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Background.Osteoporosis is the fourth most common disease after cardiovascular diseases, cancer, and diabetes. All these diseases have common pathogenetic mechanisms associated with impaired cholesterol metabolism. In recent decades, the use of the key enzyme of cholesterol synthesis inhibitors — statins, which can stimulate osteogenesis, has become widespread. However, statins affect the production of the vitamin D active form by reducing the production of testosterone and thus reducing the activity of 1α-hydroxylase. The combined use of statins and α-calcidol (α-C) for the osteoporosis prevention seems promising. The aim of the study was to evaluate the effect of long-term atorvastatin (ATV) and α-C administration on morphometric growth parameters and bone vascularization in the experiment.Materials and Methods. The experiment was conducted for three months on 120 laboratory male rats, which were injected daily intragastrically with ATV and α-C. After 90 days of the experiment, the animals were decapitated under ether anesthesia. For the study, the right femur and jawbone were taken from the animals. The rat bone sections were impregnated with silver, decalcified, and the histosections were stained according to van Gieson. The distribution of the studied features was evaluated according to the Shapiro-Wilk test. The differences were considered statistically significant at p0.05.Results.It was found that ATV, both separately and together with α-C, increased the size of the newly formed bone in the endoostal and periosteal zones of the femur by 64.8; 40.4 and 15.8; 29.1%, respectively. The combined use of ATV and α-C had a positive effect on the growth of blood vessels in the femur (+23.4%). ATV increased the size of the newly formed bone from the periodontal and vestibular surfaces of the lower jaw by 18.3 and 29.5%, respectively. α-C potentiated the effect of ATV on the size of the newly formed bone tissue in the periodontal and vestibular growth zones of the mandibular bone by 10.1 and 15.0%, respectively. As for the number of vessels in the jawbone tissue, thanks to ATV, it increased by 17.2%, α-C had no effect.Conclusion. ATV increases the thickness of the newly formed bone layer in the growth areas of the femur and jawbone and increases the number of vessels in the jawbone. α-calcidol increases the number of vessels in the bone tissue of the femur and potentiates the effect of ATV on the jawbone growth zones. The combined use of ATV and α-C shows that they positively complement each other.

The aim of this work is to study the state of the problem of the development of small-for-gestational-age fetus and fetal growth restriction over the past 5 years. A review of randomized trials of the PubMed database for the period of 2015 to 2020 was carried out. Experts reached an agreement on the definition of diagnostic criteria for small-for-gestational-age fetus and fetal growth restriction, a clinically valid classification was created, and the main monitoring strategies were developed. Due to the different pathogenesis, fetal growth restriction is divided into early and late. The observation algorithm includes tests that have shown higher sensitivity and specificity. There is no single standard for the median weight and abdominal circumference of a fetus, indicators of the reference range for fetal Doppler. Smoking cessation and taking acetylsalicylic acid at a dose of 150 mg at high risk of preeclampsia is recommended to prevent the small-for-gestational-age fetus and fetal growth restriction. The pregnancy management algorithm includes Doppler ultrasound examination of the umbilical artery, cardiotocography. If this pathology occurs before 32 weeks of pregnancy, the blood flow in ductus venosus is additionally examined, and after 32 weeks of pregnancy, the middle cerebral artery blood velocities and cerebroplacental ratio are assessed. Indicators of Doppler velocimetry and cardiotocography, which serve as criteria for early termination of pregnancy, are developed, measures are proposed to improve neonatal outcomes prevention of respiratory distress syndrome at 2434 weeks of gestation, as well as magnesium therapy for fetal neuroprotection. The problems of preventing fetal growth restriction and the algorithm for monitoring pregnant women who do not have risk factors for small-for-gestational-age fetus, management tactics and indications for delivery while slowing fetal weight gain remain unresolved.

