№4' 2018


State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, Ukraine
Effect of antihypertensive therapy and bariatric surgery on arterial stiffness in patients with arterial hypertension and morbid obesity
5 - 10
In order to establish the features of the dynamics of the elastic properties of the arterial wall in patients with arterial hypertension and morbid obesity under the influence of antihypertensive therapy depending on the presence of bariatric obesity, a study was conducted that included 56 patients with obesity I−III degree and uncontrolled hypertension. The design of the study consisted of four stages. Office systolic and diastolic blood pressure and the elastic−elastic properties of the arterial wall RT, AIx ao, AIx br, DRA, SAI and DAI were measured using an Arteriograph oscillometric instrument (Tensiomed, Hungary). The dynamics of changes in the elastic properties of the arterial wall in patients with arterial hypertension and morbid obesity under the influence of long−term antihypertensive therapy was studied depending on the bariatric surgical treatment. The features of the influence of surgical treatment of obesity on the course of arterial hypertension and the characteristics of vascular stiffness are determined. It was established that, despite the achievement of target blood pressure numbers in both groups, it was after surgical treatment of obesity that the level of systolic and diastolic blood pressure was significantly lower. By the end of the study, the achievement of normal performance of all the characteristics of elastic−elastic properties was established. However, at the 4th visit, the pulse wave velocity was 17.94 % lower in the bariatric surgery group, and the RT level was 30.16 % higher than in the control group. An increase in the mass fraction of the diastole phase was also observed in accordance with the DAI value in the main group and the absence of statistically significant changes in this indicator after 6 months in the control group. At the same time, AIx ao significantly decreased only in the group of exclusively drug treatment and at the time of completion of the semi−annual observation it decreased by 19.23 %.
Key words: arterial hypertension, blood pressure, morbid obesity, body mass index, bariatric surgery, arterial stiffness, pulse wave velocity, augmentation index, antihypertensive therapy.
Kharkiv Medical Academy of Postgraduate Education

Kharkiv State Academy of Physical Culture

Sumy State University, Ukraine
The efficiency of physical rehabilitation in patients with cardiopulmonal pathology
11 - 14
Great importance in enhancing the effectiveness of the treatment of patients with COPD accounts for the introduction to the program of rehabilitation therapy techniques, psychological training, patient education about the disease and the specific situation for the development of partnership in the fight against the disease. An important component of the treatment of patients with COPD should be physical rehabilitation. An integrated approach to the treatment of these patients can improve tolerance to physical and mental stress, improve quality of life, restore the social and professional status, improve clinical and laboratory efficacy of treatment and eventually slow down the progression of the disease. The aim of the study was to investigate the influence of physical rehabilitation program on respiratory function (ERF) and cardiac hemodynamics in patients with COPD combined with hypertension. The study involved 46 patients with severity II of airflow limitation COPD (all male) in remission stage with step II hypertension (stage 2) which established for at least five years ago and with clinical signs of congestive heart failure (CHF). The patients were divided into 2 groups. The first group included 25 men who, against the background of basic drug therapy, underwent a course of physical rehabilitation (GR1). The second group included patients who received standard basic drug therapy without a set of physical rehabilitation methods (21 people, GR2). To confirm the diagnosis a spirometric study was performed, the forced expiratory volume in the first second (FEV1), the forced lung capacity (FVC) was measured and the ratio of these indicators (FEV1/FVC) was determined. Spirographic studies were carried out using the computer system "SPIROLAB". All patients underwent one− and two−dimensional echocardiography in a pulsed mode with a phased sensor (2−4 MHz), spectral and tissue doppler−echocardiography from standard accesses on the "ULTIMA PRO 30" device. Basic drug therapy included taking a combination of Tiotropium at a dose of 5 mg per day with Olodaterol at a daily dose of 5 mg, Candesartan at a dose of 16 mg, Amlodipine at a dose of 5−10 mg. The main component of the comprehensive physical rehabilitation program was therapeutic gymnastics, which included standard exercises in combination with breathing exercises with elements of shallow breathing, muscle relaxation, auto−training and metered walking. The results showed that the treatment of patients with COPD in conjunction with the hypertension with the use of physical rehabilitation contributed significantly larger positive changes ERF parameters and reduction in blood pressure levels than in patients receiving only medical therapy.
