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Background. Modeling allows investigating both existing and predicted processes and is widely used in basic science and in many industries. The aim is to develop a mathematical model for determining the size of the foreign bodies (FB) and their radiographic density in non-biological and biological models to improve the results of diagnosis for gunshot ricochet wounds. Materials and methods. In the biological non-living model (a piece of pork) and non-biological models (polystyrene, foam rubber), we place the FB made of paper, leather, rubber, plastic, and lithium-ion batteries. The number of the FB is 9 of each type. Number of models is 3 each: pork, polystyrene, foam rubber. We measure the dimensions of the FB and models with a metric ruler. For each model, we select the FB, which we label with the study number. We immerse the FB to the same depth using a Billroth general surgical medium hemostatic clamp in the following sequence: paper, leather, rubber, plastic, and lithium-ion battery. Multislice computed tomography (MSCT) of the models is performed on the Revolution EVO (2021) apparatus with measurement of the sizes and radiographic density of the FB and models. Radiographic density was measured in conventional units on the Hounsfield scale. For each study group, the ratio of the actual sizes of the removed FB and according to MSCT data was determined in the MathCad 15 computer math software, depending on the radiological density of the FB and the model. Results. According to MSCT data, the radiographic density of the models on the Hounsfield scale is as follows: polystyrene — –990.0 ± 0.3 units; foam rubber — –985.0 ± 0.2 units; pork — 62.0 ± 0.3 units; radiographic density of the foreign bodies: paper — –743.0 ± 10.3 units, leather — –258.0 ± 14.2 units, rubber — –12.0 ± 2.6 units, plastic — 183.0 ± 14.6 units, lithium-ion batteries — 3071 units. Visualization of paper in non-biological and biological models and leather in non-biological models is problematic due to the similar radiographic density of the models and the inability to measure the dimensions. When the FB (rubber, plastic, battery) is immersed in polystyrene, the coefficient of length (CL) is 1.0612, the coefficient of width (CW) is 1.928; in foam rubber: CL is 0.9926, CW is 1.9641; in pork: CL is 0.8394, CW is 1.534. Comparing the average coefficients of the ratio (CL and CW), we find that the coefficient in a biological model is closest to 1. This means that the FB from rubber, plastic, and batteries are best detected in pork. Conclusions. The actual dimensions of the FB placed in biological and non-biological models differ from those obtained by MSCT. Data correction is performed through calculated coefficients for length and width. The radiographic density of the model affects the radial visualization of the FB. The use of mathematical modeling in determining the sizes and radiographic density allows reducing the measurement error and determine the structure of the FB.

The scientific review deals with the modern ideas about the importance of low concentrations of nitric oxide in the process of dispersing and eradicating of bacterial biofilms. For writing the article, information was searched using Scopus, Web of Science, MedLine, PubMed, Google Scholar, EMBASE, Global Health, The Cochrane Library, CyberLeninka. The paper highlights the value of nitric oxide in the development of relapses of respiratory infectious-inflammatory diseases. It is emphasized that the ability of nitric oxide at high (micromolar) concentrations can become a highly toxic compound for bacteria and an important component of the nonspecific protection of a macroorganism from pathogenic microorganisms, and at low (nanomolar) concentrations can act as a signaling molecule. The ability of nitrogen monoxide to disperse the biofilm of bacteria through increased expression or activity of proteins associated with the motility of bacteria pili, rhamnolipids is described. The characteristics of the main donors of nitric oxi­de and molecular platforms that can be used for their delivery to the macroorganism are presented. The main groups of nitric oxide donors are described, such as organic nitrates, nitrosylated metal compounds, diazenium diolates (N-diazeniumdiolate — NONOate) and S-nitrosothiols (S-nitrosothiol — RSNO). It is indicated that nitric oxide donors enhance the dispersion of biofilms and contribute to an increase in the antibacterial activity of antibiotics. The paper characterizes the molecular platforms for the delivery and optimization of the nitric oxide release regime: inorganic and polymer nanoparticles, organometallic coordination polymers, dendrimers, liposomes, micelles. The possibility of using these compounds to develop new drugs that will be effective in treating diseases associated with the formation of biofilms by pathogenic bacteria is underlined.

The purpose of this paper is to draw gastroenterologists’ attention and underline the necessity to conduct detailed differential diagnosis in patients with dyspepsia syndrome. This paper shows a clinical case of abdominal form of the partial epilepsy. We have focused on the medical history; therefore, this disease has been suspected and electroencephalography and neurologist’s consultation were recommended in order to correct treatment. Partial epilepsy has to be included into the list of differential diagnosis in dyspepsia. Gastroenterologists and other internal medicine practitioners should be familiar with different clinical types of epilepsy and symptoms of partial epilepsy, as well as with the features of its medical treatment for early diagnosis and better outcomes in patients with epilepsy. It is necessary to collect detailed medical history and refer to neurologist patients with dyspepsia and a history of head injury, participation in combat sports, football or any severe infectious diseases with an intoxication syndrome. Early diagnosis of somatic masks of the partial epilepsy will allow predicting unexpected secondarily generalized seizures, since these somatic masks, according to their nature, actually are auras of the possible tonic and clonic seizures.

Background. The paper analyzed the severity and prevalence of hypertensive supratentorial intracerebral hemorrhages (ICH). This pathology is an urgent problem in the global health context, as it leads to severe consequences, including disability and death of patients. Recent discoveries and clinical guidelines provide physicians and researchers with new opportunities to improve clinical practice and improve the effectiveness of treatment for these complications. An increase in the number of cases of hypertensive supratentorial intracerebral hemorrhages and their impact on public health makes this problem extremely relevant in the field of medicine. Materials and methods. Two hundred and thirty-two patients with supratentorial intracerebral hemorrhages caused by hypertension were examined and treated in 2019–2020 at the Kyiv City Clinical Emergency Hospital. The average age of patients was 60 years: for men, it was 56 years, for women 69 years. They were observed during treatment in the hospital for up to 21 days. On the 21st day, the degree of disability was assessed. All patients underwent a neurological examination with an assessment of consciousness according to the Glasgow Coma Scale, Intracerebral Hemorrhage Score, Barthel index, modified Rankin scale, National Institutes of Health Stroke Scale (NIHSS). We have used neuroimaging methods (computed tomography, magnetic resonance angiography, if necessary). Clinical and laboratory studies were conducted. Results. It was found that 127 (57 %) patients had putaminal supratentorial hemorrhage, 24 (10 %) — thalamic, 34 (15 %) — subcortical (in the white matter of the cerebral hemispheres), 47 (20 %) — mixed. Seventy-seven (33 %) patients were hospitalized in a coma (Glasgow Coma Scale ≤ 8 points), 36 (16 %) in a sopor, 81 (35 %) in a stunned state, and 31 (13 %) patients were conscious. Patients over 60 years of age had ICH of deep localization, while young patients had cortical ones. Ninety-four surgical interventions were performed in 84 patients with lobar and lateral hematomas, as well as with breakthrough into the ventricular system (liquid drainage surgery). General mortality was 39.5 %, surgical — 46.4 %. Contraindications for surgical interventions were as follows: an existing severe coma, unstable hemodynamics, the need for constant administration of vasopressors, as well as severe comorbid conditions. Conclusions. It was found that the clinical picture of acute supratentorial intracerebral hemorrhages against the background of hypertension is characterized by polymorphic neurological symptoms according to the localization of the hematoma, its volume, cerebral edema, and intracranial hypertension. The results of the treatment of patients with hypertensive ICH indicate the need for early hospitalization, early computed tomography scan, and a differentiated approach to surgical removal of the hematoma. The favorable outcome of supratentorial ICH is more typical for patients with initial mild and moderate neurological symptoms in case of a hemorrhage volume of less than 30 cm3. The presence of blood breakthrough into the ventricular system increases the risk of death by 35 times.

Background. The purpose was to evaluate the peculiarities of microcirculation (MC) according to biomicroscopy data in respiratory diseases in children on a model of acute bronchitis. Materials and methods. The paper presents data on the study of MC in children with acute bronchitis (n = 30) compared with healthy individuals. The state of microcirculation was evaluated using nail bed biomicroscopy and by qualitative and semi-quantitative indicators. Results. In children with acute bronchitis compared to healthy persons, a number of changes were noted: in the arterioles — an increase in tortuosity, in the venular parts — the phenomena of sludge and spasms, in the capillaries — a decrease in the number of functioning microvessels and changes in their shape, slowing blood flow and sludging of red blood cells. Conclusions. Digital nail bed biomicroscopy in children is an accessible, simple and informative method for studying the state of MC in acute respiratory diseases. In acute bronchitis, even with a mild course, there are changes in the MC pattern at the level of all microvessels, with a predominance of changes in the capillaries.