Non-woven needle-punched material with silver nanoparticles was obtained from the waste of natural silk cocooning process. Silver nanoparticles were synthesized by chemical reduction from an ammonia solution of silver nitrate. It is shown that the treatment of silk material with a solution of 1-butyl-3-methylimidazolium chloride affects the amorphous-crystalline state of the fiber, its sorption properties and the resistance of silver nanoparticles on the fiber to wet treatments.

Impairments of sleep and waking in diseases such as Parkinson’s disease, dementia, Lewy body dementia, and Alzheimer’s disease are encountered in a large proportion of patients. Sleep has many functions, supporting the normal operation of the brain, and impairments to sleep may be among the factors promoting the development of neurodegenerative diseases. Impairments to sleep and waking may exacerbate the course of the neurodegenerative process and lead to increases in symptoms, including cognitive impairments. This article presents a detailed analysis of the literature linking sleep and waking impairments and cognitive impairments in neurodegenerative diseases. The phenomenology and methods of correcting sleep and waking impairments in these diseases are discussed.

The purpose — to compare the effectiveness of cerclage to reduce the frequency of preterm birth when using non-absorbable suture material in the form of a braided silk thread (4 mm) and a braided tape (5 mm), as well as to identify the frequency of complications when using them. Material and methods. A retrospective analysis of cases and childbirth was conducted, as well as the analysis of own experience of applying cerclage with various suture materials in patients with isthmic-cervical insufficiency. A total of 157 patients were examined. Pregnancy outcomes, neonatal outcomes, and post-suture complications were evaluated. Results. 157 women were given cerclage at gestation periods of 14 to 23 weeks. There was no significant difference in the choice of suture material relative to the duration of pregnancy. Cerclage with thread was performed in 92 patients (58,6%) — group 1 and 65 patients were sutured with tape (41,4%) — group 2. Preterm birth occurred in 28 patients of the 2nd comparison group (18%) and 45 patients of the 1st group (29%). The duration of pregnancy in preterm birth was comparable in both groups. Conclusions. The study found that preterm birth after cerclage using a braided tape occurred less frequently than with the use of a braided silk thread. There were no significant differences in neonatal outcomes in the comparison groups. Complications after cerclage, such as suture and cervical rupture, were found only in the group of women who underwent surgery using a woven silk thread.

Objectives. To study the N-acetylaspartate (NAA) content in the plasma of elderly patients with depression during treatment with antidepressants combined with Actovegin. Materials and methods. Nineteen patients – seven men, 12 women, age 70.5 ± 5.8 years – were treated in hospital conditions. Patients underwent clinical psychiatric evaluation using a series of psychometric scales, along with computerized tomography (CT) and biochemical assay of NAA. Patients received antidepressants (venlafaxine and fluvoxamine at therapeutic doses) and Actovegin for 28 days and were investigated before and after treatment (day 28). Results and conclusions. Decreases in blood NAA were found in pretreatment patients as compared with healthy subjects, with increases after treatment, which corresponded to a significant improvement in patients’ status both clinically and on psychometric scales. Heterogeneity was found in the cohort of patients in relation to the nature of changes in contents (increases or decreases) of NAA, which was not linked with treatment efficacy but correlated with the burden of comorbid somatic diseases, especially vascular, and some CT features (leukoaraiosis). The authors emphasize the preliminary nature of the results.

The main role in spontaneous abortion in 2nd and 3d trimesters is assigned to cervical insufficiency. According to a number of researchers, bed rest, elevated lower limbs, restriction of physical activity, tocolysis, antibacterial therapy do not affect the prolongation of pregnancy and are ineffective for preventing premature spontaneous labor. Correction of cervical insufficiency can be carried out by a vaginal form of progesterone, cerclage, pessary. The use of vaginal progesterone is justified in women with recurrent miscarriage, a history of premature birth, and shortening of the cervix to less than 25 mm. Indications for surgical correction are limited to patients with habitual loss of pregnancy due to cervical weakness or a history of premature birth. In the absence of significant obstetric history, cerclage has no advantages over the use of progesterone. The optimal time for cerclage is up to 20 weeks of pregnancy. Unlike progesterone cerclage has complications, the frequency and severity of which are attributable to the timing and indications for correction. Transabdominal cerclage is performed only when there is a technical impossibility of vaginal access due to the absence of a vaginal part of the cervix or after unsuccessful attempts of vaginal cerclages. Most often, the use of a pessary is associated with the diagnosis of a short cervix in terms of more than 24 weeks of gestation in the absence of an aggravated history. The combined use of gestagens, pessary and cerclage does not increase the efficiency of carrying a singleton pregnancy. Methods for the prevention of preterm delivery in multiple pregnancy, such as the introduction of a specialized outpatient service, bed rest, antibacterial therapy, progesterone, preventive cerclage or the insertion of a pessary do not change the incidence and mortality of newborns.