Key words: chronic obstructive pulmonary disease, hypertension, physical rehabilitation.
Kharkiv National Medical University, Ukraine
Changes in lipid metabolism markers in patients with increased body mass index with polytrauma
15 - 19
The background of violations of the body's functions at an elevated body mass index is presented by metabolic disturbances, including the lipid ones. The combination of anatomical and pathophysiological features of the body of patients suffering from obesity creates preconditions for the complicated course of the disease, especially in patients with polytrauma, who are on the verge of functional abilities against the background of subjective well−being of most vital functions for a long time after being admitted to a hospital. Studies of lipids in patients with obesity are important due to the presence of accompanying pathology that affects their condition on the background of a traumatic illness. In order to analyze the dynamics of lipid markers markers in patients with elevated body mass index during a polytrauma, 224 patients with ISS and ARA?NE II starting dates for the period from the first month of treatment to one year from the time of injury were examined. The level of total cholesterol, triglycerides, high density lipoprotein cholesterol and the atherogenicity factor have been studied. The study was conducted on days 1, 3, 7, 14, 30 and 360 from the moment of receiving a polytrauma. It was found that the indices of total cholesterol, triglycerides, high−density lipoprotein cholesterol, and the coefficient of atrogenicity directly influence the course of traumatic illness in patients with an increased body mass index, the degree of severity of which in the conditions of homogeneity of the damages received and the same range of their severity on the scale of the RAILY II depends on the index body mass at the time of the patient's arrival to the hospital.
Key words: lipid metabolism, increased body mass index, polytrauma.
State Enterprise "Institute of General and Emergency Surgery named after V. T. Zaitsev, NAMSU", Kharkiv

Kharkiv National Medical University, Ukraine
Diagnosis of infected pancreatic necrosis
20 - 23
Today, the infection of the centers of pancreatic destruction is considered the main factor, which leads to high mortality in acute pancreatitis. The infected pancreatic necrosis is the earliest form of pancreatic infection and is characterized by the proliferation and penetration of microorganisms in necrotized areas of tissues surrounding the pancreas, which are often found in the extraocute area during the most severe course of acute pancreatitis. The emergence of minimally invasive variants of pancreatic necrosis and pancreatic abscesses has expanded the range of effective therapeutic measures. However, now it is necessary to precisely differentiate them depending on the prevalence, limitation and localization of lesions of pancreatic infection, determination of place and role in the treatment of infected pancreatic necrosis. To this end, 46 (67 interventions) in patients with acute necrotizing pancreatitis were performed with percutaneous thin−layer aspiration biopsy of parapancreatic cellular tissue under ultrasound−control with microbiological research of biomaterial for the purpose of verifying purulent−septic complications of pancreatic necrosis. Technique of thin−blood aspiration biopsy consisted of the following stages: 1) choice of puncture site; 2) local anesthesia (usually a solution of novocaine 0.25 % 20−30 ml); 3) visual control of the end of the aspiration needle; 4) visual control of changes in the place of the puncture in the aspiration process; 5) evaluation of the aspirates and sending them to morphological, bacteriological and biochemical studies; 6) ultrasonic monitoring of changes in the area of intervention after aspiration. As a result of the research, it was found that the thin−layer aspiration biopsy of parapancreatic tissue with microscopic examination of punctal tissue has a high sensitivity of 84.2 %, specificity of 96.6 %, positive predictive value of 97.0 %, negative predictive value of 82,4 % and overall accuracy −− 89.6 % in the differential diagnosis of sterile and infected pancreatic necrosis. In addition, it is important to study the cellular composition of the contents of the acute liquid clusters. The use of the developed method of diagnosis of infected pancreatic necrosis enables to timely identify the infectious complications of pancreatic necrosis, which helps to reduce untimely (early) operations and the number of cases of systemic complications.
Key words: pancreatonecrosis, complications, fine-needle aspiration biopsy.
