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GENETICALLY MODIFIED PLANTS AND HUMAN HEALTH

Аuthors: A. G. Dyachenko, A. O. Zagrebelna

Pages: 1–11

Abstract

         

Genetically modified (GM) plants attracted in recent years much public attention. Although consumers remain largely unaware of what GM crops really are, what the advantages and disadvantages of existing technologies are, and in what areas of economy these technologies and their products can be used, the company overall adjusted negatively in relation to the prospects for their use as food. The spread of GMO-phobia is demonstrated by at least the presence of the label "GMO" on almost all commercial products, including mineral water and salt. Moreover this marking occurs on non-food items, such as kitchen utensils and even (!) the bags of cement, which once again testifies to a woefully low level of awareness about the subject. Moreover, parliaments of several countries, such as Russia, have introduced laws prohibiting the cultivation of GM plants and animals and the importation of them from abroad. At the same time a priori denial of the possible problems associated with the use of GM crops would also be wrong. Actually with the advent of the first generation of such crops two major concerns have emerged: the risk to the environment and risk to human health. Since the introduction of the GM-lines of plants and animals will steadily increase, we can predict a corresponding increase in public concern about potential risks. So, we tried to analyze scientific evidence about the possible impact of GM plants on human health both directly – through their participation in the human diet and farm animals and in the production of recombinant medicines, and indirectly, through the impact on the environment.

Indeed, for the discrimination of GM products being transformed with the gene of interest selective marker genes are often used (e.g., kanamycin, which kills normal cells non-GM plants). According to opponents, this increases the risk of antibiotic resistance (ABR) spreading in the bacterial population. But it is well known that the ABR genes were originally isolated from soil bacteria which are widely distributed in nature. Studies have shown that the probability of ABR transmission from plants to bacteria is extremely low. Getting selectable markers that do not use resistance to AB, as well as procedures that remove the marker from the plant genomes at the end of transformation, almost completely takes off fears this kind.

The second problem related to GM technology was the transfer to the plant genomes of the unnecessary, redundant DNA and it was also successfully solved. A minimal gene cassette was developed, which houses a well-defined DNA fragment.The third problem relates to the possible increase of the level of natural mutations result in lowering the stability of the genome, which can cause certain undesirable effects. Generally, in the process of tissue culture may appear in the so-called somoclonal variations and possible rearrangement of the endogenous DNA around the integrated transgene. In practice, however, these effects are not registered. It should be emphasized that the appearance of GM crops on the market is preceded by a variety of large-scale tests.

Keywords: transgenic food, genetically modified organisms, GMO.

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THE JUSTIFICATION OF THE USE OF SYNBIOTICS IN MEDICAL PRACTICE

Аuthors: O. Fediv, V. Bagriy, L. Kushnir, V. Vivsyanyk, I. Sitsinska

Pages: 12–26

Abstract

         

Introduction. Based on modern concepts, intestine dysbiosis (microecological disorders of the gastrointestinal tract (GIT)) is regarded as clinical and laboratory syndrome that occurs in a number of diseases and is characterized by a change of qualitative and/or quantitative composition of the flora of a particular habitat and translocation of its representatives in their unusual habitats, metabolic and immune disorders, accompanied in some patients by clinical symptoms. Colon microbiota has a distinct individual character and differs both on species, and on strain levels. Main microflora of the colon includes anaerobic bacteria genus Bacteroides (Gram-negative bacteria belonging to about 20 families) and Firmicutes (Gram-positive bacteria belonging to more than 200 families). Aerobic bacterias are E. coli, lactobacilli, enterococci, etc., relating to the accompanying microflora.

Microbiota violation causes many diseases, the list of which is growing. This list includes necrotizing enterocolitis in children, irritable bowel syndrome (IBS), antibiotic-associated diarrhea (AAD), inflammatory bowel disease (IBD), Crohn's disease (CD), chronic constipation, liver diseases, allergies, obesity, diabetes mellitus, metabolic syndrome, and others.

The greatest risk of adverse effects of antibiotics is proved for penicillin group (5–10 %), the combination of amoxicillin and clavulanic acid (10–25 %), third-generation cephalosporins and clindamycin (15–20 %).

One of the best combinations of pre- and probiotics, in our opinion, is a synbiotic "Lakten." It has the features of both the quantitative and qualitative levels. It consists of inulin, maltodextrin, magnesium stearate and ascorbic acid. Probiotic part of the "Lakten" are 8,000,000,000 Lactobacilli. Each of these components has a specific effect on intestinal microbiota and the entire body.

Purpose. Considering the quality of raw materials, availability of effective prebiotics, high dose of Lactobacillus, synbiotic compliance (1 capsule per day), possibility of the use from the first day of antibiotic therapy, "Lakten" can be recommended for use in patients with intestine microbiota violations and requires further deep study of its properties.

Keywords: Lakten, рrebiotics, probiotics, microbiocenosis, eubiosis, intestine, inulin, maltodextrin, lactobacilli.

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CYTOKINE MECHANISMS OF IMMUNOLOGICAL DISORDERS IN CHILDREN OF BUKOVINA WITH DEAFNESS DEPENDING ON POLYMORPHISMS OF CONNEXIN-26 CJB2 (RS80338939) AND INTERLEUKIN-4 (RS2243250) GENES

Аuthors: O. M. Iftoda, L. P. Sydorchuk

Pages: 27–35

Abstract

Introduction. 360 million people worldwide have disabling hearing loss. Hearing loss may result from genetic causes, complications at birth, certain infectious diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise and ageing. About 100 genes in the human body responsible for the hearing organ formation and function. Over 50 % of autosomal recessive forms of hearing loss associated with mutations in the gene connexin-26 CJB2 (gap junction protein, beta 2), localized in 13q11-q12. However, at present there are no recommendations on the use of molecular genetic tests in the early diagnosis of deafness. Debatable issues nowadays are the genetic factors impact on the type and degree of hearing loss, immune response changes, etc.

Purpose. To evaluate some immunological mechanisms of sensorineural (SNHL) and conductive hearing loss (CHL) development in children after pro- and antiinflammatory cytokine levels depending on genes polymorphism of connexin-26 (CJB2, c.35delG) (rs80338939) and interleukin-4 (IL-4, C-590T) (rs 2243250).

Materials and Methods. 102 screened children (8-18 years): 68 (66.7 %) children with SNHL, 34 (33.3 %) with CHL. The control group consisted of 30 healthy individuals. Levels of cytokines: tumor necrosis factor alpha (TNF-α), IL-1β, IL-4, IL-10 and IL-13 in plasma were determined by ELISA. Study of gene polymorphisms of IL-4 (C-590T) and CJB2 (c.35delG) performed by polymerase chain reaction. Statistical processing was performed with Statistica® 7.0 software. The differences were considered significant at p < 0.05.

Results. SNHL and CHL course in children is associated with a decreased concentration of IL-1β in the peripheral venous blood plasma by 36.06 % and 29.53 %, increased of IL-4 1.69 (р < 0.05) and 2.68 times (р = 0.013) and different changes of TNFα content (increases in CHL children, reduces in SNHL cases), IL-10 and IL-13 (contrary, it increases in SNHL children and decreases in CHL subjects).

The imbalance of the immune response in children with SNHL characterized by inhibition of cellular immunity and activation of humoral answer caused by low TNF-α and IL-1β content in CT-, TT-genotype carriers of IL-4 gene – 2.42 (p = 0.032) and 2.02 times (p = 0.042) with the antiinflammatory IL-4 and IL-10 cytokines hyperproduction 4.4-16.45 times (p ≤ 0.005). CHL TT genotype carriers of IL-4 gene followed by increased TNF-α 1.69 times (p = 0.033) and IL-4 35.71 times (p < 0.001), low levels of IL-10 3.11-4.44 times (p ≤ 0.01) and IL-13 – 1.66-2.72 times (p ≤ 0.026) respectively. But, in the mutational 35delG-carriers of the CJB2 gene the CHL course is associated with reduced TNFα, IL-1β, IL-4, IL-10 production with preserved IL-13 synthesis. It proved the cellular and humoral immune response reduced activity and an increased risk of allergic reactions.

Conclusion: SNHL in the T-allele carriers' children characterized by decreased activity of antiinfectious nonspecific immune defense factors. CHL course associated with cell immune response activation (mainly) and humoral part (less) as well.

 Keywords: sensorineural, conductive deafness, children, cytokines, genes CJB2, IL-4.

