmental disabilities that occur in early childhood and are characterized with a persistent deficit of social interaction. Treatment of this disease is often multimodal and may include early intensive behavioral therapy (applied behavioral analysis), speech therapy, occupational and physiotherapy, social skills training, special education and training. Modern options for drug treatment of the autism spectrum remain limited. There is no evidence that any of the known drugs have a significant effect on social exclusion, which is one of the characteristic symptoms of this disorder. However, there are potential effects on its other disorders; in particular, risperidone and aripiprazole have the highest level of evidence for the irritability treatment. Memantine, riluzole, amantadine, and buspirone reduced irritability in children with autism spectrum disorders when administered in combination with risperidone. One of the common manifestations of the autism spectrum in children is a symptom of attention deficit / hyperactivity disorder. Methylphenidate has been reported to be effective in treating hyperactivity, but its efficacy in children with autism spectrum disorders is usually lower than in those developing physiologically. The efficacy of prolonged−release guanfacine and clonidine has been demonstrated. Stereotyped and repetitive behaviors in autism spectrum disorders are difficult to treat. Antidepressants have been shown to be ineffective in children with these disorders. Moreover, children with autism spectrum disorders develop more severe side effects when taking these drugs. Cannabidiol is likely to be a promising substance for the treatment of autism spectrum disorders, but there are still insufficient convincing clinical data on the efficacy and safety of cannabinoid therapy.

Plastic and energetic reorganization of brain after its traumatic injury lasts for many years, and impaired adaptive neuroplasticity can lead to progressive development. In the long term, even with a minor injury, the organic neurological symptoms are mitigated and autonomic and psychopathological disorders come to the fore, which are the main cause of social and occupational maladaptation of patients. To identify and analyze the clinical and pathogenetic features of the long−term period of mild traumatic brain injury, 100 patients aged 20−60 years who underwent it 1−5 years ago were examined. Patients underwent clinical−neurological, neuropsychological and biochemical studies. The reparative capacity of brain was assessed by determining the content of neurotrophic factors in the serum: brain−derived neurotrophic factor (BDNF), nerve growth factor (beta−NGF) and protein−promoter of apoptosis Bcl−2 by enzyme−linked immunosorbent assay. The results of the study confirm the idea that mild traumatic brain injury most often affects the mid−stem structures of the brain, which play a leading role in ensuring the human body adaptation. Clinically, this was manifested by asthenic, autonomic and neurocognitive disorders, which is a reflection of persistent neuronal dysfunction. Decreased BDNF expression and increased beta−NGF in the long term may be a marker of neuronal dysfunction, a persistent disorder of adaptive neuroplasticity that is closely associated with emotional and neurocognitive disorders. The level of Bcl−2 remains consistently high, significantly higher than control values, even with prolonging duration of the post−traumatic period. This feature is likely to be of regulatory character as an apoptosis inhibitor.

One of the most common variants of non−specific muscle pain is myofascial one. To establish the features of myofascial pain syndrome of cervical localization and its impact on daily life in young patients withforward head posture, 37 patients were examined. There were performed clinical−neurological, vertebro−neurological examination (visual diagnosis of static disorders, manual diagnosis, kinesthetic examination of muscles), photogrammetric measurement of craniovertebral angle, assessment of neck pain on a visual analog scale and its impact on patients. In all patients a visual diagnosis revealed a shift of regional center of gravity at the cervical level forward with the formation of the head forward posrture, which was confirmed by measuring the value of the craniovertebral angle − 48.3±1.56 °. There was a negative correlation between the value of craniovertebral angle and assessment of pain on a scale (r = −0.91, p < 0.05), as well as between the value of craniovertebral angle and index of vital disorders in neck pain (r = −0.93, p < 0.05), which indicates the effect of forward shifting the regional center of gravity on the severity of cervicalgia and the degree of its impact on the daily lives of young patients. Based on the results of the study, conclusions were drawn. Myofascial cervical pain syndrome in young patients with head forward posture is characterized with a bigger number of muscle groups involved into the pathological process with shortening of the head and neck extensor muscles as well as the formation of active trigger points, greater severity of neck pain and the negative impact of cervicalgia on daily life compared to the patients with a neutral head posture.

The availability of medical resources to provide an otolaryngological care to children in the metropolis as exemplified by the city of Kharkiv was comparatively analyzed. The indices of medical service density as well as the available otolaryngological beds of the city residents have been established to be stable and on the background of reducing their number in Ukraine by the end of 2017 exceed the latter except reducing thechildren's otolaryngological beds by 19.4 %. The revealed excess in an average number of bed occupancy, its turnover and reduction of the duration of inpatient treatment indicates an active use of the hospital bed capacity. It has been statistically proven that on the background of sufficient medical resources there are decreased as follows: the number of patients' visits to otolaryngologists in polyclinics of the Ministry of Health of Ukraine; relative index of the number of children who left the hospital due to diseases of the ear and mastoid process, coverage of the Kharkiv children aged 0−14 years with reduced hearing acuity with preventive examinations. The Kharkiv region is shown to occupy the first ranking place among the regions of Ukraine in terms of the disability level due to diseases of the ear and mastoid process. It was found that in the structure of primary disability the children aged 3 to 6 years and those with deafness were mainly determined. The described dynamics of indices has been more clearly traced since 2014. The above data indicate the existing shortcomings when treating the upper respiratory tract, ear and mastoid process diseases, mainly due to imperfect interaction of otolaryngological care service elements for children, inefficiency of typical medical routes. All this determines the relevance of developing an effective functional model of specialized otolaryngological care for children in the metropolis based on determining and monitoring of indices of simulated pathology quality treatment, training of doctors at all levels of care providing.

