PLASMA CONCENTRATION OF ENDOTHELIN-1 IN PATIENTS WITH HYPERTENSION ASSOCIATED WITH OBESITY, DEPENDING ON THE LYS198ASN POLYMORPHISM OF THE ENDOTHELIN-1 GENE

Endothelial dysfunction is considered one of the main mechanisms for the further development of arterial hypertension (AH) and its complications, and endothelin-1 (ЕТ-1) plays one of the key roles in this process. Endothelium is drawn into the pathological process at the earliest stages of AH development. ЕТ-1 is currently considered as a marker and predictor of the stage and consequences of AH, chronic heart failure (CHF), coronary heart disease (CHD), in particularly, acute myocardial infarction (MI), heart rhythm disorders, pulmonary hypertension, atherosclerotic vascular injury, target vascular disorders. One factor that may influence the level of ЕТ-1 is the endothelin-1 gene Lys198Asn polymorphism, which is considered by many researchers as a possible genetic marker of AH. However, the effect of this polymorphism on the level of plasma ЕТ-1 level in patients with AH of varying severity in Ukraine is understudied. The basis of this work were the materials of a complete examination of 160 patients with a verified diagnosis of AH I, stage II of 1, 2, 3 degrees (main group) and 110 apparently healthy persons (control group). Patients of the main group were divided into three subgroups: 1st group ­– 75 patients with normal body weight; 2nd group – 48 overweight patients; 3rd group – 37 patients with alimentary obesity. In obese patients, the waist circumference in women was around 103 (96–115) cm, and in men – 108 (105–116) cm, which indicates an abdominal type of obesity in these patients. As a result of the study, it was found that the level of ЕТ-1 is higher in patients with AH who suffer with overweight and obesity as compared with patients with AH and normal body weight. Also, the peptide level depends on the genotype of patients and is higher in AH patients with the genotype Asn198Asn and Lys198Asn as compared to carriers of the genotype Lys198Lys.

Modern features of the epidemic process of viral infections with aerosol transmission in Sumy oblast

Viral infections with aerosol transmission are one of the most common infectious diseases in the world. Their relevance is due to the wide distribution and socio-medical consequences. To study the dynamics of the incidence of viral infections with aerosol transmission in Sumy Oblast, to determine the level of influence of social and natural factors on the intensity of the epidemic process. Data from the sectoral statistical reporting of the Ministry of Health of Ukraine, Sumy Regional Laboratory Center, the Main Department of Statistics in Sumy Oblast, Sumy Regional Center of Hydrometeorology were used. Epidemiological and statistical research methods were used. It was established that in Sumy Oblast the epidemic process of aerosol viral infections was characterized by a pronounced tendency to reduced incidence of influenza (Rinc.aver.= -6.2 %) and rubella (Rinc.aver.= -22.7 %), moderate reduction tendency ‒ to mumps (Rinc.aver = -2.4 %); high intensity with no reduction in incidence ‒ for other acute respiratory diseases (Rinc.aver = 0.2 %); a sharp increase in the incidence of measles (Rinc.aver.= 23.1 %). Coronavirus infection caused by SARS-CoV-2 was found in 3% of the population. The average long-term rates of measles, rubella, and mumps vaccinations with MPR-1 and MPR-2 vaccines were 70.9 % and 61.2 %, respectively. An inverse correlation was established between air humidity, population, coefficients of natural and migratory movement and measles incidence (p<0.05). The system of epidemiological surveillance of infections of viral etiology with aerosol transmission requires new approaches to the development of preventive measures.