To compare the activity of platelet glutathione reductase (GR) and glutathione-S-transferase (GST) in elderly patients with depression and in the control group, and to identify a possible relationship between the activity of these enzymes and clinical parameters of the disease.We examined 42 elderly patients (60-86 years old) with depressive episodes of various nosological categories according to ICD-10: a single depressive episode (F32.0, F32.1), a depressive episode in recurrent depressive disorder (RDR - F33.0, F33.1), and a depressive episode in bipolar disorder (BD - F31.3). The GR, GST activity and the severity of depression were assessed twice: before the beginning of the course of 28-day antidepressant therapy (day 0) and on the 28th day of the course of therapy, using the Hamilton Depressive Scale (HAMD-17) and the Hamilton Anxiety Scale (HARS).As compared with the control group, a significant decrease in GST activity was found in patients before and after the course of therapy (A pilot study has revealed a decrease in platelet GST activity, and a link between platelet GR activity and the severity of depression after a course of therapy. The results obtained indicate the promise of further study of glutathione metabolism enzymes as a biomarker for assessing the state.Сравнительная оценка активности тромбоцитарных глутатионредуктазы (GR) и глутатион-S-трансферазы (GST) у больных с депрессией пожилого возраста и контрольной группы и выявление возможной связи активности этих ферментов с клиническими параметрами заболевания.Обследовано 42 пациента пожилого возраста (60—86 лет) с депрессивными эпизодами разных нозологических категорий по МКБ-10: однократного депрессивного эпизода (F32.0, F32.1), депрессивный эпизод в рамках рекуррентного депрессивного расстройства (РДР — F33.0, F33.1) и депрессивный эпизод при биполярном аффективном расстройстве (БАР — F31.3). Активность GR, GST и тяжесть депрессии оценивались дважды: до начала курса 28-дневной антидепрессивной терапии (0 день) и на 28-й день курса терапии с использованием шкалы Гамильтона для оценки депрессии (HAMD-17) и шкалы Гамильтона для оценки тревоги (HARS).У пациентов обнаружено достоверное снижение активности GST по сравнению с контрольной группой до начала и после курса терапии (Пилотное исследование выявило снижение активности тромбоцитарной GST у больных с депрессиями и связь активности тромбоцитарной GR с выраженностью депрессии после курса терапии. Полученные результаты свидетельствуют о перспективности дальнейшего изучения ферментов глутатионового обмена в качестве биомаркера для оценки состояния пожилых больных с депрессиями.

Accumulating clinical and preclinical data indicate a prominent role of gut microbiota in regulation of physiological functions. The gut-brain axis imbalance due to gut dysbiosis is associated with a range of neurodegenerative diseases. Probiotics were suggested not only to restore intestinal dysbiosis but also modulate stress response and improve mood and anxiety symptoms. In this study, we assessed the effects of probiotic lactobacilli on behavioral reactions, the level of oxidative stress and microbiota content in mice administered to broad-spectrum antibiotics. Our study demonstrates that antibiotic treatment of adolescent mice for two weeks resulted in higher mortality and lower weight gain and induced significant changes in behavior including lower locomotor and exploratory activity, reduced muscle strength, visceral hypersensitivity, higher level of anxiety and impaired cognitive functions compared to the control group. These changes were accompanied by decreased diversity and total amount of bacteria, abundance of Proteobacteria and Verrucomicrobia phyla, and reduced Firmicutes/Bacteroides ratio in the gut microbiota. Moreover, a higher level of oxidative stress was found in brain and skeletal muscle tissues of mice treated with antibiotics. Oral administration of two Lactobacillus strains prevented the observed changes and improved not only microbiota content but also the behavioral alterations, suggesting a neuroprotective and antioxidant role of probiotics.