This paper presents the analysis of the data of studies on the genetics of type 2 diabetes mellitus. High scientific quality papers of the recent years were used to prepare this work. The article deals with the role of single-nucleotide polymorphisms in genes associated with the development of diabetes mellitus, prognosis of the disease and efficacy of the treatment. It also discusses the role of environmental factors in the development of diabetes mellitus and the use of results of genetics trials in practice.

The paper considers the features of the provision of pediatric and adult nephrology medical care during martial law in Ukraine from February 2022 to May 2023. The influence of military stages on the nephrology care are presented, territorial zones during the conflict are highlighted, event tracks are shown. Separately, the activity of the Ukrainian Association of Nephrologists/Ukrainian Association of Pediatric Nephrologists, new opportunities for integrating nephrology into the system of medical knowledge are considered. Along with the negative trends, positive results were revealed that made it possible to move forward in the system of specialized medical care, namely an increase in transplant activity, a wider use of “long” treatment regimens with rituximab, and the use of digital kidney biopsy. Statistical data, SWOT analysis at the stages of the military conflict are given, an analysis is presented for refugees who left for the European Union to receive kidney replacement therapy. The enormous role of humanitarian programs for maintaining the structure of nephrological care in Ukraine is emphasized. The accumulated experience is unique and can serve as material for the analysis of similar situations in the world in the future.

Background. Atypical hemolytic uremic syndrome (aHUS) is an extremely rare but life-threatening di­s­order in children since it may cause acute kidney injury. Patients with aHUS are at risk of recurrence. Hence, in this paper, we present a case of a 9-year-old boy with aHUS relapse. The child was admitted to the emergency department on the fifth day of illness with main complaints of facial puffiness and decreased urine output. Based on the medical history, the patient developed the second episode of aHUS after 6 years of complete recovery from the first episode. There was no preceding diarrheal illness, instead, the clinical manifestation of both aHUS episodes was triggered by a respiratory tract infection. The results of diagnostic studies performed during the first episode of aHUS were as follows: stool tests for Esche­richia coli and Shiga toxins were negative; a complement assay showed no abnormalities; ADAMTS13 activity and anti-complement factor H antibodies were normal. The results of the kidney ultrasonography and biopsy were consistent with the diagnosis. Family history was remarkable for aHUS in a younger sibling confirmed by molecular genetic testing, in particular, a pathogenic variant in the CD46/MCP (membrane cofactor protein) gene in the heterozygous state has been identified. Physical examination revealed paleness, facial swelling, moderate hypertension, and oliguria. Laboratory findings demonstrated hemolytic anemia, thrombocytopenia, significant azotemia, a severe reduction in the glomerular filtration rate, a high level of aspartate aminotransferase, insignificant electrolyte imbalance, and proteinuria. Supportive treatment included fluid and electrolyte management, fresh frozen plasma, furosemide, and dexamethasone. The child commenced acute hemodialysis due to severe acute kidney injury. Conclusions. A recurrence of aHUS is characterized by severe renal failure requiring acute hemodialysis. Viral infections are potential triggers of aHUS. A relapsing course of the disease and a family history of aHUS indicate the importance of genetic screening, as familial aHUS should be considered.

Low efficiency of cohort immunization and postvaccinal complication are not always connected with vaccine unsatisfactory quality or violation of vaccination requirements by medical workers. The paper demonstrates that epidemic dynamics, disease clinical manifestation typical for it, efficiency and safety of immunization, postvaccinal complications incidence also closely interrelate with relative quantity of persons with anomalies (polymorphism) of immune response genes and physiologic systems protected from disease development. Polymorphism of these genes has a spontaneous development by single nucleotide polymorphism and deletions forming apportioning in next generations according to Mendel’s laws. Polymorphism accumulation involved into infectious diseases pathogenesis is ironically a result of progress in control of contagious cycle infections, particularly natural smallpox. There was taken off a selective pressure from a population that extracted persons unable to react effectively on infectious agents invasion. Velocity of polymorphism accumulation is growing in relatively genetically homogeneous population (inhabitants of island countries) and in populations with typical intermarriages. It is impossible to refuse from control of contagious infectious agents. So we should expect of increase of registered postvaccinal complication associated rather with human genome peculiarity than with other reasons. That causes the necessity to adjust a strategy of immunization of various cohorts and methods for determining the reasons of postvaccinal complications. The paper also describes polymorphism of immune response genes significantly associated with low effectiveness of vaccination against measles, rubella, epidemic parotitis, B hepatitis and complications after live smallpox and tuberculosis vaccine Mycobacterium bovis BCG.

The lecture presents data on the etiology, pathoge­nesis, clinical picture, diagnosis and treatment of hypoglycemia as one of the frequent syndromes in emergency medicine. The paper presents the main causes of the hypoglycemic syndrome and features of diagnosis and emergency care for patients with hypoglycemia of varying degrees of severity in cases with and without diabetes.

Background. Fibrillary glomerulonephritis is a rare glomerular disease that presents with hypertension, hematuria, nephrotic syndrome and renal insufficiency. The purpose of this research was to assess effect of DNAjB9 staining marker in kidney biopsy specimens on kidney outcomes. Materials and methods. In this analytic (experimental) clinical study with randomized clinical trial design in meta-analysis article, 72 patients with biopsy-proven fibrillary glomerulonephritis were investigated. Clinical features, laboratory data at initial presentation, management and outcomes were collected. The paper has written based on searching PubMed Central and Google Scholar to identify potentially relevant articles. Median, percentage, mean ± standard deviation (SD), two-tailed t and Chi-square, two proportion difference meta-analysis and Kaplan-Meier analysis were used for statistical evaluation. Moreover, relative risk, odds ratio, Spearman’s correlation for statistical analyses were used. Results. The median and interquartile range of age of patients with fibrillary nephropathy at the time of diagnosis were 55 and 18 years, respectively. There was no statistically significant difference between two sex groups of males and females in current research ­(p-value: 0.35). There was significant statistical correlation between elevated serum creatinine level and time of last serum creatinine measurement with p-value of 0.01 and confidence interval (CI) of 0.7820 to –0.1258 during follow-up. Relative risk of kidney failure progression to kidney replacement therapy (↑ ≥ 2-fold in serum creatinine or dialysis or kidney transplant) in DNAjB9-positive (group I) and DNAjB9-ne­gative patients (group II) was assessed 2.67 with 95% CI of 1.128 to 6.3044 and p-value of 0.025. Odds ratio of kidney failure progression to kidney replacement therapy (↑ ≥ 2-fold in serum creatinine or dialysis or kidney transplant) was assessed 4.33 with 95% CI of 0.9464 to 19.8417 and p-value of 0.058. There was statistically significant difference when comparing group I and group II for mortality probability (Kaplan-Meier analysis) during follow-up (P < 0.0001). Conclusions. The present study revealed high mortality in DNAjB9-negative (8/64, 12.5%) versus DNAjB9-positive patients (0/8) with statistically significant level. Relative risk and odds ratio of kidney failure progression to kidney replacement therapy were assessed 2.67 and 4.33, respectively.

The paper examines the issues of circadian rhythms functioning and their significance in the regulation of physiolo­gical processes of the excretory system. The article deals with the issue of desynchronosis, its causes and effects on the physiological processes of the excretory system in children. The practical significance of chronobiological aspects, their dependence on both individual and population factors, the dynamism of such disturbances and their relevance in the age aspect are shown. The value of chronobiological aspects in the functioning of the excretory system and the expediency of continuing scientific and practical research in this direction of medical science were emphasized.