The safest method of inducing labour with misoprostol

Prolong pregnancy cause is unknown; some risk factors like obesity and the previous history has been outlined. The risk for bad outcomes increases with the increase in the time of delivery. Intrauterine fetal death, meconium aspiration, fetal distress, oligohydramnios increased rate of caesarian section are among the complications. Timely delivery with accurate dose of Misoprostol can reduce the bad outcomes. Misoprostol is a prostaglandin, not expensive and easy to store but with different side effect once wrongly administered. It is not indicated for obstetrics and gynecology in some countries but currently it is widely used for induction of labour. To assess the effect of Oral miso juice and its outcomes for labour induction in postterm cases and in premature rupture of membrane (PROM) at term. Search of registered documented files of clients at Kivulini Maternity Center for the year 2020. Out of 2399 deliveries per year, 67 received oral miso juice due to postterm and PROM. 61 participants aged 17 to 34 years and 6 females were above 35 years of age. 44 (65.7%) started active phase of labour within 24 hours and delivered. 16 (23.9 %) delivered after 24 hours of oral miso juice administration. 7 (10.4%) took more than 48 hours and delivered safely. 57 (85%) of those who received oral miso juice had SVD and 10 (15%) underwent emergency caesarian section due to a complication of Misoprostol as well since the drug can course fetal distress, meconium stained and other complications. 66 (98.5%) of all deliveries had Apgar score of >7 in the 1st minute, while 1 (1.5%) had Apgar of <7. Out of all deliveries, only 1 (1.5%) underwent caesarian section reason being non reassuring fetal status (NRFS). Out of all deliveries, 14 (20%) were accompanied by perineum tear of I&II degree and in 14 (20%) cases episiotomy was applied. The weight of the babies delivered after miso juice was distributed as follows: 2.5 to 3.5 kg – 54 cases and 3.6 to 4.5kg – 13 cases. No babies were delivered with weight above 4.5 kg. Among them, 33 (49%) were male babies and 34 (51%) were female babies. Oral miso juice is effective to achieve a safe spontaneous vaginal delivery. It is more effective than other method of induction of labour especially in developing country and in facility with limited human resources. It is possible to say that oral miso juice is the optimal regimen with less risk once in a right dose.

ANTIULCEROGENIC EFFECT OF CRYOPRESERVED PLACENTA EXTRACT AND THE EFFECT OF LOW TEMPERATURES ON THE DIGESTIVE TRACT INJURED BY DICLOFENAC SODIUM IN THE EXPERIMENT

Today, the ulcerogenic effect of nonsteroidal anti-inflammatory drugs is a key factor that significantly limits their clinical use and is a serious medical and social problem, as these drugs are among the most commonly used drugs – they are used annually by about 5­–7% of the world's population. The aim is to characterize the antiulcerogenic effect of cryopreserved placenta extract and its application against the background of low temperatures in the model of diclofenac sodium-induced ulcerogenesis in rats according to macroscopic studies of the proximal and distal digestive tract. The study was performed on 42 male rats weighing 200–220 g. Acute diclofenac sodium-induced gastrointestinal damage was replicated by a single intragastric administration of diclofenac sodium to rats at a dose of 50 mg/kg. Euthanasia of animals was performed after 24 hours. The condition of the mucous membrane of the digestive tract was assessed on a scale and calculated integrated indicators – ulcer index and antiulcer activity. Cryocell-cryoextract of placenta was administered to rats intramuscularly at a dose of 0.16 ml/kg body weight. Cryoirrigation was performed once by local injection of liquid nitrogen vapor (temperature – 120˚C) for 10 s. It was found that diclofenac sodium at a dose of 50 mg/kg led to erosive-ulcerative damage to the gastric mucosa in 100% of rats, and the ulcer index was 3.9. The most pronounced leveling of the ulcerogenic effect of diclofenac sodium was observed against the combined preventive use of placental cryoextract and low temperature effect – the ulcer index was 12.6 times lower than that of rats with diclofenac sodium-induced ulcerogenesis without correction. Macroscopic evaluation of the distal gastrointestinal tract showed that the introduction of diclofenac sodium led to a statistically significant (p < 0.05) lesion of the mucous membrane of the small and large intestine in 42.9% of rats. According to the magnitude of antiulcer effect (%) in the model of diclofenac sodium-induced ulcerogenesis, the investigated prophylactic approaches for antiulcer activity have the following priority: action of low temperatures + cryoextract of placenta (96.7%) > cryoextract of placenta (92.1%) ~ esomeprazole (88.2%) > action of low temperatures (72.1%). No lesions of both the small and large intestine on the background of the introduction of placental cryoextract in the model of diclofenac sodium-associated ulcerogenesis were detected.