The study material was 20 autopsy samples obtained from males aged 65 to 72 years who died from acute atherosclerotic cardiovascular insufficiency. Aortic segments (from the arch, thoracic and abdominal regions), coronary arteries and the arteries of the base of the brain (In unstable atherosclerotic lesions, there were active neovascularization processes in both the fibrous cap and the underlying parts of the adventitia. These changes are usually combined with a pronounced cellular inflammatory response that can contribute to their development. Endothelial growth factor may be one of the causes of neovascularization in unstable atherosclerotic lesions.A comparative immunomorphological study in the human aorta, coronary arteries, andИзучить морфологические особенности неоангиогенеза в различных атеросклеротических поражениях, а также выяснить роль в неоваскуляризации фактора роста эндотелия сосудов (VEGF).Материалом исследования являлись образцы, взятые во время 20 аутопсий мужчин в возрасте от 65 до 72 лет, умерших от острой сердечно-сосудистой недостаточности атеросклеротической этиологии. Были изучены сегменты аорты (из района дуги, грудного и брюшного отделов), коронарные артерии и артерии основания головного мозга (В нестабильных атеросклеротических поражениях выявлены активные процессы неоваскуляризации как в фиброзной покрышке, так и в подлежащих отделах адвентиции. Эти изменения, как правило, сочетаются с выраженной воспалительной клеточной реакцией, которая, возможно, и способствует их развитию. Одной из причин, вызывающих неоваскуляризацию в нестабильных атеросклеротических поражениях, возможно, является фактор эндотелиального роста.В результате сравнительного иммуноморфологического исследования в аорте, коронарных артериях и

У статті висвітлено основні підходи та вимоги до переходу надання первинної медико-санітарної допомоги населенню, основні функції та роль медичної сестри загальної практики – сімейної медицини в задоволенні потреб пацієнтів та необхідності формування її професійно-педагогічної компетентності як основи етико-деонтологічної та професійної діяльності.

The possibilities of obtaining porous permeable cermet SHS-materials with catalytic properties are studied. The mixture consisted of powders of steel alloy scale, concentrate of ilmenite, oxides of aluminum or chromium, the basis of the material formed the backbone of metal ceramics (Al2O3) and reduced iron, as well as additives of metal oxides. The resulting material is intended for the catalytic purification of exhaust gases of diesel engines, in particular, from nitrous oxide, carbon monoxide and soot.

The possibilities of obtaining porous permeable cermet SHS-materials with catalytic properties are studied. The charge composition consists of powders of alloy steel scale, ilmenite concentrate, aluminum or chromium oxides, the basis of material forming the backbone of cermet (Al2O3) and reduced iron, and also added metaloxides. The material obtained is intended for the catalytic purification of diesel engine exhaust gases, particularly from nitrous oxide, carbon monoxide and soot.