This paper presents a diagnosis of the likely risk of sepsis using the National Early Warning Score (NEWS2). Accor­ding to the UK National Health Service and the Royal College of General Practitioners, sepsis should be suspected and immediate intensive care should be considered if a patient has NEWS2 score of 5 or more, or if the patient has NEWS2 score of 3 or more: non-blanching rash, mottled/ashen/cyanotic skin; responds only to voice/pain or does not respond; no urination in the last 18 hours or diuresis less than 0.5 ml/kg on catheterization; serum lactate more than 2 mmol/l. The measures to be taken within the first hour of a diagnosis of the likely risk of sepsis are outlined, as well as criteria for the lack of their effectiveness; the main goals of intensive care in sepsis: identification and control of foci of infection; antibiotic therapy, fluid resuscitation, additional oxygen supply; recommended parameters for continuous or half-hour monitoring of patients with sepsis who are at high risk of deterioration; blocks of intensive care, which should be initiated only by specialists experienced in sepsis management. The indicators of hospital lethality depending on the level of blood serum lactate are given: less than 2 mmol/l — 15 %, from 2.1 to 3.9 mmol/l — 25 %, more than 4 mmol/l — 38 %. The presented algorithm is fully consistent with the Surviving Sepsis Campaign guidelines (2021).

Background. The morphology of the thyroid in Graves’ disease (GD) can be quite diverse: in most cases there is a diffuse enlargement of the thyroid gland (diffuse goiter), in some cases it is not increased, and in some patients there are focal neoplasms (single and multiple), including thyroid cancer. According to some studies, in patients with Graves’ disease, focal formations are observed in 10–31% of cases, and in half of the patients, they appear against the background of treatment with thionamides. The purpose of this paper was a retrospective study of the morphological features of benign thyroid neoplasms due to GD based on the results of cytological and pathomorphological studies. Materials and methods. The study was performed at the clinic of the State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”. All patients with GD who were operated in the Department of Endocrine Surgery from 2008 to 2019 (1854 patients) were first selected, and then those who had benign focal formations according to the pathohistological examination were selected among them. Results. The frequency of benign thyroid neoplasms in GD is 22.06 % in women aged 26 to 55 years. Cytological studies of thyroid neoplasm punctures in GD made it possible to clearly establish their benign nature (BSRTC-2) in 94.3 % of cases. In 5.7 % of cases, cytological categories BSRTC-3 and BSRTC-4 were established. Positive immunocytochemical reactions to thyroid peroxidase and thyroglobulin, and the absence of CK17 allow avoiding cytological overdiagnosis, characteristic of benign neoplasms of the thyroid gland in GD. Conclusions. Among pathohistologically confirmed benign neoplasms of the thyroid gland in GD, in 63.82 % of cases a histological diagnosis was adenomatous or colloid goiter, in 34.47 % — signs of nodular hyperplasia, in 1.71 % — the presence of thyroiditis.

Hypoglycemic syndrome is often noted in clinical practice in the treatment of patients with diabetes mellitus (DM), especially with insulin. This syndrome is manifested by symptoms caused by neuroglycopenia (insufficient supply of glucose to the brain, which utilizes 20 % of all glucose). Hypoglycemia occurs quite often, in about 40 % of people with type 1 DM. The clini­cal syndrome of postprandial (reactive) hypoglycemia of various etio­logies is considered, which is manifested by a hypoglycemic condition in the next hours after eating, especially easily diges­tible carbohydrates. In most cases, there is a violation of the hypothalamic regulation of carbohydrate metabolism, and the clinical picture is dominated by symptoms of activation of the sympathoadrenal system. Such hypoglycemia is usually transient, as glucose levels return to normal rapidly due to the release of counterinsular hormones. The importance of the latter in the regulation of insulin secretion is evidenced by the fact that after oral glucose loa­ding, a higher level of insulin secretion is determined than in the case of intravenous administration of an equivalent dose. Elderly patients with hypoglycemia are more likely to deve­lop neurolo­gical disorders than adrenergic disorders (palpitations, tremors, hunger). These symptoms may be mistaken for signs of cerebrovascular ischemia, as a result, hypoglycemia is not adequately detected and treated. In addition to the acute adverse effects of hypoglycaemia, a hypoglycaemic episode may have long-term consequences. Frequent hypoglycemic conditions have a significant psychological impact and are also a risk factor for dementia. The paper presents the data, based on scientific sources and own observations, on etiopathogenesis of hypoglycemia, as well as their most frequent clinical varieties, in particular, in the syndrome of unrecognization of hypoglycemia, postprandial hypoglycemia, in chronic insulin overdose in patients with diabetes mellitus in old age and insulinism.

Damage to the lung tissue is a predominant complication of the viral disease COVID-19. Recently, there have been complications from other organs, including highly vascularized endocrine glands. Regarding the adrenal glands, there are reports of their damage with a decrease in their function. Сhanging the function of the adrenal glands (AG) in patients with or after COVID-19 is important. A few adrenal autopsy studies in patients have revealed vascular thrombosis, cortical lipid degeneration, ischemic necrosis, parenchymal infarcts, and other lesions leading to a decrease in AG function. The central mechanism of adrenal dysfunction through hemorrhage and necrosis of the pituitary gland is also possible. This paper presents a rare case of the development of hypercortisolism in a young woman after recovering from COVID-19. Based on high ACTH levels (157 and 122 pg/ml), a negative nocturnal dexamethasone test, and high 24-hour urinary free (daily) cortisol excretion rates, we tentatively suspected Cushing’s disease. Chromogranin A was within the normal range of 21.35 (reference value

Background. The purpose was to study the nature of changes in the cardiorespiratory system in the case of short-term hypoxemia during functional tests with breath-holding. Materials and methods. The paper presents the results of a survey of school-age children with acute bronchitis with and without obstructive syndrome (60 patients) and a group of healthy children (52 people). Patients underwent pulse oximetry in combination with hypoxic tests for breath-holding with data recording on a computer and performed a Rufier test. Results. The severity of bronchitis in patients in the first days was average on the BSS-ped scale — 7.79 ± 0.19 points. The level of blood oxygen saturation was normal (above 95 %), but there was a difference between the groups: in patients with obstructive syndrome it was 98.60 ± 0.04 %, in the absence of this syndrome — 98.80 ± 0.03 %, which was lower than in the control group — 99.00 ± 0.01 % (p < 0.05). Time of breath-holding did not differ significantly between groups, but there was a slight decrease in saturation after them. There was greater reaction to breath-holding on exhalation. Level of oxygenation in patients with bronchitis achieved by increasing heart rate. Due to the phenomena of relative hypoxemia of peripheral tissues during convalescence, there was a decrease in tolerance to physical loading after the Rufier test. Conclusions. It is established that even in mild forms of acute bronchitis in children, according to functional tests, there is a decrease in gas exchange reserves, especially in the presence of obstructive syndrome. Compensatory mechanisms to maintain blood saturation are based on increasing systemic blood flow due to increased heart rate.

The paper analyzes the current literature data and the results of our own researches concerning the state of the cytokine network: pro- and anti-inflammatory cytokines (interleukin (IL) 1α, IL-1β, IL-4, IL-6, IL-10, IL-17 and tumor necrosis factor (TNF) α), α- and β-chemokines, including IL-8 and IL-16, as well as adipokines (leptin and adiponectin) in the peripheral blood of patients with type 2 diabetes (T2D) with normal and increased body weight/obesity. It has been shown that patients with T2D are cha­racterized by an increased content of proinflammatory cytokines (IL-1, IL-6, IL-17, TNFα), α- and β-chemokines in the peripheral blood, including IL-8 and IL-16, as well as leptin with a decrease in adiponectin content. In lean patients (with body mass index (BMI) 30.0 kg/m2), especially in obese women (BMI > 35.0 kg/m2). Similarly, an increase in proinflammatory cytokines is observed in normoglycemic people, but not as signifi­cant as in T2D. Less clear data were obtained when during determination of the anti-inflammatory cytokines IL-4 and IL-10, which is explained by a significant polymorphism of their genes, and both protective and compensatory effects on pro-inflammatory cytokine rise. In T2D patients, especially those with obesity, there is an increase in the leptin level and a decrease in the adiponectin content. The severity of the course and the percentage of mortality are closely associated with the BMI of patients. The effectiveness of the fight against an increase in the incidence of T2D should be primarily aimed at preventing obesity, and in case of already developed T2D — at reducing concomitant obesity. The analysis of the data presented also suggests that a sharp increase in the content of pro-inflammatory cytokines (so called cytokine storm) observed in patients with T2D and obesity infected with COVID-19, is a consequence of the summation and potentiation of already existing inflammatory process.

