Medicni perspektivi

Peculiarities of the clinical picture and diagnosis of dirofilariasis in the maxillofacial area: a series of cases from practice

Mon, 01 Apr 2024 00:00:00 +0300

Dirofilariasis is a helminthiasis that occurs in carnivorous animals (dogs, cats, foxes, wolves, etc.) and less often in humans, although according to some authors it is believed that the number of infected animals approximately corresponds to the number of infected people. Dirofilariasis of the maxillofacial area is not a widespread condition, its cases are described in short series, therefore, the aim of this work is to share our own experience of managing patients with this rare condition.The work presents our own experience in the management of 14 dirofilariasis patients with lesions of the maxillofacial area, of them there are 3 men and 11 women aged 29 to 54. Most patients sought help in the late autumn, winter and spring periods and only 2 people in the summer period. All patients were examined by a dentist, and an ultrasound examination of the area with a formation was performed. According to the clinical manifestations, the disease began acutely in nine patients and had a picture of inflamed atheroma (2 – in the zygomatic area, 1 – in the parotid, 2 – in the infraorbital area, 2 – in the temporal area, and 2 – in the area of the nasal bridge). All patients were operated on and tumor-like formations in dense membranes were removed, inside which one live nematode 11-18 cm long was found. In 3 observations, fragments of dead, partially lysed nematodes were removed from the oral cavity, the capsules of which imitated a migrating granuloma. According to the location – 5 capsules with dirofilaria were located in the subcutaneous fatty tissue, 3 – in the submucosal layer of the gums fused to the periosteum of the upper jaw, 1 – in the submucous layer of the lower jaw, 2 – in the fibers of the temporalis muscle and 1 – in the fibers of the buccal muscle. In each case, the localization of the nematode was close to the places of accumulation of adipose tissue or large blood vessels. In the postoperative period complex therapy was prescribed, including symptomatic anti-inflammatory and desensitizing agents, and consultation with infectionist was recommended. Thus, according to our observations, dirofilariasis most often affects areas of the face in which there are large vessels and accumulation of fatty tissue. In connection with the prevalence of dirofilariosis in humans and the predominant localization of parasitic infection in the face area, dentists, ophthalmologists and otolaryngologists need to be familiar with this pathology and show definite vigilance. Treatment dirofilariosis patients should be carried out comprehensively, together with parasitologists, with surgical excision of the lesion and appropriate drug therapy.

Perifolliculitis capitis abscedens et suffodiens: features of diagnostics and approaches to treatment

O.L. Statkevych, T.V. Svyatenko — Mon, 01 Apr 2024 00:00:00 +0300

The article presents a clinical case of the abscessing perifolliculitis of the head. Nowadays due to socio-economic circumstances, there is an increase in the number of patients with abscessing perifolliculitis of the head. Among the triggering factors are emergency conditions associated with chronic stress, poor hygiene, and the need to use special clothing and head protection in military personnel, which cause initial occlusion in the scalp area. Treatment is usually difficult and often unsuccessful, with regular relapses after treatment is stopped. However, the issues of diagnosing abscessing perifolliculitis of the head remain relevant and extremely difficult in the clinical practice of dermatologists and related specialists, and a single treatment protocol with clear recommendations has not yet been developed. All of the above determines the need to study the specifics of clinical and morphological manifestations in patients suffering from abscessing perifolliculitis of the head with the further aim of pathogenetic substantiation and development of complex therapy. The article aimed to improve the diagnosis and treatment of the abscessing perifolliculitis of the head by studying the clinical and anamnestic features and the course of the disease on the example of a clinical case with further implementation of recommendations in clinical practice.

The influence of external factors on the development of olfactory disorders in patients with the coronavirus disease 2019: an immunomorphological assessment

I.S. Shponka, O.M. Usova — Mon, 01 Apr 2024 00:00:00 +0300

Olfactory disorders of various etiology are an actual problem for a large part of the adult population of the world, according to the results of conducted research, their prevalence is about 19%. Hyposmia, anosmia, or dysosmia are considered the initial symptom in more than 25% of patients, but over time they affect more than 75% of the total number of patients. The main risk factors for the development of olfactory disorders are old age, male gender, head injuries, exposure to toxic substances and infectious diseases of the upper respiratory tract. The purpose of the study is to clarify the immunomorphological features of the olfactory epithelium of the nasal cavity of patients with the 2019 coronavirus disease, taking into account the background pathological changes in the structures of this area for a better understanding of the mechanisms of the development of olfactory dysfunction during infection with the SARS-CoV-2 coronavirus, depending on the presence of aggravating factors. Autopsy material was used for the study, namely fragments of the mucous membrane of the upper parts of the nasal cavity (olfactory epithelium), obtained from 20 deceased (8 women and 12 men) aged 53 to 86 years with a diagnosis of "Coronavirus disease 2019", confirmed by laboratory (polymerase chain reaction) and olfactory disorders of various degrees in the anamnesis. Mucosal samples were stained with standard hematoxylin and eosin and using an immunohistochemical method with antibodies to neuron-specific beta-III tubulin (TuJ-1), olfactory marker protein (OMP) and angiotensin-converting enzyme (ACE-2). The distribution of expression variants of receptors to OMP, TuJ-1 and ACE-2 in sections with signs of structural rearrangement and without signs of structural rearrangement at a magnification of 200x showed a significant difference (p<0.05): the number of OMP-positive cells in sections of the olfactory epithelium of the first group on average was 43.5 in the field of view (16.0-59.0), TuJ-1-positive cells in these sections – 44.5 in the field of view (17.0-61.0), ACE-2-positive cells – 37 in the field of view (14.0-55.0), and in the samples of the olfactory epithelium of the second group, the expression of receptors to OMP was only partially positive (18 (12.0-25.0) cells), TuJ-1 – 17.5 (14.0-24.0) cells, ACE-2 – 14 (9.0-18.0) cells. That is, the occurrence of olfactory disorders under the conditions of infection with the SARS-CoV-2 coronavirus can be both de novo and against the background of previous changes in the structural elements of the olfactory area of the mucous membrane of the nasal cavity. In this case, more vivid symptoms are likely, as well as criticality and irreversibility of pathological changes.

Influence of organism stimulation with bacterial lipopolysaccharide on the metabolism of the extracellular matrix of the heart of rats under conditions of experimental metabolic syndrome