THE RELATIONSHIP BETWEEN DECREASED COGNITIVE FUNCTIONS AND THE LEVEL OF PROINFLAMMATORY CYTOKINES IN PATIENTS WITH ALZHEIMER’S DISEASE, VASCULAR DEMENTIA, AND MILD COGNITIVE DISORDER

Alzheimer's disease (AD) is a degenerative disease that leads to dementia symptoms [1, 2]. Histopathological signs of AD are amyloid plaques in the brain, mainly consisting of fibrillary forms of amyloid β-peptide-40 (Aβ-40) and amyloid β-peptide-42 (Aβ-42). Neutrophils are the main targets for IL-17 in the central nervous system (CNS) that promote inflammation and damage to CNS tissues, and may play an important role in the development of AD pathology. Interleukin 23 (IL‑23) synergizes with IL-6, IL-1 and is involved in the differentiation of Th17 cells in a pro-inflammatory context. The aim of the study was to analyze the relationship between interleukin levels of IL-17, IL-23 and neurocognitive scales in patients with AD, vascular dementia (VD) and mild cognitive disorder (MCD). The study involved 89 patients, of which 59 patients had cognitive impairment (32 men and 27 women, mean age 66.8±8.4 years); among them, 29 had major neurocognitive impairment (NCD), including 15 patients with AD, 14 – with VD, 30 patients – with MCD and 30 people in the control group had no cognitive deficit. All patients were tested with comprehensive neuropsychological examination using the following tests and scales: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Alzheimer Disease Assessment Scale-cognitive (ADAScog). Serum levels of cytokines of IL-17 and IL-23 were assayed using sandwich ELISA on «Chem Well 2900» immunoanalyzer (Awareness Technology, USA). Test systems using Bender Medsystems, Australia (IL-17 and IL-23) were used in accordance with the manufactures instructions. Levels of detectable interleukins (IL-17 and IL-23) were significantly higher in patients with AD vs. patients with VD and MCD. The correlations between the two cytokines and the MMSE scales, MoCA, ADAS-cog and FAB were examined. Our results showed a significant positive correlation between the serum concentration of IL-23 and neurocognitive scales in all patients with AD. The most relevant correlations in the AD group were linked with the scales: ADAS-cog (r = 0.760; р = 0.001), namely with the sections «tasks for repeating words» (r = 0.775; p ˂ 0.001), «constructive praxis» (r = 0.651; p = 0.010), «orientation» (r = 0.684; p = 0.01), as well as «word recognition tasks» (r = 0.616; p = 0.020); and with MoCA scale (r = −0.592; p = 0.020), namely with the section «delayed recall» (r = −0.641; p = 0.010). A significant positive correlation was established between IL-23 and individual sections of the ADAS-cog scale in patients with MCD (r = 0.423; p = 0.020), namely with «word recognition tasks» (r = 0.466; p = 0.030), «understanding» (r = 0.306; p = 0.059) as well as «strike out numbers» (r = 0.301; p = 0.061). A weak positive correlation was found between the serum concentration of IL-23 and ADAS-cog scores in patients with VD (r = 0.497; p = 0.045). Moderate positive correlation was observed for IL-23 with «concentration and distraction» (r = 0.558; p = 0.040). An inverse correlation was established between the serum levels of IL-23 and MoCA scores in patients with VD (r = −0.510; р = 0.060), especially with «language» (r = −0.538; p = 0.047) and «executive functioning» (r = −0.485; p = 0.079). However, no other significant correlations were found between the serum concentration of IL-17 and neurocognitive domains in patients with MCD and VD. Correlation analysis confirmed the relationship between the severity of cognitive impairment and the level of proinflammatory markers, suggesting that inflammation can lead to cognitive decline in AD patients. The results of the study indicated that IL-23 may have a more complex relationship with the progression of this disease which gives reason to consider IL-23 as a marker of inflammatory activity. Levels of detectable proinflammatory cytokines (IL-17 and IL-23) were significantly higher in patients with AD vs. patients with VD and MCD. Such more pronounced changes in the production of interleukin 23 in patients with AD may indicate the activity of the inflammatory process. The level of IL-23 in all examined patients with Alzheimer's disease had high correlations with indicators of neurocognitive scales, which indicated its important role in the pathogenesis of this disease. There were no other significant correlations between the serum concentration of IL-17 and neurocognitive domains in patients with MCD and VD.