Enhanced levels of homocysteine during pregnancy induce oxidative stress and contribute to many age-related diseases. In this study, we analyzed age-dependent synaptic modifications in developing neuromuscular synapses of rats with prenatal hyperhomocysteinemia (hHCY). One of the main findings indicate that the intensity and the timing of transmitter release in synapses of neonatal (P6 and P10) hHCY rats acquired features of matured synaptic transmission of adult rats. The amplitude and frequency of miniature end-plate currents (MEPCs) and evoked transmitter release were higher in neonatal hHCY animals compared to the control group. Analysis of the kinetics of neurotransmitter release demonstrated more synchronized release in neonatal rats with hHCY. At the same time lower release probability was observed in adults with hHCY. Spontaneous transmitter release in neonates with hHCY was inhibited by hydrogen peroxide (H2O2) whereas in controls this oxidant was effective only in adult animals indicating a higher susceptibility of motor nerve terminals to oxidative stress. The morphology and the intensity of endocytosis of synaptic vesicles in motor nerve endings was assessed using the fluorescence dye FM 1-43. Adult-like synapses were found in neonates with hHCY which were characterized by a larger area of presynaptic terminals compared to controls. No difference in the intensity of FM 1-43 fluorescence was observed between two groups of animals. Prenatal hHCY resulted in reduced muscle strength assessed by the Paw Grip Endurance test. Using biochemical assays we found an increased level of H2O2 and lipid peroxidation products in the diaphragm muscles of hHCY rats. This was associated with a lowered activity of superoxide dismutase and glutathione peroxidase. Our data indicate that prenatal hHCY induces oxidative stress and apparent faster functional and morphological "maturation" of motor synapses. Our results uncover synaptic mechanisms of disrupted muscle function observed in hHCY conditions which may contribute to the pathogenesis of motor neuronal diseases associated with enhanced level of homocysteine.

Development of highly selective COX-2 inhibitors – coxibs has proved a decreased risk of gastrointestinal toxicity, which was typical for non-selective NSAIDS, according to the evidence-based medicine. But such situation caused an imbalance in the impact on the synthesis of arachidonic acid metabolites: inhibition of COX-2 vasodilatatory prostacyclins and activation of thromboxane synthesis by platelets, which is accompanied by the increase in the frequency of thrombotic complications – myocardial infarctions and strokes. Some meta-analyses have proved this association: the higher is COX-2 inhibitors selectivity – the higher are CV-risks and cardiovascular toxicity of coxibs. Discontinuation or limitation of indications of coxibs, assessment of risk / benefit ratio is recommended in the conditions of comorbidity of CVS pathology, pain syndromes in rheumatology. Drugs of choice are moderately selective COX-2 inhibitors = meloxicam and nimesulide., Разработка высокоселективных ингибиторов ЦОГ-2 – коксибов, подтвердила при использовании методов доказательной медицины снижение риска гастротоксичности, характерное для неселективных НПЗП. Однако такая ситуация привела к дисбалансу во влиянии на синтез метаболитов арахидоновой кислоты: угнетение ЦОГ-2 вазодилататорных простациклинов и активацию тромбоцитами синтеза тромбоксана, что сопровождалось приростом частоты тромботических осложнений – инфарктов миокарда или инсультов. Ряд метаанализов подтвердил эту ассоциацию: чем выше селективность ингибиторов ЦОГ-2 – тем больше КВ-риски и кардиотоксичность коксибов. В условиях коморбидности патологии ССС, болевых синдромов в ревматологии рекомендуется отмена либо ограничение показаний к коксибам, оценка соотношения риск/польза. Выбор следует акцентировать на умеренно селективные ингибиторы ЦОГ-2 = мелоксикам или нимесулид., Розробка високоселективних інгібіторів ЦОГ-2 – коксибів, підтвердила при використанні методів доказової медицини зниження ризику гастротоксичності, характерне для неселективних НПЗП. Однак така ситуація призвела до дисбалансу у впливі на синтез метаболітів арахідонової кислоти: пригнічення ЦОГ-2 вазодилататорних простациклінів і активацію тромбоцитами синтезу тромбоксану, що супроводжувалося приростом частоти тромботичних ускладнень – інфарктів міокарда та інсультів. Ряд метааналізів підтвердив цю асоціацію: чим вища селективність інгібіторів ЦОГ-2 – тим більші КВ-ризики і кардіотоксичність коксибів. В умовах коморбідності патології ССС, больових синдромів у ревматології рекомендується відміна або обмеження показань до коксибів, оцінка співвідношення ризик / користь. Вибір слід акцентувати на помірно селективних інгібіторах ЦОГ-2 = мелоксикам або німесулід.

