FEATURES OF DYSLIPIDEMIA AND ITS INFLUENCE ON ENDOTHELIUM FUNCTIONAL STATE IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ARTERIAL HYPERTENSION

Purpose of the study. Was to identify the features of blood lipid spectrum and endothelium functional state in patients with rheumatoid arthritis (RA) and arterial hypertension (AH). Materials and methods. 83 patients were examined (40 with RA combined with AH, 23 with RA and 20 with AH). The blood lipid spectrum and endothelial function were studied in all patients. Results. The analysis of blood serum lipid parameters demonstrated that in patients with RA, regardless of the presence of AH, there was a significant increase of proatherogenic lipid profile parameters in comparison with those in healthy subjects. It was shown, that lower concentrations of high-density lipoproteins and higher atherogenic coefficient indices was a characteristic feature of the lipid profile in RA patients both with and without AH - in contrast to the same parameters of the lipid spectrum in patients with AH without RA. In the groups of patients with RA a significant increase of the brachial artery diameter at rest and decreased indices of endothelium-dependent vasodilation and endothelium-independent vasodilation were revealed. Subjects with RA in combination with AH had significantly lower indices according to the tests with both reactive hyperemia and nitroglycerin, while in patients with RA without AH, only NG-test was significantly lower. Conclusion. Dyslipidemia of atherogenic type and endothelial dysfunction develops at the initial stages of rheumatoid process and depends on the activity of the inflammatory process, the presence of extra-articular manifestations and rheumatoid factor seropositivity. Keywords: rheumatoid arthritis, arterial hypertension, dyslipidemia, endothelial dysfunction.

ANTIBACTERIAL THERAPY OF PYOGENIC LIVER ABSCESSES

Purpose of the study. To study the features of the microbial landscape, to develop an algorithm for antibacterial therapy in patients with pyogenic liver abscesses. Prove the effectiveness of the developed algorithm in the treatment of such patients. Materials and methods. The results of treatment of 79 patients with pyogenic liver abscesses were analyzed. The mean age of patients was 48,4 ± 4,7 years, with men predominating (62,9%). The inclusion criterion was the presence of pyogenic liver abscesses, the exclusion criteria were cholangiogenic and specific abscesses. The main group consisted of 44 patients operated on minimally invasive technologies based on modern diagnostic methods. They received a comprehensive conservative therapy, which took into account antibacterial treatment according to the developed algorithm. The tactics of surgical treatment of 35 patients in the control group did not differ from the main one. The groups did not differ significantly in age, sex, comorbidity, severity of the disease and the results of microbiological examination. Results. The number of inoculations of microorganisms from the purulent center was dominated by monoinfection – 86,4–88,6% of cases, which was mostly aerobic. Most of them were facultative anaerobic bacteria of the genus Enterobacteriaceae, namely Kl. pneumoniae – 34,1–40,1%. Less than a quarter of patients (11,4–13,6%) isolated cultures are represented by microbial associations – aerobic-anaerobic and aerobicaerobic. However, aerobic-aerobic infection prevailed – 75,0–83,3%. MRSA strains of staphylococci were isolated in 5,7–6,8% of patients. Treatment began on the first day of hospitalization. Empirical treatment was immediately prescribed, followed by antibiotic replacement, if necessary, based on the results of microbiological examination and determination of the sensitivity of the isolated cultures. According to microbiological studies, in patients with AP most of the isolated microorganisms (71,4–90,9%) were sensitive to linezalide and taigecycline. These antibacterial drugs were reserve drugs and were prescribed in extremely severe cases in the absence of sensitivity to other drugs. The effectiveness of treatment was evaluated by clinical data and improvement of laboratory parameters (normalization of body temperature and leukocyte formula). Conclusion. Carrying out adequate combined antibiotic therapy for patients with AP according to the developed algorithms, along with surgery, allowed to reduce the recovery time of patients: for 2–3 days normalization of body temperature (t = 5,66176; P < 0,000001) and leukocyte formula (t = 8, 56860; P < 0,000001) patients of the main group in comparison with control patients. In turn, this contributed to a probable reduction in the length of stay of the patient in the hospital for 3 days (t = 3,95561; P = 0,000116). Keywords: liver abscess, ultrasound semiotics, sonography intervention, classification of abscesses, antibiotic therapy.

