CHARACTERISTIC OF FREE-RADICAL DAMAGE AND ANTIOXIDANT PROTECTION STATE IN PATIENTS WITH CHRONIC KIDNEY DISEASE AGAINST A BACKGROUND OF MALABSORPTION SYNDROME

Oxidation processes play an important role in damage of the renal structures, especiallyagainst a background of other serious pathologies, in particular, malabsorptionsyndrome.The study of the mechanisms of mutual aggravation and progression of kidneydamage against a background of malabsorption is a very urgent problem of the presenttime.Purpose - to investigate the state of free radical oxidation of lipids, proteins andantioxidant defense in patients with chronic kidney disease of different ages withoxaluria against a background of malabsorption syndrome.Material and methods. 98 patients with chronic kidney disease of the I-II stages(pyelonephritis) with the presence of oxaluria against a background of malabsorptionsyndrome of different age were examined.The age of the patients under examination was32 - 64. All patients underwent a study of the system of free radical oxidation of lipidsand proteins.Results. chronic kidney disease with the presence of oxaluria is accompanied by asignificant increase in the blood content of free radical oxidation products, namelyaldehyde and ketone dinitrophenylhydrazones, especially of a neutral nature,malondialdehyde, as well as a significant decrease in the indicators of the antioxidantdefense system, which manifested itself to a greater extent in patients with older age.groups.Conclusion. An essential factor in the development and progression of chronic kidneydisease with the presence of oxaluria against a background of malabsorption syndromeis an increase in the intensity of free radical oxidation of lipids and proteins (mainly dueto aldehyde and ketondinitrophenylhydrazones of a neutral nature).

FEATURES OF PREOPERATIVE MANAGEMENT AND METHODS OF EXAMINATION OF PATIENTS OF GROUPS UNDER RESEARCH

Despite the active ability to repair, it is frequently noticed that the independent potentialof bone tissue is insufficient, that is a serious problem in reconstructive maxillofacialsurgery, orthopedics and traumatology. In recent years, there has been an activesearch for implant material that would match the autologous bone in its properties andcharacteristics. Tissue engineering technologies allow to create tissue equivalents tobone tissue using autogenous stromal cells deposited on biocompatible or biologicalmaterial of tissue engineering design. The article presents the features of preoperativemanagement, description of the used examination methods and bone augmentationmaterials in patients of the groups under study.Objective – to use a set of adequate methods of examination and optimal preoperativemanagement of patients of the group under study during sinus lifting, post-extractionsocket preservation, osteosynthesis for mandibular fractures and impacted wisdom teethextraction, which were accompanied by the use of bone augmentation materials based onmultipotent mesenchymal stromal cells.Material and methods. 280 people aged 18 to 55 with partial or complete adentiaand atrophy of the alveolar process of the jaws, with chronic periodontium infectionand chronic generalized periodontitis, with fractures and impacted third molars wereexamined in the Department of Surgical Dentistry and Maxillofacial Surgery of theChernivtsi Regional Clinical Hospital. All patients were planned to make orthopedicstructures based on dental implants.Results. The use of computed tomography in preoperative examination of patients in thestudied group allows not only visually to examine the object, but also to perform directdensitometric analysis with measurement of attenuation coefficients in Hounsfield units,that is a significant advantage over X-ray examination.Conclusions. The use of bone augmentation materials based on multipotent mesenchymalstromal cells of adipose tissue during dental operations improves the regenerativeproperties of bone tissue and helps to reduce the duration of inpatient treatment.

EVALUATION OF LIPID PROFILE AND THYROID HORMONE LEVELS IN PATIENTS WITH CHRONIC PANCREATITIS COMBINED WITH HYPOTHYROIDISM