The article summarizes the data on senile osteoporosis and presents a clinical case of this disease. The reference sources on peculiarities of bone remodeling in senile osteoporosis are summarized; low bone formation takes place against the background of a pronounced bone resorption. The article also presents pathomorphological features of bone tissue remodeling resul­ting in pronounced impairments of the compact bone, which increase the risk of fracture. Vitamin D plays a significant role in the complex mechanism of senile osteoporosis. The data on the combined effect of vitamin D and parathormone on bone remodeling are summarized. The paper presents data on other cumulative effects of senile osteoporosis development. Against the background of ­ageing-associated systemic changes, calcium and vitamin D deficiency, increased pro-inflammatory cytokine expression, loca­lized bone disorders develop. An important link to the development of senile osteoporosis is an increased marrow adipose tissue with an intensified adipogenesis, resulting in a decrease of osteoblasts due to the toxic effects of adipokines, reduced differentiation and proliferation of osteoblasts. Age-associated immune-related mechanisms of inflammation, indirectly affecting the bone, are consi­dered. Peculiarities of the senile osteoporosis diagnostics by means of bone mineral density assessment tools are described. Despite the successes achieved in the study of senile osteoporosis development mechanisms, further research is required to explore local and systemic factors affecting bone tissue which are involved in the development of this disease.

Background. The problem of the quality of life (QoL) is relevant nowadays, especially for patients with chronic diseases, including juvenile idiopathic arthritis (JIA) and the subtype of JIA associated with uveitis (JIA-u). The purpose was to carry out a literature review on the QoL in children with JIA and JIA-u, with an analysis of existing tools, the possibility of their use in children, and to assess the QoL indicators of children with JIA, who were treated in a specialized department of the hospital. Materials and methods. The search was performed in the PubMed, Medline, and Google databases using the keywords: JIA, rheumatoid arthritis, uveitis, JIA-u, arthritis with uveitis, QoL, QoL in children. Inclusion criteria were as follows: publication after 2010, use of questionnaires to assess QoL, the sample of patients over 30 people. The type of instrument for assessing QoL, the sample nature, and the QoL indicators of patients were analyzed. The study was carried out at the premises of the State Institution “Institute for Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine” and involved 41 children with JIA (22 with polyarticular, and 19 with oligoarticular variants): 25 girls and 16 boys aged 3–17 years with disease duration of 40.2 ± 6.2 months. Thirty-six of them received methotrexate, and 5 — sulfasalazine. The disease activity was assessed by the Juvenile Arthritis Disease Activity Score (JADAS27) and the functional state — by the Childhood Health Assessment Questionnaire (CHAQ). For quality of life assessment, the Pediatric Quality of Life InventoryTM validated for Ukraine was used. Results. The analysis included 73 foreign scientific papers from 2011 to 2021, among which 11 are fully devoted to the assessment of QoL in children with JIA, and 62 partially cover this topic in children and adults with arthritis. In Ukraine, these issues are not discussed enough (6 articles on the evaluation of QoL in children), the factors for its deterioration remain unclear. The level of activity according to JADAS27 in children in subgroups with both poly- and oligoarticular variants was high (11.20 ± 7.04 and 8.9 ± 4.2 points), and the functional state (on CHAQ) — 0.19 ± 0.17. In children with JIA, QoL indicators are reduced, especially on the scales of emotional and school functioning, and closely correlate with disease activity (r = 0.784, p < 0.05). Conclusions. The analysis of the conducted studies showed that decreased disease activity is not accompanied by the QoL indicators optimization, which remain reduced. Recently, the situation with the QoL assessment in domestic medicine has been improving, relevant questionnaires are being actively introduced. However, the ambiguity of the results in world medicine and the presence of a small number of works on this topic determine the urgency of the problem of QoL in children with JIA in Ukraine.

The paper presents an analysis of current literature data on the use of the R-enantiomer of α-lipoic acid as an antihypertensive treatment in patients with hypertension and metabolic syndrome. An analysis of the literature was carried out on its use as an antiinflammatory agent in inflammatory diseases. Currently, a very important aspect of researches is the possibility of using R-α-lipoic acid as a micronutrient and therapeutic agent for the treatment of diabetic polyneuropathy and neurodegenerative di­seases, especially Alzheimer’s disease, carbohydrate metabolism disorders and metabolic syndrome. Lipoic acid has now become an important ingredient in multivitamin formulas, anti-aging supplements. R-α-lipoic acid is a metabolic antioxidant, its molecule contains a dithiolane ring in oxidized form, this ring has the ability to cleave with formation of dihydrolipoic acid. And since α-lipoic acid, a physiological form of thioctic acid, is a strong antioxidant that relieves the symptoms of diabetic neuropathy, the literature review analyzed data from various authors on the antioxidant effects of the R-enantiomer of α-lipoic acid and found that it had strong antioxidant effects, and its dose of 300 mg is bioequivalent to 600 mg of racemic α-lipoic acid. As presented in a sufficient number of analyzed sources, the biological role of lipoic acid is quite diverse. It is important to determine the exact causal relationship between lipoic acid and its immediate cellular targets. Lipoic acid can have a number of important and diverse physiological effects on the stimulation of neurohormonal function and, thus, indirectly affect multiple cellular signaling pathways in peripheral tissues.

Rinosinusitis is a common disease in most countries of the world, which determines significant economic costs caused by the consumption of medical services and a decrease in a labor productivity. The annual prevalence of acute rhinosinusitis (ARS) is 6–15 %. ARS, as a rule, is a consequence of viral rhinorrhea and is usually self-limited, but serious complications leading to life threatening situations and even death were described. Taking into account the fact that doctors of different specialties, including pediatricians, general practitioners and otolaryngologists are faced with ARS, making the clear algorithm of action and prescribing the relevant pathogenetic therapy is an important problem of health care. In February 2020, the European Rhinologic Society published updated treatment guidelines for acute and chronic rhinosinusitis, as well as nasal polyps (European Position Paper on Rhinоsinusitis and Nasal polyps — EPOS-2020) in patients of different categories: children, adults, patients with concomitant diseases. The EPOS-2020 gives the clear definition of rhinosinusitis and diagnostic criteria for acute and chronic rhinosinusitis (CRS), a new integrated approach to providing medical care in ARS. ARS in children is diagnosed based on a typical clinical picture — a sharp beginning of typical symptoms: nasal congestion, colorless/light discharge from the nose and coughing within < 12 weeks. According to modern criteria, ARS includes three nosological units: acute viral (AVRS), post-virus (PVRS), and bacterial rhinositis (BRS). Treatment of patients with ARS should be comprehensive and should include eli­mination of inflammation, restoration of natural paranasal sinuses, evacuation of discharge from them, eradication of the pathogen, preventing the development of complications, local immunomodulatory therapy. The main groups of medicines used for the treatment of ARS include antibacterial, anti-inflammatory, mucolytic drugs. EPOS-2020 gives the leading place to the prescribing phytotherapy and provides data on specific herbal agents that have proven efficacy for the treatment of ARS: with AVRS — eucalyptic oil and Andrographis paniculata SHA-10; with PVRS — Pelargonium sidoides and myrtol. The main criterion for choosing therapy is the minimization of medicinal load with sufficient treatment effectiveness. This is the drug Respero Mirthol, which combines the mucokinetic, mucolytic, antimicrobial and anti-inflammatory properties. The main active ingredient is myrtol standardized, anti-inflammatory and sanogenetic effect of which has been proved in more than 100 preclinical and randomized clinical studies.