GU "Dnipro Medical Academy of Ministry of Health of Ukraine", Ukraine
Features of treatment of acute thrombosis of deep veins of the lower extremities
24 - 29
Deep vein thrombosis is a complication that occurs in the postoperative period, during pregnancy and childbirth, trauma and many other diseases. The primary cause of thromboembolism in the pulmonary artery are acute thrombosis in the system of the lower vena cava, especially the deep veins of the lower extremities. Based on the comparative analysis, the advantages and disadvantages of conservative and surgical methods for the treatment of acute thrombosis of deep veins of the lower extremities in 120 patients were determined. The patients were divided into three groups: in Group 1 traditional conservative therapy was used; in Group 2 −− thrombectomy; in Group 3 −− systemic thrombolysis. The results were evaluated after the treatment according to the following criteria: blood coagulation system, inflammatory marker −− C−reactive protein, dynamics of regression of pain syndrome, dynamics of reduction of edema, ultrasound duplex scanning. Long−term results were studied by questioning patients using the CIVIQ questionnaire. Unsatisfactory results were associated with violations of patients' recommendations or anticoagulants inappropriate. The study showed the benefits of thrombectomy in comparison with the traditional ACT on the dynamics of clinical changes and hospital stay, but this method was accompanied by a large number of postoperative complications. The best treatment results were obtained with systemic thrombolysis, which was confirmed by the results of a study of the hemostasis system. However, its implementation may be limited in view of the presence of concomitant pathology and the risk of allergic reactions. In order to prevent hemorrhagic complications, systemic thrombolysis requires careful monitoring of the coagulogram.
Key words: deep vein thrombosis, anticoagulant therapy, thrombectomy, systemic thrombolysis.
GI "Institute of general and urgent surgery named after V. T. Zaytsev of NAMS Ukraine" Kharkov

Communal non&minus
profit enterprise "Kharkiv city clinical hospital of emergency aid named by prof. O. I. Meshchaninov", Ukraine
Effectiveness of natural biopolymer−based drug Hitozan−Genta in treatment of superficial and deep burns
30 - 34
Burn injuries require long and expensive treatment, accompanied by long−term disability, high mortality and disability of patients. For the local treatment of burns, numerous drugs have been proposed, including those based on natural biopolymers, which include chitosan, and its combination with antibiotics (in particular with gentamicin) enhances the therapeutic effect of the drug. In order to establish the effectiveness of the domestic drug "Chitosan−Genta" in the local treatment of burns of various depths and the optimal methods of its use, 37 patients were examined. Such parameters of the wound process as severity of inflammatory reaction, level of wound exudation, time of formation of a scab on the burn surface, terms of epithelialization of superficial and cleansing deep burns from necrotic tissues, time of skin plasty operations and terms of the final healing of burns were determined. The work confirmed the effectiveness of the treatment with Chitosan−genta of both superficial and deep burns, which was expressed in optimizing the course of the wound process, accelerating epithelialization of superficial burns, shortening the time of preparation of deep burns for surgical treatment and reducing the time of inpatient treatment of victims. Gel "Chitosan−genta" due to the successful combination of gel base and antibacterial component provides clinical efficacy in the treatment of superficial and deep burns, which allows us to recommend its use in combustiology.
Key words: burns, Hitozan-Genta gel, local treatment, wound process.
Kharkiv National Medical University, Ukraine
The role of immunological factors of invasiveness in the pathogenesis of genital endometriosis
35 - 38
The work presents new factors of immunopathogenesis of endometriosis. Endometriosis is one of the most common gynecological diseases and affects, according to different authors, from 4 % to 15 % of women of reproductive age. The aim of the work was to study the effect of expression of the main factors of endometrial invasion −− matrix metalloproteinases, as well as adhesion molecules on the development and severity of endometriosis in women. 60 patients aged 19−45 years were examined. First clinical group (control) consisted of 30 healthy fertile women. The second clinical group consisted of 30 patients with external forms of genital endometriosis of grade I−II according to the classification of the American Fertility Society. In terms of examination, all patients had general clinical (anamnesis collection, gynecological examination), instrumental examination (ultrasound, medical−diagnostic laparoscopy, colposcopy) and special research methods. The object of special research methods was the study of the expression level of matrix metalloproteinases MMPs (MMP−2, MMP−9) and the content of adhesion molecules in peripheral blood and peritoneal fluid, which was obtained during laparoscopy. Studies have shown that the endometriosis progression accompanied by increase expression of metalloproteinases, changes in proteinases expression level have an effect on the remodeling of the underlying stroma, as well as increased expression in the tissues of peritoneum adhesins responsible for the formation of strong cell−to−cell contacts. Detection of the immune mechanisms that determine the increased invasion of endometrial cells significantly expands our understanding of the mechanisms of ectopic growth. The obtained new pathogenetic factors regulating the invasive abilities of the endometrial tissue can serve as a basis for the treatment of endometriosis.