INFLUENCE OF ANTITUMOR CHEMOTHERAPEUTICS ON THE STRUCTURE AND PHOSPHORUS-CALCIUM METABOLISM OF INJURED LONG TUBULAR SKELETAL BONES

The high frequency of fractures in cancer patients is due to a decrease in bone strength which is associated with bone metabolism disorders such as osteoporosis, metastatic bone disease, and pathological fractures. Anticancer chemotherapy is prescribed for long-term periods and affects bone metabolism, in particular mineralization of bony tissue. To study the structure and macronutrient composition of long tubular bones in rats under the influence of antitumor chemotherapeutics. The study involved 96 white laboratory 7 month-old male rats weighing 230 ± 10 g that were cut by a ball-shaped dental burr to obtain a 2 mm diameter perforation defect to the medullary cavity in the middle third of the femoral shaft. The animals were divided into the control (n = 24) and three experimental groups (Group I, II, and III, n = 72), which were given intraperitoneal antitumor chemotherapeutics after the cut procedure: Group I (n = 24) – doxorubicin (60 mg/m²), Group II (n = 24) – 5-fluorouracil (600 mg/m²), Group III (n = 24) – methotrexate (40 mg/m²). The therapy was repeated every 21 days throughout the experiment. On the 15th, 30th, 45th, and 60th day after the injury, the animals were sacrificed with subsequent removal of the injured long tubular bones. The samples were studied using scanning electron microscopy and X-ray energy dispersive spectroscopy. Statistical analysis of the obtained digital values was performed with the help of MX Excel XP statistical computer program using the Student's t‑test. The difference was considered significant at p ˂ 0.05. Antitumor chemotherapy slows down the formation of bone regenerate in the area of the defect and causes disorders of phosphorus-calcium metabolism in the injured bone. This is manifested by a decrease in the intensity of newly formed organic matrix mineralization in the area of the defect and a decrease in the level of calcium and phosphorus in the native bone and on its border with the regenerate. Doxorubicin and methotrexate provide the most negative impact on mineralization process among antitumor chemotherapeutic agents. The use of antitumor chemotherapeutic agents – doxorubicin, 5-fluorouracil and methotrexate – slows down the processes of reparative regeneration at all stages of recovery after injury and reduces the phosphorus-calcium metabolism of injured long tubular bones.

USE OF THERAPEUTIC EXERCISES FOR POST-STROKE CORRECTION OF SWALLOWING

Dysphagia (Greek. Dys + phagein ­­– eat, swallow) ­– is a violation of swallowing, in which there is a feeling of discomfort or difficulty in transporting the food bolus from the mouth to the stomach. Because the disorder of the act of swallowing in stroke is usually of neurogenic origin and is defined by a number of neurologic disturbances and dysfunctions, it is better to use the term "neurogenic dysphagia" for patients with acute disturbance of cerebral circulation. The urgency of this problem is especially emphasized in the development of a set of therapeutic exercises for such socially important disease as acute cerebrovascular accident. One of the formidable complications of stroke is a violation of the act of swallowing. This leads to a significant reduction in quality of life increasing the risk of secondary complications, which, in turn, significantly increases the likelihood of death. Violation of the act of swallowing is observed in 26–45% of patients due to acute ischemic stroke. Dysphagia leads to the development of life-threatening complications such as aspiration pneumonia, dehydration, and significantly reduces the quality of life of such patients. Thus, the correction of the act of swallowing by means of physical rehabilitation after brain injury is a very important task of the rehabilitologist. For a long time, speech therapy was the only method of rehabilitation of dysphagia; now we can widely use therapeutic exercises to restore the functions of facial muscles and masticatory muscles. Screening for swallowing disorders allows us to assess the function of the masticatory muscles in five stages, which makes it possible to develop a more individual and thorough set of therapeutic exercises after each stage of the screening study. Depending on the phase of swallowing in which disorders are observed, we have developed an individual set of therapeutic exercises that will be performed by the patient in each of the five stages of the screening study, if the patient could not overcome this stage.