O.Ye. Akimov, A.O. Mykytenko, V.O. Kostenko — Mon, 01 Apr 2024 00:00:00 +0300

Until recently, the extracellular matrix was considered only a structural component of the organ, which performs exclusively the function of the framework. However, recent studies provide insight into a much broader role of extracellular matrix in metabolic homeostasis, the transmission of intra-organ and tissue signals. Metabolic syndrome and chronic infectious diseases can change the extracellular matrix’s structure in the heart. However, the combined effect of bacterial lipopolysaccharide and metabolic syndrome on extracellular matrix of the heart remains insufficiently elucidated at present. The purpose of this work is to establish the effect of organism stimulation with bacterial lipopolysaccharide on the concentration of different fractions of glycosaminoglycans, the intensity of collagenolysis and the content of sialic acids in the heart of rats under conditions of experimental metabolic syndrome. The study was conducted on 24 sexually mature rats of the “Wistar” line weighing 200-260 g. Animals were divided into 4 groups with 6 animals in each group: control, metabolic syndrome group, lipopolysaccharide injection group and combination of lipopolysaccharide injection and metabolic syndrome group. Metabolic syndrome was modelled by using 20% fructose solution as the only water source. Lipopolysaccharide of S. typhi was administered according to the scheme: the first week, 0.4 μg/kg 3 times intraperitoneally, then once a week 0.4 μg/kg throughout the experiment. Experiment lasted for 60 days. The concentration of glycosaminoglycans, their separate fractions, the content of free L-hydroxyproline and sialic acids was studied in 10% rat heart homogenate. The combined effect of stimulation of the organism with bacterial lipopolysaccharide and metabolic syndrome modeling led to an increase in the total concentration of glycosaminoglycans in the heart of rats by 73.46% compared to the control group. Under these conditions, the concentration of the heparin-heparan fraction of glycosaminoglycans in the heart of rats increased by 188.64% compared to the control group. The content of the keratan-dermatan fraction of glycosaminoglycans increased by 75.34%, and the chondroitin fraction of glycosaminoglycans increased by 17.63%. The concentration of free L-hydroxyproline increased by 167.23%. The content of sialic acids increased by 66.95%. Metabolic syndrome, stimulation of the organism with bacterial lipopolysaccharide and their combination lead to intensification of degradation of the extracellular matrix of the heart of rats due to increased collagenolysis, destruction of proteoglycans and glycoproteins.

Histopathological and ultrastructural changes in the rats brain after air shock wave impact

S.V. Kozlov , Yu.V. Kozlova, N.S. Bondarenko, O.O. Bondarenko — Mon, 01 Apr 2024 00:00:00 +0300

The using of explosive substances and devices can lead to brain injuries, the diagnosis of which requires the determination of primary biomarkers. Therefore, the aim was to establish and study histopathological and ultrastructural changes in the rats brain after exposure to an air blast wave. The study was carried out on 18 male Wistar rats, which were randomly divided into two groups: sham (n=9) and experimental (n=9). The animals of the experimental group were anesthetized with halothane and gently fixed in a horizontal position on the abdomen with the front part of the rat's muzzle at a distance of 5 cm from the device opening and subjected to an excess pressure of 26-36 kPa. Animals of both groups were decapitated, brains were removed, fixed, histopathological and ultrastructural analyzes were conducted using standard methods. Intergroup differences were assessed by Mann-Whitney U-test. Light microscopy revealed primary lesions in the form of small focal, multifocal hemorrhages, cerebral vessel ruptures and microscopic ruptures of the brain substance. In almost all brain samples, there is a significant saturation of the venous vessels with the presence of erythrocyte stasis. Violation of the blood-brain barrier, the presence of edema of the perivascular space, and petechial hemorrhages in the neuropil were registered ultrastructurally. Based on the study results, a morphological algorithm for assessing primary histostructural intracranial brain injuries and their consequences after exposure to an air shock wave was proposed. The injuries were found to be caused by the direct traumatic effect of the air shock wave. In the acute post-traumatic period, histopathological and ultrastructural changes in the brain can manifest as changes in neurons and in the blood-brain barrier and be accompanied by perivascular multifocal small-focal hemorrhages, neuropil ruptures, edema of pericellular and perivascular spaces, which together can be considered as biomarkers of primary traumatic changes after exposure to an air shock wave.

Anti-blastocystis activity of hop extracts in vitro

S.I. Pokhil, V.V. Kazmirchuk , O.M. Tymchenko , V.Y. Yevsiukova, A.L. Melnyk — Mon, 01 Apr 2024 00:00:00 +0300

Blastocystis sp. are the most common, unicellular, anaerobic parasites of the intestinal tract of many animal and human species that can cause various digestive diseases. Metronidazole has long been used as a first-line treatment for blastocystosis, but recent clinical and in vitro studies have demonstrated its low efficacy against Blastocystis sp. The aim of this study was to determine the in vitro sensitivity of Blastocystis sp. clinical isolates to carbonic acid hop extracts and alcohol hop extracts in comparison with metronidazole. Five cultures of Blastocystis sp. were isolated from faecal samples from patients with irritable bowel syndrome with predominant diarrhoea (IBS-D, Rome IV). The parasites were identified by microscopy of faecal smears permanently stained with trichrome, Wheatley’s modification and Heidenhain’s iron-haematoxylin. Blastocystis sp. was cultivated at 37°C under anaerobic conditions on RPMI-1640 with antibiotics and horse serum, taking into account their growth characteristics. To detect the antiblastocystic activity hop extracts and metronidazole were tested in the range from 1000 μg/ml to 1 μg/ml.The presence and number of viable Blastocystis sp. cells were determined after 24, 48, 72 and 96 hours. Blastocystis sp. cells were counted in a hemocytometer using the trypan blue dye exclusion test. All experiments were performed in triplicate. According to the results of in vitro sensitivity of 5 clinical isolates of Blastocystis sp. to the action of carbonic acid hop extract, alcohoicl hop extract and metronidazole, a direct positive pattern in the dose-response and contact time-response effects was established. Alcoholic hop extract showed the highest level of antiblastocystic activity with indicators (for 72-hour parasite cultures) of the minimum inhibitory concentration (which inhibits the parasite cultures growth by 50%) (2.8±0,8) μg/ml and the minimum lethal concentration (which destroys parasite cells by 100%) – 8 μg/ml, being 2.4 and 4.5 times lower than the minimum inhibitory concentration and 8 and 62.5 times lower, than the minimum lethal concentration for hop extract and metronidazole, respectively (p<0.05). It has been shown that alcoholic hop extract (≥16 μg/ml) causes gradual morphological changes in Blastocystis sp. cells, leading to their complete destruction.In contrast to metronidazole, subinhibitory concentrations of hop extract (<2 μg/ml) do not stimulate the proliferation of Blastocystis sp. cells in vitro.

Healthcare support for ukrainian refugees in the Czech Republic: a literature review

Mon, 01 Apr 2024 00:00:00 +0300

The article focuses on the analysis of "most common methods providing health care to migrants and refugees and on the other hand on the analysis of "most common health problems" of refugees and migrants especially in Europe after the outbreak of war in Ukraine. Stemming from the conflict since 2014, it has triggered the most significant wave of refugees in contemporary history. The method of analysis is a "literature review" created from available sources in Medline, Scopus, PubMed, and Web of Science, focusing on data systematization within the GAJU 101/2022/S project funded by the South Bohemian University in České Budějovice, Czech Republic. The search strategy included keywords such as "Ukrainian migrants," "refugees," "health data," "central registry," "healthcare crisis," and "aid provision," employing logical operators. We examined 41 literary sources from both Czech and international publications, as well as official institution websites. The study identifies the complex interplay between migration and health, revealing diverse needs among migrants and refugees. It emphasizes the necessity of developing effective healthcare policies, particularly in crisis situations. Understanding the implementation of legal provisions for healthcare access is crucial for adapting healthcare systems in Europe. Upholding the principles of the Universal Declaration of Human Rights during information gathering ensures equal access to medical assistance regardless of individuals' status or financial standing. Therefore, further research in this direction should not only deepen our understanding of the migration-health relationship but also translate knowledge into policies for improving healthcare conditions for migrants and refugees in Europe.