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      THE PRINCIPLES OF IMMUNNOGEMATOLOGICAL DIAGNOSTICS AND RISK ASSESSMENT OF AUTOІMUNNE HEMOLYSIS

      Аuthors: G. Myronenko, R. Pavliuk

      Pages: 36–45

      Abstract

               

      Introduction. The presence of antierythrocyte antibodies is one of the key elements in the diagnosis of autoimmune hemolytic anemia (AIHA). 80 % of AIHA are secondary (symptomatic) processes and they are a manifestation of underlying diseases (neoplasms, іnfections, lymphoproliferative disorders, autoimmune disorders, viral infections, immune deficiency states, medications and toxic effects). At the same time the traditional tests for the detection of antibodies (conglutination reaction with the adding of gelatin and Coombs test with polyspecific antiglobulin reagent) do not reveal the full range of antibodies which does not allow to form а sufficient clinician idea of the autoimmune nature of the hemolytic process and determine its activity for the prediction and optimization of patient’s treatment. This is a basic element of AIHA diagnostics detection of antierythrocyte antibodies. Due to current achievements in immunohaematology it is a necessary additional examination of patients.

      Purpose. The purpose of current research study was to demonstrate the diagnostic and prognostic value range of modern immunohematological tests to evaluate autoimmune hemolytic processes.

      Materials and methods. During current research 67 patients with acquired hemolytic anemia with positive tests serum for erythrocyte autoantibodies and varying degrees of severity of clinical and laboratory signs of hemolytic process were examined. The hemolysis in 1/3 patients had the secondary (symptomatic) origin – as a complication of malignant diseases of the blood, pernicious anemia, systemic connective tissue diseases, infections, uncontrolled unauthorized medication, toxic effects. We used the gel test for identification of erythrocytic antibodies, classes, subclasses and determining their density on erythrocytes as well as bringing the complement system (BioRad, USA). The statistical analysis using the statistical software package StatSoft STATISTICA 10.0.1011(USA) was performed in the research.

      Results and Discussion. The results of the immunohaematological study shows a serologic range of autoantibodies: warm-active agglutinins – 52,2 %, cold-active agglutinins – 25,4 %, mixed cold- and warm-active antibodies – 7,5 %, hemolysins – 14,9 %. High-density warm agglutinins IgG1/IgG3 on the surface of red blood cells were accompanied by the maximum activity of the immune destruction and caused a significant impact on the progression of anemia – in terms of hemoglobin (p < 0,05) and the number of red blood cells (p < 0,01). Wide thermal amplitude of cold agglutinins (4–32 °C) was more important for the progression of hemolysis than their high titer. The combination of warm agglutinins IgG, IgA, IgM appeared to combine with a poor prognosis for the course of hemolytic process.

      Conclusions. Coombs test is only a primary link in the diagnosis of AIHA. Consequently, further serological blood testing for the detection of all variants antibodies for the purpose of future diagnosis is needed. It is necessary to determine the density of antibodies on the surface of red blood cells in the case of warm IgG-antibodies and intensity of Coombs test reaction (3+/4+) and to examine the thermal amplitude and titer in case of identification of cold agglutinins.

      Keywords: аutoimmune hemolysis, agglutinins, hemolysins, the density of antibodies.

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      METHOD OF DIAGNOSIS OF CIRCADIAN RHYTHM DISORDER

      Аuthors: S. Pavlovskyi

      Pages: 46–50

      Abstract

               

      Sleeping is one of the most important physiological processes, ensuring normal functioning of the human body. The proof of the fact that one of the main etiological factors of any somatic pathology is a violation of individual circadian rhythm of the body, facilitates not only treatment, but also prevention of complications and recurrence as of the diseases that are most concerned about the patient and comorbidity which he can ignore, but it may significantly affect his quality of life.

      The article presents the screening method of detecting disorders of circadian rhythm, which is a survey of the patient and, after processing the results, identifying risk circadian rhythm disorder and determine the impact of this disease on the functioning of the body. Because of easiest way to determine the disorder of circadian rhythm based on answers to questions that concern the patient in the course of questioning, it was decided to focus on this method. During the test we analyzed 44 outpatient individuals that were registered by a family doctor at the Municipal Non-profit Enterprise «Consultative and Diagnostic Centre №2» of Solomyansky district, Kyiv.

      Based on the results, we described a method for determining the circadian rhythm disorder in outpatient settings. There is an example of the practical application of the method. The proposed method allows to implement questionnaires in daily activities of ambulatory care units and use this method by the neurologists, internists, general practitioners of family medicine, psychologists.

      Keywords: circadian rhythm, sleeping, screening methods of diagnosis.

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      CHANGES IN HORMONAL CONTROL IN PATIENTS WITH DEMODICOSIS AS A RESPONSE TO PARASITIC INFESTATION

      Аuthors: Zh. A. Revenko, E. Ts. Yasynska

      Pages: 51–55

      Abstract

               

      The paper establishes patterns of changes in clinical and hormonal parameters which deepen our knowledge on the pathogenesis of demodicosis and create certain preconditions for the directed correction of compensatory-adaptive possibilities of the host organism and open prospects for improving pathogenetic treatment of demodicosis and its complications.

      Keywords: demodicosis, sex, gonadotropins hormones, changes in hormonal control, parasitic infestation.

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      CHOLESTATIC SYNDROME ACTIVITY IN PATIENTS WITH ACUTE EDEMATOUS PANCREATITIS AND GENES IL-4 (C 590T), TNF-α (G-308A), PRSS1 (R122H) AND CFTR (DELF508C) POLIMORPHISM

      Аuthors: S. I. Ivashchuk, L. P. Sydorchuk

      Pages: 56–64

      Abstract

               

      In spite of studying acute and exacerbated chronic pancreatitis candidate genes polymorphism as a multifactorial pathology with involving genetic factors the role of the immune system especially polymorphism of genes that regulate the inflammatory response in the pathogenesis of pancreatitis is left out of attention. The aim of the research was to study some biochemical parameters of cholestasis syndrome in patients with acute edematous pancreatitis, depending on the polymorphism of genes of interleukin 4 (IL-4, (C-590T), TNF-α (G-308A), PRSS1 (R122H) and CFTR (delF508C), etiologic factor and gender.

      Genetic studies have been performed for 101 patients, among who 19 (18.8 %) were women and 82 (81.2 %) were men. There were 64 (63.37 %) patients with alcoholic pancreatitis genesis (AGP) and 37 (36.63 %) – with biliary (BGP). The genotypes distribution among examined patients and healthy people for the selected genes has been determined. The possible associative links of indicated genes polymorphism with the increased activity of gamma-glutamyl transferase, alkaline phosphatase, bilirubin and its fractions levels, the etiology of pancreatitis (alcoholic or biliary) and gender have been searched for.

      The study showed: gene PRSS1 (R122H) – GG-genotype was found in all groups (100 %); gene CFTR (delF508) – NM-genotype in 3 persons (2.97 %), NN-genotype – in 98 (97.03 %), in the group of healthy people only carrier state NN-genotype occurred; gene TNF-α (G-308A) – GG-genotype was identified in 81.19 %, GA-genotype – in 18.81 %; gene IL-4 (C-590T) – among the sick CC-genotype had 58 patients (57.43 %), CT genotype – 34 (33.66 %) patients, mutation TT-genotype  9 (8.91 %) patients, among the healthy – 26 (65 %), 11 (27.5 %) and 3 (7.5 %), respectively (χ2  < 1.0, p > 0.05). Afterwards, this study has not established the association of polymorphism of genes PRSS1 (R122H), CFTR (delF508) and TNF-α (G-308A) with the increased activity of cholestatic syndrome, pancreatitis etiology and gender. At the same time, the activity of cholestasis syndrome was higher, mainly in the carriers of the TT-genotype of IL-4 gene (rs 2243250) and was characterized by the growth of the content of gamma-glutamyl transferase 1.9 and 1.58 times (with biliary genesis) and 2.06 and 1.53 times (among women), total bilirubin – 1.85 and 2.13 times (with alcoholic genesis) and 1.66 and 1.87 times (among men), of direct bilirubin –2.81 and 3.22 times (with alcoholic genesis) and 2.47 and 2.96 times (among men) compared to the C-allele carriers, respectively.

      Keywords: gene, polymorphism, pancreatitis, cholestasis, alcoholic, biliary.

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      STEROID METABOLISM IN PATIENTS WITH GASTRODUODENAL BLEEDING ULCERS

      Аuthors: I. D. Duzhiy, V. O. Bratushka,I. M. Medvedeva, I. M. Lokhonya, S. V. Kharchenko

      Pages: 65–72

      Abstract

               

      Background. There are controversies in protective mucosal or other roles of oestrogens on the gastrointestinal tract in the literature. This underlines the scientific topicality.

      The aim was to study blood values of the circulatory oestrogen and gonadotropins (luteinizing hormone, follicle-stimulating hormone) in patients with gastroduodenal bleeding ulcers considering their recurrence course.

      Materials and Methods. A total of 63 patients with bleeding ulcers and 48 healthy persons were studied by the immunoenzyme method for hormones.

