THE ROLE OF ASSESSMENT AND CORRECTION OF NUTRITIONAL STATUS IN A COMPREHENSIVE APPROACH TO COVID-19 PATIENT WITH METABOLIC DISORDERS: Review

The article is devoted to the problem of coronavirus disease COVID-19 with emphasis on the nutritional status of patients. An analytical review of recent publications related to aspects of nutritional support for people in outpatient and inpatient treatment for COVID-19 is presented. The article highlights the pathogenetic justification of the relationship between the immune response and metabolic balance of the body, the optimal content of trace elements, vitamins, components of lipid metabolism. The importance of nutrition as a strategy to support human immune function is considered. Methods for determining the adequate energy balance of patients with severe COVID-19 are presented. Groups of foods and key nutrients that may affect the consequences and clinical course of respiratory infections are described. The importance of assessing and optimizing nutritional status to improve the clinical course and consequences of COVID-19 in patients with comorbid pre-existing non-communicable diseases, such as diabetes, cardiovascular disease, obesity with systemic inflammation, is emphasized.

ALLERGIC RHINITIS SYMPTOMS PREVALENCE IN CHILDREN OF KHARKIV CITY

The purpose of the study was to identify the prevalence of allergic rhinitis (AR) symptoms in children of Kharkiv city and to establish the dynamics of symptoms since 1998. The study is phase IV of the international ISAAC program. It was conducted in 2015-2017. 5735 children were interviewed, including 3238 children aged 6-7 years old and 2197 children aged 13-14 years old. The incidence of non-cold-related sneezing was found in 14.7% and 16.1%, respectively; during the past 12 months similar problems with nose breathing were noted in 9.1% and 9.9%; accompanied by conjunctivitis – in 3.4% and 4.8% of children 6-7 and 13-14 years, respectively. Most patients had seasonal exacerbations and mild / moderate rhinitis. The AR diagnosis was verified in 12.2% and 11.3% of children, respectively. The decreasing of AR symptoms prevalence was found in children of all ages. The dynamics of the AR symptoms prevalence, "eye" symptoms over the past 20 years show a probable decrease in all indicators, which can be explained by the widespread introduction in medical practice of screening methods for the disease diagnosing, activation of primary and secondary prevention.

COMPUTER TECHNOLOGIES FOR DETERMINING INDEX ASSESSMENT OF THE DESTRUCTION OF DENTAL HARD TISSUES

The aim of the study was to compare the obtained data of hard dental tissues destruction indices with the corresponding indications for the choice of the method of treatment by means of mathematical analysis. Materials & methods. 120 patients aged 20 to 55 were examined and 358 teeth hard tissue defects were identified in them. The data of indices was obtained and compared with the indications for orthopedic treatment according two indices in the same clinical situation. Results. The study showed that the indices had different meanings and different indications for treatment in the same situations. Such discrepancies in indications for treatment indicate the subjective data of one of the indices, which does not take into account the depth of destruction and the volume of the remaining natural tissue of the teeth. Comparison of these indices showed different figures in the same clinical situation, identifying corresponding incorrect indications for the choice of the design of the first investigated index, as well as more accurate data of the proposed index. Conclusion. The index assessment of hard dental tissues destruction serves as the main guideline for the dentist when choosing a method for tooth restoration, and can be calculated using photographs, scans and computer software.

TREATMENT OF BRONCHIAL FISTULA ASSOCIATED WITH NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: Review

The treatment of non-specific chronic pleural empyema with bronchial fistulae remains one of the most relevant issues in thoracic surgery. The question about the treatment phasing of bronchial fistulae associated with chronic pleural empyema is yet to be answered. Is it reasonable to seal a bronchial fistula before or after the sanitation and obliteration of the residual pleural cavity? The choice of bronchial fistula sealing technique is also a relevant issue because, in spite of the multitude of techniques, there is still no single doctrine. The terms of traditional and minimally invasive techniques aimed at bronchial fistula sealing and pleural cavity obliteration are not defined, either. This article summarises the opinions of leading authors presented in the literature concerning the solution of this complex, life-threatening problem.