Peculiarities of personalized selection of antipsychotic drugs for schizophrenia treatment

O.O. Khaustova , A.E. Asanova, N.O. Dzeruzhynska, M.M. Matiash — Mon, 01 Apr 2024 00:00:00 +0300

Determining the optimal antipsychotic drugs, its effective dose, duration of therapy, form, and route of administration play a key role in the treatment of schizophrenia. In addition, special attention should be paid to the effectiveness of using different forms of antipsychotic drugs, in particular, the orally disintegrating form as exemplified by olanzapine. To study the peculiarities of a personalized approach in the use of antipsychotic drugs to achieve more effective results in treating schizophrenia, a content analysis was conducted using Ukrainian and English-language publications for the past 15 years. The search was conducted using the PubMed and CrossRef databases. An important conclusion is that the optimal therapeutic formula or drug should be selected individually, considering the specific patient's clinical condition. However, the most important factor in achieving successful results is the individually selected form and dose of the antipsychotic drugs. In addition to the patient's mental state, the choice of antipsychotic therapy is influenced by the spectrum of side effects, individual sensitivity to the active substance, pharmacological history, economic factors, etc. This is especially true for patients with insufficient adherence to treatment, which can often arise due to the side effects of drugs. In this case, it is important to correctly select both the active substance and the appropriate route of administration. Personalized selection of antipsychotic drugs also involves dynamic monitoring of changes in the patient's clinical condition, allowing for timely diagnosis of drug side effects, dose adjustments, or changes in the route of administration. These measures help increase patient adherence to treatment and improve their health-related quality of life.

Improvement of forensic medical diagnosis of projectile type injuries from automatic firearm chambered in 5.45 mm caliber through spatial 3D modeling

Y.G. Zmiyevska, K. Tryubner , I.G. Savka — Mon, 01 Apr 2024 00:00:00 +0300

Spatial 3D modeling has become one of the modern and most accurate evidential methods of research, carving out its niche in various fields of medical science and practice. Therefore, our focus has been on laying the groundwork for its implementation in the process of conducting forensic medical examinations of gunshot injuries, which have garnered significant attention from all forensic physicians, particularly after unprovoked aggression from Russia and the onset of active hostilities in our country. The aim of the study was to improve the forensic medical diagnosis of projectile type in injuries from automatic firearm AKS-74U chambered in 5.45x39 mm caliber by utilizing spatial 3D modeling of specific elements within the wound channel. The entire series of experimental shots was conducted using an AKS-74U firearm, with a bullet caliber of 5.45x39 mm. As the research material, Roma Plastilina Number 1 ballistic clay, manufactured in the USA, was used for conducting standardized ballistic tests according to NIJ (National Institute of Justice) and HOSDB (Home Office Scientific Development Branch) standards. The series of experiments consisted of 15 gunshots; then the physical characteristics of the bullet, main morphological elements of the wound of skin and different portions of wound channel were investigated (195 measurements in general). The morphological features of individual elements within the wound channel were measured using conventional measurement tools, and also after their 3D modeling using graphic editors such as "Agisoft Photoscan" and "3ds max." Direct and strong correlations (ranging from 0.60 to 0.72) have been established between the initial velocity, kinetic energy, specific energy of bullet, and the diameter of the entry wound in 3D modeling, as well as the diameters of the wound channel in its central portion, measured both by conventional measuring tools and based on the results of their 3D modeling (р=0,02). Furthermore, inverse correlation relationships of moderate strength (ranging from -0.63 to -0.66) have been detected between the initial velocity, kinetic energy, specific energy, and the presence of abrasion collar around the entry wound (р=0,03). The created conditions allow to conduct the differentiation in diagnosing the type of projectile, the identification and study of new characteristics of key elements in firearm-related injuries, and improvement in measurement accuracy. They also enhance clarity and objectivity during the execution of forensic medical examinations in cases of combat-related firearm injuries.

Dynamics of heart rhythm disorders in combatants with acute myocarditis during a 6-month follow-up

Mon, 01 Apr 2024 00:00:00 +0300

The main factors of an unfavorable prognosis, are life-threatening heart rhythm disorders which determine the severity of the clinical course of myocarditis, in addition to impaired contractility and dilatation of the left ventricle (LV). The aim of the study was to assess the frequency and nature of arrhythmias and establish predictors of their long-term persistence, assess the severity of anxiety and depression, changes in heart rate variability in combatants on the background of changes in the structural and functional state of the left ventricle during a 6-month follow-up. The study included 52 male servicemen (combatants) with acute myocarditis (AM) with an average age of 33.4±2.5 years. All patients were assessed by Questionnaire according to the Hospital Anxiety and Depression Scale (HADS) and underwent 24 hour ECG monitoring, transthoracic echocardiography and cardiac magnetic resonance (CMR) with late enhancement using gadovist. At the onset of AM frequent supraventricular (30.7% of cases) and frequent ventricular (42.3% of cases) extrasystolic arrhythmia, as well as paroxysms of non-sustained ventricular tachycardia (26.9% of cases) on the background of heart rhythm variability disorders were recorded. After 6 months, there was an improvement in the structural and functional state of the heart, which was characterized by a decrease in dilatation and an improvement of LV systolic function, a decrease in the volume of the inflammatory lesion and the total number of affected LV segments revealed on cardiac MRI, which was associated with a decrease in the number of ventricular rhythm disorders and reduction of clinical manifestations of anxiety according to the HADS scale. The obtained data indicate that the persistence of supraventricular rhythm disorders is associated with the long-term presence of anxiety and low values of standard deviation of RR intervals (SDNN) and root mean square of successive differences between normal heartbeats (RMSSD). Also predictors of persistence of non-sustained ventricular tachycardia paroxysms were established – SDNN value ≤80.0 ms, LV end-diastolic volume index ≥95 ml/m², total number of affected LV segments ≥6 segments, presence of delayed contrasting in ≥3 LV segments, presence of ≥12 points on the HADS scale and predictors of atrial fibrillation – SDNN value ≤80.0 ms, RMSSD value ≤12.0 ms, total number of affected segments of LV≥6 seg. and ≥12 points on the HADS anxiety scale, determined at the onset of AM.

Assessment of the efficiency of treatment of patients with COVID-19 (literature review)

Mon, 01 Apr 2024 00:00:00 +0300

WHO has recognized that COVID-19 is a global pandemic. In the conditions when COVID-19 continues to spread rapidly throughout the world, covering different groups of the population, and despite the fact that the existing standards of care for these patients are constantly updated, it is urgent to continue the search for new, more effective methods of treatment. Currently, the treatment of patients with COVID-19 remains difficult, since the drugs that have a harmful effect on the virus are at the stage of development and testing. Remdesivir, favipiravir, hydroxychloroquine with or without azithromycin, ivermectin, lopinavir/ritonavir were recommended among the agents for etiotropic therapy. But at present, the WHO notes that there is no evidence to recommend any specific antiviral treatment against COVID-19. The results obtained by conducting multicenter randomized clinical trials, which were conducted in 30 countries of the world and included 11,266 people of different ages, mostly adults and elderly. Unfortunately, the use of plasma from the blood of people who have contracted COVID-19 does not save the lives of seriously ill patients from the need to be connected to a ventilator and does not increase their chances of survival. This is also reported by WHO. In treatment, emphasis is placed on the application of pathogenetic therapy. The main measures of non-specific individual and collective prevention with the introduction of quarantine are briefly given. The article is intended mainly for doctors who work with patients with COVID-19 and contact persons. Treatment of patients with COVID-19, as a rule, is pathogenetic, since there are no specific antiviral drugs.. The decision regarding medical care in an outpatient clinic setting is made after a clinical assessment of the patient's condition and an assessment of home security. People who are at risk of developing complications should be referred for inpatient treatment.

