№3' 2021


Kharkiv Medical Academy of Postgraduate Education, Ukraine
Cross−reactivity to antibiotics
5 - 9
The cross−reactivity between antibiotics affects the choice of them to treat bacterial infections. If patients had allergic reactions to any antibiotics in the past, the physician usually prescribes an alternative drug. For optimal treatment of such patients, certain circumstances should be considered: hypersensitivity to antibiotics subsides over time, cross−reactivity is rare even within one class of antibiotic; the use of alternative antibiotics is associated with increased treatment costs, prolonged hospital stay and enhanced risk of infection by resistant microorganisms. Cross−reactivity between β−lactams is infrequent and stipulated by structural similarity of R1−side chains. Hypersensitivity to a certain cephalosporin does not yet indicate the one to a whole class, and in the presence of an allergy to cephalosporins of any generation, there will be no cross−reaction to another drug if their molecules have different side chains. At anamnestic indications for immediate allergic reactions to fluoroquinolones, the use of all members of this class should be avoided. Most patients with hypersensitivity to one macrolide tolerate another with a different number of atoms in the lactone ring. In the presence of anamnestic indications for allergic reactions to aminoglycosides of the deoxystreptamine group, the use of all such drugs should be avoided too. If the patient has a history of allergic reactions to glycopeptides, the use of oxazolidinones is safer. Different imidazoles should not be used in patients with known hypersensitivity to metronidazole. If there is a high probability of an allergic reaction of the first type in a patient in the past, it is better to plan treatment together with an allergist / immunologist.
Key words: antibiotic, cross-reactivity, allergic reaction.
SI Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Preoperative verification of comorbidity in patients with high−risk coronary heart disease on the eve of surgical myocardial revascularization
10 - 14
Advances in drug therapy and interventional cardiology, availability of cardiac surgery have led not only to increased life expectancy in patients, but also to a rise in their risk profile due to comorbidity. When stratifying the risk of patients on the eve of coronary artery bypass grafting according to available risk calculators, concomitant diseases are taken into account, decompensation of which is considered as a prognostic factor of adverse outcome of surgery. The data from 194 high−risk patients who underwent surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine within 2009−2019 were retrospectively analyzed. All the patients underwent electrocardiography, echocardiography, coronary ventriculography and coronary shunt. Risk stratification on the EuroSCORE II scale averaged 7,78 %, indicating a high probability of death. All the patients had hemodynamically marked coronary artery stenosis and required coronary artery bypass grafting. Analysis of patients at high risk of coronary heart disease who were hospitalized for surgical revascularization of the myocardium showed that they were overweight, having an obesity I−III, Diabetes mellitus type 2, impaired glucose tolerance, chronic kidney disease, concomitant atherosclerosis, varicose veins of the lower extremities, gouty arthritis, chronic obstructive pulmonary disease. The developed algorithm for searching for comorbid conditions makes it possible to detect the concomitant diseases in the patients on the eve of cardiac surgery. Management of cardiac surgery patients with high−risk ischemic heart disease in the perioperative period requires a personalized approach, taking into account not only the cardiac features, but also the compensation of comorbid conditions.
Key words: coronary heart disease, high-risk patient, comorbidity, coronary artery bypass grafting.