FORENSIC MEDICAL ASSESSMENT OF MORPHOLOGICAL CHANGES AT DIFFERENT POSTMORTEM INTERVAL

Purpose: The postmortem interval (PMI) evaluation is one of priorities while performing a forensic medical examination of corpse. To date, there is lack of information of morphological postmortem changes of some internal organs. Considering the persistent need to develop the method for a precise assessment of PMI, postmortem changes in these potentially informative organs were evaluated. The aim of study was to analyze morphological postmortem changes in prostate and uterus. Materials and Methods: histological samples of 40 prostate tissues and 40 uterus (n=80) from corpses of deceased aged 18-75 years. Only cases with known time of death were included to study, the time of death was taken from police reports. Exclusion criteria were cases of violent death, cases of death with massive blood loss, tumors of studied internal organs, cases when diagnosis was not made by a forensic medical examiner. The PMI of studied cases ranged from 1 to 6 days. Histological slides were made with a staining by hematoxylin and eosin, x200 magnification, using Olympus ВХ41 and Olympus ВХ46 microscopes, Olympus SC50 camera. Postmortem morphological changes were evaluated by a calculation of blank spaces percentage in microscopical structures using a JS-based program. Connection between PMI and morphological changes was calculated by the Spearman’s rank correlation. Results: the average percentage of blank spaces in uterus tissues was smaller than in prostate tissues (1,99 and 9,65 relatively). The slower growing of blank spaces was in uterus. In prostate samples, a notable increase of blank spaces was observed between 48 and 72 hours after the death. After this period, the increase slowed down and then an increase was observed again between 120 and 144 hours after the death. In uterus samples, a slight acceleration observed between 72 and 120 hours after the death and then slowing down between 120 and 144 hours after the death. Blank spaces in evaluated histological slides were increasing directly proportional to the PMI, a statistically significant interconnection was defined (p < 0.05). Conclusions: The morphological postmortem changes in prostate and uterus were developing at certain time frames. Blank spaces percentage, in studied histological slides, were increasing directly proportional to the PMI increase, a statistically significant interconnection was defined. Therefore, the results of study show the possibility of the evaluation of a postmortem time interval by assessing such morphological changes in these organs, which could be used in forensic medical cases.

MODERN DIAGNOSIS OF PLACENTAL DYSFUNCTION AND ITS COMPLICATIONS

The aim of the study was to improve the modern diagnosis of placental dysfunction and its complications. Materials and methods. The study involved a prospective survey of 70 pregnant women divided into the main group (pregnant women with placental dysfunction) (n = 50) and the control group (n = 20). The main group was divided into subgroups of pregnant women with placental dysfunction and fetal growth retardation (n = 30) and pregnant women with placental dysfunction without fetal growth retardation (n = 20). The control group comprised 20 pregnant women with physiological gestation. Apart from history taking, the study comprised obstetric and general clinical examination, evaluation of endothelium- dependent vasodilation, serum concentrations of soluble forms of vascular and platelet- endothelial molecules of cell adhesion 1, indicators of athrombogenicity of the vascular growth wall, uterine-placental-fetal blood circulation, pathomorphological and histometric examination of the placenta. Results. Based on the obtained clinical-morphological and endotheliotropic criteria, a personalized clinical algorithm for managing pregnant women with placental dysfunction was developed and implemented. Conclusions. Assessment of pregnancy results in a prospective clinical study showed that the proposed algorithm for personalization of the risk of perinatal abnormalities not only helped to avoid antenatal mortality, but also to prevent intranatal and early neonatal losses in patients with placental dysfunction and fetal growth retardation.