Comorbidity and extra pulmonary manifestations in hospitalized patients with coronavirus disease (COVID-19) depending on age and sex

O.V. Kuryata, V.V. Semenov, S. Fetkhi, Ye.O. Frolova — Mon, 01 Apr 2024 00:00:00 +0300

Nowadays, knowledge about the causal relationships between concomitant chronic diseases and the course of coronavirus infection (COVID-19) can make a huge contribution to saving the lives of patients. Determining the impact of concomitant pathology on the severity of the course of COVID-19 will contribute to the identification and assessment of the risk of deterioration of the condition, as well as the implementation of preventive measures in high-risk individuals (vaccination). The aim of the work was to assess the influence of age and sex on the presence of comorbid pathology and the course of the disease in patients who were hospitalized with community-acquired viral pneumonia associated with COVID-19. We carried out a retrospective analysis of the case histories of 260 patients with community-acquired pneumonia associated with coronavirus disease, who were treated in the therapeutic departments of the Covid Center of ME “Dnipropetrovsk regional clinical hospital named after Mechnikov” DRC in 2020-2021. (September-December 2020, January- December 2021), single-center study. All patients included in the analysis underwent general clinical and laboratory methods of research regulated by national recommendations for the management of patients with COVID-19, PCR tests (polymerase chain reaction) for verification of coronavirus disease, CT(computed tomography)/radiography of the lungs. Comorbidity was assessed as the development of the disease before the onset / verification of coronavirus disease according to a patient survey recorded in medical records. One or more comorbid conditions were recorded in 195 (75%) patients. Multimorbidity was recorded in 111 (56.9%) patients from the total number of patients with COVID-19 and comorbid pathology. Analyzing the influence of gender in patients with comorbid pathology, men were significantly more likely to have coronary artery disease (CAD) (p=0.04) and chronic obstructive pulmonary disease (COPD) (p=0.04). A significant difference in age among hospitalized patients with a diagnosis of COVID-19 was revealed, depending on sex (p<0.001). So at the age of up to 65 years, male patients predominated (60.4%), over the age of 65 years – women (68.9%). There was no significant difference in the frequency of occurrence of moderate severity and severe course of the disease of COVID-19, depending on age and sex. At the age of over 65, the presence of type 2 diabetes (p<0.001), hypertension (R<0.001), coronary artery disease (p<0.001) and COPD (p<0.001) was significantly more common.

Primary dysmenorrhea: pathophysiology, improvement of diagnostic and treatment possibilities

T.V. Fartushok , N.V. Fartushok — Mon, 01 Apr 2024 00:00:00 +0300

Primary dysmenorrhea is one of the types of gynecological pathology, the frequency of which is 45-53% in girls and young women aged 13 to 45 years, which is not given enough attention in diagnosis and treatment.The pathogenesis takes into account the increased secretion of prostaglandins F2α and E2 in the period from the beginning of pregnancy to birth, which cause pelvic pain.The diagnosis is based on the patient's history, symptoms, examination, the treatment is aimed at improving the quality of life by prescribing nonsteroidal anti-inflammatory drugs, hormonal contraceptives and the use of non-medicinal means. Purpose: to specify some links in the pathogenesis of primary dysmenorrhea and, taking into account its multicomponent nature, to evaluate the effectiveness of the proposed treatment. Under observation there were 68 women who were divided into 2 groups: 34 women with primary dysmenorrhea (main group) and 34 healthy women (control group).The diagnosis of primary dysmenorrhea was established on the basis of complaints of patients about painful menstruation and accompanying symptoms during consultations with a gynecologist and endocrinologist.Treatment of patients in the main group was carried out with the drug, which includes Vitex agnus castus L, indinol-3-carbinol, 3,3-diindolyl-methane, extract of passionflower, California Eschscholzia. In women with typical symptoms, dysmenorrhea can be diagnosed on the basis of medical information without physical pelvic examination, empirical treatment should be initiated, including nonsteroidal anti-inflammatory drugs and/or oral contraceptives, because it is a functional condition resulting from an imbalance in the hormonal regulation of myometrial contraction. As a result of the proposed treatment, pain disappeared completely in 70% of patients (23/34), as well as vegetative-vascular (from 18 to 2% of patients), vegetative (from 10 to 1% of patients), metabolic and endocrine disorders (from 15 to 2% female patients), disorders of the emotional and mental sphere (from 25 to 10% of patients). Improvement in quality of life was noted by 80% (26/34) of patients, improvement in working capacity – by 70% (23/34) of patients, after 2 months – by 95% (31/34) and 85% (28/34), respectively, after 3 months all examined patients with primary dysmenorrhea noted an improvement in the quality of life and an increase in work capacity. Sexually active women with symptoms of inflammatory processes of the genital tract, severe dysmenorrhea should undergo pelvic examination. In view of safety and high therapeutic efficiency, the drug based on Vitex agnus castus can be offered for the treatment over the period lasting at least for3 months for girls and young women aged 13 to 45 years with primary dysmenorrhea.

A model for predicting birth defects of the fetus based on risk factors in mothers with a history of premature birth

G. Mammadzada — Mon, 01 Apr 2024 00:00:00 +0300

Birth defects (BD) are an important cause of neonatal mortality and can be associated with premature birth. The study aimed to develop a prognostic model for congenital malformations in mothers with a history of preterm delivery, using logistic regression analysis. The study included 665 mothers of children with BD, of which 432 (65%) had a history of preterm delivery (main group), and 233 (35%) had term delivery (control group). Variables examined included pregnancy history, genetic factors, and biochemical markers. Statistical analysis found significant associations between BD and preterm delivery, intrauterine malformations, miscarriages, MTHFR polymorphism, and HLA antigens. The logistic model showed good predictive performance. The area under the ROC curve was 0.769 for pregnancy history, 0.699 for miscarriages, and 0.630 for intrauterine malformations, indicating moderate predictive ability. A statistical relationship was found between BD risk and pregnancy history, intrauterine malformations, miscarriages, and genetic factors. The resulting logistic model may help predict BD risk in mothers with a preterm delivery history.