      Results. Patients with bleeding ulcers (28 %) had a peripheral dysoestrogenaemia with significantly lower circulatory oestrogen value (р < 0.05) than in healthy persons (4 %). Recurrent course appeared 3.8-fold frequent in patients with hypoestrogenaemia than in patients with normal value (р < 0.05). No changes in plasma gonadotropin values of patients with bleeding ulcers were detected.

      Conclusions. The lowering of circulatory plasma oestrogen in patients with bleeding ulcers presents a sign of severity. Studies of treatment with oestrogen for gastro-intestinal bleedings are required. Further hormonal research of all metabolic steroid pathways remains topical.

      Keywords: bleeding, hormones, oestrogen, ulcer disease.

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      30. Barclay L, Vega CP. Proton Pump Inhibitors but Not H2RAs Linked to Fracture Risk. Medscape Education Clinical Briefs. CME/CE Released: 05/20/2011. Retrieved from: http://www.medscape.org/viewarticle/743092
      31. Thanoon I, Mahmood A. Effect of omeprazole on reproductive hormonal levels and sexual function in male patients with peptic ulcer disease. Q.M.J. 2011;7(12) :190-198. Retrieved from: http://www.iasj.net/iasj?func=fulltext&aId=36805

      PREDICTION OF INHIBITORS IN HAEMOPHILIA PATIENTS BY LOGISTIC REGRESSION

      Аuthors: AV. Stasyshyn

      Pages: 73–80

      Abstract

               

      Replacement therapy in hemophilia patients is complicated by the formation of inhibitory antibodies against factor VIII (IX) (inhibitors) among 30 % of hemophilia A patients and 35 % of hemophilia B patients. The treatment of bleeding and elimination of inhibitors is complicated, costly and not always successful. The goal of this study is to develop a simple score that stratifies patients with hemophilia according to their risk of developing inhibitory antibodies.

      Data and methods. The data consists of 135 patients with hemophilia A and B divided into two groups: Group I patients with stable inhibitor (74 persons) and group II patients without inhibitor (61 people). We analyzed 16 factors affecting the tendency to develop inhibitor: type of hemophilia (A or B), severity, age, age at diagnosis, hereditary or sporadic, family history of inhibitors, intensive treatment at initial treatment (ED/1 episode), age at first exposure to FVIII/IX, reason for first treatment with FVIII, FVIII/IX product type, prophylaxis or “on demand” treatment, clotting factor concentrate switching, significant and life-threatening bleeding localization; surgery (classified according to two features): I – the urgency (urgent and selective); II the type (large and small), and the presence of purulent complications. To examine the relationship between risk factors and the likelihood of inhibitor development, we used regression models of discrete choice. Specifically, we estimate the range of one factor binomial choice models to study the individual effects of each factor on the probability of inhibitor development. In addition, we analyze the joint impact of risk factors using multiple logit regression that allows exploring the effects and importance of each factor, controlling for the presence of other factors. Adequacy of logit models was conducted using chi-square test, and the significance of regression coefficients was based on Student Wald statistics. Finally, we calculated the theoretical values of probability of an inhibitor development for each patient and ranges (95 % confidence interval) of predicted risk of inhibitor development in patients with the value of the dependent variable “yes” and “no”.

      Results.All factors except age are categorical variables and are included in the regression as dummy variables. Estimated coefficients represent the marginal effects of each factor on the probability of inhibitor development. To build a multivatiate logit model we used stewise forward regression with 1 %, 5 % and 10 % significance levels. The first model includes the following factors: age clotting factor concentrate switching, FVIII/IX product type purulent complications and the number of days of exposure (ED)/1 episode of bleeding. At 5 % significance level, the type of surgery (large and small) as well as positive "inhibitory" history are added. At the 10 % significance level, the model additionally contains a variable characterizing the urgency of surgery (urgent or planned). In this approach, the factors that determine the type of hemophilia, age, diagnosis and life-threatening bleeding are not significant and therefore, we do not include them in the final multivariate regression. The number ED/1 episode has the highest impact on the probability of inhibitor development: if it increases, the likelihood of inhibitor development increases by 27 %. For patients who changed the type of concentrates, the likelihood of inhibitor development increases by 23 %. The effect of the FVIII/IX product type, the age and the type of the surgery - is negative and significant, while purulent complications and burdened "inhibitory" history result in the increase in the likelihood of inhibitor development by 21 % and 12 %, respectively. This multivariate logit model allows predicting the likelihood of developing an inhibitor for a patient based on the information about the values of each of these factors.

      Conclusion: The prediction based on the multiple logit regression developed in this paper allows the identification of patients at high risk of inhibitor development. According to our model, the factors associated with treatment have the highest impact on the probability of inhibitor development. Based on the results, reducing the frequency of inhibitor development can be achieved by changing the approaches to the treatment of patients with hemophilia.

      Keywords: hemophilia, inhibitor, risk factors, prognosis, logit regression.

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      References

      1. Astermark J, Santagostino E, Keith Hoots W. Clinical issues in inhibitors. Haemophilia. 2010;16:54–60.
      2. Astermark J, Altisent C, Batorova A, Diniz MJ, Gringeri A, Holme PA, Karafoulidou A, Lopez-Fernandez MF, Reipert BM, Rocino A, Schiavoni M, von Depka M, Windyga J, Fijnvandraat K. Non-genetic risk factors and the development of inhibitors in haemophilia: a comprehensive review and consensus report. Haemophilia. 2010;16:747–766.
      3. Eckhardt CL, van der Bom JG, van der Naald M, Peters M, Kamphuisen PW, Fijnvandraat K. Surgery and inhibitor development in hemophilia A: a systematic review. J Thromb Haemost. 2011;9:1948–1958.
      4. Gouw SC, van der Bom JG, van den Berg MH. Treatment-related risk factors of inhibitor development in previously untreated patients with hemophilia A: the CANAL cohort study. Blood. 2007;109:4648– 4654.
      5. Gouw SC, van den Berg HM. The multifactorial etiology of inhibitor development in hemophilia: genetics and environment. Semin Thromb Hemost. 2009;35:723–734.
      6. Gouw SC, van der Bom JG, Ljung R, PedNet and RODIN Study Group. Factor FVIII products and inhibitor development in severe hemophilia A. N Engl J Med. 2013;368:231–239.
      7. Hashemi SM, Fischer K, Moons KGM, Van den Berg HM. On behalf of the PedNet Study Group. Improved prediction of inhibitor development in previously untreated patients with severe haemophilia A. Haemophilia. 2015; 21:227–233.
      8. Iorio A, Puccetti P, Makris M. Clotting factor concentrate switching and inhibitor development in hemophilia A. Blood. 2012;120:720–727.
      9. Mariani G, Kroner B. Immune tolerance in hemophilia with factor VIII inhibitors: predictors of success. Haematologica. 2001;86:1186–1193.
      10. Pratt KP. Inhibitory antibodies in hemophilia A. Curr Opin Hematol. 2012;19:399–405.
      11. Ter Avest PC, Fischer K, Mancuso ME, Santagostino E, Yuste VJ, van den Berg HM, van der Bom JG, on behalf of the CANAL Study Group. Risk stratification for inhibitor development at first treatment for severe hemophilia A: a tool for clinical practice. J Thromb Haemost 2008;6: 2048–54.

      PREDICTORS OF OUTCOME OF HEARING LOSS IN FIRST-YEAR CHILDREN

      Аuthors: Yu. V. Sorokolat

      Pages: 81–88

      Abstract

               

      Improvement of modern methods of nursing has increased the survival of premature infants, which resulted in an increasing of the proportion of illnesses specific to children who were born before term. Hearing loss occupies a prominent place among perinatal pathologies. The purpose of the study was to find out the factors determining the age dynamics and outcomes of hearing loss in children under 1 year to establish their diagnostic and prognostic role for the further development of promising proposals for the improvement of their medical and social support in the city.

      Materials and methods. The results of observations of 503 children with hearing loss have been analyzed. Data of ENT examination and the results of audiological examination by evoked otoacoustic emission have been used as a criterion of the course type and outcomes of hearing loss. The dynamics of the disease was evaluated in 2-3 months, 6 months and one year of life.

      Results and discussion. Significant predictors of outcome data of hearing loss are impaired obstetric history, gestational maturity, the condition of a newborn according to Apgar score, duration of mechanical ventilation and oxygen therapy, the use of surfactant in the treatment, the patient’s gender. The detailed information about the severity of respiratory distress syndrome and bronchopulmonary dysplasia, surgical closure of an open ductus arteriosus have high prognostic information value. Central nervous system comorbidities also generate the outcomes of hearing loss in newborns.

      Conclusion. Predictors of outcomes of hearing loss make it possible to create an age-specific scenario of outcomes of hearing loss in children of one year. The results of this study will help to improve a system of follow-up observation of this group of patients.

      Keywords: children, hearing loss, deafness outcome factors.

