№1' 2022


Kharkiv National Medical University, Ukraine
Features of content of energy and adipokine metaboliс indicators in patients with ST−segment elevation myocardial infarction and comorbidities after primary stenting of coronary arteries
5 - 10
To date, it is important to study the energy and adipokine metabolism indicators for the patients with acute myocardial infarction in the comorbid pathology presence. To determine the content of energy and adipokine metabolism in the patients with ST-segment elevation, depending on the presence or absence of obesity in the hospital period after primary coronary artery stenting, 120 patients were surveyed. They were divided into groups depending on the presence of comorbid pathology, i.e. obesity. Adropine, irisin, fatty acid binding protein 4 (FABP-4), C1q / TNF-associated protein 3 (CTRP 3) were examined by enzyme-linked immunosorbent assay. All patients underwent coronary angiography. According to the study results, a decrease in the content of adropine, irisin and CTRP 3 as well as an increase in the concentration of FABP 4 on the first and fourteenth days in the patients of both groups compared with the control group (p ˂ 0.05) were determined. In the group of patients with myocardial infarction without obesity, an inverse correlation between Syntax Score (SS) and adropine (r = -0.432, p = 0.01), irisin (r = -0.478, p < 0.01), CTRP 3 r = - 0.473, p < 0.01), positive correlation between SS and FABP 4 (r = 0.436, p <0.05) were found. In the obese group, there was an inverse relationship between SS and adropine (r = -0.412, p < 0.05), irisin (r = -0.475, p < 0.05), CTRP 3 (r = -0.427, p < 0.05) and a direct relationship between SS and FABP 4 (r = 0.428, p < 0.05). The findings showed that obese patients with myocardial infarction had better energy and adipokine metabolism than obese patients. It was concluded that changes in energy and adipokine profiles in the patients might be a prognostic marker of the effectiveness of treatment of acute myocardial infarction in the comorbidity presence.
Key words: energy and adipokine exchange, myocardial infarction, obesity, stenting.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Relaxin−2 as a promising biomarker of cardiometabolic diseases
11 - 16
Cardiovascular diseases are the most common non-communicable diseases, the leading risk factors for which are the presence of hypertension and type 2 diabetes in a patient. The versatile nature of etiopathogenesis complicates the process of their early diagnosis and determines the search for new diagnostic possibilities. The role of relaxin-2 being a reproductive hormone, which can be considered as a biomarker of cardiometabolic diseases, has been determined. It is a pleiotropic hormone with vasodilating, antifibrotic, antihypertrophic, antioxidant, antiapoptic, angiogenic, metabolic and anti-inflammatory effects, that also allows it to be considered as a potential pharmacological molecule when treating the cardiovascular disease. Relaxin-2 is involved in regulation of glucose metabolism, based on the similarity of its structures to insulin. This hormone improves muscle perfusion, increases muscle glucose uptake, and helps to reduce muscle insulin resistance. The results of studies confirm a special role in the metabolism modulatiom. It increases the levels of polyunsaturated fatty acids, carboxylic acid malate and amino acids aspartic acid, D (-) - 2-aminobutyric acid, asparagine, glutamine, and enhances the activation of AMPK in the liver, which has hepatoprotective properties and regulates energy. At base of the antioxidant activity of relaxin-2 there is its ability to reduce oxidative stress by inhibiting the secretion of reactive oxygen species, mitochondrial superoxide and, consequently, reducing the oxidative oxidation of cell membrane lipids. Relaxin-2 may play a special role in the early diagnosis of cardiometabolic diseases, as it, due to its vasoactive and cardioprotective influences, affects the regulation of metabolism, which allows it to be considered as a biomarker.