Background. The trigger factors of the development of rheumatoid arthritis (RA) may be infections associated with the carriage in the oral cavity of Actinomycetes, Campylobacter, Mycoplasma, Porphyromonas, Transducers, Proteus, Selemons, Streptococci, and Fusobacteria, but their role in the disease pathogenesis requires clarification. In turn, the quantity of cases of comorbid infectious pathology significantly increases in RA. The purpose was to study the qualitative and quantitative composition of the oral microbiota in RA, to assess the role of individual bacteria in the pathogenetic structures of the disease. Materials and methods. There were examined 121 RA patients aged 18–76 years (on ave­rage 49 years old), among whom there were 19 % men and 81 % women. The duration from the first manifestation of the disease averaged 10 years. The frequency of seropositivity of RA for rheumatoid factor in the blood was 81 %, and for antibodies to cyclic citrullinated peptide — 75 %. I, II, and III degrees of disease activity were determined in 13, 45, and 42 % of cases, respectively, and the ratio of I, II, III, and IV stages of the pathological process was 1 : 5 : 5 : 3. To assess the number of aerobic and facultative anaerobic microorganisms growing on the gingival mucosa, the technique of sterile paper discs was used. The kits “Mikro-La-Test”, “Streptotest-16”, “Anaero-Test 23”, “Neferm Test 24” were used. Results. The vegetation of associations of aerobes on the gums was found in 96.7 % of patients, anaerobic bacteria — in 91.7 %, the number of which is closely related to clinical, laboratory, and X-ray signs of RA, while the integral landscape of the gingival microbiota is influenced by the severity of the comorbid chronic generalized periodontitis, which affects the presence of Moraxella, Sarcina, Streptococci, and Eubacteria in the oral cavity, moreover, the number of anaerobes reflects the degree of RA activity and bone mineral density, and in the pathogenetic constructions of individual signs of the disease (the nature of the articular syndrome and damage to the periarticular tissues), Aerococci, Candida, Clostridia, Megasphaera, Propionibacteria, Sarcina, Fusobacteria, and Eubacteria are involved. Conclusions. The obtained data dictate the need to develop new approaches to medical techno­logy for individual etiopathogenetic therapy of RA with comorbid periodontitis, to identify criteria that allow assessing the activity of the pathological process, predicting the nature of the course of the disease and the effectiveness of therapeutic measures.

There is a complex bidirectional relationship between rheumatic diseases and cancer. Certain rheumatic diseases, in particular dermatomyositis, polymyositis, rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, and systemic sclerosis, on the one hand, are associated with an increased risk of malignant neoplasms against the background of the disease, contributing to cancer due to immunological stimulation. On the other hand, it can manifest as a result of autoimmune reactions caused by primary cancer in the form of paraneoplastic syndrome. Paraneoplastic syndrome is a symptom or set of symptoms that are secondary to the primary cancer process. These symptoms can result from substances secreted by the tumor (hormones and other biologically active substances) or due to the immune reaction to tumor cells (autoimmune reactions, the formation of immune complexes, suppression of the immune system), involving various organs and systems distant from the primary focus or metastases. This paper presents a literature review about the relationship between autoimmune diseases, to a greater extent systemic lupus erythematosus, and malignant neoplasms, and a clinical case in which the manifestation of lupus nephritis coincided with the detection of papillary thyroid carcinoma.

The article summarizes the knowledge about epidemiological data, clinical features, modern principles of diagnosis and treatment of Crohn’s disease in children based on the analysis of literature sources using paper and electronic databases PubMed, CyberLeninka, Web of Science, MedLine, The Cochrane Library. A review of literary sources on the study of this pathology demonstrates that at the present stage, the diagnosis of inflammatory bo­wel diseases, especially in young children, is still a complicated issue. The article focused on the complexity of the diagnostic search due to the not always typical course of the disease in childhood. Data are presented on the peculiarities of clinical course of the disease depending on localization of the pathological process. The author emphasizes the importance of early diagnosis of Crohn’s di­sease in order to provide immediate protocol treatment and the need for detecting this pathology already at the level of primary medical care. The article also presents data of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organisation on the necessary scope of methods for the diagnosis of Crohn’s disease in children according to the current international guidelines. The review describes the modern principles of treatment of Crohn’s disease in children, the main pharmacological groups of drugs that have a proven evidence base in pediatric practice. Particular attention is paid to the role of total enteral nutrition as the safest and quite effective direction of the initial therapy for this pathology in children. In conclusion, the author considered the problem of differential diagnosis of inflammatory bowel disease in pediatric practice.

Results show vitamin D supplementation during pregnancy improves maternal and infant 25(OH)D concentrations and may play a role in maternal insulin resistance and fetal growth. Literature search was performed using PubMed Database of the National Library of Medicine, with date limits from January 2015 to November 2020. We used the keywords: Vitamin D, pregnancy, vitamin D supplementation, hypovitaminosis D, preeclampsia, gestational diabetes, preterm birth, and other related terms. The studies of interest included original papers and review articles on the influence of vitamin D deficiency in pregnancy and the impact of vitamin D supplementation on the maternal outcomes. The published Cochrane review on vitamin D supplementation studies reported that women who receive vitamin D supplementation had lower risk of preeclampsia but with only borderline significance (RR 0.52, CI 0.25–1.05), whereas combined vitamin D and calcium supplementation significantly reduces the risk of preeclampsia. The overall level of evidence is high for vitamin D supplementation playing no role in the prevention of gestational diabetes. Although analysis of the recent observational studies suggests that vitamin D deficiency can increase the risk of C section, there is a need for investigators to conduct RCT to study the impact of vitamin D supplementation on C-section rates. Maternal vitamin D status closest to the delivery was most significantly associated with preterm birth, thereby proposing that later intervention could be used as a rescue treatment to decrease the risk of preterm deliveries. Though the level of evidence is moderate, our analysis shows no significant association between vitamin D and preterm deliveries. Many studies have been designed to investigate an association between postpartum depression and vitamin D. To determine the benefits of vitamin D supplementation in pregnancy would require further evaluation through large, multicenter double-blind randomized controlled clinical trials, with a focus on specific adverse pregnancy outcomes.

At the beginning of the Healthy Ageing Decade, a number of guidelines were published describing management of the rheumatic diseases of the elderly. The aim of the paper is to cha­racterize and discuss the Italian Society of Rheumatology’s guideline for polymyalgia rheumatica (2020) and the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardio­logy’s (2018) recommendation for positron-emission tomography/computed tomography imaging to diagnose the large vessel vasculitis and polymyalgia rheumatica. The following methods were used: original texts of recommedations, their content and methodology behind the development of both guidelines were studied by means of information analysis and compared with the recommendations for the management of polymyalgia rheumatica and giant cell arteritis elaborated in 2018–2020 by the European League Against Rheumatism, American College of Rheumatology; the German, Austrian, Swiss and British rheumatological societies; the European Headache Federation and their references. We’ve established the priority of consensus approach for the development of modern guidelines for polymyalgia rheumatica. The specific feature of the Italian guideline’s development is the search for prototypes restric­ted to the two evidence-based medicine databases and the grey li­terature as well as selection of three international guidelines for ­adaptation, one of them elaborated by the societies for nuclear me­dicine. The following issues were updated: the patient management in primary care (whose algorithm is proposed), including the conserted clinical decision-making and alertness to the giant cell arteritis. Out of the first-line therapy tools, only the initial doses of glucocorticoids are evidence-based, and their reduction is allowed as an alternating regimen. The ineffectiveness of hydroxichloroquine use is justified, while both azathioprine and alternative medical drugs are not subject to discussion. It is necessary to identify the risk factors for vasculitis and its relapses, longterm glucocorticoid use and their side effects. For the first time, the use of positron-emission tomography/computed tomography is recommended for detecting of vasculitis. The recommendation for adjuvant therapy with methotrexate and abstaining from the biologic agents is found the most evidence-based, strongest and consistent; referral to a rheumatologist being the least agreed-on position. Conclusion. Solving such an urgent healthcare problem as improving the quality of polymyalgia rheumatic management suggests the medical standards being raised on the most clinically important issues, the importance of at-risk patient identification and referral to rheumatologists and ophthalmologists, and consideration of the methotrexate’s benefits.

Testosterone is a hormone that plays a key role in carbohydrate, fat and protein metabolism in men. Age-related decrease in testosterone levels, which is facilitated by the development and progression of comorbidities, especially type 2 diabetes mellitus, obesity, dyslipidemia, can have a significant impact on the development of cardiovascular diseases in men and increase the risk of premature death. The paper presents an analysis of modern literature data on the prevalence of late-onset hypogonadism and its impact on the development of cardiovascular pathology in men. An analysis of researches presented in the search database and MedLine database was performed using the keywords “testosterone”, “male”, “late-onset hypogonadism”, and “cardiovascular diseases”. The controversy of a number of hypotheses about the role of androgen deficiency in the development of cardiovascular pathology in men is shown. However, it was determined that most studies showed the correlation between androgen deficiency and the development of metabolic disorders, which are factors for the development of metabolic syndrome, obesity, type 2 diabetes mellitus. In turn, these comorbidities are direct factors that lead to the early onset and progression of vascular pathology and associated mortality in older men. Testosterone therapy is necessary in men with type 2 diabetes mellitus and clinically and laboratory confirmed testosterone deficiency, provided that its safety standards are met. Due to ambiguous results regarding the effect of testosterone on the development of cardiovascular disease, this issue needs further study.

