Аuthors: A. V. Kustov, Yu. A. Alieksieieva
Despite the fact that the clinic of delusional disorders is known, described, studied from different perspectives, their nature is still an unexplored area of psychiatry. It is not clear what psychological processes and mechanisms are involved in the formation of delusions, what mental material forms the basis for its clinical diversity, why delusions, despite the existential differences in people's lives, have the stable forms and a stereotypically repeating semantic structure. Biologically oriented medicine does not provide answers to these questions.
Therefore, the aim of this publication was to create a model in which, by analyzing, comparing, generalizing the positions of individual concepts recognized in psychology, one could find answers to emerging questions, try to discover the nature of delusions, understand the processes and mechanisms underlying in its formation and identify those links that will help to optimize the processes of therapy and reveal the possibilities of psychocorrection.
For this purpose, certain provisions of the theory of K. Jung on the collective unconscious and archetypes, which are actively developed in archetypical psychology, were used. To understand the basis on which archetypical concepts and images are structured, the principles and laws that are the basis of Gestalt psychology were involved. Convenient conceptual elements became firstly developed in psychoanalysis, and then in general psychology the notions of projection and reflection, which are traditionally considered separately. From our point of view, projection and reflection are a single mechanism based on the universal principle of the continuum, which underlies in the organization of virtually all dynamic interactions of mental activity. Thus, the delusional states are a complexly organized form of pathology, which is well revealed first of all from the positions of the regularities already studied and known in psychology. Analyzing these processes, we came to the conclusion that the recognized positive effect of neuroleptic and anxiolytic drugs in delirious therapy can be studied using psychological criteria for treatment of pathology. Another important conceptual point. The study of pathology can be the key to understanding some important aspects of the normal functioning of the psyche. Such a problem is the pathology of faith and its destructive form, which is an important pathogenetic link in the formation of delusional states.
Keywords: archetypes, concepts, gestalt, projection, reflection, destructive faith.
Аuthors: A. A. Antoniv
The increase in the frequency of nonalcoholic steatohepatitis (NASH) comorbid course on the background of obesity and chronic kidney disease (CKD) in people of working age in Ukraine and in the world necessitates conducting research on mechanisms of mutual burden and finding new factors for the progression pathogenesis of this comorbidity.
The purpose of the study was to establish the mutual burden and progression mechanisms of non-alcoholic steatohepatitis and chronic kidney disease in obese patients based on the study of protein and carbohydrate-protein components of the extracellular matrix, lipid profile of the blood, and functional state of the endothelium.
Material and methods. 114 patients with NASH were examined on the background of degree І-ІІ obesity, including: 52 patients with NASH (group 1) (without accompanying CKD), 62 patients with NASH with comorbid CKD, І-ІІ stage (group 2). The average age of patients was (45.8 ± 3.81) years. The control group consisted of 20 practically healthy persons (PHP) of the corresponding age and sex.
Results. We studied the dynamics of patients with non-alcoholic steatoatepatitus (NASH) with comorbid obesity and chronic kidney disease, І-ІІ stage (CKD), the role of hydrogen sulfide in the mechanisms of mutual burden and progression of comorbid diseases: hyperlipidemia, hyperproduction of extracellular matrix components (protein-bound and free hydroxyproline, glycosaminoglycans, fibronectin, hexosamines, sialic acids), osteoporotic proteins, proteinase-inhibitory imbalances (activation of proteolysis, collagenolysis), endothelial dysfunction (imbalance in generating nitrogen monoxide, endothelin-1, homocysteine).
Conclusions. In patients with NASH on the background of obesity, a significant increase in the synthesis of collagen and glycoproteins was observed, which was accompanied by an ineffective resorption of newly formed collagen due to inhibition of collagenolysis (CLA) on the background of proteinase inhibitors (α2-MG) activation, which was accompanied by hyperproduction of the growth factor fibroblasts, homocysteine, endothelin-1, deficiency in the liberation of hydrogen sulfide and nitrogen monoxide. Under the conditions of the comorbidity of NASH with the CKD of the 1st and 2nd stages, both collagen synthesis and resorption are activated, but the processes of anabolism prevail in spite of the compensatory activation of collagenolysis, with a significant hyperproduction of actinic-phase proteins, fibronectin, glycosaminoglycans, fibroblast growth factor and increased degradation of the extracellular matrix fucoglycoproteins and lead to progressive fibrosis of the liver and disturbance of its functions.