Key words: endometriosis, invasiveness, metalloproteinases, adhesion molecules.
Kharkiv National Medical University, Kharkiv, Ukraine
Clinical and laboratory characteristics of abnormal pubertal uterine bleeding
39 - 41
One of the most common disorders of menstrual function during puberty is abnormal uterine bleeding puberty period. The main cause of uterine bleeding in adolescent girls is a defect in the interaction of the ovaries and the hypothalamic−pituitary area of the central nervous system. In order to identify the features of clinical and laboratory characteristics of abnormal uterine bleeding, 98 teenage girls aged 11 to 18 years were examined, 33 of them were hospitalized with relapses of bleeding.All patients were given anamnesis, ultrasound examination of pelvic organs, doppler examination, determination of hormonal profile (gonadotropic and sex hormones), biochemical examination with the study of parameters of the hemostasis system. As a result of the study, it was discovered that some of the etiological factors of abnormal uterine bleeding during puberty were changes in the physical and sexual development of patients, as well as hereditary predisposition to menstrual function disorders. An ultrasound examination showed an increase in ovarian volume with the development of follicular cysts, the presence of hyperplastic processes and increased blood flow in the endometrium. Established hormonal disorders indicate changes in the hypothalamic−pituitary−ovarian system. In teenage girls there are various−directional changes in the general condition of the hemostasis system, which are determined by the size of blood loss, the weight of the induced hemodynamic and metabolic disorders. In abnormal uterine bleeding puberty period, violations in gonadotropic ovarian function are observed, which leads to a change in the concentration of sex hormones. In adolescent girls with uterine bleeding, an increase in cortisol levels in serum is detected, which may indicate a high level of stress.
Key words: abnormal pubertal uterine bleeding, hemostasis system, hormonal disorders.
Donetsk National Medical University, Liman, Ukraine
Comparative analysis of the effectiveness of non−invasive methods of treatment of non−dendritic kidney stones
42 - 46
Currently, extracorporeal shock−wave lithotripsy is the first−choice method for treating kidney stones of a small size. However, the limited capabilities of this operation have prompted researchers to seek new, more effective methods, in particular in the clinical practice they began to actively apply fibroureteroenoscopy in combination with laser nephrolithotripsy, the technique of percutaneous nephrolithotripsy. To conduct a comparative analysis of the results of treatment with the use of different low−invasive technologies and to determine the tactics of the treatment of concretions of different magnitudes, a study involving more than a thousand patients was conducted. The obtained data made it possible to draw conclusions about the effectiveness of treatment of non−corneal kidney stones. Thus, the use of extracorporeal shock−wave lithotripsy is effective in patients with concrements of 6−10 mm and a density of not more than 1000 HU, fibroureteronoscopy in combination with laser nephrolithotripsy is justified by stones smaller than 1 cm and a density greater than 1000 HU, as well as any density at sizes up to 27 mm, the mini−percutaneous nephrolithotripsy is successfully applied at concrements from 17 to 27 mm. At the same time it was emphasized that the use of minimally invasive methods in patients with stones over 30 mm leads to an unjustified increase in the duration of operation and the increase in the frequency of complications.
Key words: non-dendritic kidney stones, extracorporeal shock wave lithotripsy, fibroureterorenoscopy, mini percutaneous nephrolithotripsy.