The paper is devoted to the review of the reports on current ideas about adverse reactions of using the fluoroquinolones. As a group of antibiotics with a wide range of effects on microbial pathogens, they have recently found a sufficient use in infectious diseases in clinical practice. However, the spread of indications is accompanied by the accumulation of information about the growth of adverse reactions. Among the first mentioned ones there were reactions in gastrointestinal tract, allergic reactions, photosensitization, prolongation of the QT interval, deterioration of joint and tendon function, lesions of the nervous system. Some toxic reactions contributed to the banning of certain drugs: temafloxacin, grepafloxacin, trovafloxacin. Further observations were made on the development of hypoglycemic reactions, eosinophilia, liver damage. Among the mechanisms of toxicity the free radical reactions, structural modifications of the antibiotic molecule are considered. Therefore, both the United States (FDA) and European experts are paying close attention to serious warnings to limit the indications for these drugs. Some studies have shown an increase in the frequency of tendon rupture, as well as the risk of aortic aneurysm and its rupture, due to the mechanisms of effects on collagen metabolism, widely present in the tissues of the joints and surrounding tissues and in the aorta. The reports demonstrate the frequency of lesions to joints, muscles, nervous system and separately formulated complications in the mental sphere of patients. The accumulation of information on the injury of the nervous system and mental disorders resulted in the proposal to limit the indications for the easy course of infections, with their recurrence in urinary tract infections, diarrhea prevention. Restrictions also include as follows: old age of patients, previous anamnestic reactions to these drugs, diseases of the joints and kidneys, interaction with glucocorticoids.

Coronavirus disease can have a variety of clinical symptoms, ranged from asymptomatic to severe and even critical ones. To date, an information on the epidemiology, clinical features, prevention and treatment of this disease is insufficient, which requires a further study of the problem. To personalize the treatment, it is important to determine the leading clinical and laboratory predictors to forecast the severity of COVID−19. The algorithm of examination of a patient includes the assessment of all complaints, data of the anamnesis of the disease, epidemiological anamnesis. The combination of clinical examination to determine the severity of the patient's condition includes physical examination, the one of diagnostic material using methods of nucleic acid amplification and / or enzyme−linked immunosorbent assay, pulse oximetry. Laboratory, etiological diagnostics, tests and antibodies play an important role. In case of hospitalization of the patients with moderate, severe and extremely severe infection, clinical studies are required such as: general (clinical) and biochemical blood test, coagulogram, diagnosis of disseminated intravascular coagulation syndrome, as well as identification of risk factors. Instrumental and radiological diagnostics include: pulse oximetry with measurement of SpO2 level, computed tomography and ultrasound examination of lungs and pleural cavities, electrocardiography. Comprehensive evaluation of clinical and laboratory data of patients allows to determine a clinically confirmed COVID−19, to route the patient and to start complex therapy in time. A promising direction is the introduction of the method of quantitative diagnostics by polymerase chain reaction on SARS−CoV−2 RNA in the activity of laboratories of Ukraine, which will help to individualize the degree of viral load in patients, improve treatment control.

Diagnostic visual examinations for patients with any type of spinal stenosis include either magnetic resonance imaging or computed tomography with myelogram, sometimes both tests are prescribed to patients. Ultrasound is usually most effective for tissues with a high content of collagen, i.e. tendons, ligaments, joint capsules and fascia. In osteochondrosis, spinal ultrasonography is used to determine whether a back pain is the result of cracks or a herniated disc. To evaluate the possibilities of ultrasound in diagnosis of lumbar spine stenosis, an analysis of its results in 48 patients aged 41−57 years. Forty five of them were diagnosed with intervertebral disc herniation, 3 with protrusion of various localization and hypertrophy of the yellow ligament. All the patients underwent radiography, magnetic resonance or computed tomography, as well as ultrasound. In 24 patients the laminectomy was performed in 31 discs. In 21 cases, the hernia was paramedian, in 17 it was − median and in 14 this was circular. Laminectomies were performed much more frequently due to median and circular hernias. The slightest deformation of spinal canal is observed in the posterolateral localization of hernia or protrusion. In thin individuals, ultrasound images of the spinal canal elements were excellent, in those with moderate weight they were slightly inferior to magnetic resonance imaging. In three cases of spinal canal stenosis in obese patients who underwent laminectomy, the results of ultrasonography were unsatisfactory and the decision for surgery was made only on the basis of magnetic resonance imaging. It is concluded that ultrasound is a very informative way of assessing the degree of lumbar spine stenosis resulted from degenerative changes in intervertebral discs.

In modern medicine, self−assessment of health is a reliable, affordable, objective tool for a large−scale clinical and hygienic research, the WHO recommends it as one of the main indices for monitoring the health and quality of life. By means of a screening survey, it is possible to determine not only the medical and social characteristics of an individual and a team, but also to establish the degree of prevalence of threatening symptoms at the pre−nosological level in different age and gender groups. To assess the level of influence of the daily routine elements as risk factors on the subjective assessment of health by middle schoolers using the diagnostic method titled as "Screening of the survey on schoolchildren health" a study among 200 students aged 12−14 in secondary education institutions was conducted. According to the results of self−assessment of their own health, the most common signs were asthenia ones especially among girls. A significant number of students did not follow the recommended duration of night sleep and walks in fresh air, the mode of visual load and physical activity. One−factor analysis of variance revealed the level of influence on the formation of pathological conditions (cardiorheumatological, endocrine, ophthalmic, hematological, dental and otolaryngological pathology, signs of asthenia and hypovitaminosis) failure to comply with basic elements of the daily routine. The most important for the general level of health problems are the time of homework, watching TV time, computer games or using other gadgets, diet, these are the ones that are considered to be controlled factors in the development of childhood pathology. Signs of cardiorheumatological and hematological diseases, asthenia and mental disorders were the most sensitive to daily disorders.