Application of Near-infrared reflectance spectroscopy in the diagnosis of varicocele in children and adolescents

V.A. Digtiar, D.G. Vernihora, Yu.V. Zavorotnya , A.P. Gladkiy, M.O. Kaminska — Mon, 01 Apr 2024 00:00:00 +0300

Varicocele is a venous anomaly characterized by the enlargement of the plexus of veins in the testicle. In pediatric cases, indications for surgical intervention in varicocele include palpable dilatation of the enlargement of the plexus veins, intermittent pain in the ipsilateral testicle, and a 20% reduction in size of the ipsilateral testicle compared to the contralateral healthy one. The limitations of evaluating these criteria and the need to assess semen parameters prompt clinicians to explore new diagnostic methods for timely surgical interventions in adolescents. One such promising study involves Near-infrared reflectance spectroscopy (NIRS) in the Near-infrared range. The aim of the research is to evaluate the diagnostic capabilities of NIRS in children with varicocele to determine the indications for surgical intervention. The study included 65 boys aged 11 to 17 years with left-sided grade III varicocele (main group) and 29 healthy boys as a control group. Monitoring of regional oxygen saturation (rSO₂) of testicular tissues was conducted using optical spectroscopy. NIRS examination of testicular tissues in both study and control groups showed statistically homogeneous data for regional oxygen saturation in the healthy (right) testicle. However, the NIRS study revealed significantly lower oxygen saturation (rSO₂) in the testicular tissue of the left testicle in patients with varicocele compared to the control group. The diagnostic significance of the difference in bilateral NIRS monitoring Δ rSO₂ >13% reliably characterized the presence of testicular hypotrophy by more than 20% compared to the healthy contralateral side (AUC=0.64, 95% CI (0.505-0.775), sensitivity – 79%, specificity – 50%, p=0.042). Δ rSO₂>11% values indicated disturbances in spermogram related to oxidative stress (AUC=0.702, 95% DI (0.51-0.88), sensitivity – 82%, specificity – 61%, p=0.031). Therefore, NIRS study data have potential valuable information for the diagnosis and selection of treatment for varicocele in children. The research utilizing Near-infrared Reflectance Spectroscopy revealed a significant potential of this method for diagnosing and assessing the impact of varicocele on the microcirculation of testicular tissue in children. The diagnostic significance of the difference in bilateral monitoring using this non-invasive technique in determining the state of testicles and the possibility of addressing the question of the necessity of surgical intervention is established.

Significance of single-nucleotide variants of anorexigenic hormone genes in childhood obesity

A.O. Nikulina — Mon, 01 Apr 2024 00:00:00 +0300

Obesity-induced dysregulation of hypothalamic neurons is not completely eliminated by restoring body weight, therefore the most urgent task of modern precision medicine is to predict the trajectory of development of metabolic disorders associated with obesity in children. The aim of the study was to determine the level of association of single-nucleotide variants of genes that determine eating behavior – Neuronal growth regulator 1, Fat mass and obesity associated gene, Glucagon-like peptide-1 receptor, ghrelin, leptin receptor, cholecystokinin, in the development of metabolically unhealthy obesity. 252 obese children aged 6-18 years were examined. The main group (n=152) consisted of children with metabolically unhealthy obesity (MUO) according to Identification and prevention of Dietary- and Lifestyle-induced Health Effects in Children and Infants 2014 criteria. The control group (n=100) consisted of children with metabolically healthy obesity (MHO). All children underwent a general clinical, immunobiochemical examination at the Synevo laboratory (Ukraine). Whole-genome sequencing (CeGat, Germany) was performed in 31 children of the primary and 21 children of the control group. Static analysis: variance analysis ANOVA, method of estimating data dispersion, ROC-analysis, method of testing statistical hypotheses. The level of single nucleotide variants association of anorexigenic hormone genes with MUO that exceeded the threshold accepted by 75% of the available data was, respectively, in ascending order: leptin receptor (LEPR) rs1137101 (40.38%), Glucagon-like peptide-1 receptor (GLP1R) rs1126476 (40.38%), GLP1R rs2235868 (42.31%), GLP1R rs1042044 (42.31%), LEPR rs3790435 (48.08%), cholecystokinin (CCK) rs754635 (50%), LEPR rs2186248 (55.76%), GLP1R rs6918287 (55.76%). Genotypes of the GLP1R gene, such as CC rs10305421 determine insulin resistance (F=5.6); GA/AA rs3765468 – meta-inflammation (F=5.8); AA rs6918287 – basal hyperglycemia (F=6.3) and triglyceridemia (F=51.3), p<0.05. Single-nucleotide variants of the gene GLP1R rs6918287, LEPR rs2186248, CCK rs754635 of the anorexic hormones that control eating behavior are highly associated with the presence of metabolically unhealthy obesity in children.

Impact of protein and carnitine consuption on outcomes of care development of full-term newborns with critical perinatal diseases

I.O. Anikin , B.O. Varynskyi , L.S. Stryzhak, L.N. Serhieieva, V.I. Snisar — Mon, 01 Apr 2024 00:00:00 +0300

There were studied results of the impact of increased consumption of proteins and L-carnitine in the nutrition program of full-term newborns with perinatal diseases on the results of physical development and inpatient treatment features. The purpose of the work was to study the correlations between short-term higher consumption of protein and carnitine by full-term newborns and the results of their physical development, the duration of hospital care development. The vital signs of 59 full-term newborns were studied in a randomized controlled trial in the period 2017-2020. The main critical disease of the perinatal period in newborns of both groups was found to be hypoxic-ischemic encephalopathy of a moderate degree in 86.7% and 86.2%, without a statistically significant difference. One group (n=30) received nutrition with mother's milk or formula, the second group (n=29) received similar nutrition with fortification with a protein and L-carnitine supplement during the hospital stay. At the beginning and at the end of the treatment, physical development of the newborns was studied and correlations between the obtained data were investigated. Newborns of both groups did not differ in characteristics at the beginning of the study. The proportions of the newborns' weight corresponded to the limits of the 50% percentile. The group with increased consumption of protein and carnitine, fortification group (FG) demonstrated better indicators of physical development, they regained body mass faster. Body mass of the newborns of the fortification group goup was 3966.9±439.1 g, compared to the standard nutrition (SN) group, with indicators being 3554.6±452.3 g, at p=0.003. The rate of increase in body length in FG was twice that of the SN group. Consumption of a larger dose of protein was accompanied by a shorter stay in the intensive care unit – 10.0 (8.0; 12.0) days versus 12.0 (11.0; 16.0) days, with U=235.0; p=0.002; earlier discharge from the hospital – 21.0 (19.0; 27.0) days versus 26.5 (22.0; 31.0) days, with U=267.0, p=0.01. Carnitine supplementation in the FG group led to an increase in the level of free carnitine in the blood plasma samples taken before the discharge from the hospital. The study of correlations revealed a positive correlation between the consumption of a full dose of proteins and the total increase in height (R=0.3, p<0.05), the increase in body weight (R=0.3, p<0.05). A negative correlation was found between the protein level and the duration of treatment in the hospital (R= -0.3, p<0.05). The level of free carnitine had a positive effect on the increase in body length (R=0.51, p<0.05), daily weight gain (R=0.3, p<0.05). A poor increase in body length was associated with a longer duration of respiratory support: the correlation had an inverse direction R= -0.4, p<0.05. Improving nutritional strategies has significant prospects for improving care development of full-term babies with critical perinatal states.