Kharkiv Mediacl Academy of Postgraduate Education, Ukraine
Modern data on neuromyelitis optica, or Devic’s disease
47 - 53
Neuromyelitis optica (NMO) or Devic's disease is a chronic inflammatory demyelinating disease of the central nervous system characterized by selective involvement of optic nerve and spinal cord myelin in the pathological process, leading to severe disability. For a long time, the disease was considered as a variant of multiple sclerosis (MS) due to the similarity of symptoms. Detection of NMO−IgG antibodies (Neuromyelitis Optica, NMO) specific molecular biomarker aquaporin−4 (AQP4) in the blood allows to differentiate these two diseases. The purpose of the article is to expand and deepen doctors' knowledge in etiopathogenesis, pathomorphology, clinical course, diagnostic and treatment strategies of NMO, taking into account modern data. The disease is based on an autoimmune process with specific antibodies response on the periphery, its penetration through the blood brain barrier and protein aquaporin−4 (AQP4) binding, which leads to inflammation and demyelination, followed by necrosis of oligodendrocytes and neurons, its cystic degeneration. According to the new diagnostic criteria, the list of NMO Spectrum Disorder includes not only seropositive (with the presence of AQP4−IgG), but also seronegative cases. In patients without antibodies to AQP4, antibodies to myelin oligodendrogliocyte glycoprotein (MOG−IgG seropositive) are present. NMO has monophasic and recurrent flow types. NMO is clinically manifested by syndromes of optic neuritis and/or longitudinal−transverse myelitis. Diagnosing NMO is based on diagnostic criteria and data of neurological examination, neuroimaging, and laboratory (serological) tests. Treatment of NMO depends on stage and type of disease. The standard of care for the treatment of an acute attack is intravenous pulse therapy of corticosteroids (CS) and/or plasma exchange. For prevention of recurrence, the first−line drugs are azathioprine, mycophenolate mofetil and rituximab. Greater efficiency is shown by combined regimens of taking these drugs with low−dose CS. Intravenous immunoglobulin therapy is also possible. There are no clear recommendations regarding the duration of preventive treatment. The effect of complement inhibitors and neutrophil elastase, as well as AQP4−IgG binding blockers with AQP4, is being investigated. These include eculizumab, tocilizumab and a C1−esterase inhibitor. The outcomes of the disease vary from complete recovery and the presence of remission of the disease to the most unfavorable option with progressive deterioration and death of the patient.
Key words: neuromyelitis optica, Devic’s disease, aquaphorin-4, seropositive and seronegative cases, etiopathogenesis, pathomorphology, clinical findings, diagnostic criteria, treatment.
Kharkiv Academy of Postgraduate Education, Ukraine
Acute and chronic disorders of cerebral venous blood circulation
53 - 58
Brain defeat as a result of cerebral circulation disorder represents a serious medical and social problem and causes huge economic damage to society, as it is the cause of emergency hospitalization and long−term disability. Analyzing the publications, it can be noted that more than 90 % of the work is devoted to the study of cerebrovascular disorders, and only 10 % of studies are related to the pathology of venous blood flow. Meanwhile, the value of the venous system in the blood supply of the brain is difficult to overestimate. Difficulties in lifelong diagnosis of venous circulation disorders were the cause of the false idea of the low incidence of this pathology. Thus, a practitioner neurologist needs to know the features of the structure and functioning of the venous system of the brain, pathological changes and ways of correcting the corresponding disorders. Special attention is given to the issues of etiopathogenesis as acute (venous hemorrhages, venous thrombosis, venous thrombophlebitis), and chronic disorders of cerebral venous circulation (venous congestion and venous encephalopathy), the classifications used by doctors are given, the features of the clinic are reflected taking into account the localization of the pathological process, modern methods of diagnosis and interpretation of the results, directions in the treatment of patients with this pathology are covered. The study of the condition of this problem is relevant not only for neuropathologists, psychiatrists, neurosurgeons, but also for doctors of other specialties, since it provides an opportunity for a timely diagnosis and adequate treatment to reduce the mortality and maintain the working capacity and quality of life of patients.
Key words: venous hemorrhage, venous thrombosis, venous sinus thrombosis, venous stasis, venous encephalopathy, venous circulation, venous thrombophlebitis.