Avrasiya Hospital, Baku, Azerbaijan
State of lipid peroxidation in patients with diabetes mellitus and erectile dysfunction
15 - 18
Diabetes mellitus is the most common cause of men erectile dysfunction, which is observed in everyday medical practice. Diabetic erectile dysfunction occurs as a result of a combination of neurogenic and vascular disorders. Important mechanisms of microcirculation disorders include those of lipid peroxidation of biomembranes. Normally, the lipid peroxidation is controlled by antioxidant regulatory systems, among which the key role belongs to the intracellular antioxidant system. For a comparative study of lipid peroxidation in the patients with Diabetes mellitus and erectile dysfunction, 59 people were examined. The diagnosis was determined on the basis of anamnesis, results of physical examination, test with intracavernous injection, echo−Doppler penile assessment, cavernosography−cavernosometry and the penile night test. Cavernous and peripheral venous blood was sampled from each patient, lipid peroxide levels were determined, and overall antioxidant status was established. Analysis of the results revealed a slight difference between nitric oxide levels for venous and cavernous parameters in patients with diabetes. The strong correlation between venous and cavernous values of levels of biochemical markers indicates systemic transformations in the body. Based on high levels of lipoprotein−α and malonic dialdehyde and low levels of nitric oxide for peripheral venous blood, a conclusion was made about the correlation with the severity of erectile dysfunction, which is determined during duplex ultrasound investigation. The need for future research on various biochemical markers among a larger population of men with this associated pathology is emphasized.
Key words: etiology, erectile dysfunction, diabetes mellitus, lipid peroxidation, diagnosis.
SI Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Methods of diagnosis and results of surgical treatment of ascending aneurysms and aortic arch
19 - 23
Treatment of ascending and aortic arch aneurysms (or just aorta) is the most difficult problem of cardiovascular surgery, due to the need to correct the underlying pathology and adequate protection of the brain and visceral organs. To determine the methods of surgical treatment of aneurysms, the nature and frequency of post−surgery complications and treatment results, a study was conducted at the basis of the Amosov National Institute of Cardiovascular Surgery, wherein 419 patients were operated since 1994 to 2018. Aneurysms were diagnosed based on clinical data, transthoracic and esophageal echocardiography, computed tomography, X−ray examination, aortography. All surgeries were performed under general anesthesia, through midline sternotomy and with the use of an artificial circulation device, as well as under conditions of deep or moderate hypothermia. In all cases, retrograde cerebral perfusion, antegrade selective perfusion of brachiocephalic arteries with preserved perfusion through the femoral artery of the visceral organs and lower extremities, or circulatory arrest were used to protect the brain and visceral organs. For the correction of main defect, valve−saving technique with resuspension / plastic of the aortic valve and prosthesis of the semicircle / arch was used; Bentall operation with semi−arc / arch prosthesis, hybrid operations Elephant trunk (conventional Elephant trunk) + TEVAR. Brain was protected differently at each of the two stages of surgery. The best result was achieved at the second stage. According to the results of the study, the rate of post−surgery complications decreased from 34,4 to 8,4 %, hospital mortality reduced from 17,2 to 5,3 %, that allowed for certain indications to safely increase the volume of surgeries.
Key words: aorta, aortic arch aneurysm, aortic dissection, deep hypothermia, antegrade and retrograde cerebral perfusion.
SI "Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O.M Lukyanova, National Academy of Medical Sciences of Ukraine ", Kyiv
Verum Medical Center LLC, Kyiv, Ukraine
Use of lipofilling in reconstructive and plastic surgery for rehabilitation of patients after surgery for breast cancer
24 - 29
Breast cancer is the most common malignancy in women worldwide. The number of cases of breast cancer among young women under 40 is increasing, that requires surgery to not only remove the malignancy, but also to preserve the aesthetic appearance after completion of comprehensive treatment. One of the effective surgical techniques is lipofilling. Real meta−analysis did not show a rise in the recurrence rate in patients who underwent lipofilling after the surgical stage of breast cancer treatment, compared with the group of the patients without this procedure. Lipofilling is an effective method of correction of aesthetic defects, improves the quality of life of patients after the surgical stage of breast cancer treatment. It is important when performing subcutaneous mastectomies with simultaneous endoprosthesis. According to a published reports, lipofilling can be performed in elderly patients. It does not increase the risk of breast cancer in women when performing surgery for aesthetic correction with the absence or presence of benign breast pathology. The lipofilling can influence the choice of surgical method, reduce the need to mobilize large glandular or subcutaneous fat flaps. Patients with affected lymph nodes have an increased risk of developing local and systemic recurrences after the lipofilling procedure. However, there is a number of issues that need to be explored in further research. It is important to study the time period when lipofilling should be performed after the surgical stage of breast cancer treatment, radiation therapy and adjuvant chemotherapy, as the study does not recommend a lipofilling less than 16 months after surgery.