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      References

      1. Znamenskaya TK. [The main problems and directions of development of neonatology at the present stage of development of health care in Ukraine]. Neonatology, Surgery and Perinatal Medicine. 2011; 1(1):5–9.
      2. Sorokolat YuV, Klimenko TM, Golubova MА, Korovaj SM. 2012. [On the question of effective models of perinatal centers]. Neonatology, Surgery and Perinatal Medicine. 2012; 3: 5–7.
      3. Sorokolat YuV, Klimenko TM, Melnichuk OP. [The results of the hearing screening in newborns with perinatal pathology]. J. Pediatrics, Obstetrics and Gynecology. 2012; 4: 16–18.
      4. Bolat H, Bebitoglu F, Ozbas S. Newborn Hearing Screening Program in Turkey: Struggles and implementations between 2004 and 2008. International Journal of Pediatric Otorhinolaryngology. 2009; 73 (2): 1621–1623.
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      6. Yu J, Kam Y, Wong C. The Outcome of a Combined Otoacoustic Emissions and Automated Auditory Brainstem Response Screening Protocol. J. Paediatr. (New Series). 2010;15(1): 2–11.
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      8. Sorokolat YuV. [Experience and direction of development of comprehensive assistance to families with children up to 3 years with impaired health ]. Neonatology, Surgery and Perinatal Medicine. 2013; 4(10): 19–23.
      9. Zosimov АM , Golik VP. Disertatsіjnі pomilki: Monografіya. [Doctoral error: Monograph]. KHarkіv: ІNZHEK Publ., 2009. 264 p.
      10. Gubler EV. Vychislitel'nye metody analiza i raspoznavaniya patologicheskikh protsessov [Computational methods of analysis and detection of pathological processes]. L.: Meditsina. Leningradskoe otdelenie Publ., 1978. 294 p.

      THE ROLE OF PHYSIOTHERAPY IN THE TREATMENT OF MOTOR DISORDERS IN PATIENTS WITH GLIOBLASTOMA

      Аuthors: A. P. Khoroshun

      Pages: 89–94

      Abstract

               

      Introduction. The rehabilitation of neurooncological patients is a very important medico-social problem. A topical question of neurooncology is postoperative recovery treatment of patients with cerebral gliomas, who have neurological motor deficit.

      Purpose.Determine the effectiveness of physiotherapy methods in complex postoperative treatment of patients with glioblastoma clinical signs of movement disorders.

      Materials and methods. We made analysis of surgical treatment of 136 patients with glioblastomas. Patients received rehabilitation treatment, directed at the removal of motive disorders. Treatment course includes physiotherapeutic methods (electro-miostimulation, laser therapy), massage, medical gymnastic. The method of treatment of motional defects which includes the use of laser therapy on biologically active points with the subsequent electrostimulation of paretic extremities ("The way of recovery therapy of patients with motional cerebral defects") is developed and introduced in a clinical practice. The efficiency of the conducted treatment is proved by the study of indexes of quality of life in the dynamics of treatment. Laser therapy wascarriedoutusinglowintensiveradiationwithawave-length 870 nm, exposedtotherayscorporal points. Recipes of points were made according to the clinical indications of motional defects. The course of treatment consisted of 7–12 sessions, with duration of 10–12 minutes. ). Also, in recovering treatment the psychological approach is necessary that takes into account the various sides of patient’s social life and gives a possibility to individualize the treatment and furthers psychological adaptation after operation and raises the quality of life. The optimization of physiotherapeutic methods is to account for the patient general condition, rate of tumor malignization, characters of functional disturbances, accompanied diseases etc. The results of treatment were estimated according to the scale of quality of life.

      Results and discussion. All the patients had early renewal of the broken functions: multiplying the volume of active motions, improvement of walking and degree of domain domestic skills, positive psychotherapy effect.

      Conclusion. The use of physiotherapeutic methods in early postoperational period gives a possibility to individualize the recovery treatment, raises comfort of the procedures, provides essential positive psychotherapy effect.

      Keywords: glioblastoma, recovery treatment, laser therapy.

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      1. Gil-Robles S, Duffau H. Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures. Neurosurg Focus. 2010;2(28):8.
      2. Ford E, Cat lS, Chalmers A. Systematic review of supportive care needs in patients with primary malignant brain tumors J.Neuro Oncol. 2013;14:392–404.
      3. Rozumenro VD. [Neurooncology: modern state of the problem]. Oncology. 2006;8(2):188–191.
      4. Rozumenko VD, Khoroshun AP. [Brain gliomas: postoperatively recovery treatment and qualite of life in patients]. Ukr. nevrolog. J. 2014; 2 (31):26–31.
      5. Belova AN, Neuroreabilitachia [Neurorehabilitation]. Mockva: Antudor Publ., 2002. 736 p.
      6. Semennikova CV., Maslenikov TN., Sokolova EV. [Early rehabilitation of patients after surgical treatment in neurooncology]. Materialy megdynarodnoi naukovo-praktychnoi konferencii po neuroreabilitacii v neurochirurgii [Proceeding of scientific and practical conference: for Neurorehabilitation in neurosurgery]. Kazan, 2012, pp. 219–221. (In Russian).
      7. Khoroshun AP. [Postoperative rehabilitation and quality of life in patients with brain gliomas]. 36 nauk. Prakt. spivrobitnukiv NMAPO im. PL. Chypika. 2013;22(1):238–243.
      8. Rozumenko VD, Khoroshun AP. Lazernaya terapia v obchey oncologii u neurooncologii [Laser therapy in oncology and neurooncology]. Cherkassu: Vertikal Publ., 2011. 363–380 pp.
      9. Grusuna TN, Reabilitacia v oncologii: phyziotherapia [Rehabilitation in oncology: phythiotherapy]. Mockva: Geotar Publ., 2006. 240 p.
      10. Rozumenko VD., Khoroshun AP., Khomenko OV, inventors. Sposib vidnovnoi terapii chvoruch z ruchovumu serebralnumu defectamu [The way of recovery therapy of patients with motional cerebral defects]. Ukrainian patent, no. 20041210345, 2006.
      11. Karnofsky D. A. The use of the nitrogеn mustards in the palliative treatment of carcinoma. Cancer. 1948;1:634–656.
      12. Ovsyznnikov VA. [Energy model of carcinogenesis]. Voprosu Onkologii. 2005;51(1):34–40.
      13. Kochetkov VA., Gorbunov EF., Minenkov AA. [Optimization program of early rehabilitation of patients with cerebral stroke: the use of magnetic and laser techniques]. Voprosu kurortologii, phyzioterapii u lechebnoi phyzkulturu. 2000;3:17–22.
      14. Khoroshun AP. [Physiotherapy methods in recovery treatment in patients with brain tumor] International Neurological Journal. 2013;3(57):66–72.

      VASOMOTION FUNCTION OF ENDOTHELIUM IN CASE OF GASTRODUODENOPATHY INDUCED BY NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN PATIENTS WITH OSTEOARTHROSIS

      Аuthors: L. M. Honcharuk

      Pages: 95–100

      Abstract

               

      Osteoarthrosis is an acute medical and social problem resulting in temporary incapacity to work, disability and significant lowering of patients' life quality. As of today the main method of osteoarthrosis treatment is use of nonsteroidal anti-inflammatory drugs. According to the references 46.5 % of side effects in Ukraine are the result of nonsteroidal anti-inflammatory drugs use. Gastric erosions and ulcers induced by nonsteroidal anti-inflammatory drugs use are one of the most frequent causes of admission to in-patient surgery and gastroenterology departments in Europe and the USA. That is why study of some pathogenetic action mechanisms leading to gastroduodenopathy development caused by nonsteroidal anti-inflammatory drugs use in case of patients with osteoarthrosis is topical for modern medicine. The object of this study was to determine endothelium vasomotion function in case of gastroduodenopathy induced by treatment of patients with of osteoarthrosis by nonsteroidal anti-inflammatory drugs.

      Materials and Methods. 50 patients were examined for osteoarthrosis with concomitant gastroduodenopathy induced by nonsteroidal anti-inflammatory drugs use. The patients’ distribution has been performed irrespective of Helicobacter pylori presence and/or alimentary tube affection degree. All patients underwent fibrogastroduodenoscopy with targeted biopsy performed by the standard technique using fibrogastroduodenoscopy device “Olympus” in order to diagnose gastroduodenopathy. The presence of Helicobacter pylori has been determined by means of invasive express analysis of urease tissue activity using diagnostic sets Helpil®-test (“AMA”, Saint Petersburg), morphologic tests (using azur-II-eosin stain) as well as by means of immunochromatographic Helicobacter pylori antigen faeces test (CerTest Biotec, S.L., Spain, “Pharmasco”).

      Vasomotion endothelium function has been studied by means of duplex ultrasonic scanning of brachial artery.