Keywords: nonalcoholic steatohepatitis, chronic kidney disease, obesity, hydrogen sulfide, endothelial dysfunction.
Аuthors: Ye. B. Sharhorodska, O. S. Shkolnik, H. V. Makukh, Ya. M. Korinec, N. M. Prokopchuk
Introduction. Annually more than 5.5 thousand of children with congenital heart defects are born in Ukraine. 14 % of children with cardiac anomalies die during the first week of life and 25 % of them – during the first month, and about 40 % do not survive up to 1 year. An important factor is the time of diagnosis the congenital heart defects (prenatal or postnatal), and actions to be taken.
Purpose. We are to study the structure of congenital heart defects among newborn babies, according to medical records of the Regional Clinical Hospital in Lviv during 5 years and to analyze the possibilities and the results of their prenatal diagnosis.
Materials and Methods. The analysis of health and statistical data of primary medical documentation has been done and the history cases of the 172 newborns with congenital heart diseases during 2011-2015 were analyzed. The inclusion criterion was the history of the newborn development with a clinical diagnosis of “Congenital heart disease”, according to the International Classification of Diseases -10 (Q20-Q28).
Results and Discussion. During 5 years, among 15 429 newborns 172 children were born with heart defects. The frequency of congenital heart disease was 1.1 %. It is established that in the spectrum of this disease the first place is in the structure of congenital heart defects with arteriovenous discharge of blood (“pale”) – 102 (59.6 %); the second place is taken by heart diseases with reduced or normal blood flow: 49 (28.5 %); the third – by heart diseases without discharge of blood, with the presence of obstacles at the level of the valves or major blood vessels – 14 (8.1 %). The fourth are the heart diseases that are rare – 7 (4.1 %). 28 (16.3 %) children identified concomitant congenital pathology: multiple congenital malformations – 12 (7.0 %), chromosomal disorders, 7 (4.1 %) and congenital malformations of the nervous system – 6 (3.5 %). We have set that 40.1% of the heart defects were diagnosed prenatally. In one female patient (1.5 %) heart defect was detected during the first trimester, 24 (35.8 %) – during the second trimester, 42 (62.7 %) during the third trimester of pregnancy.
Conclusions. In the structure of congenital heart defects among newborns the most common are defects with arteriovenous discharge of blood – 102 (59.6 %). 28 (16.3 %) children were born with concomitant congenital pathology, among them 7 (4.1 %) – with chromosomal pathology. According to the ultrasound prenatal diagnosis 40.1 % were diagnosed with congenital heart defects, and 59.9 % – constituted a reduction reserve of perinatal morbidity and mortality with timely diagnosis.
Keywords: congenital heart defects, prenatal diagnosis, newborn babies, retrospective analysis.
Аuthors: L. M. Sizova
Introduction. To date, the Global measles and rubella strategic plan is in effect, with the goal of eliminating measles by 2020. However, Ukraine is in the list of 9 countries of the European Region of endemic measles and over the past 15 years, 80 % of cases of this disease were registered among Ukrainians. Thus, the study of the epidemiological characteristics of measles in certain regions of Ukraine in order to strengthen preventive measures on this disease is an actual scientific and practical task.
Purpose. The study was aimed to analysis the measles incidence and vaccination coverage against this disease in the Poltava region, as well as to prognosticate the epidemic trends in the region for the period until 2020.
Materials and Methods. A retrospective epidemiological analysis of data from official statistical reporting documents approved by the Ministry of Health of Ukraine for the period from 2012 to 2018 (6 months) was carried out to analysis the measles incidence. Forecasting the incidence of measles was carried out by the linear regression method using the construction of a polynomial trend line.
Results and Conclusions. Determined that measles incidence of the Poltava region during 2013-2016 registered at a low level (1.16 and 0.14 per 100 thousand population respectively), in 2015 and 2016 cases of the disease was not detected, whereas from 2017 and for the first 6 months of 2018 this indicator increased by 19.3 times − from 1.34 to 25.9 per 100 thousand population, the absolute number of reported cases of measles among children and adults increased by 13.6 and 24 times, respectively. The scope of vaccination against measles in the Poltava region for the period 2012–2016 has a tendency to decrease: among children aged 12 months − in 3.3, 6 and over 7 years − in 2.4 and 5.5 times, respectively. By 2020 a rapid measles incidence rate up to 50.0 per 100 thousand of population is expected in the region.