Key words: breast lipofilling, breast cancer, rehabilitation, reconstructive plastic surgery.
Municipal Non&minus
Profit Enterprise of Kharkiv City Council "Regional Clinical Perinatal Center", Kharkiv, Ukraine
On the issue of urinary incontinence in women
30 - 32
An important and very delicate medical problem, i.e. urinary incontinence in women of perimenopausal age has been considered. There are two types of this condition: anatomical and associated with bladder disease. According to the classification of the International Continence Society (2002) there are stress incontinence, imperative (urgent), mixed, enuresis (night), permanent etc. Diagnosis includes careful history taking, complete clinical examination, assessment of gynecological status, laboratory methods (general analysis and bacterial examination of urine), functional tests (cough, straining, one−hour pad test, swab−applicator), complex urodynamics, urofluorometry, profilometry of urethra), and cystoscopy according to the indications. Treatment can be conservative or operative. Conservative one involves the use of anticholinergic drugs, alpha−adrenoceptor antagonists, serotonin and norepinephrine reuptake inhibitors for 3−5 months. In the absence of drug therapy effect, it is necessary to address the issue of surgical treatment (mostly performed sling operations using synthetic materials: TVT, TVT−o). In the presence of genital prolapse, surgical correction is indicated, because 80 % of women with lowering of the internal genitals are diagnosed with stress urinary incontinence. When the uterus falls out, there are performed its extirpation, colporrhaphy, colpoperineoraphy. At the same time there the urethropexy is also done. Vaginal access is getting better due to the fact that during surgery the symptoms of urinary incontinence are eliminated. Thus, urinary incontinence is an extremely delicate problem that is at the intersection of two specialties,namely gynecology and urology, its solution requires a differentiated, individual approach to the choice of treatment tactics.
Key words: urinary incontinence, involuntary urination, perimenopausal age, urethropexy, genital prolapse.
Zaporizhzhia State Medical University, Ukraine
Possibilities of using combined second generation oral contraceptives in overweight women
33 - 36
Many gynecological studies are devoted to the problem of overweight in women. One of the topical issues is the prevention of unwanted pregnancies in this category of patients. A study was conducted to evaluate and compare the safety and effectiveness of different types of modern hormonal contraception in 60 young overweight women. All the patients were divided into two groups: those who used the second−generation combined oral contraceptives (30 µg ethinyl estradiol and 150 µg levonorgestrel) and those who took third−generation drugs (20 µg ethinyl estradiol and 150 µg desogestrel). The influence of the second−generation hormonal contraception on the reproductive health of overweight women has been studied, the nature and frequency of adverse reactions have been determined, its advantages and disadvantages have been assessed, and the parameters of the hemostasis system and blood lipid spectrum have been compared. The dynamics of changes in the level of blood pressure, HOMA index in the patients using different methods of hormonal contraception has been shown. The need for a comprehensive examination of overweight women to choose the method of hormonal contraception has been emphasized. The second−generation hormonal contraceptives have been determined to be highly effective in preventing unwanted pregnancies in overweight women of childbearing age, especially if they have financial problems. The effect of the hormonal contraceptive with desogestrel on the blood coagulation system in women was also noted, which was demonstrated by a decrease in the clotting time by the end of the study and an increase in the prothrombin index and fibrinogen. Therefore, it was found that for this group of women it was desirable to use the second−generation hormonal contraceptives, the advantage of which was a lower risk of thrombosis.
Key words: hormonal oral contraceptives, overweight, women.