THE USE OF VARIOUS TECHNOLOGIES IN THE SURGICAL TREATMENT OF DECOMPENSATED FORMS OF VARICOSE VEINS OF THE LOWER EXTREMITIES WITH UNILATERAL VALVULAR INCOMPETENCE OF THE GREAT SAPHENOUS AND ANTERIOR ACCESSORY SAPHENOUS VEIN

Purpose of the study. Comparative evaluation of the results of treatment of patients with varicose veins (VVs) in stage C6, with the valve incompetence of the trunks of GSV and ASSV in one lower limb, by traditional venectomy and radiofrequency ablation (RFA). Materials and methods. The study was conducted on the basis of MI «RCH n.a. І.І. Mechnikov», MNE «CCH №16» DCC and MC «JMC Menorah» from 2010 to 2020 yy. Included 43 patients: women – 29 (67,4%), men – 14 (32,6%). Age - from 29 to 74 years (average – 52,7 ± 10,8 years). Patients are divided into 2 groups. The I group (n = 22) included patients who underwent traditional venectomy of GSV and ASSV, the II group (n = 21) – patients who underwent RFA under local anestesia. The observation lasted 12 months. Results. The average area of ulcers ranged from 1 to 12 cm2. The average area of ulcers in group I was 6,3 ± 3,1 cm2, in group II – 6,2 ± 2,7 cm2. Complete epithelialization of ulcers occurred faster with the use of RFA (group II) – 38,1 ± 5,7 days against 44,7 ± 6,2 days in group I. After 3 months. the number of healed ulcers in group I. was 20 (83,3%), in II – 24 (96,0%). Ulcer recurrence one year after surgery occurred in 4 (5,6%) patients of group I, in group II there were no recurrences. After 6 months the difference between the severity of CVI (VSS) was 10,5 ± 2,8 points in group I and 13,9 ± 2,2 points in group II. Conclusions. 1. Surgical treatment of VVs at unilateral defeat of GSV and ASSV with use of RFA differs in the better profile of a postoperative pain syndrome, less traumatism, has the best indicators of recovery in comparison with a traditional venectomy. 2. Treatment with RFA in comparison with traditional phlebectomy one year after surgery had an advantage in the number of recurrences of trophic ulcers Keywords: varicose veins, venectomy, radiofrequency ablation, trophic ulcers.

SURGICAL TREATMENT OF COMPLICATED FORMS OF ERYSIPELAS

Purpose of the study. The goal of the article is to find out the frequency of complicated forms of erysipelas among the general population of the disease and to determine the main directions for their surgical treatment. Materials and methods. 114 case histories of patients who were hospitalized in the center of purulent-septic surgery of the Non-profit municipal enterprise «City Hospital № 3» in Zaporozhye for the period 2019–2020 were analyzed retrospectively and prospectively. Results. It was found that most often the focus was localized on the upper and lower extremities. In the complex treatment of patients with surgical forms of erysipelas, the main place belongs to antibiotic therapy (ABT) and early surgical treatment of the area of the pathological process. Determination of the level of procalcitonin in blood serum makes it possible to assess the progression of the inflammatory process and is a sensitive test for the effectiveness of treatment. Conclusions. The incidence of complicated forms of erysipelas requiring surgery in the general population was 78,9%. Patients with circular erysipelas need the most extensive surgery, when it is necessary to perform an autopsy within the area of inflammation with longitudinal and transverse wavy autopsies throughout the pathological focus. Determination of the level of procalcitonin in blood serum makes it possible to assess the progress of the process and is a sensitive test for the effectiveness of treatment. Keywords: surgical forms of erysipelas, procalcitonin.

