SOCIAL-HYGIENIC MONITORING OF MORBIDITY BY PSORIASIS UNDER CONDITIONS OF THE ZAPOROZHSKY INDUSTRIAL REGION

Relevance. The high prevalence of psoriasis among the population of the earth (0.1-7.0%), as well as the difficulty of its treatment, necessitate the development of new methods for its prevention and increasing the effectiveness of treatment. Objective. To study the peculiarities of the incidence of psoriasis in the population of the Zaporozhye region under the influence of unfavorable environmental factors. Methods. Under supervision in 2012, there were 5475 patients with psoriasis, of whom 2439 (44.5%) were women, 2731 (49.9%) were men and 305 (5.6%) were children. In 2013, there were 5635 patients with psoriasis, of whom 2504 (44.4%) were women, 2818 (50.0%) were men and 313 (5.6%) were children. Results. The highest levels of psoriasis in the Zaporozhye region are registered in Zaporozhye, Gulyaypol, Veselovsky, Kuibyshev, Primorsk and Vasilievsky districts. In these administrative units, the prevalence of psoriasis was within 269.6 - 513.8 cl. / 100 thousand, significantly higher than the average regional level (p <0.05), the prevalence of psoriasis in Zaporozhye (by 146.1 - 180.6 sl. / 100 thousand), in Gulyaypol district (by 96.1 - 141.9 cases / 100 thousand), and Veselovsky district (by 84.9 - 105.9 cases / 100 thousand). Conclusions: For the first time, a systematic approach to the analysis of the incidence of psoriasis with regard to environmental factors was used, in order to achieve stable remission in patients with active psoriasis, it is necessary to correct exogenous and endogenous trigger factors in order to minimize their effects.

A GENETIC STUDY OF PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY BASED ON CLINICAL AND GENEALOGICAL METHOD

Relevance. Practically 10-15 % of the world's population has varicose veins as a manifestation of chronic venous insufficiency. The clinical and genealogical method is the method allows to identify family cases of disease in patients with chronic venous insufficiency. Objective: to demonstrate the role of heredity in varicose disease, to analyze family cases of varicose disease, to determine the type of disease inheritance and to give a prediction of heredity for descendants, using the clinical and genealogical method. Materials and methods. The study involved 72 patients, mostly women – 46 (63.9 %) persons, with different classes of varicose veins according to the CEAP classification. To determine the type of inheritance we used clinical and genealogical method of pedigrees’ study. The nature of the trait – hereditary or non-hereditary disease; type of the inheritance – autosomal-dominant, autosomal-recessive, sex-linked, were defined. Results. The family nature of the varicose disease was revealed in 17 (23 %) of the 72 examined patients. The autosomal-dominant type of inheritance was determined. There is direct inheritance across generations. Conclusions. We determined the family nature of the disease inheritance, with the autosomal-dominant type of inheritance with a high degree of gene expression. In these families there is a high risk of the birth of the children who will have chronic venous insufficiency.

EFFECT OF MODIFICATION OF THE EXTRACTION TECHNIQUE OF THE SUBSTANCE IN A SOXHLET FOR CONTENT OF FATTY ACIDS

Relevance. The search for new forms of herbal medicine is an important area of modern biotechnology, pharmacology and pharmacy. More and more attention is paid to the development of extracts from plant materials, since the extraction products provide the maximum content of biologically active substances, which increases the rationality of their use, due to the accuracy of dosing, the therapeutic effect is increased, the period of use increases and storage conditions are simplified. The extraction of the fruit mixture of Citrullus сolocynthis in the Soxhlet apparatus was modified by reducing the procedure time 5-10 times and improving the processing of raw materials by using a press at the same time and increasing the temperature, or even by modifying the apparatus. Objective: to study the composition of FA in an aqueous solution of the dry extract of Citrullus сolocynthis when modifying the extraction mixture in the Soxhlet apparatus by increasing the temperature and technological reduction of processing time. Materials and methods. We carried out the determination and comparison of the composition of FA’s by gas-liquid chromatography of all parts of the fruit of Citrullus сolocynthis and in an aqueous solution of its dry extract with various concentrations of the substance. Results. Chromatographic analysis showed that all parts of the fetus Citrullus colocynthis are promising sources of saturated and unsaturated FA. In all parts of the fruit of Citrullus colocynthis, linoleic acid prevails in quantitative content. The modification of the extraction of the mixture in the Soxhlet apparatus by increasing the temperature and technological reduction in the processing time of the raw materials led to the production of a substance with a new composition and FA content. The ratio of unsaturated / saturated FA in the resulting dry extract is 5 times greater than the similar ratio separately in seeds, pulp and shell. At the same time, the distribution of separate unsaturated and polyunsaturated FA’s in the dry extract solution is fairly uniform. The relative amount of linoleic FA in the dry extract was smaller, and the linolenic FA was greater than in the seeds and pulp of the fruit. Conclusions. Modifying the extraction of the mixture in the Soxhlet apparatus by increasing the temperature and technological reduction of the processing time did not lead to complete degreasing of the substrate and allowed to obtain a dry extract of Citrullus solvent with content of microdoses of the FA, their balanced (uniform) in amount, and predominance of 5 times the amount of unsaturated polyunsaturated FA over the amount of saturated. We assume that such a redistribution of FA, and especially their micro doses, can be the basis for creating medicines with more effective effects on the body.