With hypothyroidism (HТ) there is a change in homeostasis in tissues sensitive to thyroidhormones, which in its turn leads to a violation of fat metabolism. HT induces a significantincrease in lipid peroxidation and reduces the activity of antioxidant enzymes, oxidativestress, which is formed in HT, can play a key role in the progression of pancreaticdysfunction (PD).Purpose – to study the indicators of the lipid profile and the level of thyroid hormones inpatients with CP and CP, combined with HT.Material and methods 107 people were examined, including 29 patients with CP (group1), 30 patients with HT (group 2), 28 patients with CP on the associated with HT (group3), 20 almost healthy individuals (AHI) (group 4). The age of the examined patientsranged from 44 to 72 years, the main percentage (53%) was dominated by people ofworking age from 49 to 58 years (mean age - 54.26 ± 1.87). The gender distribution wascomparable across all groups. According to the local ethics committees for biomedicalresearch, guided by Ukrainian health legislation and the 2000 a. declaration of Helsinki,all patients and AHI surveyed gave written informed consent to participate in the study.All patients were hospitalized at the Chernivtsi Regional Clinical Hospital and theChernivtsi Regional Endocrinology Center.The results. According to the results of the study of the lipid profile in all groups of patientsthere were manifestations of dyslipidemia, but they were more pronounced in patientswith combined pathology: total cholesterol increased 36.04% (p <0.05) compared withAHI; 21.37% compared with the group of patients with CP and by 15.06% compared withthe group of patients with CP. The level of triglycerides increased in the group of patientswith CP, associated with HT in 2.2 times compared with AHI group, in comparison ofthe groups of the combined pathology with CP patients and with HT patients it is higher 34.51% and 9.4% (p <0, 05). Patients in all 3 groups had an increase in very low-densitylipoprotein cholesterol compared with AHI, with a tendency to increase in patients inwhom CP was combined with HT.Conclusion. The most pronounced signs of dyslipidemia were found in patients with CPcombined with HT, which confirms the close pathogenetic link between these nosologies- a marker of thyroid insufficiency (increased TSH levels, decreased T4), manifestationsof dyslipidemia, which is a predictor of pancreatic lesions. The study of comorbidity ofthese nosologies is a promising area of clinical gastroenterology and endocrinology. Theresults prove the need for more detailed and in-depth study of the clinical course andinteraction of these diseases, in order to optimize the therapeutic treatment regimens, thatwill allow to avoid the development of complications and disability.

CHALLENGES AND OPPORTUNITIES OF MEDICAL EDUCATION UNDER CONDITIONS OF CORONAVIRUS DISEASE (COVID-19) PANDEMIA

The article analyzes how higher medical education is currently undergoing a gradual butsignificant change to the transformation into online learning adapt accordingly in orderto fulfill the core competencies of medical training and to provide quality education tomedical students during the COVID-19 pandemia.Objective – to study the challenges and opportunities faced by medical schoolsin introduction of the remote learning for basic science teaching in response to theCOVID-19 crisis.Conclusions. Despite the pace of this transition, both formal and informal studentfeedback indicated that students have an extremely high level of satisfaction andengagement with online learning activities. The use of emergent technology (e.g.,artificial intelligence for adaptive learning, virtual simulation, and telehealth) foreducation is most likely to be indispensable components of transformative change andpost-COVID medical education. These measures could then be followed by hands-onexperience that is provided in a safe environment. As physicians begin to use telehealth(phone calls, video visits, and communication over online medical record applications)to communicate with their patients, students should be included (and instructed) in thislearning environment. It is likely that telehealth will persist long after the pandemicrecedes perhaps even as a preferred method of physician-patient interaction in somesituations. Therefore, it is essential that students graduate from medical school welltrained in telehealth including technological aspects as well as learning the mostprofessional models of the physician-patient distance interaction.

EPIDEMIOLOGICAL ASSESSMENT OF DYMAMICS OF THE PREVALENCE AND INCIDENCE OF THE THYROID GLAND DISEASES IN UKRAINE AND CHERNIVTSI REGION

Objective – to assess the dynamics of the prevalence and incidence of the thyroid diseaseamong the adult population of Ukraine and Chernivtsi region during 2015-2020.Material and methods. A comparative analysis of official accounting and reportingstatistics of the Ministry of Health of Ukraine and the main indicators of the endocrinologyservice of Chernivtsi region on the prevalence and incidence of adult pathology of thethyroid gland over the past 5 years.Results. In Ukraine, the number of pathologies of the thyroid gland has increased,accounting for 48% of the total incidence of endocrine diseases. The most commonpathology is diffuse and nodular goitres. Their level in the western region, includingChernivtsi region, is higher than the national average. In Ukraine the incidence ofhypothyroidism has increased 20.3% for 5 years. Thyrotoxicosis increased 9.1%, andthe prevalence of thyroiditis increased 16.8%. The increase in the Chernivtsi region wasslightly lower. The high frequency of thyroid pathologies depends on the imbalance oftrace elements and vitamins in the diet against a background of iodine deficiency in thediet, environmental degradation and insufficient preventive measures.Conclusions. The analysis shows that in the western regions of Ukraine it is necessaryto apply a differentiated approach to the diagnosis, treatment and prevention of patientswith various thyroid diseases.