This paper presents detailed analysis of current views on the epidemiology, etiology and pathogenesis of diabetic cardiomyopathy. Diabetes mellitus causes various structural and functional modifications of myocardial tissue. These pathophysiological changes occur due to metabolic disorders caused by hyperglycemia, insulin resistance and dyslipidemia. Free fatty acids can stimulate oxidation and accumulate in the cytosol, leading to lipotoxic effects through the formation of ceramides, diacylglycerol and reactive oxygen species. Hyperglycemia also causes an increase in reactive oxygen species and the formation of end products of glycation, which is accompanied by the development of cardiac glucose toxicity. The combination of these pathophysiological processes, adenosine triphosphate deficiency and lipo-/glucose toxicity are promoters of Ca2+ imbalance, mitochondrial/endoplasmic reticulum stress and apoptosis, activation of protein kinase C signaling pathways, mitogen-activated protein kinases, ubiquitin-proteasome system, proteotoxic stress, activation of the cyclic modulator of adenosine 5’-monophosphates, renin-angiotensin system, causing low-grade chronic inflammation, development of diastolic and, subsequently, systolic dysfunction, myocardial fibrosis. Chronic hyperglycemia, insulin resistance and hyperinsulinemia cause cardiomyocyte resistance to insulin and metabolic disorders that exacerbate mitochondrial dysfunction, oxidative stress, production of glycation end products, alteration of Ca2+ metabolism in the mitochondria, chronic low-grade inflammation, activation of the renin-angiotensin-aldosterone system, stress of the endoplasmic reticulum, death of cardiomyocytes, as well as microvascular dysfunction. These pathophysiological disorders contribute to cardiac stiffness, hypertrophy and fibrosis, the development of diastolic and systolic myocardial dysfunction and heart failure.

More than a hundred-year history of the study of Hashimoto’s thyroiditis testifies to the urgency of the disease and the theoretical and practical problems not solved yet. From a practical point of view, it is important to choose the therapeutic approach and treatment method. The complexity of the pathogenesis of this autoimmune process, which from a local, organ-specific subsequently acquires systemic features, creates certain difficulties for diagnosis and treatment. Accordingly, the clinical picture of the disease changes from local symptoms and hypothyroidism to multifaceted extrathyroid symptoms. They include arthralgia and muscle pain, mental and memory disorders, problems with women fertility, behavioral responses and quality of life. Therefore, therapeutic approach and methods of treatment should correspond to changes in the nature of the pathological process, its activity and clinical course of the disease. Today, it looks simplistic, focused only on drug treatment. There is no pathogenic treatment, and thyroid hormone replacement therapy only relieves the symptoms of hypothyroidism and does not affect the course of the autoimmune process. Hashimoto’s thyroiditis problem is associated with a steadily growing incidence and an increase in the number of patients with extrathyroid lesions and a severe clinical course. In recent years, publications are appearing in the literature that have raised questions about the feasibility of surgical treatment, and thyroidectomy is suggested a method of choice. In this review, we have attempted to analyze publications, which are based on the literature data about the issues raised over the past two decades. Almost all papers emphasize the need to eliminate the active focus of autoimmune aggression. In this regard, the choice of therapeutic approach and indications for surgical treatment remain unresolved.

The article deals with the experience of remote teaching of pediatrics to the fourth year medical students at the Department of Pediatrics 1 and Medical Genetics of Dnipropetrovsk Medical Academy in quarantine time due to the COVID-19 pandemic. The attention of educational institutions to distance learning has increased; due to the introduction of remote teaching it became possible to create educational and scientific sources that are several times greater than the capabilities of paper media. Clinical departments of medical universities have the opportunity to expand their experience in the application of the latest information technologies and for the first time to introduce the teaching of online clinical disciplines. The article describes the experience of preparing and conducting practical classes, teaching lecture material. The dynamics of changes in the load on teachers and students in the process of gaining distance learning experience is described. The stages of preparation of educational materials, tests and clinical tasks for students are described. Possibilities of using tests from KROK-2 base in the preparation of students for practical sessions are considered. Options for testing the knowledge obtained by students during preparation for practical classes are presented. The article examines in detail the possibilities of conducting practical classes and lecturing on various platforms presented on the Internet, the possibility of identifying students, as well as various forms of communication between student and teacher. Attention is also paid to the procedure and methods of accepting students’ classes, which were missed before the quarantine period. The Department of Pediatrics 1 and Medical Genetics also shares the experience of conducting methodological meetings of the department, student research group and educational activities that may also take place in the work of the department during quarantine measures in the COVID-19 pandemic.

Background. Searching for the fundamental pathogenic mechanisms of atopic dermatitis (AD) and improvement of options for prevention and treatment, increasing attention is paid to the state of trace elements supply of the child’s body. Particular role is given to zinc, which is one of the most versatile trace elements. The purpose was to study the features of atopic dermatitis in children depending on the serum content of zinc. Materials and me­thods. The paper presents the materials of clinical observation, clinical laboratory and instrumental examination of 168 children aged 7 to 18 years with AD. The control group consisted of 60 healthy children. The serum zinc content was determined by atomic absorption spectroscopy on a C-115-M1 spectrophotometer according to the instructions that are attached to the device. Results. More than half of children (55.6 %) had very low levels of zinc (0.35 ± 0.11 mg/l), while another 22.2 % had extremely low levels (0.12 ± 0.02 mg/l). Several features of AD clinical course were noted: more frequent episodes of acute respiratory infection, predominance of mode­rate and severe course with periorbital, perioral, perianal dermatitis, dystrophic changes and hyperkeratosis of the nails, increased hair brittleness, expressed skin dryness (2.31 ± 0.73 vs. 1.92 ± 0.69 points, p

The paper deals with the data on the geographic distribution of leptospirosis in the most endemic areas of Odesa region. The highest prevalence of leptospirosis was established in Savranskyi district overrunning the average long-time level by dozens of times. 97.73 % of all cases fell at the seasonal pickup from July to September.

Giant cell arteritis is the most common systemic vasculitis in adults and especially in older people. Its development and treatment is often associated with comorbidities, relapses and va­rious complications. The paper represents an analytical review, systema­tic generalization and discussion of evidence on modern strategies, main risks, medicines and outcomes of the treatment of patients with giant cell arteritis. We studied specialized literature data published in English, Russian and German, found by electronic and manual search, checked for indexing in the main computer databa­ses of evidence-based medicine (Cochrane Library and Medline) and selec­ted without time limiting. Special attention is paid to prevention of early and severe complications and adverse effects of therapy — eye, cardiovascular, cerebrovascular and infectious diseases, diabetes, osteoporosis, fractures and malignancies. Best practice and the results of the introduction of an accelerated approach to management of a patient with suspected giant cell arteritis in primary healthcare setting are described, as well as current evidence base and prospects for early diagnosis and use of glucocorticoids and adjuvant immunosuppressive and biologic therapy with a focus on methotrexate and tocilizumab. Main principles, recommendations and evidence base of the 2020 British Society for Rheumatology guidelines on diagnosis and treatment of this vasculitis are represented and discussed.

The paper analyzes the literature on the problem of the management of patients with neuroendocrine tumors both from a historical perspective and from a modern aspect. Particular attention is paid to classifications, clinical diagnostic and laboratory diagnostic stages of the management of a patient with neuroendocrine tumors, especially the study of biological markers.