In order to reduce the risk of occurrence and spread of large epidemic outbreaks of measles in Ukraine, it is recommended to conduct additional immunization among epidemically significant age groups of the population, since preventive vaccinations are a priority task for the health care of Ukraine to overcome the risk of morbidity and mortality of the population from measles.
Keywords: measles, incidence, vaccination, prognosis.
Аuthors: V. I. Hula
This article is devoted to studying the morphological changes of structures of the stomach fundus on the macro- micro- and ultrastructural levels of the organization under conditions of different types and degrees of dehydration on the organism of laboratory rats and the possibility of correction of the morpho-functional state of the stomach tissues with using of ethylmethyldisopyridine succinate.
The purpose of the research was to study histological, histochemical, immunohistochemical, ultramicroscopic, and morphometric changes of the stomach fundus structures of laboratory rats in conditions of general and intracellular dehydration of the organism and to determine the possibility of their pharmacological correction with the membrane protective and antioxidant properties (2-ethyl-6-methyl-3-hydroxypyridine succinate).
Materials and methods. 36 white male laboratory rats of mature age and 150–190 g of weight were used for the research. Animals were divided into control and experimental series. The experimental series consisted of 4 groups of 6 rats in each of them. In the first group of animals the general dehydration of the sublethal degree of gravity was created. The second group of rats was in similar conditions, but throughout the experiment of general dehydration they received the intramuscular injections of ethylmethylhydroxypyridine succinate.
Severe intracellular dehydration conditions were created for the third group of rats. The fourth experimental group of rats consisted of 6 animals that were under similar conditions of intracellular dehydration of the body but they received an ethylmethylhydroxypyridine succinate throughout 30 days of this experiment. The control series consisted of 2 groups of animals that were on the usual drinking and feeding diet and were excluded from the experiment on the 9th day (6 rats) and the 30th day (6 rats) of the research. Experimental animals were also excluded from the research according to the indicated terms. The histological, histochemical, immunohistochemical, ultramicroscopic and morphometric study of the structures of the rat`s stomach wall in fundal part under that conditions, as well as statistical analysis of the obtained results was conducted.
Results. The obtained results show the functional ability of mucocytes of the stomach to form a mucous layer on the surface of the mucous membrane of the stomach, to preserve the structural organization of the glands, to reduce the quantitative losses of cells and their destructive-dystrophic changes, to improve the reparative ability and to reduce the intensity of microcirculatory disorders.
Conclusion. It has been discovered that usage of ethylmethylhydroxypyridine succinate is effective for maintaining the vital functions of the fundus of the stomach wall, depending on the type of dehydration.
Keywords: stomach, fundal part, rats, general dehydration, intracellular dehydration, correction, ethylmethylhydroxypyridine succinate.
Аuthors: O. M. Chernatska
As far as we know, the coexistence of arterial hypertension and type 2 diabetes mellitus is associated with increased risk of heart failure. Furthermore, the rise of uric acid levels is a strong, independent and modified factor of cardiovascular morbidity and mortality.
The aim of our clinical trial was the detail analysis of relationship between uricemia and heart function indicators in persons with arterial hypertension and coexistent type 2 diabetes mellitus.
Our study involved 96 patients with arterial hypertension and coexistent type 2 diabetes mellitus (І group), 25 people with arterial hypertension (ІI group), 15 practically healthy persons treated in Sumy City Clinical Hospital № 1 during 2014−2017 years. The methods of our trial were clinical, anthropometric (height definition), biochemical (uric acid levels determination), instrumental (echocardiography), statistical (Microsoft Excel 2016).
Based on the findings uric acid levels increased in proportion to the left ventricular mass index (r = 0.27; р = 0.0075) in patients with arterial hypertension and type 2 diabetes mellitus. The study proved that the uricemia was unreliablу higher in comorbid patients from the І group with third functional class of chronic heart failure compared with the second.
In conclusion, in patients with arterial hypertension and type 2 diabetes mellitus the increase of uric acid levels is associated with the higher left ventricular mass index which may cause largest heart function disorders.
Further study is required to improve treatment of coexistent pathology by prescription medicines with additional ability of uricemia decrease.
Keywords: uricemia, left ventricular mass index, comorbidity, arterial hypertension, type 2 diabetes mellitus.