Zaporizhzhia State Medical University, Ukraine
Electroencephalography features in regulation of autonomic nervous system in women with infertility
37 - 43
The method of electroencephalography is used for scientific and clinical purposes. It applies the modern mathematical methods of data processing and analysis, allows qualitative and quantitative analysis of the functional state of brain and its responses under the action of stimuli and when performing various activities. Owing to the analysis of published papers over the past five years on the features of electroencephalography as a method of assessing the regulation of the autonomic system of women depending on their age and the presence of extragenital diseases, the diagnostic value of this method in treatment of infertility patients in program of in vitro fertilization was grounded. Methods of system and content analysis were used in the research. In clinical practice, the use of electroencephalography allows to determine the functional activity of human brain and to identify the risk group of patients with dysfunction of the autonomic nervous system, up to the appearance of pathological conditions, as well as in reproductive sphere of women with infertility. The study is of important diagnostic and prognostic value in the examination of almost healthy people and women with various pathologies: dysfunction of the autonomic nervous system, mental and neurological diseases, especially with epilepsy. In modern science, various methods of computer analysis of electroencephalograms are used, mostly spectral, that allows to mathematically determine and study their frequency characteristics. Evaluation of the results of electroencephalography in patients of reproductive age makes it possible to determine the bioelectrical activity of brain, disorders of autonomic regulation, to identify the risk groups, as well as increase the effectiveness of assisted reproductive technologies based on appropriate changes in electroencephalogram.
Key words: women with infertility, electroencephalography, autonomic nervous system, reproductive health.
Zaporizhzhia State Medical University, Ukraine
Pathoplastic influence of social and hygienic factors on clinical presentation of disease in adolescents with mild mental retardation
44 - 47
Assuming a strong prevalence of mental retardation among all age groups, the analysis of the impact of social factors on formation of personality with intellectual decline is extremely relevant, especially in terms of improving the adaptation and rehabilitation of this group of people. Existing methods for assessing the clinical manifestations of mild mental retardation are often incongruent, as they study a purely medical aspect and, as a rule, do not take into account its psychological, spiritual, social and financial aspects. It is the atmosphere in the family, the proper organization and full functioning of interpersonal relationships are prerequisites for the development of cognitive functions of the child and the full formation of its emotional sphere. To study the influence of socio−hygienic factors on the clinical design of pathology in adolescents with mild mental retardation, 154 patients were examined. The study used as the main method "Map for clinical and epidemiological studies", which included socio−demographic and anamnestic information, the clinical part with a description of the existing symptoms and syndromes. The study found that the most significant factors are: age of onset, severity of psychopathological disorders, disease progression, intellectual development up to adulthood, presence of concomitant mental pathology, social environment and living conditions. It is noted that more than half of the subjects had in the clinical picture of mild mental retardation some manifestations of complications. Negative microsocial factors that most often affected adolescents with mild mental retardation complicated by additional mental disorders were: poor upbringing, large family, family conflicts, and low financial level.
Key words: mental retardation, social adaptation, psychoeducation, rehabilitation, psychiatry.
Kharkiv National Medical University, Ukraine
Hemostasis indices in transient ischemic attacks
48 - 52
Currently, the number of patients admitted to hospitals with a diagnosis of transient ischemic attacks is increasing, due to possible effective management of this group with early treatment. Problems of their diagnosis, prognosis and prevention are relevant because the importance of early examination and treatment of patients, which should be a signal for the primary prevention of vascular diseases of the brain. The study of hemorheological parameters allows to substantiate the approach to the pathogenetic treatment of cardioembolic and atherothrombotic ischemic attacks. For this purpose, endothelial dysfunction was studied in 142 patients. Comparative analysis of indices determines clinical and biochemical correlations to improve the detection and treatment of this pathology. Patients' blood was sampled 12 hours after the onset of neurological symptoms. The clinical diagnosis was set on the basis of clinical and paraclinical data using standard protocols of neurological examination, the results of neuroimaging methods. The main vasodilators and vasoconstrictors of blood plasma were studied. In patients with cardioembolic seizures, the hemocoagulation properties of blood were not prone to thrombosis, despite increased platelet aggregation. Other data of hemocoagulation and hemostasis remained without significant deviations from the norm, that indicated the primary causes of occlusion of vessels of extravasal nature and a mild form of the disease. In patients from the group of atherothrombotic ischemic attacks, these indices were much worse, due to severe course of the disease and slower regression of focal neurological symptoms. Such differences in the pathogenetic mechanisms of occlusion in cardioembolic and atherothrombotic ischemic attacks necessitate a differentiated approach to treatment.