      Discussion. 70 % of patients with concomitant gastroduodenopathy induced by nonsteroidal anti-inflammatory drugs use were diagnosed with insufficient vasodilation. For instance, 46 % of patients under examination were diagnosed with insufficient vasodilation, 24 % of persons under examination were diagnosed with paradoxical vasoconstriction. It is to mention that endothelium shear stress and endothelium shear stress sensitivity during reactive hyperaemia test was decreasing more apparently in case of patients with concomitant Helicobacter pylori infection. Obtained results indicate development of endothelial dysfunction of patients with osteoarthrosis in case of gastroduodenopathy induced by nonsteroidal anti-inflammatory drugs use. Concomitant Helicobacter pylori resulted in significant dysfunction of endothelium of patients with osteoarthrosis with gastroduodenopathy induced by nonsteroidal anti-inflammatory drugs use.

      Keywords: gastropathy, nonsteroidal anti-inflammatory drugs, osteoarthrosis, endothelium, Helicobacter pylori.

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      9. Shostak NA. [Osteoarthrosis: pressing questions of diagnostics and treatment]. Rus.Med. J. 2014; 3:1-4.
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      DIAGNOSTIC FEATURES OF TUBERCULOSIS IN CHILDREN

      Аuthors: S. Bokova, V. Gritsenko, S. Yanchuk, T. Yarkova

      Pages: 101–109

      Abstract

               

      The epidemiological situation of tuberculosis in the world and in Ukraine is still very difficult. The number of the children who were infected with Mycobacterium tuberculosis in our country is growing with the highest rates among teenagers and young adults – 85 %.

      Tuberculosis (ТВ) is a disease which can have asymptomatic period from several weeks to several decades, thus increasing the reservoir of infected persons. Its course in children depends on many factors: the child's age, the prevalence of the process, premorbid status, presence of complications or comorbidities. The hereditary risk factors such as defects of immune system, malformations of the respiratory system, enzyme insufficiency can significantly influence. It is particularly dangerous for young children and adolescents. The children of early age with the anatomical and physiological characteristics of the respiratory tract which contribute to the deterioration of ventilation. The infants and young children have immature immune system that is unable to locate the source of infection and as a result, the time between infection and clinical disease becomes shorter and clinical manifestations are more acute. These children have the higher risk of severe forms of the disease that can lead to disability and death. The adolescent children have practically same clinic of TB as the adult population.

      Diagnostic process of an infection of TB in the children, especially hidden, has some problems, thus, approach to this problem is always complex. The doctor takes into account the subjective and objective examination of the patient information, laboratory, instrument and immunological methods. The key method for detecting of tuberculosis infection in children in Ukraine for many decades is tuberculin. It is based on determine specific sensibility of the organism to Mycobacterium tuberculosis. The Х-ray is a one of the most informative methods for diagnosis of primary tuberculosis, which reveals the character of morphological changes and indicates the size of the damage. The laboratory diagnosis has value too. The DST-test used in some countries widely. It is immunological method similar to PPD test but it is stimulated specific proteins ESAT-6, CFP-10 M.tuberculosis, which are absent in the genome of BCG M.bovis. The immunological gamma interferon tests were well-established in many countries

      They are more specific tests, safe, not limited in time, and interpreting of their results excludes the subjective evaluation. These methods help to diagnose active and latent tuberculosis. Also safe and specific methods that are frequently used in Ukraine are molecular-genetic tests. But the high cost of research, the difficulty in interpreting the results and low sensitivity in patients with negative sputum smear make their using not always necessary. The development of modern medicine and science gives to physicians many new possibilities in the diagnosis and treatment of TB in children. However, the most sensitive and specific diagnostic tests have not found a place in the routine evaluation of children with suspected TB. The standard diagnostic methods are still used in diagnostics of TB.

      The different methods of the diagnosis of tuberculosis in children were reflected in the article. None of the described diagnostic methods is able to substantiate the diagnosis independently and should be used in conjunction with others. A detailed study of cellular and humoral immunity increases diagnostic and therapeutic capabilities in the fight against disease.

      Keywords: tuberculosis, children, diagnostic methods, immunity.

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      UNCOMPLICATED COMPRESSION FRACTURES OF THE LOWER THORACIC AND LUMBAR SPINE WITH THE USE OF MINIMALLY INVASIVE FIXATION SYSTEMS

      Аuthors: M. V. Khyzhnjak, O. O. Potapov, O. F. Таnaseichuk, Ju. A. Bodnarchuk

      Pages: 110–115

      Abstract

               

      Uncomplicated compression fractures of thoraco-lumbar spine are quite common in clinical practice. Such fractures account for more than half of all fractures of the spine. The most common complaints of patients is local pain and radiculalgia. To reduce the trauma surrounding tissues, duration of surgery, prevention of bleeding, rapid rehabilitation and according to modern concepts of biomechanics widely implemented in practice minimally invasive transpedicular systems. In order to determine the degree of biomechanical properties of the affected vertebral-motor segment in trauma, proposed a number of methods. For the most accurate measurement used method of determining the angle of scoliotic deformation using the methods Cobb and Fergusson.

      The results of the treatment received after the minimally invasive pedicle fixation in 34 patients with unstable thoracolumbar compression fractures, the average age of the patients – (53 ± 0.25) years. In the appropriate clinical and neurological symptoms in all patients we include the data from spondylography with morphometry and computer tomography (CT). 17 patients (50 %) with radicular pains additionally performed magnetic resonance imaging (MRI). We have made 34 surgical interventions, of which 16 cases were used stabilizing systems "Sextant", in 18 cases – "Stryker". All patients have been activated in the next 18–20 hours after setting the stabilizing systems. The average time patients stay in hospital was (3.7 ± 0.2) days. Noting the positive dynamics in the form of post-operative pain recourse. Thus, it was found that the mean score before surgery (VAS) was (8.94 ± 0.2) points, in the early period after surgery – 2.44 ± 0.1 in the interim – (1.62 ± 0.1) in the distant – (1.59 ± 0.1). The degree of kyphosis in all periods of observation after surgery does not fall as compared to the preoperative morphometry results. Thus, differentiated application of minimally invasive methods of treatment is a highly effective treatment for patients with unstable thoracolumbar compression fractures.

      Keywords: trauma, fracture vertebrae, transpedicular fixation, post-traumatic deformity.

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      AGE PECULIARITIES OF CARDIAC STRUCTURAL CHANGES AND THE STATE OF MYOCARDIAL REMODELING IN MEN WITH CHRONIC HEART FAILURE SECONDARY TO OVERWEIGHT AND OBESITY

      Аuthors: P. P. Bidzilya

      Pages: 116–123

      Abstract

               

      Introduction. Chronic heart failure is a relevant health, social and economic problem in Ukraine that becomes more common with aging. Overall, the prevalence of chronic heart failure in the general adult population is 1–2 % and in most cases is observed in older patients. Epidemiological studies demonstrated that the prevalence of disease in adult population ranges 1.5 to 5.5 %, increasing proportionately with age. At the age of over 70 years, the number of chronic heart failure cases reaches 5–10 %, and after 80 years it reaches 10–20 %. Age is a proven adverse factor of chronic heart failure; episodes of progression and mortality in older patients are more common as compared to the young. Among elderly patients, chronic heart failure is accompanied by 10–50 % one-year mortality, depending on the age of patients, the etiology of disease, ejection fraction of the left ventricle, the presence of atrial fibrillation and comorbid conditions.

      Progressive spread of chronic heart failure and obesity in the general population, issues regarding the details of structural changes of the heart, types of myocardial remodeling in men with CHF, the polarity of opinions concerning the influence of age, sex and concomitant obesity on the course and consequences of the disease determine the relevance of the chosen direction of research.

      Purpose. To study age peculiarities of structural changes of heart and the state of myocardial remodeling in men with chronic heart secondary to overweight and obesity.

      Materials and methods. 126 men of different age groups were investigated who had chronic cardiac failure of I–III functional class, normal, overweight and abdominal obesity I–III degree. According to the objectives of the study were formed three groups: I group included 53 middle-aged men (45–59 years), II group consisted of 45 elderly patients (60–74 years), III group involved 28 patients of senile age (75–89 years). Patients underwent echocardiography according to the standard technique in ultrasound scanner of SAMSUNG Medison "SONOACE" 8000 SE. Statistical data processing was performed using licensed software package Statistica (version 6.0).

      Results. We identified that men in older age group tend to more significant dilatation of the heart cavities and the spread of an eccentric type of hypertrophy and concentric remodeling of the left ventricle. With age there is an increase of the hypertrophy degree of the left ventricle, calcification of mitral and aortic valves with the prevalence of their regurgitation.

      Conclusion. Negative influence of age affecting the structural changes of heart and the state of myocardial remodeling in men with CHF secondary to overweight and obesity were demonstrated

      Keywords: heart failure, men, overweight, obesity, cardiac remodeling, age factor.