Key words: cardiovascular diseases, hypertension, type 2 Diabetes mellitus, relaxin-2, insulin resistance, metabolism, antioxidant action.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
“Essel” clinical effectiveness in non−alcoholic fatty liver disease
17 - 20
Non-alcoholic fatty liver disease has become a very common and urgent problem during recent years. In the patients with cardiovascular disease, it may be the criterion and the only manifestation of disorders of lipid metabolism, demanding the clinician to examine purposefully the patients to identify other components of the metabolic syndrome. Non-alcoholic fatty liver disease is a factor not only in the risk of cardiovascular disease, but also their consequences. Clinical efficiency and safety of Essel dietary supplement (5 ml once daily) in outpatient treatment of patients with this pathology, taking into account the impact of the drug on the subjective manifestations of the disease, biochemical parameters of blood and life quality was studied. Twice during the follow-up period (at the beginning and end of the four-week period), a blood biochemistry was tested, as well as the quality of life using a valid version of the general questionnaire The RAND-36-Item Health Survey was assessed. It is shown that the use of dietary supplement "Essel" in a standard dose for four weeks led to a significant improvement in traditional indices of the therapy effectiveness, i.e. clinical symptoms and functional liver function tests (decreased activity of ALT, AST). The use of the drug "Essel" helps to improve the life quality of patients in most parameters that reflect the physical, psycho-emotional and social spheres. It was emphasized that the Essel dietary supplement was well tolerated by patients and did not cause any side effects. The findings showed that the quality of life, which is assessed by available screening methods (according to special questionnaires), can be an objective criterion for the effectiveness of treatment of non-alcoholic fatty liver disease, along with traditional biochemical indices.
Key words: non-alcoholic fatty liver disease, “Essel” drug, life quality, biochemical counts of blood.
A. A. Shalimov National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Thoracoscopic surgery of large and invasive mediastinal tumors
21 - 24
Mediastinal neoplasms are a key problem in the practice of thoracic surgeons. An asymptomatic course is the feature of these formations. The most common manifestations of the disease are the tumor large size, resulting in a compression of vital structures that are located in the mediastinum. The question arises on the use of minimally invasive surgical methods in the resection of large tumors of the mediastinum. The advantages of thoracoscopic access over open surgery are less painful and traumatic, better cosmetic effect, faster rehabilitation period, especially in the elderly patients and those with pathology of the cardiopulmonary system. This study is based on the materials of clinical examination and surgical treatment of 40 patients treated at the Shalimov National Institute of Surgery and Transplantology in 2019-2021. All the patients underwent computed tomography or magnetic resonance imaging of the chest and abdomen, fibrogastroduodenoscopy. The great variability of the location of neoplasms in the mediastinum requires an individual approach in the diagnosis and supervision of patients. The treatment of large (diameter > 5 cm), small (diameter < 5 cm) and invasive mediastinal tumors, which were removed by thoracoscopic method, was analyzed. These studies indicate the safety of treatment of large mediastinal tumors with thoracoscopic access, as the length of stay of patients after surgery in the hospital was minimal, and the number of complications was insignificant. According to the analysis results, it was concluded that thoracoscopic interventions for large and invasive mediastinal tumors did not significantly prolong the duration of surgery, its post-recovery. Evidence of the safety and reliability of thoracoscopic surgery is the absence of significant complications.
Key words: mediastinal tumors, thoracoscopic surgery, histological structure of neoplasms.
Zaitsev Institute of General and Emergency Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv
Municipal Non-Profit Enterprise "City Clinical Hospital of Ambulance and Emergency Medicine named after Prof. O. I. Meshchaninov", Kharkiv City Council, Kharkiv, Ukraine
Examining the adaptive immunity dynamics in severe burns treatment
24 - 28
Burn injury is one of the most severe types of injuries, accompanied by damage to the skin, severe intoxication, and frequent infectious complications. The favorable outcome of the wound process depends on the state of the non-specific defense system and the organism immune reactivity. To study the dynamics of adaptive immunity in treatment of severely burnt patients, the indices of celland humoral immune response and metabolic products (phagocytic activity of neutrophils, subpopulations of T-lymphocytes, concentration and constant of circulating immune complexes, molecules of average molecular weight) were examined. It was found that the change in these indices in the patients with complete recovery of the skin, detected within the early post-traumatic period, had a positive trend in future. Functional insufficiency of the neutrophilic immune system and decreased ceruloplasmin content were determined in deceased patients. These processes disordered the elimination and accumulation of immune complexes and led to an aggravation of the underlying pathological process. In severely burnt patients, the concentration of oligopeptide, peptide and nucleotide fractions of medium molecular weight molecules was significantly increased, which indicated a high level of catabolic reactions and cell destruction processes, that leads to unfavorable development of the pathological process. Therefore, the detected functional insufficiency of neutrophil and T-cell immune systems, high concentrations of circulating immune complexes and fractions of molecules of medium molecular weight were most pronounced in the patients with lethal outcome. The study of the dynamics of immune reactivity and metabolism allows to optimize the therapy by correcting the identified disorders.