INFLUENCE OF DIFFERENT LIGHTING REGIMEN ON THE MORPHOMETRIC CHARACTERISTICS OF NEURONS IN THE PARAVENTRICULAR NUCLEI OF THE RAT HYPOTHALAMUS

Paraventricular nuclei (PVN) of the hypothalamus are the autonomic center forcoordination of functions and consists of a number of neuronal populations - sub-nuclei,which differ in structural and functional features and the nature of nerve connectionswith various parts of the nervous and neuroendocrine systems. When studying stressreactions and actions of the stress-limiting factors, it is important to study subpopulationsof PVN neurons of the hypothalamus, synthesizing stress-releasing hormones, whichinitiate stress reactions of the body. One of the main factors that show a pronouncedeffect in the regulation of ACTH secretion is corticotropin-releasing factor (CRF). TheCRF-immunoreactive tracer was found mainly in the medial small-cell subnucleus of theparaventricular nuclei of the rat hypothalamus. Despite deep and comprehensive studiesof the hypothalamus, until now there are no unifed ideas about its individual reactivityand the degree of involvement of these structures into the stress reaction caused by theprolonged change in the lighting regime.Purpose - to fnd out the effect of different illumination regimes on the morphometriccharacteristics of the medial small-cell subnuclei of the paraventricular nuclei of thehypothalamus of mature and old rats.Material and methods. The experiments were conducted on 72 nonlinear white malerats, divided into 6 series of studies, in each of which the biomaterial sampling wascarried out at 14.00 and 02.00 h using morphometric and statistical research methods.Results. Morphometric assessment of the medial small-cell sub-nuclei of theparaventricular nuclei (msPVN) of the hypothalamus of rats revealed the diurnaldynamics of indices. It has been established that in both old and mature rats, theiraverage volume (p <0.05) signifcantly decreases at 2.00 compared to 14.00 undernormal lighting. The nuclear-cytoplasmatic ratio at 02.00 increases in comparison with14.00 respectively.When the animals were kept under constant illumination, more pronounced changesin the structures under study were established. In particular, the volume of neurons inthe msPVN of the hypothalamus decreases both mature and old rats compared withrats under standard illumination and even more in comparison with rats under lightdeprivation. In accordance with this, the NCR also changes. The average number ofneurons on the standard plane of the histological section also decreases in comparisonwith other illumination regimes. It is also necessary to point out that under conditionsof light stimulation in mature rats in msPVN, the average volume of neurons (p <0.05)noticeably decreases at 02:00 in comparison with 14:00, when the volume of theirnuclei does not change on average during the indicated study periods. This is reflected,respectively, in the NCR change, which increases at 02.00 in comparison with 14.00.As to the old rats, the average neuron volume does not decrease at 2.00 in comparisonwith 14.00 in msPVN neurons at light stimulation, as well as the volume of their neucleichanges, on average, is barely noticeable ,and according to it, NCR at 02.00 remainsstable in comparison with 14.00, and the average quantity of neurocytes in msPVN doesnot change on a standard plane of the histological section during various periods ofthe twenty four hours. At the same time, with various modifcations of the light regime,cytometric parameters of neurons under study in old rats, on average, are signifcantlylower (p <0.001) than those in mature rats.Conclusions. 1. The duration of the photoperiod signifcantly affects the 24 hoursactivity of msPVN in the hypothalamus of mature and old rats. In particular, in bothinvestigated groups of rats, the average volume of neurons (p <0.05) reliably decreasesat 2.00 under normal illumination in comparison with 14.00, and, accordingly, the NCR at 02.00 increases compared to 14.00. All cytometric parameters of their neurons in oldrats are, on average, signifcantly lower (p <0.001) than in mature rats.2. Constant illumination causes more pronounced changes in the morphometricparameters of the msPVN of the hypothalamus than light deprivation. Thus, in maturerats in the msPVN, the average volume of neurons (p <0.05) decreases noticeably at02:00 in comparison with 14:00, which is reflected, respectively, in the change in NCR,which increases at 02:00 compared to 14:00. For old rats, under light stimulation, allthe studied cytometric parameters of their neurons, on average, are signifcantly lower(p <0.001) than those in mature rats.