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      ACUTE RENAL FAILURE: PREVENTION AND TREATMENT

      Аuthors: V. H. Lytvynchuk

      Pages: 124–127

      Abstract

               

      One of the difficult situations in clinical practice critical states is acute renal failure (ARF). Expanding the range of surgery, sepsis, severe exogenous and endogenous intoxication, especially with multiple organ failure, can only make the prognosis of the pathology more severe. Early diagnosis allows improving the results of treatment of acute uremic intoxication. The article presents the results of our clinical researches and treatment of 22 patients with ARF who underwent complex treatment at the Lviv City Clinical Emergency Hospital. The age of patients ranged within 40–71 years. The control group consisted of 18 practically healthy people. Based on our data it was demonstrated that in addition to the diagnosis of ARF besides a daily urine definition as also the concentration of sodium in the urine and daily excretion of nitrogen metabolites are most informative. Research was carried out in stages of oligoanuria. Evaluation of quantitative and qualitative urine can detect AKI on earlier stages of development of this pathology. The indications for the starting of renal replacement therapy should consider the lack of clear diuretic effect with an increase in nitrogenous slags more than in 1.5 times. Timely beginning of extracorporeal detoxification helps to prevent the multiple organ failure and reduces mortality in AKI.

      Keywords: acute renal failure, nitrogen metabolites excretion.

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      MORBIDITY INFLUENCE OF NATURAL, SOCIAL AND ECOLOGICAL FACTORS ON THE EPIDEMIC PROCESS OF ACUTE INTESTINAL INFECTIONS

      Аuthors: N. G. Malysh

      Pages: 128–137

      Abstract

               

      In modern times there are significant changes in the epidemic process of acute intestinal infections, indicating a new stage in its evolution and showing a shift in the direction of the etiological structure of viral infections, with a consistently high level of registration. The influence of environmental factors on the dynamics of diarrheal infections remains poorly investigated.

      In order to determine the influence of meteorological, demographic and technological factors on the epidemic process of acute intestinal infections the official reports of the State Sanitary and Epidemiological Service of Ukraine in Sumy region, the Department of Statistics, Sumy Regional Center for Hydrometeorology and Environmental Monitoring have been studied.

      As a result of epidemiological and statistical analysis it has been found that the epidemic situation in diarrheal infections in the Sumy region in modern conditions remains valid, without tendency towards improvement. Incidence rates range 159.8 to 195.6 per 100 thousand of population. The proportion of shigellosis has decreased from 21.6 % to 0.8 %, salmonella – remained within 3.9–9.0 %. Among registered pathogens were predominate opportunistic pathogens: Klebsiella pneumonia, Staphylococcus aureus, Enterobacter cloacae. The incidence of acute intestinal infections in children is higher than in adults (p < 0.05) and ranged from 550.1–768.4 per 100 thousand child population. City dwellers suffer more, compared with rural residents (p < 0.05). There smoothing of monthly distribution of cases was observed. Shigellosis are usually registered in February, March, July, August, September, salmonellosis – in June and July, acute intestinal infection caused by other established agents – in June, July, August, diarrheal infections of unknown etiology – in January, February, March and July, August, September.

      Directly and indirectly, the health of people is affected by natural, socio-economic and technological factors. The influence of climatic parameters on the seasonal fluctuations of certain diseases of acute intestinal infections has been proven. There is a direct correlation (r = 0.790) (p < 0.05) between recorded frequency of diarrheal infections caused by opportunistic pathogens and temperature characteristics. The amount of precipitation (r = 0.692) (р < 0.05) affects the race of incidence of salmonellosis.

      In the period of intensive migration, the financial crisis in the society, social factors become increasingly important in the evolution of the epidemic of diarrheal infections. Indicators of detection of shigellosis are strongly dependent on the amount of people living in the area (r = 0.824) (p < 0.05) and density (per 1 km2) (r = 0.730) (p < 0.05). The incidence of salmonellosis depends on the level of migration (r = 0.596) (p < 0.05). There is a direct correlation (r = 0.529) (p < 0.05) between the incidence of acute intestinal infection caused by other agents and the establishment of unknown etiology and indicators of natural movement of the population.

      Anthropogenic pollution suppresses non-specific immune response, influences on a particular system of protection against infectious diseases. Air pollution by dust, nitrogen dioxide, formaldehyde is 1.3–1.5 times higher than the maximum permissible concentration. Immediate direct impact of toxicants on the incidence of acute intestinal infections has not been established. However, during 2001–2014, the prevalence of intestinal infectious among adults increased by 22.6 % and constituted 17311.66 per 100 thousand population, among teenagers – by 19.2 % (in 2014 1552.6 per 10 thousand population concerned). Chronic diseases of the gastrointestinal tract has been found in 17.4 % of cases of foodborne diseases, 30.8 % – patients with salmonellosis and 41.2 % – acute intestinal infection caused by other pathogens of unknown etiology.

      Keywords: acute intestinal infections, migration movement, temperature, humidity.

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      ANALYSIS OF OUTCOMES AND ALTERED STATES OF CONSCIOUSNESS IN PATIENTS WITH TRAUMATIC BRAIN INJURY WITH REGARD TO -675 4G/5G POLYMORPHISM OF PLASMINOGEN ACTIVATOR INHIBITOR-1 GENE

      Аuthors: O. O. Potapov, R. I. Aksenchuk, I. M. Pankiv, O. P. Kmyta

      Pages: 138–145

      Abstract

               

      Introduction. Traumatic brain injury (TBI) is an important problem in modern clinical medicine having not only medical, but also social significance. In recent years, the incidence of TBI has increased and accounts for 25 to 80 % of all central nervous system diseases. Despite all significant achievements of modern medicine and numerous scientific studies on this problem, TBI remains one of the leading mortality and disability factors for working population. According to the data of recent investigations, TBI is the top mortality cause among young and middle-age subjects, leaving behind tumors and vascular diseases. Lately, association studies of TBI course depending on genetic factors have developed especially. Special attention should be paid to a very significant TBI notion – patients’ altered states of consciousness – in order to make prognosis for further treatment.

      The purpose of our study was to analyze altered states of consciousness and outcomes in patients with TBI in dependence on genotypes for ‑675 4G/5G polymorphism of РАІ-1 gene.

      Materials and Methods. The study is based on the investigation of 200 patients with an isolated TBI, who were undergoing hospital treatment at the neurosurgery department at Sumy Regional Clinical Hospital in 2011–2013 and had been admitted within the first 3 days after the injury. To evaluate TBI clinical course in patients, the Glasgow Coma Scale (GCS) was used. Altered states of consciousness in TBI patients were assessed by means of GCS over time: on admission, 3-rd, 7-th and 14-th day. Statistical analysis of the results was performed using SPSS17 program. To manage the task we divided the patients into two groups depending on evaluation of consciousness and trauma severity by means of GCS on admission. The first group consisted of 81 patients with minor craniocerebral injuries (MTBI). The second group (STBI) involved 119 patients. The average age of the patients was 39 ± 0.81. 675 4G/5G allelic polymorphism (rs 1799768) in the promotor of plasminogen activator inhibitor-1 (PAI-1) gene was studied by polymerase chain reaction with subsequent analysis of restriction fragment length polymorphism. The outcomes were assessed by means of modified Glasgow Outcome Scale (GOS) on the final day of the study (14-th day).

      Discussion. It was established that 4G/5G genotype for -675 4G/5G polymorphism of PAI-1 gene was associated with slow consciousness recovery as assessed by GCS in comparison with 4G/4G and 5G/5G genotypes. The outcomes assessed by GOS were significantly different in carriers with different genotypes of the studied polymorphism. The patients with 4G/4G and 4G/5G genotypes had worse results. Thus, during treatment it is reasonable to take into account genetic factors that can influence the course of injury and outcomes.

      Keywords: enzyme linked immunosorbent assay, immuno­electrophoresis, irrelevant proteins.

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      CHRONIC TRAUMATIC ENCEPHALOPATHY (MARTLAND’S SYNDROME)

      Аuthors: V. O. Malakhov,V. S. Lychko, V. J. Petrenko, E. N. Belevtsova, A. V. Zubkov

      Pages: 146–152

      Abstract

               

      Physical culture and sport have a positive effect on the human body, although certain sports can cause injury. Boxing is a sport with a high risk of brain injury, as well as the long-term consequences of sustained during boxing training injuries. In boxing there is a direct threat to the opponent's head, as is often the victory is awarded when the opponent loses consciousness.

      Chronic traumatic encephalopathy is an extremely urgent medical and social problem not only in Ukraine but all over the world. The article is devoted to increasing knowledge about the negative effects of frequent traumatic brain injuries when practicing power sports, which are then transformed in Martland’s syndrome.
      At present both domestic and foreign literature data on this pathology are quite incomplete. The article brought into the material and are made based on it will be useful for medical students, interns and various specialists – neurologists, neurosurgeons, family physicians, internists, psychiatrists, neuroscientists, rehabilitation, occupational pathologies.