Key words: hemostasis, cardioembolic transient ischemic attack, atherothrombotic transient ischemic attack, hemocoagulation, hemorheology.
Kharkiv Medical Academy of Postgraduate Education
Ukrainian Scientific and Research Institute of Prosthesis, Construction of an Artificial Limb and Restoration of Work Capacity, Kharkiv, Ukraine
Management of rehabilitation measures for patients with spinal cord injury (Part I)
53 - 59
Spinal cord and its injuries are the main problems in neurosurgery, traumatology and neurorehabilitation, that is associated with a big number of complications, concomitant spinal cord injuries, gross functional disorders, resulting in limited self−care and movement, loss of pelvic control and high levels of disability, social and psychological maladaptation of patients. Rehabilitation of patients with spinal cord injuries is relevant, that is associated with an increased frequency of this category of injuries and depends on the basic principles of this process, i.e. the stage and sequence of measures. According to the degree of loss of basic motor functions, there are four stages of motor rehabilitation, which are aimed to maximally compensate the disorders. After studying the motor system and assessing the degree of loss of support and movement functions, the task of each of the rehabilitation and measures stages to address them has been set. The tasks of the first stage were the preparation of functional systems of the body for training loads, physical therapeutic measures were involved. The task of the second stage was to restore the ability of standing and moving using the technical means. The third stage comprised assimilation of walking without devices, its correction, high−quality and quantitative improvement. The condition for this stage is the presence of moderate spastic hemiparesis and mild paraparesis, stable fixation of motor skills, systematic loading of the limbs in a vertical position, which contributes to the development of a spastic reflex of knee closure. The fourth stage is social and labor adaptation. The expediency of a comprehensive approach to the rehabilitation of this category of patients with the involvement of modern training and work equipment creates the preconditions not only for providing them with high−performance support products, but also for their social adaptation.
Key words: spine, spinal cord, rehabilitation, maladaptation, neurosurgery, traumatology.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Systematic review and meta−analysis of stroke−associated psychopathological disorders
60 - 62
Stroke remains a global health problem and the second leading cause of death, the main cause of adult disability worldwide. In the provision of medical care for such patients, the emphasis is usually done on the restoration of motor activity, which often pushes into the background disorders in the psycho−emotional and cognitive spheres. By the way, a stroke is the main cause of vascular cognitive dysfunction, that is one of the inhibitory factors in the regeneration of neurological deficits in patients. Many factors and pathophysiological processes play a significant role in the development of these disorders: from the localization and extent of brain injury to the imbalance of monoamine levels in the limbic structures of the central nervous system. To study psychopathological disorders in the patients suffered an ischemic stroke in the right hemisphere of the brain, a search was performed in databases: PubMed, The Cochrane Library, Google Scholar. With the calculation of relative statistical values, the medical records of inpatients and scientific publications on cerebral infarction and neuropsychological disorders, causes, features, manifestations and their impact on the rehabilitation of patients have been analyzed. It is noted that one−third to one−half of stroke patients had psychopathological symptoms. The most common psychoneurological disorders after an acute vascular catastrophe are anxiety−depressive, apathetic−abulic, senestopathic syndromes and the phenomenon of negligence. The redistribution of cases of acute cerebrovascular disorders depending on the type and location of brain damage has been established. Psychopathological syndromes that occur as a result of ischemic stroke in the right hemisphere of the brain: psychoorganic, depressive, asthenic, neurotic syndromes and vascular dementia have been noted.