TAXONOMIC COMPOSITION, MICROSCOPIC INDICES OF URINARY TRACT MICROBIOTA IN MEN WITH CALCULUS PYELONEPHRITIS

The aim of the study – to investigate the taxonomic composition, qualitativemicroecological indicators (index of constancy, frequency of occurrence, indices of speciesrichness of Margalef, species diversity of Whittaker and species dominance of Simpsonand Berger-Parker) and the immunosuppressive effect of causative agents of calculouspyelonephritis on the activity of the complement system, lysozyme and inhibition of themain immunoglobulin classes (IgM, IgA).Material and methods. Microbiological (bacteriological and mycological) urineexamination was carried out in 30 men aged 37-65 years (48.81 ± 4.27 years), patientswith calculous pyelonephritis. The ecological method was used to reveal the mechanismsof colonization of the biotope by microbiota. The adhesive properties were studied onnative human erythrocytes of group I (0I). Anti-immunoglobulin activity was studied bythe method described in the work of I.S. Gaidash, etc.Results. Out of 30 samples of the research material, 34 strains of opportunistic gramnegative and gram-positive bacteria were isolated and identifed. The majority (86.67%)had a monoculture of enterobacteria, enterococci, associations consisting of two taxonswere found in 13.33% of patients. It has been shown that 97.06% of isolated and identifedstrains from the urinary tract exhibit adhesive activity of varying degrees of activity. Onestrain of S. saprophyticus also exhibits adhesive activity (the average adhesion index is1.83 ± 0.09), which is considered as a non-adhesive strain. All strains of enterobacteriaand gram-positive cocci that persist on the mucous membrane of the urinary tract ofmen with infectious and inflammatory processes of the urinary tract with calculouspyelonephritis inhibit (P <0.05) immunoglobulins of class A (IgA).Conclusions. The infectious and inflammatory process on the mucous membranes of theurinary tract in men with calculous pyelonephritis is caused by facultative anaerobicgram-negative enterobacteria and gram-positive cocci. The presence of an infectious andinflammatory process is confrmed by an acceleration of the erythrocyte sedimentationrate by 76.67% and other clinical and laboratory studies. Pathogenicity factors arerevealed in isolated and identifed opportunistic taxons, that determine the initial stagesof the infectious and inflammatory process (cytoadhesion and colonization of the urinarytract mucosa), inhibit the functional activity of class A and M of immunoglobulins.

ULTRASTRUCTURAL ORGANIZATION OF NEURONS OF THE LATERAL PREOPTIC NUCLEUS OF THE HYPOTHALAMUS OF OLD RATS UNDER VARIOUS LIGHT CONDITIONS

Purpose – to study the changes in the ultrastructure of neurons of the lateral preopticnucleus (LPON) of the hypothalamus of old rats under various light conditions.Material and methods. The experiments were carried out on 36 old white male rats.The material was fixed in a 2.5% solution of glutaraldehyde, prepared on the basisof phosphate buffer with a pH of 7.2–7.4. Then, postfixation was performed in a 1%solution of osmium tetraoxide and dehydrated in propylene oxide, after which it waspoured into a mixture of epoxy resins. Ultrathin sections made on an ultramicrotomeLKB-3 were contrasted with uranium acetate and lead citrate according to the Reynoldsmethod and studied under electron microscope TEM - 125 K.Results. Studies of LPON neurons under the standard light mode revealed nuclei withuneven contours. The nucleoli are quite large. The neuroplasm contains well-developedtubules of the rough endoplasmic reticulum (ER) and small cisternae of the Golgi complex(GC). Mitochondria are rounded, small, with moderately pronounced cristae. Underconditions of round-the-clock darkness, we have found that the cell nuclei are rounded,less often determined by the nucleoli. In the neuroplasm there are locally dilated tubulesof the ER and cisternae of the GC, mitochondria with enlightened matrix and fragmentedcristae. Under conditions of round-the-clock illumination, the nuclei of the rounded formwith uneven contours of a nuclear membrane forming deep intussusception are revealed.Nucleoli were rarely identified. In the hyaloplasm, locally dilated tubules of the ERare identified. Mitochondria are small in size with an enlightened matrix and reducedcristae.Conclusions. The obtained results of submicroscopic examination of LPON neuronsof the hypothalamus of old rats revealed their relatively increased functional activityin the dark period. Under conditions of round-the-clock lighting, more pronouncedhypertrophic and initial destructive changes of the nuclei and organelles of the neuronsof the LPON of the hypothalamic were revealed, compared with the animals that wereunder the conditions of round-the-clock darkness. This is confirmed by the change in theultrastructure of nerve cells at 2 am the appearance of "dark" cells.