The influence of chronic stress on periodontal tissues in orthodontic patients in conditions of martial law

Ye.Ye. Vyzhenko, V.D. Kuroiedova, P.S. Korobov , L.B. Halych — Mon, 01 Apr 2024 00:00:00 +0300

There is a close relationship between the condition of periodontal tissues and maloccluson. Timely functional diagnosis of changes that occur in periodontal tissues during orthodontic tooth movement is an important link in the prevention of periodontal diseases during orthodontic treatment. At the present time, special attention is paid to the problem of the influence of "war stress" on the maxillo-facial system of a human. Aim of the was work to study the changes in the state of periodontal supporting tissues in orthodontic patients according to periotestometry data during the last 15 years and in the conditions of martial law. Periotestometry of teeth in orthodontic patients was performed before the start of treatment with the Periotest device. All patients were divided into 4 groups according to the results in different years of the study. A total of 136 patients participated in the study. The biggest discrepancies when comparing periotestometry indicators were found between the data of the control and fourth group (in conditions of martial law) and an increase in the indicators of tooth mobility with a statistically significant difference of p<0.001 was proven. When comparing the indicators of groups 2 and 4 for most teeth, the statistically significant difference was from p<0.05 to p<0.001. When comparing the data of the tooth periotest in patients of groups 3 and 4, the indicators of tooth mobility also increased, although within the limits of statistical error (p>0.05). Over the past 15 years, a steady trend to increase in the mobility of all teeth on both jaws has been established. The largest changes in indicators were found in the dynamics of the fifteen-year follow-up (2008 to 2023) between people with an orthognathic bite of the control group and patients of the 4th group with malocclusion. Such changes may be related to the social and psycho-emotional stress that a person constantly experiences in conditions of martial law.

Current regenerative approaches to the treatment of generalized periodontitis in young people (literature review)

O.V Kopchak , I.V. Kovach , Y.V. Litvinova , K.A. Yanishevsky, N.S. Marchenko — Mon, 01 Apr 2024 00:00:00 +0300

Periodontal diseases are a component of the global burden of chronic morbidity worldwide. The prevalence of periodontitis increases with age, reaching a high at the age of 40, which has increased medical and social importance. In Ukraine the prevalence of periodontal diseases among people aged 19-24 reaches 30%, 25-30 years – more than 60%, and in the age group 35-44 years and older – varies from 92 to 98%. With the generalized form of periodontitis in young people, considerable degradation of periodontal tissues occurs, while treatment measures are mainly ineffective, with a temporary therapeutic effect that only stabilizes the course of disease. The goal of this literature review was to identify innovative approaches to the reparation and regeneration of affected periodontal tissues that could be used as non-invasive treatment modes. The conducted analysis included studies whose findings were published in 52 English- and Ukrainian-language information sources for the period 1985-2022. The literature search was carried out in the PubMed, Scopus, Google Scholar databases and in the electronic catalog of the National Scientific Medical Library of Ukraine. The results of the literature review confirm the considerable potential of cell therapy supplemented with platelet-rich plasma for the formation of new periodontal tissues, which supported their use to promote the regenerative process. In combination with stem cells, platelet-rich plasma provides a considerable increase in the effectiveness of periodontal disease treatment in young people. The literature search was carried out in PubMed databases (327 sources), Scopus (121 sources), Google Academy (16 articles) and in the electronic catalog of the National Scientific Medical Library of Ukraine (89 records). Out of 537, 52 sources were selected for review. Periodontal tissue disease is an actual problem today. According to the data of the analyzed literature, the use of stem cells in dentistry is actively studied, but there are no recommendations and protocols for their use in periodontology. The analyzed scientific sources, the results of which were published in English- and Ukrainian-language sources, aimed at tissue regeneration, have a significant impact on the creation of new approaches to the treatment of generalized periodontitis. The world experience of using cellular technologies with using stem cells demonstrates the significant potential and positive results of their application to promote the regenerative process in the comprehensive treatment of periodontal diseases. The combination of stem cells and platelet-enriched plasma significantly increases the effectiveness of treatment of periodontal tissue diseases, in particular generalized periodontitis in young people. The use of stem cells and growth factors, which contains platelet-rich plasma, allows you to significantly increase the effectiveness of periodontal disease treatment.

A socio-psychological portrait of a pathological gambler as a prerequisite for preventing gambling addiction (gambling disorder)

Z.M. Toporetska, C.V. Aymedov , T.V. Synitska, O.P. Oliinyk — Mon, 01 Apr 2024 00:00:00 +0300

Gambling always carries risks for the player's mental health, as it can provoke the development of gaming addiction. A direct connection between the socio-psychological portrait of the player, his gaming behavior, and the risks of game addiction can be traced. The purpose of the work is to form a socio-psychological portrait of a "pathological" gambler. The work was performed based on the State Institution "Institute of Forensic Psychiatry of the Ministry of Health of Ukraine". Methods used: CAWI (Computer Assisted Web Interviewing) questionnaires in online gambling establishments; CAPI (Computer Assisted Personal Interviews - server event tracking method) in land-based casinos (more than 9,000 people were interviewed); statistical (for selection and analysis of materials). A questionnaire specially developed by the authors with a point evaluation of the results (from 71 to 90 points) allows us to conclude that the interviewee is a pathological gambler. For the first time in Ukraine, the survey was conducted exclusively among gamblers at gambling establishments. The obtained results made it possible to form a statistically reliable р<0.05 socio-psychological portrait of a pathological gambler, mostly men (87.7%) aged 25-35 years (52.4%) with secondary special (43.4%) or higher education (37.7%). In this group, 94% of people declared their inability to resist the desire to play, and 83.0% thought about stealing money to continue. Of pathological gamblers, 85.0% consider gaming as a means of earning money. All interviewed pathological gamers have experienced continuous gaming for more than 5 hours; 79.2% play almost every day. Such players in 95.0% noticed that they lost more money or spent more time than they planned, 96.0% felt culpable for the game, and 95.0% started the day with a game. Based on this portrait, the authors derived quantitative criteria that the organizer of gambling games can use to prevent gambling addiction among players within the framework of the application of the principles of responsible gaming.

Socio-demographic characteristics of patients with negative and positive symptoms in schizophrenia

Yu.A. Kushnir — Mon, 01 Apr 2024 00:00:00 +0300

Schizophrenia is a severe mental disorder that leads to impaired social adaptation, interpersonal interaction, and disability. Negative symptoms are an integral part of schizophrenia. In the world psychiatric science and practice, there are still many questions about the typology of schizophrenia, the description of its clinical manifestations, first of all, the features of negative symptoms in schizophrenia. Psychiatrists of different countries draw attention to the fact that these descriptions do not always coincide. Socio-demographic factors can be considered as factors affecting the prognosis of the course and outcome of schizophrenia. In this regard, a comprehensive approach to the study of socio-demographic characteristics of patients with schizophrenia involves the study of the influence of social factors on the formation and course of schizophrenia and determines the relevance of this study. The purpose of the study was to determine the features of socio-demographic characteristics of patients with schizophrenia in order to improve diagnosis and create psycho-corrective measures. 252 patients with negative symptoms of schizophrenia and 79 patients with positive symptoms of schizophrenia were examined. During the research, a comprehensive approach was used, consisting in the use of clinical-psychopathological, clinical-anamnestic and statistical research methods.
Socio-demographic features of patients with negative symptoms in schizophrenia were established, consisting in the predominance of women; patients aged 20-29 years; persons with special secondary education; divorced and single persons; patients busy with physical labor; average level of material wealth; very poor and poor living conditions. Socio-demographic characteristics of patients with positive symptoms in schizophrenia were outlined by the predominance of men; patients aged 30-49 years; persons with incomplete higher education and with higher education; divorced and single persons; patients with disabilities; with extremely low and low levels of material well-being and a satisfactory level of living conditions. The conducted research made it possible to draw conclusions that socio-demographic features of patients with negative and positive symptoms have their own specificity, which should be taken into account when diagnosing patients with schizophrenia.