practical Center of Neurorehabilitation "Nodus", Brovary, Kyiv region, Ukraine
Changes of clinical and neurological indices in patients with post−comatose disorders of consciousness after severe craniocerebral trauma
59 - 65
Craniocerebral trauma is one of the main factors of mortality and disability of young and middle−aged people. The evaluation of clinical and neurological manifestations of post−comatose post−traumatic conditions, especially in the dynamics of restoration of consciousness, remains important, especially in view of the need to develop prognostic criteria for the restoration of functional capabilities that allow patients to integrate into the social environment.In order to analyze the dynamics of clinical and neurological parameters in severe craniocerebral trauma, 220 patients were examined to determine their prognostic value for restoration of consciousness. The results of their clinico−neurological examination, regardless of the stages of consciousness renewal, indicate the absence of specific neurological focal symptoms and are characterized exclusively by the topical−functional features of the primary brain structures on the segmental and supersegmental levels. A detailed study of neurological symptoms, which has changed in the dynamics of restoration of consciousness, is important for determining the beginning of a new stage / stage of restoration of consciousness to determine the necessary therapeutic (rehab) effect at this stage in order to improve the general condition of the patient, the quality of his life, which will facilitate a faster transition. to the highest possible level of consciousness.
Key words: craniocerebral trauma, coma, post-comatose disorders of consciousness, vegetative status.
V. N. Karazin Kharkiv National University

"Institute of problems of endocrine pathology named after V. Ya. Danilevsky of NAMS of Ukraine", Kharkov, Ukraine
Absolute insulin insufficiency in different variants of diabetes mellitus
66 - 69
In the conducted study, the importance of determining C−peptide in patients with various types of diabetes mellitus (DM) at the stage of absolute insulin insufficiency (AIN) development was studied. It is important to determine the C−peptide in the differential diagnosis of types 1 and 2 of diabetes, as well as when it is impossible to determine the type of the disease by clinical signs, that is, to distinguish between absolute and relative insulin deficiency. Evaluation of the insulin−producing function of ?−cells according to this indicator will allow to justify the legality of the appointment or cancellation of insulin therapy in patients with diabetes. The aim of the study was to determine the severity of AIN in patients with different variants of the course of diabetes on the basis of the C−peptide study. 168 patients with diabetes were examined: 62 patients with type 1 diabetes, 72 patients with slowly progressive autoimmune diabetes in adults and 34 patients with type 2 diabetes with the development of insulin dependence. The control group was made up of healthy individuals with unceremonious heredity according to diabetes that were representative by sex and age. Considering the results and literature data obtained in the presented study, it should be considered that the determination of C−peptide in patients with diabetes is a reliable criterion by which the functional activity of ?−cells can be assessed, in particular, when prescribing insulin therapy. When studying the indicator, it is necessary to take into account the peculiarities of the course of the disease, including the presence of immunological markers of insulitis, signs of insulin resistance. In doubtful cases, it is necessary to conduct studies of C−peptide in the dynamics of observation, which will allow not only to prescribe an adequate hypoglycemic therapy to the patient, but also to evaluate its effect on the insulin−producing function of the pancreas. The findings suggest that C−peptide is a reliable marker of the functional state of ?−cells. Based on a comparative analysis of fasting C−peptide levels in patients with different types of diabetes at the stage of absolute insulin deficiency, a different degree of decrease in insulin secretion was established. It has been proven that in patients with type 1 diabetes, the severity of absolute insulin deficiency is not the decisive factor in the relatively stable or labile course of the disease. For an objective assessment of the functional state of ?−cells and the effect of hypoglycemic therapy on insulin secretion in doubtful cases, it is advisable to determine the C−peptide over time.
Key words: type 1 and 2 diabetes mellitus, slowly progressive adult autoimmune diabetes, C-peptide, absolute insulin deficiency.
State Enterprise "Institute of Endocrinology and Metabolism named after V. P. Komisarenko, NAMS of Ukraine", Kyiv, Ukraine
The use of phosphodiesterase type 5 inhibitors in patients with type 2 diabetes mellitus and erectile dysfunction
70 - 75
Erectile dysfunction is one of the most common complications of diabetes and may be a predictor of its development. Testosterone deficiency and the severity of erectile dysfunction independently of each other are associated with a decrease in the quality of life of patients with type 2 diabetes: the deterioration of physical function, social and vitality, general health. To study the effectiveness of the use of phosphodiesterase type 5 inhibitors (sildenafil, tadalafil and vardenafil) in men with type 2 diabetes and erectile dysfunction, a study was conducted, which included 89 patients aged 39−69 years who had a permanent sexual partner. Patients were divided into 3 groups in accordance with the prescribed drug. The results of the study indicate that the administration of sildenafil led to a significant improvement in the "Erectile Function" indicator compared to the pre−treatment index by 5.31 points, tadalafil −− by 5.8 points; Varedenafil −− by 8.3 points. Adverse reactions such as facial flushing, nasal congestion, headache, and throat irritation occurred in a small number of patients, had a mild severity and did not require discontinuation of the drug. The results of the study confirm the high efficacy of sildenafil, tadalafil and vardenafil in patients with type 2 diabetes and erectile dysfunction. The frequency of adverse reactions in our patients was low and comparable in the three groups examined.