EFFICIENCY OF NORFLOXACIN IN THE PROPHYLAXIS OF HEPATORENAL SYNDROME

Purpose - to evaluate norfloxacin efficacy for the prevention of hepatorenal syndrome(HRS) development in patients with alcoholic liver cirrhosis and concomitant chronicpyelonephritis.Material and methods. In all, 157 patients, divided into two groups depending on themethod of HRS prevention, were examined: group 1 (n = 78) - received placebo; group 2(n = 79) - received norfloxacin. The main endpoint of the study was short-term survival.The probability curves were constructed using the Kaplan – Mayer method.Results. The rate of renal failure was much lower in group 2 (7 vs. 16 patients, p = 0.03).HRS was associated with bacterial infection in 4 patients of group 2 and in 6 patients ofgroup 1. HRS developed during the first 3 months of the follow-up period in 9 patientsin group 1 and only 1 patient in group 2 (p = 0.006). The incidence of HRS developmentduring the first 14 days was significantly lower in group 2. In all, 10 patients died ingroup 2 and 13 in group 1. The main cause of death in both groups was HRS (5 and8 patients, respectively). Mortality during the first 3 months was significantly higherin group 1 (10 vs. 2 patients, p = 0.02). Three-month (group 2 - 94%, group 1 - 62%)and annual survival (60% vs. 48%, respectively, p = 0.05) were significantly higher ingroup 2.Conclusions. Peroral antibiotic prophylaxis with norfloxacin almost 5 times reduces therisk of hepatorenal syndrome development type 1 in patients with alcoholic liver cirrhosisand concomitant chronic pyelonephritis, and increases their short-term survival.

DISORDER OF SPERMATOGENESIS UNDER CONDITIONS OF EXPERIMENTAL CHRONIC KIDNEY DISEASE

Purpose - to estimate the disorder of spermatogenesis under conditions of experimentalchronic kidney disease (EChD).Material and methods. The study was carried out in two series of experiments on malemice with EChD, the model of which was created by immunizing animals with a kidneyhomogenate. The first series of experiments was devoted to the study of: sperm count(sperm concentration (mln / ml)) and the number of abnormal sperm forms; the ratio ofcells of different generations of spermatogenic epithelium (%) in the testes; pathways ofcell death of cells of the testes and epididymis (spermatocytes (primary) and spermatozoa).The fertile qualities of males were assessed in the second series of experiments, afterreplanting them to intact females. Pre- and post-implantation embryonic mortality andthe number of living fetuses per female mouse have been investigated. The research resultswere compared with the performance of animals in the control groups for each series.Results. No significant changes in the number of spermatozoa were found under EChDconditions (p> 0.05). An increase in the number of abnormal spermatozoa (22%) andthose with primary abnormalities (p <0.05) was found. Among the generations of testescells, a decrease in the number of spermatids and living spermatocytes (primary) (15%)was established, with an increase in the number of cells with apoptosis and necrosisamong them (p <0.05). The number of living cells of the epididymis (spermatozoa) alsodecreased (17.8%), with the growth of cells with apoptosis and necrosis among them (p<0.05). There was an increase in the pre- and post-implantation mortality of embryos (p<0.05); decrease in the number of living fetuses (p <0.05).Conclusions. Under conditions of four-time treatment with renal homogenate (EChD)there is a disorder of spermatogenesis in male mice. Experimental model of kidneydamage, proposed by us, can be useful for studying other aspects and consequences ofkidney pathology, and both for establishment of the features and detection of possiblepathogenetic links in the development of spermatogenesis disorder under conditions ofchronic kidney disease and search of the effective ways to correct it in future.