Medical students’ mental health in the COVID-19 pandemic

N.M. Inshyna , I.V. Chorna — Mon, 01 Apr 2024 00:00:00 +0300

The COVID-19 pandemic has had a significant impact on the well-being, both mental and physical, of students worldwide. Medical students faced challenges in the educational process, including online education, uncertainty as for the terms of licensing exams, and limited practical experience. The present study aimed to compare the impact of the COVID-19 pandemic on the mental health of medical students from Ukraine, India, and African countries, focusing on the frequency of incidence of psychosomatic symptoms, anxiety/insomnia, social dysfunction, and depression. 230 students of the Academic and Research Medical Institute of Sumy State University were survey participants. The mental well-being of medical students was assessed using the General Health Questionnaire. The obtained data were analyzed using the statistical software PAST v4.03. It was found that 60 % of students had mental health disturbances during the COVID-19 pandemic. Symptoms of depression were detected in 15% of medical students, psychosomatic symptoms in 34%, anxiety and insomnia in 47%, and social dysfunction in 65% of respondents. The main psycho-emotional disorder in most students was social dysfunction, which was associated with limited social activity during quarantine. It was found that students from India and African countries had a higher incidence of depression than Ukrainian students. Obviously, being away from home during a pandemic has an additional negative impact on the mental health of international students. The frequency of anxiety and insomnia was higher among Ukrainians than among foreign students. Changes in learning environments and concerns about personal and family health have contributed to heightened anxiety levels among Ukrainian students. It should be noted that with the transition to online learning and communication, students had to spend more time in front of screens, which could contribute to digital fatigue, disrupt sleep patterns, and negatively affect mental well-being. The results of the study provided valuable insight into the mental health challenges faced by medical students during the COVID-19 pandemic with regard to their nationality, highlighting the need for targeted psychological support interventions for students to improve their mental health.

Prediction of risks and odds of rehospitalization of patients with eating disorders in anxiety-depressive disorders

V.V. Ogorenko , V.O. Kokashynskyi — Mon, 01 Apr 2024 00:00:00 +0300

The article represents the results of a study aimed on predicting the risks and odds of rehospitalization among patients with eating disorders in anxiety-depressive disorders. In total, 147 patients with anxiety and depressive disorders were examined. Patients were divided into a main group of 82 and a comparison group of 65 patients. The main group consisted of 21 (26%) men with a mean age of 38.33 (SD 11.53) and 61 (74%) women with a mean age of 43.15 (SD 11.44). The comparison group consisted of 19 (29%) men, mean age 37.53 (SD 9.75) and 46 (71%) women, mean age 45.22 (SD 12.17). At the time of the initial examination in the main group, 35 (43%) patients were hospitalized for the first time, 47 (57%) – rehospitalized; in the comparison group, 23 (35%) patients – for the first time hospitalized, and 42 (65%) – rehospitalized. It was found that 27 patients were rehospitalized within the next year after the intervention and treatment. Clinical-anamnestic, clinical-psychopathological and psychodiagnostic study supplemented by psychometric scales (PHQ-9 health questionnaire, Dutch Eating Behaviour Questionnaire (DEBQ), State-Trait Anxiety Inventory (STAI; C.D. Spielberger), Methodology for assessing the integrative Quality of Life Index (QLI; J.E. Mezzich)) was conducted. As a result of the study, it was found that patients in the main group had a 3.6 times lower risk of rehospitalization over the next year than patients in the comparison group. When constructing a unipolar regression model, the best predictive power and discriminative ability was demonstrated by the number of previous hospitalizations (p<0.01, AUC 0.75 (0.67-0.82)) and the intervention in the main group, which reduced the odds of rehospitalization over the next year by 4.8 times. The highest discriminative ability was demonstrated by the multiple logistic regression model (AUC 0.83 (0.76-0.88)), according to which intervention in the main group reduced the odds of rehospitalization in the next year by 5.9 times. The results of the study became the basis for the development of differentiated treatment and correctional measures for eating disorders in patients with anxiety-depressive disorders to improve the quality of care, prevent psychosocial maladjustment and improve the quality of life of this population.

Physical therapy of patients after cerebral ischemic stroke from the standpoint of a patient-centered approach

Y.M. Malyarova, A.M. Rudenko, O.M. Zviriaka , N.V. Kuksa — Mon, 01 Apr 2024 00:00:00 +0300

Acute cerebrovascular accident remains an important medical and social problem. An important area of intensification of rehabilitation care for patients after cerebral ischemic stroke is the using of a patient-centered approach, which is often associated with increased patient satisfaction and adherence to rehabilitation. The aim of the study was to balance the restoration of physical and functional capabilities of patients after cerebral ischemic stroke in the post-acute rehabilitation period using a patient-centered approach. A program of physical therapy for patients after cerebral ischemic stroke in the post-acute rehabilitation period was implemented from the standpoint of a patient-centered approach in accordance with the defined goals of rehabilitation intervention. The study included 37 patients, 22 men and 15 women with post-stroke muscle spasticity who were under a nine-month follow-up during the second stage of rehabilitation in the post-acute rehabilitation period. The average age of men was 52.1±8 years, the average age of women was 50±13 years. A comparative evaluation of the effectiveness of the physical therapy program was conducted, based on examination methods in accordance with the International Classification of Functioning, Disability and Health. At the end of the experimental study, the following changes in patients after cerebral ischemic stroke were found: decrease in the intensity of pain in the muscles of spastic limbs according to the visual analog pain scale by 12.9±1.02 points (p<0.05); decrease in the severity of motor deficit by an average of 1.7±1.0 points (p<0.05) according to the Motor Deficit Scale (Medical Research Council); the index of muscle tone of the adductor muscles of the shoulder decreased by 0.9±0.4 points (p<0.05), the muscles of the forearm flexors by 0.4±0.2 (p<0.05) points on the Ashworth Scale (Modified Ashworth Scale); assessment of motor function of the affected limb showed an increase in motor activity by 15±0.4 points (p<0.05), before physical therapy the index was 29±0.2 points (p<0.05), and after it – 44.3±0.8 points (p<0.05) on the Action Research Arm Test scale; statistical improvement in self-care and functionality in patients by 1.2±0.1 points (p<0.05) on the Modified Rankin Scale; the average walking and mobility score in patients increased by 3.7±0.1 points (p<0.05) on the Rivermead mobility index. The results of the experimental study confirmed that the algorithm and content of the physical therapy program from the standpoint of a patient-centered approach were effective for patients who had suffered a cerebral ischemic stroke; this indicates the possibility and feasibility of their further using for post-stroke patients in the post-acute rehabilitation period.