Key words: type 2 diabetes mellitus, erectile dysfunction, phosphodiesterase inhibitors.
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Vitamin D and skin pathology
76 - 80
In recent years, information has been obtained on the role of vitamin D in the mechanism of development and treatment of many diseases; its participation in many biological processes (modulation of cell growth, neuromuscular conductivity, immunity and inflammation, angiogenesis) has been shown. Vitamin D is a unique substance that, under certain conditions, acts as a hormone. Vitamin D deficiency increases the risk of autoimmune and atopic diseases, tumors, cardiovascular, infectious diseases, etc. Vitamin D is involved in the regulation of the proliferation and differentiation of cells of all organs and tissues, including immunocompetent cells, skin cells. It directly initiates a congenital immune response, modulates the proliferation of T−lymphocytes, inhibits the development of Th17 lymphocytes, slows B−cell differentiation, inhibits Th1−associated production and stimulates Th2−associated cytokines, etc. filaggrin, participates in the formation of the stratum corneum, while suppressing the hyperproliferation of keratinocytes, stimulates the formation of antimicrobial peptides, has a photoprotective effect. The role of vitamin D disorders in the pathogenesis of skin diseases: eczematous, autoimmune, bullous, and so on is discussed. Vitamin D reduces susceptibility to infection in patients and controls the local inflammatory immune response. Detection of the anti−inflammatory and immunosuppressive activity of vitamin D opens up new possibilities for the therapeutic use of this substance and its analogues in skin diseases.
Key words: vitamin D, deficiency/insufficiency, pathogenesis, skin, chronic dermatoses.
CPR "Urban Skin and Venereal Dispensary N4", Kharkov, Ukraine
Indicators of melatonin and vascular endothelial growth factor (VEGF) in psoriatic patients with sleep disoders
81 - 84
Psoriasis is a chronic recurrent skin disease of multifactorial nature with immuno−mediated pathogenesis, in which inflammation and unbalanced angiogenesis are the key causes of manifestation of the disease in the form of characteristic erythematous−squamous rashes. The vascular endothelial growth factor (VEGF) is an anti−inflammatory marker that demonstrates endothelial dysfunction and pathological neoangiogenesis. Melatonin, the hormone epiphysis among many regulatory processes obtains anti−inflammatory and antiangiogenic functions. In order to determine the level of melatonin and VEGF in the blood of patients with psoriasis of varying degrees of severity of dermatosis and evaluation of these indicators, based on sleep disorders, 60 patients were examined. The definition of sleep quality was performed using a score assessment questionnaire for subjective sleep characteristics. A marked increase in the level of VEGF and a decrease in the level of melatonin in the blood of patients with psoriasis with the most significant deviations in the severe form of the disease was found. Correlation dependence of these indicators on the presence of sleep disturbances is established. The results obtained suggest that the clinical course of psoriasis and the quality of sleep depend on the imbalance of the prohangio−genic growth factor VEGF and the antiangiogenic factor of melatonin.
Key words: psoriasis, sleep loss, comorbidity, melatonin, VEGF.