Background. Inflammatory bowel diseases (IBD) typically presented by Crohn’s disease (CD) and ulcerative colitis (UC) are still regarded as one of the most difficult and unsolved challenges in contemporary gastroenterology due to its wide spread, high incidence, severe disease progression and complications in diagnosis. Unfortunately, the etiology of IBD is still unknown, but the hypothesis of an immune “hyper-response” caused by environmental factors in relation to the altered gut microbiota or pathogenic microorganisms in a genetically susceptible host is considered the most plausible. The changes of microbiota in IBD are widely recognized and their studies are of great significance for deeper understanding of etiology and pathogenesis of these diseases, as well as for the search of new alternative methods of their treatment. Therefore, the studies of the intestinal dysbiosis in IBD attract more and more attention of the scientists worldwide. Purpose: the current paper aims at studying the features of intestinal dysbiosis and the incidence of small intestine bacterial overgrowth (SIBO) in patients with IBD depending on the disease area and gender. Materials and methods. Forty-six patients with IBD aged 20 to 79 years have been examined, their average age was (47.4 ± 2.4) years. The patients have been distributed into two groups according to the di­sease area. The first group consisted of 15 individuals with CD, the second group included 31 patients with UC. There were 19 females and 27 males in these groups. All patients underwent hydrogen breath test for SIBO detection and the bacteriologic fecal culture. Results. The microbiological study has revealed the presence of deep qualitative and quantitative changes in the colonic microflora in 97.8 % of patients with IBD, with predominance of dysbiosis II in 48.4 % of people with UC and dysbiosis II and III in 33.3 % of individuals with CD. These changes were caused by a decrease in the quantity of bifidobacteria and lactobacillus flora, an increase in the concentration of opportunistic microorganisms and yeast-like fungi. The results obtained after performing hydrogen breath tests evidence the high incidence of SIBO in patients with IBD (50 %). The analysis of the received data allows revealing the fact that SIBO prevailed in patients with UC (51.6 %). The certain difference has been noted between males and females: in both groups of patients with detected SIBO, the males prevailed. Conclusions. The results obtained indicate that virtually all patients with IBD are characterized by changes in the gut microbiota, mainly due to a sharp decrease in the number of major symbionts of colonic microbiocenosis and an increase in the concentration of opportunistic microflora. Fecal microbiological examination and hydrogen breath test are the most available non-invasive methods that allow rapid detection of intestinal microflora disturbances.

The scientific review presents the significance of some amino acids in the process of dispersing of bacterial biofilms. To write the article, information was searched using Scopus, Web of Science, MedLine, PubMed, Google Scholar, EMBASE, Global Health, the Cochrane Library, CyberLeninka. The influence of amino acids as nutrients on the late stages of biofilm life is considered, the effect of the D-enantiomers of amino acids on tryptophan and its derivatives on the biofilm dispersion is presented. It is emphasized that D-amino acids, namely, D-tyrosine, D-methionine, D-leucine, D-tryptophan, prevent the adhesion of amy­loid fibers, which keep the aggregation of the biofilms. D-amino acids inhibit the expression of genes involved in the production of components of the biofilm matrix, and thus realize their antibiotic effect. The ability of tryptophan to prevent the development and dispersion of biofilms, in particular those associated with the bacteria Pseudomonas aeruginosa, is highlighted. It is indicated that the role of anthranilates is to disrupt the structure of the biofilm and to stimulate the separation of sites from biofilms formed by the bacteria Pseudomonas aeruginosa. Anthranilates can help interrupt the chronicity of the infectious process. It is assumed that the use of amino acids and their derivatives, the creation of new chemical compounds that mimic the structure of amino acid molecules or alter the activity of the synthesis and degradation of certain amino acids will allow purposefully to control the life cycle of biofilms of certain types of pathogenic bacteria, which will contribute to the recovery of infectious recurrent and chronic diseases. The paper presents the prospect of developing new drugs based on anthranilic acid and halogenated indoles that promote bacterial eradication in respiratory tract infections associated with the development of bacterial biofilms of antibiotic-resistant bacterial agents.

Chronic inflammatory bowel diseases, namely ulcerative colitis and Crohn’s disease, still remain one of the most complicated and pressing challenges of gastroenterology and coloproctology. As chronic inflammatory bowel disease are very common and number of patients with this disease increases, the scientists all over the world have to study the clinical features and pathogenesis of systemic lesions in ulcerative colitis and Crohn’s disease more intensively in order to develop some new methods for the diagnosis and treatment of such patients. The problem is that physicians do not focus enough attention on detection of the nutritional status disorders in this ca­tegory of patients. One of the causes for such situation is that there is no common standard for assessing nutritional status and risk of its disorders, which reduces possibility of analysis, generalization of research results and development of algorithms to correct these disorders. This paper reflects the principal methods to diagnose the nutritional status disorders. The possibilities of instrumental and laboratory research methods are shown. The attention was paid to gastrointestinal microbiota, as it is well known that small intestinal bacterial overgrowth and microflora disorders in large bowel play an important role and lead to the progression of malnutrition. The search was done using PubMed, Medline, Embase databases.

The article deals with the problem of functional dyspepsia. Functional dyspepsia is characterized by diverse non-specific symptoms such as discomfort, troublesome early satiety, nausea, or epigastric pain or burning. It can easily be overlooked as the symptoms overlap with gastro-oesophageal reflux disease and irritable bowel syndrome that requires diagnosis specification. The pathophysiology of functional dyspepsia is not completely understood. It is thought to be associated with upper gastrointestinal inflammation and motility disturbances, which may be triggered by an infectious or allergenic agent, or a change in the intestinal microbiome. While functional dyspepsia is distressing and affects the quality of life, it has no long-term impact on mortality. There are many treatment options available, with varying levels of evidence of effectiveness. These include dietary modification, acid suppression, prokinetic drugs including tricyclic antidepressants and psychological therapy. Proton pump inhibitors (PPIs) and prokinetics are commonly used first-line medications. The paper paid attention to a preparation Domrid containing domperidone (prokinetic).

The paper presents 4 clinical cases of membranous pharyngitis caused by Corynebacterium ulcerans in subjects aged 27, 32, 44 and 46 years, with detailed analysis. The role of the zoonotic pathogen Corynebacterium ulcerans in the emergence of a disease similar to classic diphtheria is shown. The importance of vaccination against diphtheria is emphasized in order to prevent the incidence of zoonotic infection caused by Corynebacterium ulcerans.

Acute poisoning in children occupies a leading place among all accidents. Intentional poisoning is more typical for adolescents. Most often, they are drug poisoning caused by the wide choice of drugs and their easy availability. The paper describes a case of acute amlodipine poisoning in an adolescent who took 90 mg of amlodipine simultaneously for suicide. When the patient was admitted to the hospital, her condition was extremely severe due to the symptoms of general intoxication and hemodynamic disorders, in particular, significantly reduced blood pressure. Within the next few days, the patient is most likely to developed non-cardiogenic pulmonary oedema with a significant amount of effusion into the pleural cavity, that required four pleural punctures and additional drug therapy. Gradually, the patient’s condition improved and she was discharged in good condition on the 20th day from the start of treatment after consulting the child by a psychiatrist. Amlodipine, like other dihydropyridines, is a potent vasodilator. Capillary vasodilation that leads to excessive pulmonary capillary extravasation, underlies the non-cardiogenic pulmonary oedema mechanism, that most likely was observed in our patient. Considering the popularity of amlodipine as an effective antihypertensive drug, we can assume that in the future such poisoning may occur in clinical practice of doctors. That is why the physicians should be informed about the clinical symptoms of amlodipine poisoning, the severe complications that may develop in the case of an overdose, and the effective medical measures for such poisoning.

Background. The presence of hypertension, which in diabetic patients occurs 2 times more often than in the general population, increases the risk of cardiovascular complications. The main tool for the diagnosis of hypertension in children is ambulatory blood pressure monitoring (ABPM) due to the fact that a number of ABPM parameters may act as predictors of the deve­lopment of cardiovascular events. The purpose was to establish the features of the daily blood pressure in children with diabetes depending on the duration of the disease. Materials and methods. The paper investigated the features of the daily arterial pressure in 53 children (mean age 14.79 ± 0.25 years) with diabetes mellitus, according to the ABPM data. Depending on the duration of the disease, there were 3 groups: group 1 — 11 children with disease duration of up to 1 year, group 2 — 19 persons with disease duration of 1–5 years, and group 3 — 23 patients with disease duration of more than 5 years. The control group consisted of 20 children, representative by the age and sex, who had no disorders of carbohydrate metabolism and intercurrent diseases. Results. In children with diabetes, with an increase in the duration of the disease, there was an elevation in the blood pressure, its variability and the index of hypertension. Hypertension occurred in 21.0 % of patients with duration of diabetes from 1 to 5 years and in 43.5 % of persons with disease duration of more than 5 years. Identified changes occurred on the background of the circadian blood pressure changes, which took place during the first year of the disease and observed in 51.0–54.5 % of patients. Among the pathological profiles of nocturnal blood pressure reduction in patients with diabetes mellitus, the non-dipper type prevailed (43.5–47.4 %). Conclusions. The majority of patients with diabetes mellitus experienced changes in blood pressure, the first signs of which were registered in the first year of the disease and progressed with an increase of its the duration. The findings suggest that children with diabetes, regardless of the duration of the disease, should be classified as high risk for developing hypertension.