Key words: psychopathological disorder, depression, apathy, neglect phenomenon, cenestopathy, stroke, examination, meta-analysis.
Republican Hospital of Medical Service of the Ministry of Internal Affairs of the Republic of Azerbaijan, Baku
Characteristics of risk factors for ischemic stroke in law enforcement officers
63 - 66
Law enforcement is associated with high levels of stress, contributing to an increased prevalence of cardiovascular disease among police officers. They often have traditional risk factors, including hypertension, hyperlipidemia, metabolic syndrome, smoking, and a sedentary lifestyle. In addition, the police officers experience sudden physical exertion, acute and chronic psychological stress, difficulty of night shifts and exposure to noise. To study the structure of subtypes of ischemic stroke and establish their relationship with risk factors for its development, 225 law enforcement officers were surveyed. The following subtypes of stroke have been identified: atherothrombotic pathogenetic, disorders of hemostasis and hemorheology (stroke on the background of coagulopathy). Accompanying and background diseases were dominated by hypertension, atherosclerosis of cerebral vessels and their combinations, atrial fibrillation, Diabetes mellitus. The severity of neurological symptoms among patients was quite similar, the exception was the patients with lacunar stroke − they differed from others with the NIHSS lower score, but in the dynamics these differences were smoothed. Functional activity on admission to the hospital was also higher in the subgroup with lacunar stroke compared with that between groups, and then by the 21st day the differences disappeared. Early detection of leading risk factors is the most important measure of ischemic stroke prevention. An integral part of prevention is a lifestyle change with an emphasis on regular physical activity, a diet low in salt and saturated fat, as well as high in fruits and vegetables, weight loss and smoking cessation and alcohol abuse. Adequate long−term secondary prevention is associated with a reduced risk of death and recurrent stroke, as well as improved outcomes under normal conditions.
Key words: ischemic stroke, brain vascular diseases, diagnosis, neurological aspects.
V. N. Karazin Kharkiv National University
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Immunohistochemical characteristics of skin of patients with androgenetic alopecia
67 - 71
Hair is an important part of appearance and social communication, its loss can significantly affect psychological trauma to patients. One of the main areas of research in trichology is the study of various aspects of androgenetic alopecia. The results of the original study on the assessment of immune histochemical parameters of patients with androgenetic alopecia were analyzed in detail. Based on a study of the published reports on the pathogenesis of androgenetic alopecia, indicating the signs of perifollicular inflammation, oxidative stress and fibrosis formation as the disease progresses, immune competent T−lymphocytes CD3 +, CD4 + and CD8 +, macrophages (VEGF polyG, CDF +) were investigated thoroughly. β1, EGFR, oxidative stress enzymes eNOS and iNOS, pathological fraction of Collagen IV. Owing to the data obtained, that the cascade of pathological reactions "oxidative stress − microinflammation − fibrosis" was confirmed to be found in patients with androgenetic alopecia, and it was suggested that these links of pathogenesis could potentially be a target for therapeutic effects. Data on the results of immune histochemical examination of scalp biopsies in patientsave been presented, a and the location of certain markers to be studied, and the methodology of the study have been described. According to the biopsy results, the characteristics of inflammatory perifollicular infiltrate (CD3 +, CD4 + and CD8 +, macrophages (CD68 +), accumulation of oxidative stress enzymes (eNOS and iNOS) and imbalance of growth polypeptides (VEGF, TGF−β1, EGFla) were described. Treatment of androgenetic alopecia was concluded to be likely supplemented taking into account the imbalance of immune histochemical parameters.
Key words: androgenetic alopecia, immunohistochemistry, cytokines, growth factors, oxidative stress enzymes.