The analysis of dynamics of physical accessibility of pharmaceutical aid in Ukraine

V.M. Koval , O.V. Kryvoviaz — Mon, 01 Apr 2024 00:00:00 +0300

The level of development of the country's health care system can be assessed in different ways, in particular by the level of pharmaceutical aid provision to the population. The quality of pharmaceutical aid for the population depends on many factors, including physical accessibility and the number of pharmacies located in a certain area. The aim of the work was to study the dynamics of changes in the physical accessibility of pharmaceutical aid provision for the population and changes in the number of pharmacies in Ukraine during 2017–2022. Annual reports of the State Service of Ukraine for medicinal products and drug control, regarding licensees in the field of economic activity in the production of medicines, wholesale and retail trade of medicinal products, circulation of drugs have been used for the analysis of dynamics. It was established that the pandemic of the coronavirus disease, which was caused by the SARS-CoV-2 (COVID-19) coronavirus, and the full-scale invasion of the Russian Federation had a significant impact on the development of the pharmaceutical market in Ukraine according to the results of the study. There is a general tendency to decrease the number of economic entities conducting their activities in the retail trade of medicines, while simultaneous increasing the places of activity, which may indicate the globalization of the pharmaceutical market. However, it can also cause a reduction in the quality of the competitive environment and limit the choice of pharmaceutical aid providers by patients. Thus, in the studied period, the number of economic entities decreased by more than 1,400. The number of pharmaceutical establishments engaged in the compounding of medicinal products also decreased significantly, by 23.5%. The total number of economic entities engaged in activities related to the circulation of narcotic drugs, psychotropic substances and precursors also decreased significantly, which definitely worsened the physical availability of this group of drugs.

Comparative toxicological-hygienic assessment, structural-morphological, physicochemical characteristics, and virucidal properties of new nanopowder materials TiO2 and TiO2@Ag

Mon, 01 Apr 2024 00:00:00 +0300

In order to address safety concerns related to the acquisition and utilization of TiO₂ and TiO₂@Ag nanomaterials, as well as to investigate their disinfectant and biological effects, the structural-morphological, morphometry, toxicological, cytotoxic, and virucidal properties of these specified nanomaterials have been studied through experiments conducted on laboratory animals and in vitro. It has been demonstrated that the TiO₂@Ag nanocomposite exhibited distinct physicochemical characteristics: it consisted of TiO₂ nanoparticles ranging in size from 13 nm to 20 nm and Ag nanoparticles ranging from 35 nm to 40 nm with 4.0 wt% of silver localized on the surface of titanium dioxide. The purity of the modification of synthesized nano-TiO₂ and nano-TiO₂@Ag has been confirmed. Acute intraperitoneal administration of nanopowders revealed LD₅₀ values of 4783.30 mg/kg for nano-TiO₂ and 724.44 mg/kg for nano-TiO₂@Ag. A slight accumulation was observed upon repeated (28-fold) intragastric administration of nano-TiO₂. The cumulative dose administered, which equated to 15.9 multiples of the LD₅₀ (76040 mg/kg), did not result in animal mortality but led to retardation in body weight gain. TiO₂ and TiO₂@Ag nanopowders do not irritate the skin, induce mild conjunctival irritation, and may exhibit a weak sensitizing effect. Nano-TiO₂ and nano-TiO₂@Ag powders accumulate in the tissues of internal organs and cause damage to the liver, kidneys, and lungs of laboratory animals upon intraperitoneal administration. The most characteristic morphological signs of the toxic effect of nano-TiO₂ on liver tissue were observed at a level of 67.7% (cytoplasmic vacuolization in hepatocytes), while in the case of nano-TiO₂@Ag initial necrotic changes were at a level of 70.0% (hepatocytes with pyknotic nuclei). Immunoassay analysis has demonstrated that TiO₂@Ag and TiO₂ nanomaterials at concentrations of 30 µg/ml can enhance the functional activity of peripheral blood mononuclear cells in vitro by increasing the production of cytokines IL-1, IL-6, TNF-α, and IL-4 in donors (p<0.05). This indicates the potential for chronic inflammation and allergic reactions among synthesis operators. In the study of the impact of nanomaterials on murine germ cells, it has been established that they affect the activity of mitochondrial enzymes and exert a damaging effect on mitochondrial membranes and overall cell integrity. Estimated approximate safe exposure levels in the workplace air are 0.3 mg/m³ for nano-TiO₂ and 0.2 mg/m³ for nano-TiO₂@Ag. Nano-TiO₂@Ag and nano-TiO₂ at a concentration of 100 µg/ml exhibit pronounced extracellular virucidal activity against human adenovirus serotype 2. The TiO₂@Ag nanocomposite has a less damaging effect on Нер-2 cells compared to nano-TiO₂.

Hygienic assessment of occupational risk for workers during pre- and post-emergence herbicide treatments of sunflower crops

Mon, 01 Apr 2024 00:00:00 +0300

Modern agriculture extensively uses pesticide formulations at various stages of crop growth. Sunflower cultivation accounts for 31% of the global production. Assessing the occupational risk associated with pesticide application in sunflower farming is of paramount importance. Improper handling and application of pesticide formulations can have immediate adverse effects on workers, leading to acute poisoning, long-term health consequences, and the potential for chronic illnesses, including neurotoxic effects. The aim of this study was to conduct a hygienic assessment of the professional risk faced by workers during pre- and post-emergence herbicide applications in sunflower cultivation. This assessment was carried out to establish the regulations for their safe usage. Research samples after the application of the herbicides AGAT, GARPUN, KORVUS, and PARUS (patches from overalls, gloves, skin swabs from exposed areas (face-neck, hands), air samples (atmospheric air, working zone and drift zone). The assessment of professional risk was conducted in accordance with the methodological recommendations provided by experts from the L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Ukraine (State Enterprise). Statistical analysis of the results was carried out using the licensed statistical software packages MedStat v.5.2 (Copyright^© 2003-2019) and Microsoft^® Excel^® for Microsoft 365 MSO (Version 2305, Build 16.0.16501.20074). It has been determined that under real conditions, during pre- and post-emergence herbicide applications in sunflower cultivation using AGAT, GARPUN, KORVUS, PARUS preparations, while adhering to recommended agrotechnical and hygiene safety regulations, the inhalation, dermal, complex, and combined (AGAT and PARUS) risks for applicators are 0.0409±0.0179, 0.0429±0.0193, 0.0838±0.0224, and 0.1557±0.1322 a.u., respectively, and for tractor operators – 0.0818±0.0358, 0.0425±0.0192, 0.1243±0.0356, and 0.2347±0.1567 a.u., respectively. There is no observed increase in hygiene standards in the workplace atmosphere and in the air of the potential drift zone. It has been proven that the professional risk of their use does not exceed permissible limits (<1). It has been determined that during the performance of technological operations, the mentioned risks in applicators and tractor operators did not differ significantly (p>0.05). However, a significant difference was found in the proportion of percutaneous risk (42.7±17.4% in applicators compared to 34.8±17.0% in tractor operators; p=0.034). The regulations for the safe use of the investigated pesticide formulations have been substantiated. Statistical analysis of the obtained results revealed that the values of inhalation, dermal, and combined risks during the application of these pesticides did not significantly differ during the various technological operations (applicators and tractor operators) (p>0.05). The values of the combined comprehensive risk associated with the use of the studied preparations also did not show significant differences (p>0.05). The proportion of dermal risk was significantly higher in applicators compared to this parameter determined in tractor operators (p=0.034).