NEW DISCOVERIES IN THE MECHANISMS OF INTERFERON-DEPENDENT CONTROL OF LATENT ALPHA-HERPESVIRUS IN SENSORY GANGLIA. REVIEW

Relevance. The study of the mechanisms of immune surveillance over latent alpha herpesvirus in the sensory nerve ganglia is an important task of clinical immunology, since the data obtained during such studies may help to develop effective approaches to immunotherapy of recurrent and/or severe forms of herpes infections by restoring lost immune control over latent pathogens. Objective: to conduct a systematic review of the results of studies devoted to the study of mechanisms of intraganglionar and intraneuronal protection over latent alpha herpesvirus in sensory nerve ganglia, to develop a modern concept of immune surveillance in human alpha herpesvirus infections. Methods. Review of scientific publications in the international electronic science databases PubMed, Embase and Scopus was conducted on the keywords «alpha herpesviruses», «Toll-like receptor type 3», «natural killers», «natural killer T-cells», «intraganglionar immunity», «intraneuronal immunity» for the full time available (1972-2014). Results. The article presents modern data on interferon-dependent mechanisms of control of latent alpha herpesvirus in sensory nerve ganglia. The system of the intraganglionar control presented by resident natural killers, natural killer T-lymphocytes and cytotoxic CD8+ T-cells that are part of the satellite cells of the nerve node, and the system of intraneuronal defense contained in the centripetal fibers and presented by cascade system TLR-3 , the activation of which promote the production of interferons type I. Genetic or acquired abnormalities in intraganglionar and intraneuronal immunity systems are the cause of the development of recurrent and/or severe forms of infections caused by alpha herpesviruses in humans. Preparations of natural and recombinant alpha interferons and interferonogens are potentially useful agents in the target immunotherapy of disorders in intraganglionar and intraneuronal immunity in immunocompromised patients with severe forms of alpha herpesvirus infections. Conclusions. In the human body there are highly organized intraganglionar and intraneirononal immune control systems for latent alpha herpesviruses. The activity of these systems ensures the long stay of the virus in a latent state in the sensory nerve ganglia, and the disturbanses of the implementation of such mechanisms is responsible for reactivation of the virus from the latent state with subsequent damage to the skin, mucous membranes and/or the central nervous system.

INFLUENCE OF REVOLUTIONARY EVENTS IN THE SOCIETY ON VIOLENT DEATHS STRUCTURE

Relevance. The detector of the stability of the social system and its level of development is the frequency of violent deaths – murders, suicides and accidents. The level of murders correlates with the economic and social protection of the population. In a society reform, these indicators are changing. On the basis of the analysis of cases of violent death, on the basis of forensic medical expertise, it is possible to plan areas for preventive work of the police and health services to improve the assistance to the population. Objective: to study the peculiarities of the violent death of Kyiv residents against the backdrop of the revolutionary events of 2013, in order to improve the preventive work of health authorities and law enforcement agencies in reducing the incidence of violent deaths among the population in the context of the reform of society. Materials and methods. The material of the research was the acts of forensic research of 43138 corpses – residents of the city of Kyiv who died of violent death in 2001-2015 as a result of causing death wounds, gunshot injuries, height drop, mechanical asphyxiation, traffic accidents, poisoning, high and low temperature, and electrical trauma that were investigated in the Kyiv City Clinical Bureau for Forensic Medical Examination. Results. In the course of active revolutionary events, 92% of deaths are death by force. The number of deaths among women is significantly reduced. The number of incidents of firearms is 21 times higher. The number of murders increases by 49%, and in the next it falls to the original level. The number of suicides remains at a constant level during revolutionary events, but increases by 25% after them. The level of accidents decreases by 3.7 times during the revolutionary events and increases after them to a level that was even higher than at the beginning of this period. The number of injuries in dull and sharp objects increased by 25%, followed by a fall to a level that was less than revolutionary events. Conclusions. During active revolutionary events, the distribution of types of violent death changes.