V. N. Karazin Kharkiv National University, Ukraine
Study of cytokine profile dynamics in adult patients with chickenpox
72 - 75
In order to determine the nature of changes in immunological processes in adult patients with chickenpox, depending on the severity of the disease, 157 patients were examined. Immunological examination included quantification of concentrations of cytokines IL−1β, IL−4, IL−6, IL−10, IL−17, IL−23. Favorable course of chickenpox in the first week of the disease was found to be associated with a pronounced response of pro−inflammatory cytokines IL−1β and IL−6 with a decrease in the production of anti−inflammatory cytokines IL−4, IL−10. The severe course of this disease was characterized with low levels of production of these cytokines. In the second week of the disease, IL−10 was recorded in increased serum levels in all patients with moderate severity. However, in the group of patients with severe course, its level differed towards a decrease from the control values. No significant changes in the content of IL−4 were found. When analyzing the content of the mediator of autoimmune inflammation IL−17A, it was exceeded 8.5 times in patients in the first week relative to the control group (p < 0,01). In the second week of inpatient treatment, a moderate decrease in IL−17A activity was observed (p > 0,05). At hospitalization, an increase in the level of proinflammatory Th1−cytokine IL−23 relative to the control group by 2.5 times (p < 0,05) was found. Prior to a discharge from the infectious hospital, the content of IL−23 was slightly higher than that for healthy donors. It is concluded that in patients with chickenpox hyperproduction of proinflammatory serum cytokines (IL−1β, IL−6, IL17A, IL−23) indicates an early strong combined Th1−Th2−immune response with the presence of autoimmune and allergic inflammatory reactions. In these patients, anti−inflammatory reactions are limited (moderate activation of IL−4, IL−10) and indicate insufficient immune suppression of inflammatory processes.
Key words: chickenpox, cytokines, adult patients, laboratory diagnostics.
V. N. Karazin Kharkiv National University, Ukraine
General characteristics of Toll−like receptors and their participation in immune response
76 - 79
The innate immune response is the first step in protecting the body against pathogens. Cells of this response express various image recognition receptors, including Toll−like (TLR), which detect pathogen−associated molecular patterns and induce an inflammatory immune response. TLRs are involved into recognition of quite all pathogens, i.e. bacteria, viruses, fungi and protozoa. All TLRs are type 1 transmembrane proteins that contain leucine−rich repeats responsible for recognizing pathogen−associated molecular patterns and activating downlink signaling. The signaling cascade triggered by TLR type 9 depends on intracellular transport of the receptor and begins as soon as it and its ligand enter the endolysosomal system. Activation of this receptor, depending on the cell type, leads to the production of various mediators. The etiopathogenesis of most autoimmune diseases has not been fully studied, as their development may be facilitated by a large number of factors. A number of studies in TLR9−deficient mice prone to lupus have demonstrated a particular need for TLR9 to form the autoantibodies in vivo, indicating a critical role for innate immune activation in autoimmune processes. Previous studies of the involvement of TLR9 into signal transduction when pathogens enter the body have shown that activation of receptors occurs after their interaction with unmethylated CrG−DNA. However, recent studies have demonstrated an importance of these receptors in the case of RNA−containing viruses. Further in−depth study of the involvement of TLR in the body protection against both DNA and RNA−containing viruses will not only provide a better understanding of immune system damage, but also develop the methods and tools supporting and strengthening the immune response.
Key words: measles, Toll-like receptors, cytokines, interferon, autoimmune diseases.