Hydrogen sulfide (H2S) is endogenously produced from sulfur containing amino acids, including homocysteine and exerts neuroprotective effects. An increase of homocysteine during pregnancy impairs fetal growth and development of the offspring due to severe oxidative stress. We analyzed the effects of the H2S donor&mdash, sodium hydrosulfide (NaHS) administered to female rats with hyperhomocysteinemia (hHcy) on behavioral impairments and levels of oxidative stress of their offspring. Rats born from females fed with control or high methionine diet, with or without H2S donor injections were investigated. Rats with maternal hHcy exhibit increased levels of total locomotor activity and anxiety, decreased muscle endurance and motor coordination, abnormalities of fine motor control, as well as reduced spatial memory and learning. Oxidative stress in brain tissues measured by activity of glutathione peroxidases and the level of malondialdehyde was higher in rats with maternal hHcy. Concentrations of H2S and the activity and expression of the H2S generating enzyme&mdash, cystathionine-beta synthase&mdash, were lower compared to the control group. Administration of the H2S donor to females with hHcy during pregnancy prevented behavioral alterations and oxidative stress of their offspring. The acquisition of behavioral together with biochemical studies will add to our knowledge about homocysteine neurotoxicity and proposes H2S as a potential agent for therapy of hHcy associated disorders.

To develop a personalized approach to the appointment of a complex antidepressant therapy in combination with drugs of neuroprotective and neurotrophic action in depressed elderly patients based on the selection of predictors of low therapeutic response (LTR).The study included 152 hospitalized patients, aged 60 years and older, with moderate and mild depression (ICD-10) who received monotherapy (44 people) with antidepressants of the new generation and complex therapy (108 people) with the same antidepressants in combination with neuroprotective drugs. In the monotherapy group, correlations between treatment efficacy (change in average total HAMD-17 scores) and a set of parameters, including socio-demographic data, results of psychopathological, somatic, standardized assessment and neuroimaging (CT) of the brain were analyzed. The validity of the established correlations as predictors of LTR was estimated based on a comparison of their frequency among the responders (≥50% reduction) and non-responders (50% reduction). Comparison of the efficacy of therapy in groups of patients with mono - and complex therapy was carried out depending on the presence or absence of predictors of LTR.LTR predictors are living alone, complaints about memory loss and signs of pronounced diffuse lesions of the subcortical white matter of the brain, which are significantly more frequently observed in non-responders (p0.05). The increase in the number of predictors (2 and more) correlates with a significant decrease in therapeutic efficacy (p0.001). Patients with complex in structure and protracted depressions tend to decrease in efficiency, and in most of them (more than 87% of cases) LTR predictors are detected. In patients with LTR predictors, the complex therapy is significantly more effective than monotherapy, allowing in all cases to achieve 50% reduction of depressive symptoms by the 4th week of treatment.Personalized indications for the appointment of complex antidepressant therapy in combination with neuroprotective drugs in depressed elderly patients are formulated.Цель исследования. Разработка персонализированного подхода к назначению комплексной антидепрессивной терапии в сочетании с препаратами нейропротективного и нейротрофического действия у депрессивных больных пожилого возраста на основе выделения предикторов низкого терапевтического ответа (НТО). Материал и методы. Обследовали 152 госпитализированных пациентов в возрасте 60 лет и старше с депрессиями средней и легкой степени тяжести (МКБ-10). Монотерапию антидепрессантами нового поколения получали 44 больных; комплексную терапию теми же препаратами в сочетании с препаратами нейропротективного действия - 108 пациентов. В группе монотерапии анализировались достоверные связи между эффективностью лечения (изменение средних суммарных оценок по шкалам HAMD-17) и набором показателей, включавших социально-демографические данные, результаты психопатологического, психометрического, соматического и нейроимейджингового (КТ головного мозга) обследования больных. Валидность установленных коррелянтов как предикторов НТО оценивалась на основании сравнения их частоты среди респондеров (с улучшением 50% и более) и нонреспондеров (с улучшением менее 50%). Сравнение эффективности терапии в группах больных с моно- и комплексной терапией проводилось в зависимости от наличия или отсутствия у них предикторов НТО. Результаты. Предикторами НТО оказались одинокое проживание, наличие жалоб на снижение памяти, а также признаки выраженного диффузного поражения подкоркового белого вещества мозга, которые достоверно чаще отмечались у нонреспондеров (p0,05). Увеличение числа предикторов (2 и более) коррелировало с достоверным снижением терапевтической эффективности (p0,001). У больных со сложными по структуре и затяжными депрессиями наблюдалась тенденция к снижению эффективности лечения, причем у большинства из них (более 87% случаев) были выявлены предикторы НТО. У больных с предикторами НТО комплексная терапия оказалась достоверно более эффективной, чем монотерапия, - у всех пациентов была достигнута 50% редукция депрессивной симптоматики к 4-й неделе лечения. Заключение. Сформулированы персонализированные показания к назначению комплексной терапии антидепрессантами в сочетании с нейропротективными препаратами у депрессивных больных пожилого возраста.