ANALYSIS OF WORKING CONDITIONS ON THE STATE OF EALTH WORKERS IN THE TEXTILE INDUSTRY

Relevance. The textile industry is one of the leading industries in the light industry, in which most workers are women. However, manufacturing technologies are harmful, and equipment of enterprises is outdated. Therefore, the optimization of working conditions in the industry is extremely relevant and important for improving the demographic situation in Ukraine. Objective: to analyze literary data on working conditions in the textile industry, to identify the main hazards in the industry and their impact on the health of workers. Method. Retrospective search in Ukrainian scientific sources for 2003-2015. Results. Influence chemical (dyes, acids, alkali, formaldehyde, carbon disulfide, chlorine compounds); physical (noise, vibration, microclimate); biological factors (microorganisms in the raw material); as well as unfavourable factors of the labour process (static load, slopes of the case, awkward posture, tension of the muscles of the hands and eyes) and dust onto textile workers It was found. Workers experience changes in the functional state of the central nervous system (vegetative-vascular disorders, hearing loss); respiratory tract (laryngotracheitis, bronchitis, bronchial asthma, bisynosis); bone marrow (flatfoot, osteochondrosis, varicose disease, radiculitis); genital system (violation of reproductive function); skin diseases (dermatitis, burns) and eyes (conjunctivitis, cataracts). Conclusions. The combination of chemical agents, noise and vibration is a leading factor in the negative impact on the health of workers in the textile industry.

INTRAPERITONEAL USING OF BUPIVАCAIN FOR THE ANESTHESIA OF PATIENTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Relevance. The local anesthetics were used intraperitoneally after some minimally invasive gynecological interventions like a component of postoperative multimodal anesthesia in recent years. Objective. The aim of work was to study the effectiveness of intraperitoneal administration of bupivokain for the anesthesia of patients after laparoscopic cholecystectomy. Material and methods. 28 patients aged 32-60 years (16 women, 12 men) were examined. The patients were divided into two groups. In the first group for anesthesia after the operation, was used ketorolac trometamine in dose 0.2 mg/kg intramuscularly each 6 hours. If the patient complained of postoperative pain, which was assessed by Visual-analog scale in 7 points or higher, fentanyl was administered intramuscularly in dose of 0.003 μg/kg. In the second group, besides the components of multimodal anesthesia used in the first group, at the end of the surgical intervention at the drainage tubes were injected 40 ml of 0.125% solution of bupivocaine (50 mg). This injection was repeated throughout the first day each 6 hours. The condition of patients was assessed by a Visual-analog scale after 1, 4, 8, 12 and 24 hours after the finishing of surgery. The average dose of fentanyl in μg/kg used for postoperative anesthesia first 24 hours after operation was also determined. Results. We have received a significant reduction in the rates of pain evaluation for Visual-analog scale in patients who used bupivacaine as a component of multimodal anesthesia. One hour after the end of the operation, the pain score for Visual-analog scale was less than the corresponding one in the control group in 1.77 times, after 4 hours – in 1.47, and in 8 hours – in 1.55 times. In all cases, P <0.001. The mean dose of fentanyl used for treatment in the study group was 1.55 times less than that in the control group. There were no significant complications in both groups. A patient in group 1 had nausea, requiring a single dose of ondasetron 2 mg Conclusion. Intraperitoneal administration of bupivocaine had a significant anesthetic effect after laparoscopic cholecystectomy.