      Such injuries can cause irreparable harm to the intracranial structures, and the consequences of occupation power sports can be quite unpredictable – from acute complications concussion type to chronic processes leading to dementia in athletes.

      Statistics on capacity development of the disease in athletes were analyzed.
      In the world’s medical and sports circles issues of security exercise, injury prevention, in particular, brain damage, and verification of the early signs of brain injury are seriously debated.

      The article describes the main pathogenic, clinical and therapeutic aspects of the functioning of disorders of the central nervous system in this nosology. Special attention is paid to the problem of treatment of chronic traumatic encephalopathy. A clinical example is described of disclosing the stages of diagnosis and difficulties on the path to proper verification of the diagnosis.

      Keywords: traumatic brain injury, axonal injury, dementia, encephalopathy, boxer.

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      References

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      CHANGES OF INTEGRAL HEMATOLOGICAL INDICES IN PERSONS FROM LYME BORRELIOSIS RISK GROUP, DEPENDING ON THE SEROLOGICAL IDENTIFICATION

      АuthorsT. Boletska

      Pages: 153–160

      Аbstract

      The article shows the existence of a hidden epidemic process of Lyme borreliosis in Sumy region. It is evidenced by the presence of positive titers of IgG antibodies against B. burgdorferi in 70.5% of persons of risk group. Complaints along with positive titers of IgG antibodies against B. burgdorferi may be a sign of chronic latent course of Lyme borreliosis. In order to prevent complications it is important to examine these individuals. Identified hematological changes in the group of seropositive individuals indicate disturbances in the immune system, such as the prevalence of humoral component (increase of lymphocytic index, allergization index) and inhibition of cellular component of immunity (increasing of lymphocyte granulocyte index, decrease of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, neutrophil-monocyte ratio, neutrophils reactive response). These changes create favorable conditions for the development of autoimmune processes in the body. That’s why persons from risk group need constant clinical supervision.

      Keywords: Lyme borreliosis, immune layer, hematological indices, immunity, risk group.

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      1. Sandugey AV, Hrustalev OA, Baranova NS. [Trudnosti klinicheskoy diagnostiki Laym-borrelioza]. Uchenyiezapiski Petrozavodskogo gosudarstvennogo universiteta. 2011; 8: 42–46.
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      PLASMA CONCENTRATIONS OF ENDOTHELIN-1 IN YOUNG WOMEN WITH POLYCYSTIC OVARY SYNDROME

      AuthorsT. L. Arkhypkina, L. P. Lyubimovа, O. V. Tyazhelova, N. A. Kravchun

      Pages: 161–168

      Abstract

      Polycystic ovary syndrome (РCOS) is one of the most studied pathologies in gynecology, and despite this, its etiology and pathogenesis is not completely understood. Lately, more attention has been paid to study the role of endothelial dysfunction as one of the causes of PCOS.

      Objective. Estimate the level of endothelin-1 (as a marker of endothelial dysfunction) in the blood and its relationship with hormonal and metabolic parameters at young women with PCOS.

      Methods. We examined 40 patients (age 21.4 ± 0.2 years) with PCOS. All patients have different complaint: for primary infertility – 100%, for menstrual dysfunction in the form of oligomenorrhea – 30 (75%), secondary amenorrhea – 7 (17.5%), hirsutism – 32 (85%), acne – 16 (40%), adiposity – 15 (37.5%). The control group: 15 healthy women with a normal menstrual function, who want to determine the state of the reproductive system before planning of pregnancy.

      Results. During the study of the marker of activity endothelial function, there was found that the basal levels of ET-1 in the serum of young women with PCOS (2.29  ±  0,2 fmol/ml) were significantly higher than of the healthy women (0,83 ± 0,2 fmol/ml; p > 0.05). To the frequency of determine of increase ET-1 found that 21 (84%) patients of the first group value of ET-1 in 1.5 times, and in 12 (80%) patients in the second group 2.8 times higher than the healthy women.

      Conclusions. It was found that patients with PCOS have increased level of endothelin-1 regardless of body weight and presence or absence metabolic disorders. A positive correlation between levels of endothelin-1 and LH, T/E2 coefficient and a negative correlation with level of E2 was established. Determination of plasma concentrations of endothelin-1 may be useful to identify factors activating endothelial system, but its increase cannot be considered as an independent diagnostic marker for PCOS.

      Keywords: polycystic ovary syndrome, metabolic syndrome, endothelin-1.

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      STRUCTURAL REBUILDING OF SUBLINGUAL SALIVARY GLANDS AT EXPERIMENTAL DIABETES AND ITS HERBAL REMEDY PROTECTION

      АuthorsA. Biloshitska

      Pages: 178–185

      Abstract

      Introduction. Today diabetes type 2 is the most threatening disease. It is an important medical and social problem, because of high prevalence, chronic and serious complications.

      Purpose. Morphological changes of sublingual salivary gland were studied in experimental diabetes type 2 and its herbal remedy protection.

      Materials and Methods. All experimental animals were divided into 3 groups: 1 – intact, 2 – rats, which simulated diabetes, 3 – diabetes prevention with herbal remedy (decoction of leaves of blueberries 2 ml dilution 1:10). There were 30 rats, 10 animals in each group. Animals of the second group were injected intradermally by dexamethasone at a dose of 0.125 mg/kg body weight for 14 days. In the third group, experimental diabetes was created with its preventive medicines.

      Results. Studies have shown that in experimental group the serum glucose was higher by 30 % as compared with the intact animal group. Herbal remedy prophylactic administration led to decrease of blood glucose by 30 % compared with experimental diabetes rats. During the experiment mass of test animals and their organs varied. In experimental pathology group there was registered weight loss, the increase in mass of major salivary glands. So in experimental diabetes body weight decreased by 23 %. Preventive administration of traditional herbal medicine has led to weight loss only by 13 %. In experimental diabetes rats index of major salivary glands increased 2 times compared to the intact group of animals, while in prevention group it only grew 1.5 times. Experimental diabetes led to increased volume mukocytes by increasing the cytoplasmic volume. Lumen of acines decreased. Mukocytes were very tight. There was a little of mucous secretions in the lumen acini. Straits also had little secret. Van Gison staining showed a significant increase in connective tissue not only around gland capsule, but also between acinus and vessels. Histological examination of lipid accumulation set them between acinus and around vessels. Lipids were as large droplets. Lipids were not observed at the ducts. Prophylactic administration of decoction of the leaves of blueberry was to approach to the histology of intact animals. Acinus increased, it contained secret. A small amount of mucus was observed in the excretory ducts. The amount of connective tissue between the acinus, around the vessels significantly decreased. Lipids are observed as the single small droplets between acinus.

      Conclusion. Thus decoction of the blueberry leaves has a solid organ protective action.

      Keywords: diabetes, salivary gland, protection, herbal remedy.

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      References

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      6. Yavorska-Skrabut IM. [Morphological changes of parenchyma and vessels of salivary glands during streptozocin-induced diabetes]. Zbior raportow naukowych: Aktualne naukowe badania. Od teorii do praktyki. Zakopane-Polska. 2014, pp. 80–82 (In Russian).

      EXPERIENCE OF IMMUNOGLOBULIN LABORATORY ANALYSIS FOR INTRAVENOUS ADMINISTRATION

      Аuthors: L. Vergun,A. Tymchenko, L. Korshun

      Pages: 169–177

      Abstract

               

      The aim of work was to study the content of total IgG, IgM, IgA in production batches of intravenous immunoglobulin (IVIG), obtained from the pool of donor blood plasma. Electrophoresis researches, enzyme linked immunosorbent assay (ELISA) of production IVIG 5 % and 10 % were used for it. The standards of comparison were 10 % IVIG of Mikrogen production and samples of IgG, obtained in a laboratory by the method of ion exchange chromatography. It is shown that immunoelectrophoresis and immunodotassay are informing methods which allowed estimating processes of IVIG cleaning. Quantity of IgM and IgA irrelevant proteins from five production batches was detected by enzyme linked immunosorbent assay. It's changed from 20 to 40 µg/ml and from 60 to 70 µg/ml accordingly. The level of irrelevant proteins is lower in 5 % IVIG than in 10 % IVIG. According to results, 5 % IVIG is let in on the ground for clinical practice as preparation with a lower content of irrelevant proteins. The presented methods of testing immunoelectrophoresis and enzyme linked immunosorbent assay are suitable for the estimation of processes of IgG isolation from human blood plasma from donors, does not require expensive equipment and large expense of reagents. The value of methods will considerably grow at the use of referent samples and monoclonal antibodies or monospecific serum to IgM and IgA.