MEDICAL AND SOCIAL CONSEQUENCES OF PELVIC BRAKE FRACTURES ACCORDING TO ZAPORIZHZHIA TRAUMATOLOGICAL MSEC

The purpose of the study. Is to analyze the medical and social consequences of pelvic fractures in combination with polysegmental injuries, study the health care system for these injuries, predict complications and mortality to assess the quality of life of patients with pelvic fractures and other segments (lower or upper limb). Materials and methods. The examination reports were examined according to the Zaporizhia Regional Trauma expertise commission code ICD-10 codes/manual S32 (Fracture of the lumbar spine and pelvic bones). Results. According to the Zaporizhia Regional Trauma expertise commission, the number of patients after bone fractures in 2014–2018 is 44 people. The analysis of the material revealed the general tendencies of steady growth of the number of patients with pelvic trauma to disability, which confirms the world statistics. During the period 2016–2019 on the basis of «Сity hospital of emergency medical care» and «City Hospital № 9» were operated on 28 patients with fractures of the acetabulum, of which as a result of osteoarthritis of the hip joint surgery was performed in 3 cases (10, 7%). Conclusions. Some methods of trauma care need to be improved, aimed at reducing their trauma, as well as preventive measures for the development of general and local complications in victims with combined pelvic trauma, refusal of surgical treatment entails improper fracture fusion and disability Keywords: polytrauma, disability, temporary disability, polysegmental injuries, quality of life.

PATHOGENETIC TREATMENT OF PATIENTS WITH HYPERTENSION, DEPENDING ON THE LEVEL OF SYMPATHОADRENAL SYSTEM ACTIVITY

Purpose of the study. Recently, new opportunities to optimize clinical efficacy and tolerability of treatment of patients with essential hypertension appeared. Determination of the indicators of increased activity of the sympathetic nervous system (SNS) in practice could contribute to differentiated treatment of patients with hypertension. Comparative estimation of influence of complex treatment with bisoprolol or amlodipine on the SNS activity parameters in patients with arterial hypertension (AH) of II stage. Materials and methods. 121 patients (men and women) with documented II stage AH were examined clinically. Concentrations of adrenaline, noradrenaline, dopamine and DOPA in urine were evaluated by spectrochromatography, endotheliumdependent vasodilation was studied using complex rheographic ReoCom Professional (HAI-Medicom, Ukraine). Patients were divided into 2 groups: if concentration of noradrenalin in urine exceeds healthy subjects levels more than on 20% – patients were added to basic treatment (enalapril, atorvastatin, aspirin) bisoprolol, if concentration of noradrenalin in urine exceeds healthy subjects levels less than on 20% – we added amlodipine. Statistic analysis was done on Apache OpenOffice (version 4.1) and PSPP (version 0.7.9). Results. The study showed that after treatment there was significant decrease of adrenalin, noradrenalin in 1st group . Increase of DOPA levels was higher in 1st group (Δ% = +46,5 [30,0; 55,4]% vs Δ% = +8,8 [–2,1 ; 16,0]%, (p < 0,05).). Trends in daily urinary excretion of adrenaline (–44,8%) and norepinephrine (–33,7%) showed the impact of effective Δ-blocker on the activity of pressor systems. DOPA excretion was increased significantly in both groups which can indirectly indicate hemodynamic load reduction in hypertensive patients. When choosing the individual antihypertensive treatment in patients with arterial hypertension, if excretion of noradrenalin is increased it is rationally to add adjuvant therapy with β-blockers. Conclusion. The results of our research can be applied into the practice of general practitioner as recommendations for individual selection of antihypertensive treatment depending on the activity of sympathetic nervous system. Keywords: arterial hypertension, treatment, sympathetic nervous system, β-blocker, calcium antagonists.