PUNCTIONAL DRAINAGES UNDER ULTRASOUND CONTROL IN ABDOMINAL SURGERY

Relevance. Punctic-drainage interventions under the control of ultrasound have become an effective help in complex treatment. But some technological aspects in the procedure and post-operative management of patients remain the subject of discussion. Objective: to improve the results of the use of punctional drainages under ultrasound control in abdominal and retroperitoneal pathology. Materials and methods. Echo-controlled puncture-drainage interventions are used in 89 patients: with pancreatogenic fluid concentrations in the stuffing box, parapancreatic cellular spaces (34); with intra-abdominal complications following operations on the abdominal organs (18), inflammatory processes in the gall bladder (15), tumor obstruction of the bile ducts (12), and with liver abscesses (10). Depending on the nature of the contents of the "target", its localization for puncture drainage was used by trokars of various modifications and diameters, as well as stylet-catheters of the type "PIGTAIL". Manipulation was carried out using ultrasonic devices with convection (frequency 3.5 MHz) and linear (frequency 7-12 MHz) sensors. In 68 patients, the display for intervention was infected fluid formation. In 12 – jaundice syndrome and 9 patients – sterile clusters of enzymatically active content. The main task of puncture-drainage procedures was the evacuation of the content of pathological or anatomical fluid formations to reduce intoxication and (or) their decompression. In assessing the effectiveness of minimally invasive techniques, account was taken of the effectiveness of the operation, that is, the target effect for which the intervention was performed, and the number of complications. Results. Puncture-drainage interventions have become independent and end-of-term treatment in 68 out of 85 cases (with the exception of 4 patients who, due to complications during the procedure, used other methods). The reasons for the reduced effectiveness of echo-controlled puncture-drainage interventions in 9 patients were: the predominance of the tissue component (large sequester) in the cavity, the presence of multiple isolated gates, the use of drainage structures with insufficient drainage properties. Fatal consequences in 5 patients are caused both by the above reasons, and by endogenous factors (a significant prevalence of the pathological process, decompensated background pathology, reduction of internal reserves of the organism). Conclusions. Puncture-draining interventions under ultrasound control are an alternative to open surgical interventions, especially in patients with severe concomitant pathology, severe general condition. In this case, they can be as element (stage) of complex treatment and an independent, final method of surgical care. The choice of echo-controlled interventional technologies as a method of operational correction should be carried out with understanding their capabilities. The effectiveness of such mini-invasive methods allows us to recommend their acceptance in surgical hospitals for diseases of the abdominal cavity organs and retroperitoneal space.

KELOIDS TREATMENT USING TRIPLE MEDICINE COMBINATION

Relevance. A lot of conservative approaches have been proposed to the management of keloids, but none of them provides a guaranteed positive result and a stable absence of relapse. Objective: to evaluate the effectiveness and side effects of triple keloid scar therapy. Materials and methods. Thirty-three patients aged 18-69 years, who received treatment of keloids by triple medicine combination therapy, were investigated retrospectively. All patients were divided into two groups. In first one (16 patients) intralesional injections of mixture of 5-fluorouracil, triamcinolone acetonide and bovine origin hyaluronidase were performed. In the second group (17 patients) instead of triamcinolone betamethasone suspension was used. Four sessions of therapy were performed with a monthly interval. Results were assessed 1 month and 6 months after the last session. The planimetric investigation and measurement of scars’ volume were performed. The influence of treatment on the number of telangiectasias within the scar was performed with the help of our method of computer processing of its digital photographs. Results. There was not statistically significant difference in linear size, area and volume of the scars in patients of two groups before beginning of the treatment. One month after the fourth session scars’ width increased statistically significantly. Their length and area also increased but difference did not reach statistically significant level. At the same time maximal height of the scars over surrounding tissues (p<0.001) and their volume (p=0.012 та 0.001) reduced significantly in both groups. There was not difference in percentage of scar volume reduction ((67.4±18.01) % and (74.3±14.71) % correspondingly, p=0.308) in different groups. The main negative effect of treatment was redness of the scars due to purpura and increase of telangiectasias number. Reliable increase of the part of the scars’ surface taken by the telangiectasias was registered in both groups without difference between them. Despite the overall improvement in self-esteem, the patients noted that the change in the color of the scar after the treatment came into the first plane among the factors causing aesthetic dissatisfaction. Supplementary methods of telangiectasias and hyperemia correction were used in 12 patients of the first and 11 patients of the second group. Pain syndrome and itching were eliminated in 11 out of 14 (78.6%) patients in the first group and in 11 out of 15 (73.3%) patients in the second group (p = 0.753). Performed treatment positively influenced patients’ quality of life. Their self-esteem increased essentially ((3.4±2.16) points, p=0.005 and (3.2±1.92) points, p=0.001 correspondingly). At re-examination 6 months after the termination of triple therapy, no statistically significant changes in the size of scars were found, pain and itching did not restore. The quality of life self-esteem remained unchanged. Conclusion. The combined use of 5-fluorouracil, glucocorticoid, and hyaluronidase reduced the protrusion and volume of not-burn keloids in patients of both groups (by (67.4 ± 18.01) % and (74.3 ± 14.71) % respectively (p = 0.308)). Triple medicine therapy permitted to eliminate the pain syndrome and itching in 78.6 % of patients of group where triamcinolone acetonide was used, and in 73.3% of patients who received mixture that included betamethasone suspension (p=0.753). Triple medicine therapy effectiveness, both in term scars’ resizing, and eliminating clinical symptoms and improving the quality of life, was the same for both variants of the combination of drugs. The main side effect, that somewhat worsened the aesthetic result of treatment, was the increase of telangiectasias number. The part of the scar area taken by telangiectasias increased from the (3.4±1.16) % to the (9.7±3.51) %, p<0.001 in the first group and from the (3.3±1.31) % to the (9.7±3.05) %, p<0.001 in the second one. The use of glucocorticoid in triple therapy, which to a lesser extent will stimulate the formation of telangiectasias, will improve the cosmetic result of the treatment.