Dnipro State Medical University, Ukraine
Prediction of development of the central nervous system HIV−associated infectious diseases assuming variations of HLA−DRB1 alleles
80 - 83
Most people living with HIV develop central nervous system diseases as immunosuppression progresses, often leading to disability and death. Studies show that HLA−DRB1 plays a role in the progression of HIV infection and development of opportunistic infections of the central nervous system. The most important components of the management of HIV−associated lesions of the nervous system are the analysis of risk factors for their development and timely adequate treatment. To develop an algorithm for predicting the development of HIV−associated infectious diseases of the central nervous system, a study was performed with the participation of 70 patients having stage 4 HIV infection. The algorithm was created on the basis of determining the prognostic value of variations of HLA DRB1 alleles, the duration of the period from HIV detection to the development of stage 4 and the initial level of CD4−T lymphocytes in blood plasma. A feature of HIV−associated diseases of the central nervous system was the presence in the patients of homozygous allelic variants DRB1 * 01 and DRB1 * 16. According to ROC−analysis, the best operational characteristics were: the initial level of CD4−T lymphocytes in blood plasma below 80 cells / μl; the duration of the period from the detection of HIV infection to the development of stage 4 HIV is less than 1 year. According to the logistic regression indices, the limit values of the total score ( s) were calculated to classify the degree of risk of neurological diseases (RND) associated with HIV infection: if es < 2, the risk is low (probability p ≤ 0.26); if +2 ≤ s ≤ +3 the risk is moderate k (p < 0,50); if +4 ≤ 5s ≤ +9 the risk is high (p 0,50−0,89); if 8s ≥ 10 the risk is very high (p ≥ 0.90). The developed algorithm makes it possible to predict a high risk of HIV−associated diseases of the central nervous system with a prognostic 78,6 % accuracy, 64,5 % sensitivity, and 89,7 % specificity.
Key words: HIV infection, HIV-associated infectious lesions of the central nervous system, prognosis, HLA DRB alleles, CD4-T lymphocytes.
Kharkiv National Medical University, Ukraine
Medical and epidemiological characteristics of the circulatory system diseases, cerebrovascular diseases and strokes in Ukraine and Kharkiv region
84 - 88
When studying the medical and epidemiological characteristics of diseases of the circulatory system, cerebrovascular diseases and strokes in Ukraine in general and Kharkiv region in particular, basic trends to reduce their prevalence and primary morbidity were identified. Nthe number of patients with circulatory system and cerebrovascular diseases, as well as strokes decreased, meanwhile with significant trends (+83,9 %) the primary incidence of strokes increased within the period of 2010−2017. An increase in the prevalence of diseases of the circulatory system in the regions: Zhytomyr (+ 18,3 %), Chernihiv (+ 7,8 %), Khmelnytsky (+ 7,4 %), etc .; cerebrovascular diseases: in Zhytomyr (+149.8 %), Khmelnytsky (+11,5 %), Ternopil (+ 5,6 %), etc.; strokes: Chernivtsi (+69,4 %), Kharkiv (+62,5 %), Sumy (+43,6 %) etc. The same applies to the primary incidence of these pathologies: in Zhytomyr (+22,4 %), Mykolayiv (+5,1 %), Ternopil (+3,6 %) etc. for diseases of the circulatory system; in Zhytomyr (+98,1 %), Zakarpattia (+19,4 %) and Dnipropetrovsk (+9,7 %) for cerebrovascular diseases; in Kharkiv (+249,2 %), Chernivtsi (+235,8 %), Sumy (+188,2 %) etc. for strokes. The decrease in the prevalence and primary incidence of circulatory system diseases (−1,1 % and −7,2 %, respectively) and cerebrovascular diseases (−2,7 % and 18,5 %) within 2018−2019 was found in Kharkiv region, with tendencies to increased prevalence of strokes (+4,6 %) with the largest trends in Lyubotyn (+84,6 %) and Zolochiv (+46,7 %), Shevchenkivsky (+41,9 %) and Bohodukhiv (+37,3 %) areas. In 2010−2017, there was a rise in mortality rates in most regions of Ukraine due to diseases of the circulatory system and cerebrovascular diseases, and a significant increase in primary disability among the adult population.
Key words: diseases of the circulatory system, cerebrovascular diseases, strokes, prevalence, primary morbidity, primary disability, trend, mortality.
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