Key words: burns, immune response, metabolic disorders, severe burns.
Kharkiv National Medical University
Municipal Non-Profit Enterprise of Kharkiv Regional Council "Regional Clinical Hospital", Kharkiv, Ukraine
Pregnancy and childbirth course in women with diabetes and placental dysfunction
29 - 34
To investigate the clinical features of Diabetes mellitus in pregnant women, its types, severity and state of compensation, as well as to identify gestational and perinatal complications, 128 histories of pregnancy and childbirth in such patients were analyzed. Among them, 40 women had type 1 diabetes, 6 had type 2 diabetes, and 82 had gestational diabetes. The latter is one of the most common complications of pregnancy, manifested by impaired glucose tolerance of any degree and it is first detected during pregnancy. In women with placental dysfunction, the ratio of pre-gestational diabetes to gestational was 1: 2. The mean age of women made 30.6±5.7 years, almost half were older. It was noted that 63 pregnant women had cardiovascular lesions and 73 had concomitant endocrine pathology (obesity, thyroid disease). It has been noted that 21 pregnant women had a disability as a result of complications of pre-gestational diabetes. Pathology of pregnancy, in addition to placental dysfunction, was diagnosed as anemia of pregnant women, preeclampsia, polyhydramnios, colpitis, which evidences the prevalence of inflammatory lesions of the genital tract in patients, especially with pre-gestational diabetes. Cesarean delivery was performed in 97 cases. The mean delivery time was 36.8±1.9 weeks. With a weight of more than 4.000 g, 12 babies were born. A highly reliable moderate direct correlation was found between Diabetes mellitus and placental dysfunction (r = 0.45; p < 0.001). It is concluded that women with placental dysfunction due to diabetes are more likely to have concomitant extragenital pathology, polyhydramnios, infectious lesions of the genital tract, macrosomia, diabetic fetopathy, they have a high percentage of cesarean section. Newborns in such mothers have a low Apgar score.
Key words: Diabetes mellitus, placental dysfunction, pregnancy complications.
Kharkiv National Medical University, Ukraine
State of blood coagulation system in pregnant women on the background of thrombophilia and burdened obstetric history
35 - 38
In most cases, the normal pregnancy course is disrupted as a result of complications, the development of which is responsible for the abnormal vascular network of the placenta and hemostasis due to thromboembolic disorders. The state of blood coagulation system in pregnant women on the background of thrombophilia and burdened obstetric history was analyzed. There was a slight predominance of prothrombin levels in pregnant women in the absence of thrombophilia compared to pregnant women with thrombophilia. An increased levels of thromboplastin time, international normalized ratio and prothrombin time during pregnancy on the background of thrombophilia in comparison with its course without it was determined. The same levels of fibrin-monomeric complexes were intentionally noted during pregnancy both with and without thrombophilia. The predominance of thrombin time levels in pregnant women with thrombophilia was likely to be found in contrast to a strong prevalence of fibrinogen levels in women without thrombophilia. The predominance of homocysteine levels among pregnant women with thrombophilia compared to those without thrombophilia was established, as well as the probable significant predominance of D-dimer in thrombophilia compared to the control. Intentionally lower levels of prothrombin production were observed in thrombophilia and pregnancy burden compared to unburdened pregnancy. The predominance of thromboplastin time, international normalized ratio and prothrombin time in aggravated current pregnancy compared to its normal course was intentionally stated; as well as thrombin time and homocysteine levels compared to the current course of pregnancy. Some predominance of levels of fibrin-monomer complexes, fibrinogen and D-dimer in women with a normal current pregnancy on the background of thrombophilia compared with its complicated course has been recorded.
Key words: blood coagulation system, pregnant women, burdened obstetric history, thrombophilia.
