Asymmetric dimethylarginine – a marker of repeated cardiovascular events in patients with comorbid pathology

Annotation. Today, diseases of the cardiovascular system retain their leading position among the incidence in the world. The presence of comorbid pathology in the form of type 2 diabetes mellitus (DM) significantly complicates the course of these diseases, worsening its prognosis. The aim of the study: to analyze the prognostic value of asymmetric dimethylarginine (ADMA) as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes for 6 months of follow-up. 120 patients were examined: group 1 – patients with acute myocardial infarction (AMI) in combination with type 2 diabetes mellitus (n=70), group 2 - patients with isolated AMI (n=50). The control group included 20 practically healthy individuals. All patients underwent general clinical and instrumental examinations, on the first day of AMI the level of ADMA was determined using a commercial test system "Human Asymmetrical Dimethylarginine ELISA". Statistical processing of the obtained data was performed using the software package StatSoft Inc, USA – "Statistica 6.0". The analysis of the average level of ADMA showed a significantly higher value of this indicator in patients with AMI in combination with type 2 DM than in patients without concomitant type 2 DM 2.57 times (1.57±0.11 μmol / l and 0.61±0.06 μmol / l, respectively), (p<0,05. ADMA level >1,72 μmol / l in patients with AMI in combination with type 2 DM and >0,69 μmol / l in patients with AMI without concomitant type 2 DM was identified as a predictor of recurrent acute myocardial infarction within 6 months of follow-up. Thus, the level of ADMA was higher in the presence of comorbid pathology in the form of type 2 DM in patients with AMI, reflecting endothelial dysfunction combining disease. It is advisable to further study this indicator of endothelial dysfunction as a predictor of the adverse course of AMI in combination with concomitant type 2 DM.

History of the development of surgical science (based on publications from the fund of rare books and manuscripts

Annotation. The article provides information about publications from the fund of rare and valuable publications of the Scientific Library of VNMU. MI Pirogov, which reflect the development of surgery in the XIX - early XX centuries.

Diagnostic and prognostic value of psoas muscle thickness and area in patients with liver cirrhosis and sarcopenia

Annotation. Sarcopenia is a typical complication of liver cirrhosis (LC) and is associated with a poor prognosis. The skeletal muscle index is the most studied radiological marker of sarcopenia, but it’s using requires the qualification of a radiologist, specialized software, time reserve. The aim of the study: to investigate the relationship between different radiological markers of skeletal muscle mass, to determine their reference ranges for Ukrainian population and to assess their diagnostic and prognostic value in patients with LC. The study involved 216 healthy people and 147 patients with LC. During 18 months of follow-up 45 patients died from LC complications. Skeletal muscles were assessed by computed tomography. Skeletal muscle index (SMI), psoas muscle index (PMI), and transverse psoas muscle thickness (TPMT) at L3 were determined. Statistical data processing was performed in SPSS22. Diagnostic and prognostic value of SMI, PMI, TPMT were studied in ROC analysis. It was found that in Ukrainian population the reference ranges of SMI are >52.2 / 39.3 cm2/m2, PMI>6. 44 / 3.49 cm2/m2, TPMT>11.1 / 7.42 mm/m, in men / women, respectively. Sarcopenia was diagnosed in 54.9% and 86.3% of LC class B and C patients. PMI and TPMT had a high diagnostic value in sarcopenia detection (SMI≤52.2 and ≤39.3 cm2/m2) in male and female LC patients (AUC PMI 0.899 and 0.955, p˂0.001, AUC TPMT 0.884 and 0.942, p˂0.001). SMI, PMI and TPMT predicted one-and-a-half-year mortality in male and female LC patients (AUC SMI 0.815 and 0.786, p<0.001; AUC PMI 0.745 and 0.804, p<0.001; AUC TPMT 0.752 and 0.871, p<0.001). The optimal cut-off values for predicting death in male and female are: SMI≤49.1 and ≤38.4 cm2/m2; PMI≤5.99 and ≤3.30 cm2/m2; TPMT≤11.0 and ≤6.70 mm/m. Thus, routine assessment of PMI and TPMT in LC can identify patients with sarcopenia and high risk of complications.