Clinicians often see a recurrent miscarriage caused by isthmic cervical incompetence. Today, obstetric pessaries and surgical sutures are widely used to correct cervical incompetence during pregnancy. The occurrence rate of this abnormality continues to rise, which emphasizes the need to diagnose and correct cervical incompetence prior to the upcoming pregnancy. In the available literature there is little information about the «hidden» defects of the cervix that can lead to miscarriage in the I-III trimesters of pregnancy. Here we present a case of two different pregnancy outcomes in a single patient with cervical incompetence before and after surgical correction of the cervix by the LASH procedure. The present case supports the importance of surgical correction of cervical incompetence in non-pregnant women.

The choice of drugs in traumatic injuries of the head is one of the most complex problems in the complex treatment of such patients. The aim was to estimate the cerebroprotective action of Ademol on the indicator of lethality of rats against the background of an experimental traumatic brain injury (TBI). The experimental model of the TBI of severe severity was caused by the action of the flow of carbon dioxide under pressure that was created using a gas cylinder pneumatic gun. The therapeutic effect of Ademol on the model TBI was evaluated at doses of 1, 2 and 4 mg/kg intravenously. Pseudo-operative animals and control group received a 0.9% NaCl solution at a dose of 2 ml/kg. The results were processed using the statistical program StatPlus 2009. Used Fisher angular transformation when accounting for results in an alternative form. In the course of the experiment, it was found that in the control group at the end of the experiment, 8 days after the TBI model, death of 90% of the rats was recorded p

Object: to study the physical and chemical properties of the lipoprotein complexes of rats` blood in the long-term administration of statins and vitamin D. Material and methods. The experiment was performed on 4 experimental groups of rats for 90 days: 1 - intact; 2 - placebo; 3 - intragastric administration of atorvastatin; 4 - intragastric administration of atorvastatin with α-calcidol. The lipoprotein blood complexes were isolated by the method of differential ultracentrifugation. The microflow and microviscosity of the lipoprotein complexes were determined using pyrene. Results. The placebo group revealed an increase of the micropolarity of the total lipid pool of VLDL and a decrease of the microviscosity of the annulary pool of LDL and HDL. The administration of atorvastatin reduces the microviscosity of HDL. The combined application of atorvastatin and α-calcidol reduces the microviscosity of HDL. Conclusion. We have drawn a conclusion about the complex effect of stress, atorvastatin, and α-calcidol on the physical and chemical properties of the lipoprotein blood complexes and a conclusion about the positive effect of atorvastatin and α-calcidol on the microviscosity of HDL.