Zaporizhzhia State Medical University, Ukraine
Treatment of psycho−emotional disorders by neurofeedback in women with a history of infertility and prenatal stress
38 - 42
There was studied 41 patients to determine the clinical efficiency of biological feedback in the treatment of infertile women who experienced a prenatal stress. The women were divided into two clinical groups: one used the author's treatment and biological feedback method, and the other used standard infertility treatments. Biological feedback training is a set of procedures in which the patient is provided with information about his/her condition or body functions by a special technical means through a chain of external feedback. The basis of biological feedback is the relationship between mental and autonomic functions of the body. The psycho-emotional state of patients was assessed according to the Beck Depression Scales, the level of anxiety was determined according to the Spielberger - Hanin scale on the 1st day of observation (1st visit) and at the end of the biological feedback training course on the 10th day of observation. According to the study, the number of patients with infertility and prenatal stress who improved their psycho-emotional state as a result of a course of biological feedback training increased immediately after completing the course with daily self-training. There was a significant difference between the indices on the appropriate scales at the beginning and end of the study, that reflects the ability of women to improve their psycho-emotional state through the method of biomanagement. Thus, a 10-day course of biological feedback training is fully accompanied by improved cognitive function and psycho-emotional state of women with infertility and prenatal stress. Patients have a positive effect of bioadaptive therapy for a long time.
Key words: infertility, prenatal stress, psychoemotional disorders, bioadaptive management, neurofeedback method.
Odessa National Medical University, Ukraine
Transosseous osteosynthesis of distal−third diaphyseal humeral factures
43 - 47
Diaphyseal fractures in the humerus lower third among all fractures in the elbow joint make 30 %. Their treatment is characterized by the greatest difficulties in ensuring stable fixation of fragments, and the results are not always favorable. To solve this problem, a closed minimally invasive controlled rod external fixation technique was developed on the basis of G. A. Ilizarov's apparatus and Osteomechanics, having an external stabilizing support as two segments of one quarter of the ring connected by threaded rods, and located on them two semi-hinged brackets that fix the stabilizing screw rods. The repositioning support is a threaded rod on which the clamp in the form of a "cube" with two mutually perpendicular holes is located. A threaded rod passes through it in the transverse direction, which has semi-hinged brackets at the ends for fixing the repositioning screw rods. The supports are connected by threaded rods hinged by means of single-plane brackets connected by a bolt. The use of semi-hinged brackets provides the ability to fix the screw rods at different angles and the implementation of controlled movements in different planes and directions. According to this method, 26 surgeries were performed. In all cases of application of the offered device intraoperative reposition of fragments, fusion of a humerus in optimum terms and a positive result of an assessment of function of an elbow joint by a technique of Mayo clinic is reached. Based on the results of technical capabilities, it was concluded that the device can be recommended as a method of choice in surgical treatment of humeral fractures at the lower third level.
Key words: humerus, lower third, transosseous osteosynthesis.
Educational and Scientific Medical Institute of NTU "Kharkiv Polytechnic University", Ukraine
Ukrainian Research Institute of Prosthetics, Prosthetic Design and Rehabilitation, Kharkiv, Ukraine
Management of rehabilitation measures for patients with spinal cord injury (clinical and diagnostic checkup and examination) (part II)
48 - 54
The significance of the task of treatment and rehabilitation after vertebral trauma is determined by the severity of motor disorders, developing in the patients with spinal cord injury, as well as the severity of complications. Analysis of practical experience shows that the final result of treatment of such injuries significantly depends on the proper organization of the rehabilitation process. The algorithm for compiling an individual rehabilitation program for the patient in the recovery and late periods of spinal cord injury has the following stages: collection of complaints and medical history of the patient; study of available documentation; examination and palpation of the patient; study of the patient's neurological condition; application of laboratory and instrumental methods of diagnosis (magnetic resonance imaging, electroneuromyography, ultrasound methods of vascular examination, blood and urine analysis; blood pressure monitoring and electrocardiography; biomechanical examination of walking, electroencephalography); study of the patient's nutritional status. The algorithm for preparing individual rehabilitation programs of the patient should include a set of functional studies of the cardiovascular system. The autonomic nervous system plays an important role in regulating the state of cardiovascular system. The most common manifestations of cardiovascular deficiency in spinal cord injury are orthostatic hypotension and bradycardia. Lowering blood pressure in such patients is logical. Dysreflexia develops in the injured Th6 segment of the spinal cord. The nature of changes in hemodynamics depends on functional changes in the myocardium. Thus, physiological responses of neurohumoral regulation to stress make it possible to determine the nature of the response of regulatory systems to external and internal factors, to select therapeutic interventions that have the necessary impact on regulation, prove the effectiveness of patient management tactics.