Peculiarities of expression indicators and accentuated personality traits in men with psoriasis without taking into account somatotype and in representatives of meso- and endo-mesomorphic somatotypes

Annotation. Exacerbation and aggravation of psoriasis increases the chances of neurosis, depression, can significantly impair mental health through social stigma and leads to social isolation and maladaptation, a significant reduction in quality of life. Studying this problem from the standpoint of comparative assessment of the distribution of character accentuations in patients with different dermatoses can provide insight into how a certain level of adequacy of psychological adaptive response is associated with organic pathological process or genetically existing expression of certain traits. The aim of the study was to found the features of indicators of expression and features of accentuated personality traits in men with psoriasis without taking into account somatotype and in representatives of meso- and endo-mesomorphic somatotypes. Men aged 22 to 35 years, patients with psoriasis (n=100, including 32 with mild and 68 with severe course) at the Department of Skin and Venereal Diseases with a course of postgraduate education National Pirogov Memorial Medical University, Vinnytsya and Military Medical Clinical Center of the Central Region, conducted an anthropometric survey by V. V. Bunak Estimation of the expression and features of accentuated personality traits made according to G. Shmishek The reliability of the difference between the values between the independent quantitative values was determined using the U-Mann-Whitney test. In healthy subjects, taking into account and without taking into account the somatotype, it is seen that the type of physique did not significantly affect the severity of individual traits and their combinations in this group of people. With the increase in the course of psoriasis among subjects without somatotype, there is a decrease in the percentage of persons with hyperthymic and demonstrative and an increase – with emotional, pedantic, anxious, cyclothymic, excitable, dysthymic and exalted type of character accentuation; among patients of mesomorphic somatotype there is a decrease in the percentage of people with stuck and demonstrative and an increase – with emotional, pedantic, anxious, cyclothymic, excitable, dysthymic and exalted type of character accentuation; among patients of endo-mesomorphic somatotype there is a decrease in the percentage of people with hypertension and an increase – with stuck, demonstrative and excitable type of character accentuation. All this maintains a pathologically high level of affective tension, which disrupts the autonomic balance in the body, can be a pathogenic factor in the development of psychosomatic illness and leads to ineffective treatment of psoriasis.

Immediate and long-term results of retropubic prostatectomy and simultaneous preperitoneal hernia repair in patients with benign prostatic hyperplasia and inguinal hernia

Annotation. The aim of the study was to evaluate the immediate and long-term results of valvular prostatectomy and simultaneous peritoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia and assess the quality of life of patients. The article presents the treatment results of 152 patients with benign prostatic hyperplasia. All individuals were divided into two groups. The general group consisted of 32 (21.1%) patients with benign prostatic hyperplasia and inguinal hernia, who underwent one-stage retropubic prostatectomy and simultaneous preperitoneal hernia repair. The comparison group consisted of 120 (78.9%) patients with benign prostatic hyperplasia who underwent only a one-stage retropubic prostatectomy. Assessment of the life quality of patients after simultaneous preperitoneal inguinal hernia repair was performed according to the EuraHS - Quality of Life scale in 6 and 12 months after surgery. The obtained quantitative data were processed by the variation statistic methods with the calculation of t-Student criteria. The data were considered reliable at a significance level of 0.95 (p<0.05). The average age of men in the comparison group was 68.0±7.2 years, in the general group – 67.1±6.9 years; the average prostate volume in the comparison group was 94.4±42.3 cm3, in the general group – 91.2±32.6 cm3; 44 (36.7%) patients of the comparison group and 4 (12.5%) patients of the general group were admitted to the department urgently (due to acute urinary retention or chronic complete urinary retention). The inguinal hernia was found in all 32 patients of the general group, among them in 4 men – on both sides. The average time of ciliary prostatectomy in the general group and in the comparison group was the same (82.8±25.6 and 80.1±17.4 minutes). The simultaneous inguinal hernia repair on the one side lasted 55.0±17.4 minutes. Neurological complications in the general group were noted in 2 (6.25%) patients, in the comparison group – in 9 (7.5%); urological complications took place in 11 (34.2%) and 40 (33.3%), respectively. The average postoperative inpatient stay in the general group was 9.5±1.7; in the comparison group – 9.8±2.9. It was statistically better due to these periods after surgery when compared with preoperative life quality.