Kharkiv National Medical University, Ukraine
Efficiency of the application of the innovative method of prophylaxis of periodontium in teenage girls with a disorder of the menstrual cycle
85 - 89
Periodontal disease is one of the topical problems in dentistry. It is known that there is a close connection between almost all infectious and non−infectious diseases of the teeth and oral cavity. The presence of inflammatory process in the oral cavity can cause inflammation in the female genital organs and thus contribute to the violation of the hormonal background of the girl's body. In order to develop the main measures for the prevention of periodontium in adolescent girls with pathology of menstrual function and to determine the effectiveness of the proposed innovative method, 60 teenage girls with a history of menstrual function were examined, which used both traditional and innovative methods of prevention. The innovative system of prophylaxis of periodontal disease was conducted taking into account the development group of this pathology and a combination of prognostic variants. Methods of prophylaxis of periodontal disease were conducted with the definition of predictors of the development and course of inflammatory diseases of the oral cavity, the etiology of development of menstrual disorders and the compilation of an individual pathogenetic profile. The traditional method of prevention included: rational and proper nutrition; training of the masticatory apparatus for the purpose of normal periodontal formation; timely orthodontic treatment with multifunctional therapy; training basic rules of hygiene of the cavity of the mouth; timely, full−fledged orthopedic treatment; elimination of local traumatic factors; therapy for menstrual disorders and surveillance in a pediatric gynecologist.The innovative method involves the elimination of pathogenic and opportunistic microflora in the body; thorough and regular individual hygiene, oral sanitation and elimination of dysbiosis; eliminating factors that prevent the normal functioning of the salivary glands and the salivation of its functions; restoration of mineral balance and salt metabolism in general; normalization of the hormonal background; strengthening and maintaining universal immunity; restoration of local immunity of the oral cavity; the restoration of a lack of vitamins, micro−and macro elements; reducing sugar intake, reducing the number of snacks between the main meals. The application of innovative prophylaxis of periodontal diseases has allowed to significantly neutralize their development or the emergence of light forms.
Key words: periodontal disease prophylaxis, innovative scheme, female adolescents, menstrual disorders.
Azerbaijan Medical University, Baku, the Republic of Azerbaijan
Comparative study of the effectiveness of middle−acting muscle relaxants in small surgical interventions in children
90 - 94
Ensuring adequate muscle relaxation with small surgical interventions in children is one of the urgent problems of modern pediatric anesthesiology. In order to comparatively study the effectiveness of the average action of muscle relaxants with small surgical interventions in children, a study was conducted in which 156 patients aged 0 to 16 years took part. All operative interventions were performed under balanced general anesthesia with the use of besilat atracurium, besilat cisatracuria and bromide rocuronium. TOF −− stimulation ("traine of four") monitoring of neuromuscular conduction was carried out using the TOF −− Watch (Organon Ireland) device. A comparative assessment of the neuromuscular block with titrated doses of rocuronium bromide, atracuria besilata and cisatracuria besilate was performed in combination with 1.3 MAC isoflurane (subgroup "+ iso") at the stages of tracheal intubation, maintaining general anesthesia and spontaneous recovery of neuromuscular conduction. The development of neuromuscular blockade with the achievement of 90 % suppression of T1 in children of the older age group with the highest rate occurred in the group with rocuronium bromide. The results of the study allowed to deduce the conclusions that when using isoflurane, a reduction in loading doses of atilate of besylate to 0.4 mg/kg, cisatracuria of besylate to 0.12 mg/kg and rocuronium bromide to 0.45 mg/kg ensure sufficient depth of the neuromuscular block (suppression of T1 from 90 % and above). The time of onset of action in children under the age of one when using isoflurane does not significantly change. And in older children, significant differences were obtained only when comparing rocuronium bromide at doses of 0.45 mg/kg and 0.6 mg/kg (p < 0.05).
Key words: medium-effect muscle relaxants, surgical treatment, children, neuromuscular block.
Kharkiv National Medical University, Ukraine
Medical and social substantiation of an optimized model of rehabilitation of patients with chronic pancreatitis
95 - 100
Since chronic pancreatitis is a topical medical and social problem and has a high prevalence, the subject of the study was the study of the organization of provision of medical care and rehabilitation measures for patients with chronic pancreatitis. A sociological survey of 500 respondents over 18 years old was conducted for this purpose. On the basis of the obtained data an optimized model of medical and social rehabilitation of patients with chronic pancreatitis based on a multilevel approach was developed and provides the possibility of applying monitoring at different levels of management between subjects. For its functioning, the functional−organizational system of rehabilitation of patients was proposed, which includes normative−legal, organizational−structural, resource, personnel, clinical, scientific and informational components. According to the results of the work, it has been established that the development and implementation of an optimized model of rehabilitation of patients with chronic pancreatitis in healthcare practice corresponds to modern international approaches and strategies for rehabilitation measures, its social and medical efficiency has been proved.
Key words: chronic pancreatitis, rehabilitation, rehabilitation model.
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