Key words: spinal cord injury, rehabilitation measures, rehabilitation treatment.
V. N. Karazin Kharkiv National University
S. P. Grigoriev Institute of Medical Radiology, NAMS of Ukraine, Kharkiv
V. T. Zaitsev Іnstitute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine
Kharkiv National Medical University, Ukraine
Assessment of risk factors in geriatric patients with locally advanced esophageal cancer in polymorbidity conditions
55 - 58
Chemotherapy in geriatric patients with esophageal cancer may be accompanied by the development of complications due to tumor forms, severe polymorbid background, reduced adaptive mechanisms. These patients require a special approach, managing and treatment of concomitant pathology, which in the vast majority of cases allows to achieve favorable results. Features of the clinical course of esophageal cancer, along with the lack of effective screening techniques do not help to improve the early diagnosis of this disease. The fact of significant delay in seeking medical care in this group of geriatric patients is noteworthy. Due to the late diagnosis of esophageal cancer in the vast majority of patients, treatment tactics can only be based on chemotherapy or chemoradiation. The disease severity in esophageal cancer is also accompanied by the rapid development of cachexia on the background of dysphagia, cancer intoxication, anemia. Comprehensive geriatric examination includes assessment of concomitant diseases, functional and emotional state, cognitive status, life expectancy, the degree of weakening of the patient. All these aspects of the patient's health and living conditions can influence the choice of therapy. Individually for each patient it is necessary to choose a method of controlling the concomitant diseases. In this regard, the survey becomes relevant, the main objectives of which are to determine the prevalence of cancer and assess the body functional reserves. Age alone is not a prognostic factor for the effectiveness and toxicity of treatment. Aggravated comorbid status, as well as the patient's advanced age, is an independent risk factor for complications. Adequate assessment of the body's functional reserves contributes to the development of optimal treatment tactics, assuming the individual characteristics of a geriatric patient.
Key words: esophageal cancer, chemotherapy, old age, polymorbidity.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Clinical features of epilepsy in young men
59 - 61
Epilepsy is a polyetiological disease caused by brain damage, which is characterized by recurrent seizures, impaired sensory, autonomic, cognitive functions, occurring because of the excessive neuronal discharges in the cerebral cortex and is often accompanied by personality change. This pathology is a certain problem for each sex, which requires gender-specific approaches in the treatment of such patients. In order to examine the features of epilepsy in young men, a study was conducted by prospective and retrospective analysis of data from 80 patients aged 18-44 years. It is noted that epilepsy occurs more often in men than in women. This is mainly due to the greater susceptibility of men to injuries: due to the large weight of the mother during childbirth, the choice of occupations at risk of injury, military service, as well as the role of testosterone, which stimulates aggressive behavior. Factors that cause the development of epilepsy in men include intoxication (alcohol), infections, cerebrovascular disorders, anti-perinatal pathology, the presence of tumors and more. It was found that structural epilepsy predominated in the examined men, as the etiology of the disease was mostly traumatic brain injury - in 27.5 %, and anti-perinatal pathology - in 21.25 %. The most common combination of secondary-generalized with focal seizures (52.5 %), as well as a combination of several types of generalized seizures (30.0 %). Frequent epileptic seizures predominated in patients who started treatment late or took antiepileptic drugs irregularly. Thus, the study found that young men with epilepsy needed early correct and long-term treatment due to the debilitating effects of the disease.