Secondary neurogenic prosopalgia in a neurological clinic

Annotation. Prosoplgia is one of the most common pain syndromes in the craniofacial area. In the clinic practice of the facial pain treatment, neurogenic prosopalgia accounts for 25-30% of cases. The aim of the study was to evaluate the clinical, laboratory and functional parameters of patients with secondary neurogenic prosopalgia at neurological department. The medical histories of 21 patients (17 (81.0%) women and 4 (19.0%) men) suffered from secondary neurogenic prosopalgia were analyzed retrospectively. The clinical picture, data of general blood and urine tests, biochemical blood tests, neuroimaging, electrophysiological and ultrasonic research methods were evaluated. A preliminary comparison of retrospective patients quality indicators was assessed using simple mathematical methods. A predominant lesion of the I branch of the trigeminal nerve was shown in elderly women with postherpetic neuralgia, while other reasons of secondary neuralgia of the II and III branches of the trigeminal nerve more often caused left-sided lesions. Primary diseases included: herpetic ganglionitis, malignant tumor of the bladder with herpetic complications, sinusitis, dental diseases, meningoencephalitis, atherosclerosis of the brain vessels, concussion of the brain. The features of the clinical picture of each case were evaluated, as well as the characteristic concomitant groups of symptoms, among which were determined cephalgic, asthenoneurotic, vestibulo-atactic, vegetative dystonia, pyramidal syndromes. Among the general and functional studies carries out, attention was drawn to the increase of ESR in almost half of the patients, even without exacerbation of the primary disease, as well as the presence of metabolic disorders in the myocardium according to the electrocardiogram in 47.6% of cases, including in relatively young individuals. Thus, the problem of secondary neurogenic prosopalgia, despite the modern treatment, remains relevant.

Influence of VDR gene polymorphisms on the development and course of breast cancer

Annotation. Breast cancer is the most common cancer diagnosed in women. In the last 5 years, it has been diagnosed in 7.8 million women, and in 2020, 685,000 deaths from breast cancer were registered. The growing number of patients with this pathology and the cost of therapy creates a need to study new methods of diagnosis and treatment. Therefore, detailed attention is paid to genetic risk factors for cancer, in particular, the VDR gene and its polymorphisms ApaI, TaqI, BsmI and FokI. Therefore, the purpose of this review is to collect and analyze currently known information about these SNPs and their relationship to the development, course and effectiveness of breast cancer treatment. To do this, an extensive literature review was conducted using basic databases, which described the effect of vitamin D3 on the tumor process and found that VDR receptor dysfunction increases the risk of breast cancer and affects the sensitivity of patients to treatment, which proves the effect of polymorphisms. ApaI, TaqI, BsmI and FokI on the development of pathology. Therefore, the prospects for further research are to study the prognostic value of each polymorphism and develop new treatments for the disease.

Osteoporotic changes in bone and cartilaginous tissue in women with ovarian hypofunction