The purpose of the paper is to provide a review of the effects of nutrition as a risk factor and intervention in the aspect of rheumatic diseases. Using information analysis methods, more than 100 special literature sources have been studied, including evidence based medicine computer databases. The significance of nutrition as a risk factor for the development and outcomes, first of all for rheumatoid arthritis and gout, is proved in large observational studies, systematic reviews and meta-analysis dedicated to both preventive and therapeutic potential as well as to safety of different food products, diets, micronutrients and probiotics, including in connection with associated main risk factors of non-infectious diseases (tobacco smoking, alcohol consumption, increased body mass index). The pathogenetic role of nutrition is considered in the context of its influence on gut microbiota. Necessity of the randomized controlled trials is shown in order to assess the protective potential of different nutritional patterns, as well as the effects of modified Mediterranean diet, some dietary supplements and probiotics intake in rheumatic diseases, and as a result — to develop special guidelines on nutrition in rheumatic patients. There is a sufficient evidence base of preventive counse­ling of such patients on nutritional issues with the aim of cardiovascular risk reduction.

The scientific review presents data on the functioning of the quorum-sensing systems Agr and RAP/TRAP of Staphylococcus aureus bacteria. The paper gives the characteristics of medications inhibiting the export of AIP from a bacterial cell, the activity of histidine kinase AgrC, the expression and functional activity of AgrA, the expression of the RNAIII transcript of Staphylococcus aureus bacteria. It is suggested that the drugs developed to inhibit the activity of the mechanisms of the quorum sensing of Staphylococcus aureus bacteria will take a worthy place in anti-staphylococcal therapy.

Background. The variability of laboratory results leads to an in­depth study of the past medical history and clinical picture, as well as diagnostic procedures to detect parathyroid glands with altered functional activity. The purpose of the study was to determine the most effective methods for assessing the persistence of primary hyperparathyroidism (PHPT) in the early postoperative period and ways to prevent such a condition. Materials and methods. A retrospective review of a prospectively collected database of patients operated for PHPT has been conducted. At the preoperative stage, an ultrasound examination of the neck, along with the evaluation of ionized calcium, parathyroid hormone and blood creatinine, was performed in all patients to visualize parathyroid adenomas. Results. Between January 1, 2014 and December 31, 2018, 436 patients underwent surgery for PHPT, 408 women (93.6 %) and 28 men (6.4 %). Seven patients (1.6 %) required repeated surgery for the persistence of hyperparathyroidism, which correlates with data from foreign scientific papers. Each case is considered separately. Three patients underwent 99mTc­MIBI scan at the preoperative stage. The persistence criteria were parathyroid hormone and ionized calcium levels on the first day of the postoperative period. The average level of parathyroid hormone before surgery in these patients was 182.15 ± 31.25 pg/ml, the average level of Ca2+ — 1.44 ± 0.05 mmol/l. After performing first surgery, the level of parathyroid hormone decreased on avera­ge to 117.55 ± 20.55 pg/ml, Ca2+ — to 1.34 ± 0.05 mmol/l. It should be noted that all these patients underwent a unilateral revision of the parathyroid glands. Considering the presence of obvious laboratory signs of hyperparathyroidism persistence, additional instrumental study (contrast­enhanced computed tomography of the chest) and repeated surgery were performed in 4 patients. After repeated surgical treatment, the level of parathyroid hormone decreased on average to 40.19 ± 13.21 pg/ml, the level of Ca2+ — to 1.25 ± 0.03 mmol/l. For the control group, 80 patients were selected, they underwent successful surgical treatment for PHPT. The average level of parathyroid hormone before surgery was 206.3 ± 16.0 pg/ml, the average level of Ca2+ — 1.48 ± 0.02 mmol/l. After first operation, parathyroid hormone decreased on average to 16.67 ± 1.28 pg/ml and Ca2+ — to 1.19 ± 0.01 mmol/l. The main cause of PHPT persistence is a combination of parathyroid hyperplasia and parathyroid adenoma (4 patients (57.14 %)). Rarely, the cause of disease persistence was double parathyroid adenoma — in 2 patients (28.57 %) and true parathyroid hyperplasia — in 1 patient (14.29 %). Conclusions. Determining the level of parathyroid hormone on the first postoperative day is of critical importance after intervention for PHРT in terms of hypocalcemia or disease persistence detection, followed by determination of ionized calcium in the blood, which characterizes the effectiveness of surgical treatment. The combination of parathyroid adenoma and true parathyroid hyperplasia that was not verified at the preoperative stage by additional instrumental methods (contrast­enhanced multislice computed tomography of the neck and chest with) is the main cause of persistence of primary hyperparathyroidism. Rarely, the cause of disease persistence is double parathyroid adenoma and true parathyroid hyperplasia. 99mTc­MIBI scan is an important method of preoperative diagnosis, but only in combination with other radiological methods in case of the defeat of 2 or more parathyroid glands.

Giant cell arteritis (GCA) is the most common systemic vasculitis affecting large vessels in subjects over 50 years old. This di­sease is associated with an increased risk of other inflammatory disea­ses and vascular conditions. Many studies and guidelines focus on sol­ving GCA-associated problems. The aim of this paper is to perform an analytical review, systematic generalization and discussion of evidence on various epidemiological GCA aspects, modern approaches and me­thods of its diagnosis as well as risk factors of unfavorable prognosis.

Osteopetrosis is a hereditary disease with an autosomal recessive or autosomal dominant type of inheritance, caused by a disruption in the functional activity of osteoclasts due to gene mutation. The article systematizes data on etiology, classification, pathomorphology, gene disorders based on the analysis of 38 sources of literature, and deals with the modern approa­ches to the treatment of osteopetrosis. Three types of osteopetrosis with different severity degrees of skeletal disorders and pathological severity are described. The main pathomorphological changes in the structural organization of bone tissue are presented and features of the state of osteoclasts are shown depending on the mutation of genes controlling their functional activity. There are no protocols for the treatment of this pathology, but treatment me­thods based on the use of hematopoietic stem cells are under development. The paper presents with clinical case report of a patient with marble bone disease.

The paper deals with the diagnostic algorithm including a comprehensive study, substantiates the necessity to evaluate the results obtained taking into account the age and sex of the child. The article considers the features of management of children with liver pathology and the mechanisms of action of ursodeoxycholic acid on the human body as well as the results of clinical research and observations on the use of the ursodeoxycholic acid for the treatment of children with liver diseases.

This review presents the results of the study of combined pathology of the gastrointestinal tract and the thyroid gland, the most likely mechanisms of development and prospects for further use of the data obtained. The question of combined gastro-thyroid pathology is actively studied both by world and native scientists. The paper deals with the results of meta-analysis and own scientific researches, which confirm the possible interrelation and interdetermination of the development of combined pathology of the gastrointestinal tract and thyroid gland.

Background. In order to eliminate measles around the world, a panel of experts from the World Health Organization recommends increased attention be paid to improving the immunization system as a whole, to carry out early detection of infections, to assess the level of immune protection of the population, and to improve the network of laboratory services for timely diagnosis and prevention of the spread of this infection. Our purpose was to study the dynamics of measles incidence in the Odesa region in 2010–2018 and to determine the impact of the number of vaccinated and seropositive persons on the epidemic process. Materials and methods. Using analytical and statistical approaches, an epidemiological analysis of the official statistical reports of State Institution “Odesa Regional Laboratory Centre of State Sanitary and Epidemiological Service of Ukraine” was performed in the paper. Results. From 2010 to 2018, the incidence of measles in Odesa and the Odesa region has coincided with the frequency of epidemic morbidity in Ukraine as a whole. The greatest number of cases was among children aged 1–4 and 5–9 years, as well as people from the age group over 30 years. The level of antimeasles IgG detected in 2018 in all age categories have averaged 69.46 %. Conclusions. It is necessary to increase the number of vaccinated persons up to 95 % to ensure the epidemic welfare of the population in Odesa and the Odesa region and for measles elimination. Increasing level of immunized people will lead to the prevention of infection spread among the population.