Key words: epilepsy, epidemiology, etiology, types of seizures, young men.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Evaluation of changes in retina functions for patients with diabetic retinopathy after antioxidant therapy use
62 - 64
One of the most severe ophthalmic manifestations of Diabetes mellitus is diabetic retinopathy, which ranks first in disability and blindness among people of working age. Oxidative stress, which is a consequence of non-enzymatic glycation of proteins, activation of the polyol pathway and protein kinase, plays an important role in its development. Drug therapy of the disease largely depends on the pathology form and stage. One of the areas of treatment is the search for drugs that would help restore and preserve the regulatory mechanisms of cell-to-cell interaction. The group of such drugs includes "ViziloTon Complex", which combines three categories of nutrients: carotenoids (zeaxanthin and lutein), omega-3 polyunsaturated fatty acids, vitamins E, C and trace elements (zinc, copper), lutein, zeaxanthin, vitamins E, C in the drug "ViziloTon Complex" corresponds to the optimal effective doses to combat free radicals and oxidative stress, which is confirmed by the results of clinical studies. Assuming this property of the drug, its use in treatment of the patients with diabetic retinopathy is considered promising. To evaluate the effectiveness of the drug "ViziloTon Complex" in such patients, based on investigation of the retina functional state, there were studied 70 patients. Its results indicate a sufficient effectiveness of the drug "ViziloTon Complex", having a tissue-specific effect on retinal cells, improves their trophism, helps to normalize functional changes. The drug has a positive effect on neuroepithelial cells, as evidenced by optical coherence tomography. Due to its pronounced antioxidant properties and metabolic action, ViziloTon Complex strengthens the capillaries of the eye and can help in improving the visual function and stabilizing the process.
Key words: diabetic retinopathy, retina, antioxidant therapy, “VisiloTon Complex”.
Dnipro State Medical University, Ukraine
Diabetic macular edema: visual evoked potentials in assessing the activity of subcortical structures and primary visual areas of patients
65 - 70
To determine the role of visual evoked potentials in assessing the activity of subcortical structures and primary visual zones in the patients with diabetic macular edema, 91 patients with type 2 Diabetes mellitus with nonproliferative diabetic retinopathy were examined. The study used methods of visiometry, refractokeratometry, measurement of intraocular pressure, biomicroscopy and ophthalmoscopy, computed perimetry, optical coherence tomography, electroencephalography to determine the visual evoked potentials. In all examined patients the visual acuity was 0.19±0.001. The ophthalmoscopic picture was characterized by the presence of microhemorrhages, hard and single soft exudates, distinct veins, vascular venous loops along the veins, tortuosity of the arteries. In patients with diabetic macular edema, diffuse retinal thickening in the macular area, significant changes in the thickness and volume of the central, para- and periphoveal areas were observed on optical coherence tomography. The analysis of visual evoked potentials showed that in patients the most deformed were components P2 - P3, N2 - N3, which participate in information processing at the level of primary and integrative cortical modal-specific processing. The high sensitivity of the initial parts of visual analyzer to the unfavorable state of intracerebral homeostasis in diabetic macular edema, which respond to its disorder in the first place, has been suggested. The results of the study of induced brain activity confirm the development of neurodynamic disorders of a complex nature in this category of patients. Investigation of induced activity in diabetic macular edema is a highly informative method that should be used to optimize diagnosis, pathogenetic therapy, control treatment, and prevent the progression of diabetic retinopathy.
Key words: diabetic macular edema, visual evoked potentials, diagnosis.
Kharkiv Medical Academy of Postgraduate Education
Municipal Non-Profit Enterprise "City Clinical Hospital of Ambulance and Emergency Medicine named after Prof. O. I. Meshchaninov", Kharkiv City Council, Kharkiv, Ukraine
Pathogenetic significance of hyperglycemia in formation of the course peculiarities of acute otitis media and its complications
71 - 78
The study of the manifestations of acute otitis media in type 2 diabetes is becoming increasingly important. The clinical course of acute otitis media in combination with intracranial complications with hyperglycemia, severity of intoxication syndrome, presence and direction of changes in laboratory parameters, magnetic resonance imaging of the pyramids of the temporal bones and brain and features and therapeutic features were studied and comprehensively analyzed. It was found that in the vast majority of patients with hyperglycemia, acute otitis media was complicated by purulent meningitis and meningoencephalitis. The discrepancy between the history of acute otitis media, complaints, otoscopic picture on other objective data and laboratory parameters, the severity of intoxication syndrome, results of MRI of the temporal bones and intraoperative findings were found. The unidirectional tendency of growth of average daily glycemia and its fluctuations, content of glycosylated hemoglobin of blood serum in all groups of patients in the presence of reliable difference between them has been shown. The severity of endogenous intoxication, negative results of microbiological examination of blood, cerebrospinal fluid and contents of the middle ear with bacterial infection within moderate severity do not preclude the idea of "other", not primary bacterial pathogenetic mechanism of latent mastoiditis under the influence of hypermia. The presence of changes in laboratory parameters and MRI data in patients with newly diagnosed hyperglycemia, similar to the results of examination of the patients with diabetes, suggests that it should not be considered hyperglycemia of critical conditions. Therefore, it is advisable to conduct further examination in such patients to diagnose, correct hyperglycemia and the resulting pathogenetic mechanisms.