ASSOCIATION OF CLINICAL, PSYCHOEMOTIONAL STATUS AND THE PATHOGENETIC THERAPY WITH THE DEVELOPMENT OF REMISSION IN ADULT PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS

Relevance. The study of the frequency of remission in adult patients with JRA treated in accordance with the "Unified clinical protocol for medical care for patients with juvenile rheumatoid arthritis" is relevant. Objective. The aim of our study was to evaluate the association of the clinical, psycho-emotional state and the pathogenetic therapy with the development of remission in adult patients with JRA. Materials and methods. 168 adult patients with JRA were examined at the transition period of the health care and adolescents. A retrospective analysis of medical records was performed to evaluate clinical symptoms and laboratory data in childhood and evaluated the clinical status, duration of the disease, activity on the JADAS and DAS-28 scales, quality of life, depression and alexithymia by scales SF-36, PHQ-9, TAS- 20, bone mineral density and methods of treatment in childhood and in adulthood. Results. All patients were divided into 2 groups: Group I - 138 patients (82.1%) with active disease at the time of examination, and II group - 30 patients (17.9%) who achieved remission. Patients who achieved remission did not differ by age at the time of the study, although the prevalence of women (58.1%) in the I group was determined, compared with 31.0% in the II group. Patients in both groups did not differ in height, however, patients with remission had a greater body weight (p <0.01) and BMI (p <0.01). There were no differences between the groups in the level of RF and A-CCP, ANA and the presence of HLA-B27, as well as in total cholesterol, LDL-cholesterol, glucose as risk factors for atherosclerosis (all p> 0.05). Patients with active disease had lower BMD in femoral neck and in ultradistal forearm area (all p <0.05). There were no difference in the the appointment of the IBT in doth groups. However, patients with remission more often did not receive GC in history (p <0.001) and at the time of examination (p <0.001), which is explained by less activity in the onset of the disease (p <0.05). Both groups did not differ in either the duration of the DMARD therapy, nor on the doses of methotrexate and sulfosalazine. Of the 53 patients with RF(+)/RF(-) polyarthritis - the most prognostically unfavorable variant of JRA, had arthritis > 3 joints (p <0.01), symmetrical arthritis (p <0.05), higher ESR ( p <0,05) compared patients with remission, and the absence of differences in the levels of CRP and JADAS. Conclusions. Patients with JRA in adulthood in 82.1% continue to have an active disease of varying degrees. The negative influence of the active disease on the BMD is found, mainly in the area of ​​femoral neck and ultradistal forearm in adult patients with active JRA compared with patients in remission. The significant influence of active disease in adulthood on the quality of life according to the SF-36 questionnaire was determined such as physical well-being, physical, role and social functioning, bodily pain, general health, and mental health compared with the group of patients in remission. An increase level of depression was found by PHQ-9 questionnaire in the I group compared to II group, although they did not differ in the level of Alexithymia. Patients who achieved remission compared with patients with active polyarthritis, were less likely to take GC in adulthood and reseived a higher dose of methotrexate.