PRACTICALLY IMPORTANT CLINICAL CHARACTERISTICS OF THE MODERN SILANTEV TO SEAL THE TEETH OF CHILDREN

Annotation. Incomplete posteruptive maturation of the chewing group of teeth in children, along with increased availability of carbohydrate food, deterioration of the ecology and composition of drinking water, as well as features of the morphology of fissure, cause increased susceptibility of occlusal surfaces to caries. It is argued that one of the key methods of preventing caries of the chewing surface of the teeth in children is the sealing of fissures, which is based on modern principles of evidence-based medicine. The advantages of sealing over the use of fluorinated lacquers are analyzed, modern groups of silants are investigated and their practically significant clinical characteristics are revealed. Keywords: fissure sealing, silenty, the chewing surfaces of molars, caries, mineralization of tooth tissues.

ORGANIZATIONAL ASPECTS OF PROVIDING MEDICAL CARE TO CHILDREN WITH INJURIES AT THE REGIONAL LEVEL

Purpose of the study. To study and analyze the trend of injuries among children aged 0-14 years and organizational aspects of providing them with medical care at the regional level. Material and methods. The research was conducted on the basis of the municipal nonprofit enterprise «Zaporizhzhya Regional Clinical Children's Hospital» of Zaporizhzhya Regional Council, and was performed as part of a comprehensive research work «Medical and social substantiation of the model of prevention of morbidity and mortality of children and adolescents behavior»(№ state registration: 0118U003679), performed in the State Institution «ZaporozhyeMedical Academy of Postgraduate Education of the Ministry of Health of Ukraine» since 2017. According to the objectives of the study, an analysis of medical histories of patients who were treated in the institution for injuries from 2014–2018. Research results and their discussion. During the period from 2014 to 2018, 4457 children aged 0 to 14 were treated for injuries and other injuries at the Zaporizhia Regional Clinical Children's Hospital. The number of injured children during this period tends to increase. It was found that the number of injured among boys is almost twice as high as among girls. The growth trend during the study period, injuries among boys is + 27,1%, among girls it tends to decrease and is -26,1%. The study found significantly more cases of injuries among children in urban areas. Thus, in 2018 they amounted to 82,5%, compared to 17,5% of cases among rural children. It was found that the number of hospitalized children with traffic injuries during the study period increased 5 times. The trend for the study period is +333,3%. The number of children hospitalized due to street injuries has doubled. The study found that the number of appeals during the first hour after the injury in rural areas is 2 times less than in urban areas. Conclusions. The results of the obtained research became a roadmap for the organization of preventive work at the inter-sectoral level, aimed at preventing the causes of injuries, the organization of timely medical care at the pre-hospital stage. Keywords: injuries of children, types of injuries, interval of appeals, medical care.

REGULATORY SUPPORT OF THE HEALTHCARE SYSTEM: ACCORDING TO THE RESULTS OF SOCIOLOGICAL RESEARCH

Purpose of the study. Forming of recommendations for improving the legal aspects of health care in modern conditions. Materials and methods. To achieve the purpose of the research, we used the survey method in the form of a standardized (formalized) interview as the main tool for gathering information. Results. A significant proportion of respondents believe that the existing regulatory framework in the field of health care only partially meets modern needs and needs significant changes. Regarding the legal framework governing the field of postgraduate education, according to more than half of respondents, it only partially meets the existing present needs and only a third believe that it meets modern requirements. Conclusion. The current legal framework of the health care sector, due to its imperfection, only partially meets the modern needs of the population of Ukraine and requires significant changes. Among the normative legal acts that regulate the activity of health care bodies and interconnection in the «doctor-patient» system, a number of normative acts need to be improved, in particular: Fundamentals of legislation of Ukraine on health care: Law of Ukraine from 19.11.1992 № 2801-XII. The regulatory framework of postgraduate medical education system also needs to be improved, as it greatly contributes to the successful reform of the medical field as a whole. Keywords. Normative legal acts, health care system, postgraduate education, legislation of Ukraine.

USE OF THE DEVELOPED BONE HOLDER FOR OPEN REPOSITION OF SMALL TUBULAR BONES

The disadvantages and traumatic injury of using traditional traumatological instrumentation for open reduction of metacarpal fractures prompted the development of a modified bone holder. The clinical experience of using the developed instrument is presented, the advantages of its use are displayed. Keywords: metacarpal bone fracture, bone holder, osteosynthesis.