Key words: acute otitis media, otogenic meningitis, hyperglycemia, parathyroid hormone, leukocyte intoxication indices, fluctuations in average daily glycemia, magnetic resonance imaging of temporal bones.
V. N. Karazin Kharkiv National University, Ukraine
About the problem of preventing the spread of COVID−19 coronavirus disease among children and adolescents of school age
79 - 83
Prevention of COVID-19 and other acute respiratory viral infections is becoming increasingly important. A crucial role in the non-specific prevention of these diseases is played by the awareness of various segments of the population of Ukraine, including schoolchildren, about the observance of hygienic skills as an effective method of preventing the infection spread. In order to determine the level of awareness of children and adolescents of school age about the ways of transmission, features, clinical manifestations and consequences of COVID-19, a study was conducted using the proposed questionnaire developed with the Google Forms application. The research group consisted of 200 students, who were divided into secondary (grades 5-7) and senior (grades 8-11) schools. The percentage of correct answers was determined from the total number of those to each questionnaire. The results of the research showed that high school students showed greater awareness of COVID-19 prevention measures than ones of grades 5-7. Ways to improve awareness among children and adolescents about the principles of prevention of COVID-19 are proposed, namely: questionnaires using Google Forms via the Internet; delivering informative lectures, creating special promotional videos in the form of animated materials on the space of youth platforms (Tik Tok, Instagram); distribution of relevant gif images on social networks; close cooperation between high school students and IT professionals, bloggers who have authority in adolescents, creating outdoor advertising (banners), acquainting students with the "bacterial and viral world" on hand using microscopes in schools. It is advisable to hold special competitions to encourage the audience and raise public awareness (for example, a competition for the best design of a protective mask).
Key words: COVID-19, questionnaire, children and adolescents, preventive measures.
V. N. Karazin Kharkiv National University, Ukraine
Ribonucleic acid efficiency in combined therapy of patients with Epstein − Barr virus−caused infectious mononucleosis
83 - 88
To evaluate the clinical and immunological efficiency of ribonucleic acid in the correction of immune disorders in patients with infectious mononucleosis caused by Epstein-Barr virus, 110 patients were examined. The surveying complex consisted of clinical and biochemical methods, enzyme-linked immunosorbent assay, polymerase chain reaction method, immunogram. According to the results of analysis of the obtained indices, in the patients with infectious mononucleosis there were revealed the changes in the system of cell and humoral links of the immune system and diversity of the immune response. The progressive nature of changes in immune parameters indicates the formation of secondary cell immune imbalance, activation of humoral link, changes in the balance of immune regulatory mediators in the direction of Th2 cells. In the acute period of the disease there were significant violations of the cell immune system, which was characterized by an increased number of cells with killer activity: mature T lymphocytes (CD3 +), cytotoxic T-suppressors (CD8 +), cells expressing the activation marker CD25 + ) and increase Th1 / Th2. Under the influence of complex immune modulatory and antiviral therapy with prescribing the ribonucleic acid, there was a positive dynamics of immunological parameters compared with patients who received only basic therapy, that was manifested by an increased proliferative response. To correct immune disorders in patients with infectious mononucleosis, it is reasonable to use Nuclex (ribonucleic acid) (250 mg 2 capsules 3 times a day) and Valacyclovir (500 mg at a dose of 1000 mg 3 times a day for 14 days). The infectious process associated with Epstein-Barr virus infection has polymorphic clinical manifestations and a large number of negative consequences, which necessitates improved clinical and laboratory diagnosis and treatment of this disease.
Key words: infectious mononucleosis, Epstein - Barr virus, immune response, antiviral and immune modulatory therapy.
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