Annotation. Osteoporosis is the most common disease of the musculoskeletal system, which ranks 4th in the world as a cause of disability and mortality among non-communicable diseases. This is a polyetiological systemic disease of bone tissue, characterized by a decrease in bone mass and deterioration of bone structure and increased fragility. This problem has not only a medical aspect, but also important socio-economic significance in all countries of the world due to the high cost of treatment of such patients and high disability. The aim of the work is to study and analyze the scientific literature and give a generalized description of etiological factors, pathogenesis, primary and secondary methods of prevention of osteoporosis in women with ovarian hypofunction in the pre- and menopausal periods. An analysis of recent research and publications on the problem of osteoporosis and changes in the skeletal system. The main risk factors, etiology and pathogenesis of osteoporosis in the pre- and menopausal period of a woman's life are determined, the main methods of prevention of osteoporosis are described. The most common form of primary osteoporosis is postmenopausal osteoporosis, the trigger of which is hypogonadal states, estrogen deficiency, which causes a sharp acceleration of bone loss. I guarantee healthy bone tissue and prevention of osteopenia and osteoporosis are: accumulation of bone mass in the first 30 years, mechanical stress contributes to the restructuring and remodeling of bone tissue throughout life, timely and early compensation of hypogonadal conditions, improvement of blood flow, improvement of blood flow stability of mineral metabolism and hormonal background. Not all women with hypogonadal condition develop osteoporosis, so studying the use of methods to prevent osteopenia and strengthen bone tissue from a young age is the basis of quality life of modern women at any time in her life in the XXI century, so it needs further study.

Analysis of a modular approach in the formation of medical rapid response units at level II medical care of NATO Allies

Annotation. The article highlights the current state of the structural construction of level 2 rapid response units for the medical service of the NATO Alliance. The relevance of this analysis is due to the fact that Ukraine's active course in cooperation with NATO allies requires the creation of a different model for the construction of medical forces units to create compliance. The non-compliance of these units prevents the possible use of the Medical Forces of the Armed Forces of Ukraine within NATO allies. Today, there is an urgent need to analyze the modern construction of NATO Alliance medical units and further reform the medical units of the 20th level of medical care of the Armed Forces of Ukraine. The purpose of this study was to analyze the medical support of NATO allies and a modular approach to the creation of medical units at the second level of medical care by forming separate functional components – medical modules. The analysis of medical rapid response units of level 2 medical care of NATO allies and their components is carried out. It was established that the use of a modular approach to the formation of medical rapid response units at the second level of medical care provides an opportunity to form the structure of the unit depending on the operational situation and the needs for medical care. It should also be noted that the "flexible" formation of the structure of the medical unit allows rational use of human resources and property in conditions of armed conflict.

Necessary diagnostic criteria of dental crowding in children during mixed dentition with different facial skeleton growth patterns

Annotation. Pathology of dental crowding during mixed dentition is one of the most common and difficult in the practice of dentist-orthodontist. Its prevalence, according to modern scientific data reaches 77% and occurs in all pathologies of occlusion (malocclusions). The aim of our study is to establish the relationship between the formation of dental crowding and the growth patterns of facial skeleton during mixed dentition in order to improve the effectiveness of orthodontic treatment. We used 42 pairs of plaster models and 42 slices of cone-beam computed tomography images (CBCT) for patients aged 7 to 11 years. Randomization of patients into study groups was performed according to the facial skeleton growth patterns and the Little index value. The analysis was performed by the method of variation statistics taking into account the mean values (mode, median, arithmetic mean) and mean error (M) with the assessment of reliable values by Student’s t-test, as well as determining the correlation coefficient using the Pearson pairwise method to detect connections between the obtained indicators at the minimum probability threshold p<0.05 using the statistical package EZR v. 1.35. According to the results of the examined patients: 30 people (71.4%) had a severe degree of dental crowding on both maxilla and mandible (LII> 8 mm.), more often it was associated with the neutral type of growth – 82% (with vertical – 60%). Statistically significant correlations were found between severe degree of dental crowding and vertical and neutral facial skeleton growth patterns (p<0.05). The results of the CBCT study showed that narrowing of the upper pharyngeal airway (UP) according to McNamara was more common in patients with neutral (85%) and vertical (80%) growth patterns with skeletal II and I class malocclusions according to Engle, which were 55% and 35%, respectively. The study revealed that the vast majority of children with dental crowding with different facial skeleton growth patterns had clinically significant disorders of the development of both maxillary and mandibular apical bases and airways which required immediate interceptive orthodontic treatment.