      Keywords: enzyme linked immunosorbent assay, immuno­electrophoresis, irrelevant proteins.

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      ROLE OF CALPROTECTIN S100A8/S100A9 IN PATHOLOGICAL BIOMINERALIZATION

      Аuthors: R. A. Moskalenko

      Pages: 186–194

      Abstract

               

      Calprotectin has two calcium-binding proteins S100A8 (calgranulin A) and S100A9 (calgranulin B), which belong to the family of S100 proteins. These proteins are involved in intracellular signaling, affecting on the level of Ca2+ and as Ca2+ -buffer proteins. S100 proteins are involved in many cellular processes, such as cell cycle regulation, cell growth, differentiation and chemotaxis.
      Today, metabolic disorders with S100 protein family are associated with development and progress of such pathologies as cardiomyopathy, atherosclerosis, neurodegenerative diseases, connective tissue diseases. Besides calprotectins take part in inflammation, reports about their antimicrobial activity, regulatory activity against cells, which are involved in immune reactions, carcinogenesis, development of amyloid-associated diseases are accumulated.
      The aim is to analyze the data of scientific literature to establish the role of proteins calgranulins A and B and their complex (calprotectin) in the development of pathological biomineralization of soft tissues in human body.
      Calprotectin is expressed by granulocytes, monocytes and macrophages in early stages of differentiation. For example, proteins S100A8 and S100A9 take up 45% of all cytoplasmic proteins in neutrophils, and in monocytes  only about 1% of protein cytoplasm. Also calprotectins expression was described in fibroblasts and endothelial cells, activated mature macrophages, osteoblasts and keratinocytes.
      The main part of cytokino- and chemokino-like calprotectin activity is caused by its conection with RAGE receptors (receptor of advanced glycation and end products) and TLR4 (toll-like receptor 4) that trigger signaling pathways, which contribute to calcification in the vascular system, prostate, regulate cytoskeleton structure through polymerization of tubulin and more.
      Calgranulin A (S100A8) and calgranulin B (S100A9) alone and as part of calprotectins complex are extremely interesting objects for stud-ing their possible role in the pathological process of biomineralization. In addition to chemokine and cytokine activity and influence on different specific receptors, these molecules have important constitutive feature: the binding of calcium and some other two valence ions. The combination of proteins S100A8 and S100A9 with biomineralization in such pathological processes as inflammation, tumor growth and atherosclerosis, says abot their obvious correlation.
      Calprotectin-dependent endothelial damage may be a critical element in vascular morphogenesis biomineralization during chronic inflammation, atherosclerosis and cancer.
      During analysis of the literature a concentration-dependent effect of S100A8/S100A9 on tumor cells is revealed: calprotectin and its components contribute to tumor growth and spread at low concentrations, at high concentrations – cause apoptosis of neoplastic cells. Besides, calprotectin affect directly tumor cells through interaction with TLR4, which are expressed in them and they are endogenous receptors for S100A8/S100A9.
      The number of calgranulin A and B increases at the early stages of complicated atherosclerosis while the development of biomineralization. S100A8 and S100A9 in atherosclerotic plaque may significantly affect the redox and calcium-dependent processes of atherosclerosis pathogenesis and its chronic complications, including abnormal biomineralization. Numerous properties of calgranulin S100A8/S100A9 and its components can be a point of the promising new drugs and finding new biomarkers of disease.

      Keywords: calprotectin, biomineralization, calgranulin A, calgranulin B, atherosclerosis.

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      PREDICTION METHODS FOR RISK FACTORS OF CARDIAC RHYTHM AND CONDUCTION DISTURBANCES

      Аuthors: E. Ts. Yasynska, Zh. A. Revenko

      Pages: 195–200

      Abstract

               

      Using clinical and statistical analysis for patients with coronary heart disease (CHD), we selected patients with and without signs of arrhythmias and conduction of the heart. We also highlighted their risk factors and, based on these findings, developed a system of predicting the diseases. To identify patients with CHD risk factors of violations of rhythm and conductivity of heart was used prospective and retrospective surveillance methods. Based on the data regarding risk factors and anti-risk using the methods of Wald and Bayes developed a diagnostic prognostic table (map) in the form of predictive coefficients (PC) this informative weight of each trait.

      Keywords: violations of rhythm and conductivity of heart, cardiovascular disease, system of prediction, risk and anti-risk factors, the prevalence of disorders of rhythm and conduction of the heart, prognostic indices, the methods of Wald and Bayes, informative weight of each trait, the observations map, the mathematical tools.

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      YEARLONG OBSERVATION OF FUNCTIONAL STATUS OF ATHLETES-SPRINTERS

      Аuthors: Ye. L. Mikhalyuk, S. N. Malakhova, M. V. Didenko

      Pages: 201-208

      Abstract

               

      Introduction. An important feature of sports medicine, unique to the athletes is the dynamics of the functional state of the body from the preparatory period to the competition; the athlete is in a state of good "fitness level".
      The purpose was to study and compare HRV, central hemodynamics and PWC170 at athletes sprint qualification of the III-rd discharge to IMS obtained in the preparatory and competitive periods of training process.
      Materials and methods of examination. A total of 35 runners who specialize in running at a distance of 100–200 m, the qualification of the III-rd discharge to IMS. The study of HRV and central hemodynamics was performed by the standard technique on the diagnostic complex "Cardio +”. Physical performance was measured on a bicycle ergometer with the calculation of submaximal test PWC170.
      Results and discussion. General data on a group of sprinters athletes (n = 35) show that in the competitive compared to the preparatory period has been some strengthening of parasympathetic effects ANS transformation eukinetic in hypokinetic TC, lack of individuals with hyperkinetic TC significant increase PWC170/kg 11.22 % and IFS. Separate analysis of the athletes has demonstrated similar shifts in the competitive period with some advantages of high-class athletes. The correlations show that increasing PWC170/kg and the IFS is a decrease to CI values characteristic hypokinetic TC, while the high-class athletes, in addition to a decrease in before the values characteristic of the prevalence of parasympathetic ANS. Increased PWC170/kg and IFS helped to improve athletic performance and enhance their skills in the competitive period.
      Conclusions. In competitive period compared to the preparatory period, in athletes-sprinters (n = 35), there has been some strengthening of parasympathetic effects ANS transformation eukinetic in hypokinetic TC and a significant increasing PWC170/kg to 11.22 %.
      At high-class athletes (n = 26) in the competitive period occurred similar to that in the general group, shifts from the HRV and central hemodynamics, and a significant increased PWC170/kg to 10.24 %.
      Athletes qualification of II–III discharge (n = 9) in the competitive period decreased parasympathetic ANS influences, prevalence athletes with eukinetic TC and the lack athletes with hyperkinetic TC and significant increase PWC170/kg to 11.93 %. PWC170/kg to 11.93 %.
      As the physical performance of athletes to a reduction in the CI values corresponding hypokinetic TC, while the high-class athletes, in addition to reduced CI values characteristic of prevalence parasympathetic ANS.
      Increase PWC170/kg and functional state in the competitive period helped to improve athletic performance and improve the skills of athletes.

      Keywords: athletes of high class and low-skill, preparation and competition period, heart rate variability, central hemodynamics, physical performance, correlation.

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      MODERN POSSIBILITIES OF ENDOSCOPIC SURGERY

      Аuthors: R. M. Mykolayenko, D. G. Sumtsov, G. O. Sumtsov

      Pages: 209–216

      Abstract

               

      A comparative analysis of the results of treatment of 4012 patients with various surgical, gynecological and urological pathologies was performed. Operated age of the patients is from 18 to 88 years. 1085 patients underwent endoscopic technique intervention and 454 patients experienced simultaneous operations. There was performed cholecystectomy in 243 (49.0 %) of 496 patients that underwent simultaneous operations and 83 (16.7 %) patients were with gynecological pathology. Only 76 (15.3 %) of the group were operated simultaneously on cholecystectomy and gynecological operation by video endoscopic method, but the majority (297 or 59.9 %) of patients were operated by means of an open surgical method, as the main problem in them was plastic hernia. 123 (24.8 %) patients were operated by means of an open surgical method only. Such simultaneous operations are possible and safe only after a thorough selection and preparedness of patients. Postoperative mortality was 0.02 % on 4012 operated patients; complications developed in 1.4 % of patients. There were no significant difference in the course of post operation period and frequency of complications after ordinary and simultaneous operations. The average hospital stay after laparoscopic operations was 2.6 days.
      To select patients for simultaneous operations it is necessary to examine the gallbladder and cholecystic ducts before gynecological intervention; in case of surgical pathology in women the organs of small pelvis should be investigated. For wider application of simultaneous operations departments of operative gynecology should be placed in the surgical hospitals.

      Keywords: laparoscopic and simultaneous operations, indications, advantages, complications.

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