CLINICAL FEATURES OF THE COURSE AND ASSESSMENT OF TREATMENT STRATEGY IN CHILDREN WITH BRONCHITIS

Respiratory diseases always account for a significant proportion of visits to the pediatrician or family doctor, and bronchitis is usually a frequent clinical manifestation of acute respiratory diseases. The doctor often faces the question of how to objectively assess the clinical picture of bronchitis, and now the assessment of respiratory symptoms is often based on criteria such as cough, shortness of breath or wheezing on auscultation. However, today there are practically no data on the severity of bronchitis in children depending on the above criteria. A cohort of 158 children with bronchitis was created at the pulmonology and allergology Department of the Municipal Medical Institution "Regional Children's Clinical Hospital" in Chernivtsi. The severity of bronchitis was assessed at the beginning and on the 3rd and 7th day of inpatient using the Bronchitis Severity Score (BSS). According to this scale, mild bronchitis was verified in 30 patients which formed the I clinical group, and 128 children had moderate bronchitis (II clinical comparison group). Aggressive inflammation of the bronchi in children with moderate inflammation of the bronchial tree compared with patients with mild bronchitis was accompanied 1.6 times more often by recurrence, a history of episodes of community-acquired pneumonia in 9.4% of patients, long-term inpatient treatment (odds ratio 2.6) and halving the duration of the outpatient treatment period. The study of clinical severity of bronchitis in children of the comparison groups made it possible to establish an increase in the chances of a more severe course of the disease on the 7th day of hospitalization in children with moderate bronchitis (odds ratio 4.8) with persistence of cough in 68.7% of children in this group (odds ratio 3.8). Evaluation of inpatient treatment tactics indicated the need to increase the volume of complex therapy in patients with moderate bronchitis relative to children with mild disease (odds ratio 12.0, relative risk 8.8), as well as increasing the risk of the need for antibacterial therapy (odds ratio 3.7, relative risk 2.8) and the appointment of intravenous antibiotics for more than 3 days (odds ratio 5.0, relative risk 1.1).

ANTIDIABETIC EFFECTS OF MEDICINAL PLANTS

Diabetes is a chronic disorder that is characterized by an increase in blood glucose (hyperglycemia) with alteration of protein, carbohydrates, and fat metabolism. Consequently, it can lead to renal failure, atherosclerosis, nerve damage, blindness, and coronary heart disease. It is also known as the 5th leading cause of death. Although, there are numerous types of glucose-lowering drugs that exhibit anti-diabetic effects but results of treatment in patients are still not so perfect. Therefore, many treatments that include the use of medicinal plants are suggested and encouraged. Medical plants are believed to contain chemical substances with potential curative effects and can often have anti-diabetic effects. This study introduced about 23 effective medicinal plants reported by various experimental researchers with the curative potential to treat diabetes. Although, most of the research used animal models, there is a clear indication that medicinal plants with anti-diabetic potentials are being investigated by several researchers. However, there is a need for further research to be conducted with isolated bioactive ingredients present in these plants in order to have potential ingredients that could be used as a pharmacological agent in the treatment of diabetes mellitus with fewer adverse effects. Again, the mechanisms of action of these medicinal plants in ameliorating diabetes need to be investigated.

Hypervetilation syndrome as a risk factor of diastolic dysfunction among hypertension patients

Hypertensive disease is one of the urgent problems in the modern cardiology. It is known that a huge variety of comorbid states influence the development of hypertensive disease, i. e. neurogenic hyperventilating syndrome. It is the sign and the marker of suprasegmental vegetative structures disorders that destabilize homeostasis, initiate the development of specific pathological processes, which are the base of somatization of hyperventilating disorders, including heart disorders. It led to research of structural and functional characteristics of the ventricles with the help of echocardiology among hypertensive patients with neurogenic hyperventilating syndrome. Ventricular dilation of cavities, mostly of the right one without thickening of the walls, was found in the patients with stage 1 hypertension disease (43.59 %). Dilation of the ventricular cavities was also revealed in hypertensive patients with stage 2 hypertension disease in 37.88% of cases. The next variations of remodeling were registered: concentric – in 10.61% of cases; concentric hypertrophy – in 22.73%; asymmetric hypertrophy – in 12.12%; eccentric remodeling and eccentric hypertrophy of the left ventricle – in 4.55% and 9.09% of patients, respectively. Thickening of the right ventricle wall was observed in 13.64% of patients. In the control group of patients without hypertonic syndrome, the signs of concentric and asymmetric hypertrophy were noticed in 10% of patients, eccentric – in 20%; extension of the left ventricle – in 20%. The assessment of the condition of transmitral and tricuspid flows revealed a significant increase in the number of cases, disorders, relaxation of the heart ventricles among hypertensive patients with neurogenic hyperventilating syndrome. It can be a sign of specific role of permanent hyperventilation in ventricle remodeling and mandatory systematic echocardiological control of these patients.