RESOURCES-BASED STRATEGIES FOR HEALTH PROMOTION OF STUDENTS WITH DIFFERENT GENERAL CONDITIONS AND DIFFERENT ORIGINS

Background: The aim of this study is to investigate the study-/work-related behavior and experience patterns of students, taking into account their origins as well as the stressful general conditions. Methods: A total of 194 students (41.8% women, 58.2% men, 58.7% German and 41.3% international students) were evaluated to their strains during the study and study-/work-related Behavior and Experience Patterns (AVEM). Four potentially stressful conditions were taken into account. Results: For only 14% of international students, but 45% of German students risk patterns for work-related behavior and experience were found. Study-/work-related behaviour and expe-rience patterns depend on the origin of the students. Resources during study were significantly higher among students of German origin. Conclusions: A study-related strengthening of resources is necessary, which can be viewed as a competitive advantage when choosing a study location.

ENDOTHELIAL FUNCTION IN PATIENTS WITH COPD AND CARDIOVASCULAR DISEASE (REVIEW)

Cardiovascular pathology is one of the frequent comorbidities in patients with chronic obstructive pulmonary disease, due to both genetic predisposition and common risk factors (smoking, senile age, male gender, sedentary lifestyle, obesity). The article shows that development of endothelial dysfunction is one of the earliest phases of pathogenesis in this setting. Endothelial dysfunction mechanisms are defined and characterized, including an imbalance of vasoconstricting and vasodilating agents with the emergence of "vicious circles" that violate hemo-vascular homeostasis. The role of nitric oxide, endothelin-1, intercellular adhesion molecule-1 (ICAM-1) in the development of endothelial dysfunction in COPD patients is discussed. The article defines the concept of oxidative stress, the most potent oxidants and mechanisms of their damaging effect arebeing listed. A particular attention is paid to 8-isoprostane as a golden standard in assessment of oxidative stress in patients with COPD.

THE ROLE OF RESISTIN IN THE PROGRESSION OF NON-ALCOHOLIC FATTY LIVER DISEASE

The aim of the research was to study the relationship between plasma concentrations of resistin and indicators of enzyme and pigment metabolism in patients with non-alcoholic fatty liver disease (NAFLD) and its combination with type 2 diabetes mellitus (DM-2). Materials and methods. On the base of Kharkiv Regional Hospital a total of 90 patients were examined, including patients with NAFLD (n = 20) and its combination with DM-2 with normal body weight (n = 20) and obesity (n = 50), as well as 20 healthy volunteers. A complex of clinical, laboratory and instrumental (including liver biopsy in 9 patients) examinations of patients was performed. Results. A direct relationship was established between the level of resistin and indicators of enzyme and pigment exchange in groups of patients with combined pathology. A significant increase of resistin plasma level, as well as disorders of the liver function were determined in all groups of patients in comparison with the controls. The most marked changes were revealed in patients with combination of NAFLD, DM-2 and obesity. Conclusions. The established relationship between the level of resistin and the indicators of the liver functional state suggests that an increase of resistin level may reflect the presence of impaired liver function in patients with NAFLD in combination with DM-2, predicting the progression of NAFLD. In order to detect the disorders of liver function in patients with DM-2, it is recommended to determine the level of resistin in patients with NAFLD, especially when concomitant obesity is present. Patients with resistin level (> 8.06 ± 0.23 ng/ml) should be considered at risk of NAFLD progression.

Pathophysiological aspects as the object of the treatment tactics in acute pancreatitis (review)

The review presents a modern view on the features of the course and treatment of acute pancreatitis, based on a cascade of pathophysiological mechanisms of this disease. A number of concepts of development and course of acute pancreatitis on the basis of randomized prospective and retrospective researches devoted to this problem are considered. Attention is paid to the mechanisms of development of organ failure in acute pancreatitis. In accordance with the above, the main positions of treatment measures for acute pancreatitis, which are based on the principles of tactics "step-up approach" were highlighted. Among them, attention is focused on the features of the conservative treatment program, minimally invasive surgical interventions, as well as the management of the postoperative period of patients. Minimally invasive surgical interventions perform the main tasks of surgical treatment in acute pancreatitis, but significantly reduce surgical trauma compared to "open" methods. Adequate management of the postoperative period of patients is carried out through the implementation of protocols "fast-track surgery".