Introduction. Nosocomial pneumonia (NP) is one of the most dangerous infectious complications of severe traumatic brain injury (TBI). According to some researchers, NP formed 0.5–1 % of hospitalized patients and in patients of ICU – NP develops with a frequency from 15 to 65 %. The aim of our study was to determine the clinical and demographic characteristics of patients with NP, developed on the background of severe TBI. Materials and Methods. 166 patients had been examined, including 58 patients with isolated severe head injury (group 1) and 108 patients with traumatic brain injury, which were complicated by the development of NP (group 2). Results. Out of the first group patients 50 (86.2 %) were men, 8 (13.8 %) were women. The average age of patients in this group was 49.2 ± 15.2 years. Out of the first group patients 89 (82.4 %) were men, 19 (17.6 %) were women. The average age of patients in this group was 48.2 ± 16.7 years. The average length of in-patient treatment was 14.1 ± 6.2 days in patients of the 1st group versus 38.7 ± 17.6 days in patients of the 2nd group. In the 1st group 41 (70.7 %) were non-smokers, 10 (17.2 %) smokers 10 cigarettes per day, 10 to 20 cigarettes per day – 3 (5.2 %), more than 20 cigarettes per day – 4 (6.9 %). In the 2nd group 40 (37.0 %) were non-smokers, 33 (30.6 %) smokers 10 cigarettes per day, 10 to 20 cigarettes per day – 16 persons (14.8 %), more than 20 cigarettes per day – 19 (17.6 %). Conclusions. In demographic structure of the NP, developed on the background by TBI, young men were dominated. The mean duration of hospital treatment of patients with NP increased 2.7 times compared with the patients with TBI uncomplicated by NP. Most patients of both the 1st and the 2nd groups were overweight (more than 50 % of patients). There is a significant percentage of the unemployed. A larger percentage of people who consume alcohol in the 2nd group of patients could be indicative of their poor social adaptation and difficult social conditions. Significantly greater number of smokers among the patients of the 2nd group confirms the importance of smoking as a risk factor of the NP development on the background of TBI. nosocomial infections; traumatic brain injury; TBI

Diabetes mellitus (DM) is a systemic disease characterized by changes in many organs and tissues, including the motor system. The processes of exo- and endocytosis in the motor nerve ending of the mouse diaphragm muscle during high-frequency activity in experimental alloxan model of DM were studied. Endplate potentials (EPPs) were recorded using intracellular microelectrodes during single and high-frequency (50 Hz, 1 min) stimulation. In mice with the experimental DM, the amplitude-time parameters of EPPs did not differ from those of the control; however, an increase in EPPs depression and a slower recovery were observed during high-frequency stimulation. Using an endocytosis marker FM 1-43, it was shown that in animals with experimental DM fluorescence intensity of the nerve terminals loaded with the dye by high-frequency stimulation increased that was prevented by 1-azakenpaullone (2 μM), an inhibitor of slow dynamin-1-mediated endocytosis. In addition, in the model animals, the destaining of the pre-loaded nerve terminals during high-frequency (50 Hz) stimulation slowed down. The obtained data indicate that in the experimental first type DM recycling of synaptic vesicles via long path becomes more pronounced and the mechanisms of the vesicular transport are impaired, which was confirmed by methods of mathematical modeling.

The article presents the results of our own research of the effect of L-arginine L-glutamate as a metabolic corrector in patients with post-infarction cardiosclerosis. The findings were obtained in the post-infarction department of the trade-union sanatorium “Khmilnyk”. 99 patients with post-infarction cardiosclerosis and stable angina pectoris were involved in the study. The patients of the comparison group (n=49) continued to receive a standard treatment, while the patients of the main group (n=50) received additional L-arginine L-glutamate drug. It was found that additional usage of Larginine L glutamate led to a reliable significant decrease of angina attacks number by 54,5 %, while the daily nitroglycerin consumption was significantly decreased by 53,9 %. There was also a decrease in daily ischemia episodes by 52,3 %, general duration of ischemia episodes by 41 % according to ECG monitoring. These data allowed to recommend including Larginine L-glutamate in the scheme of treatment of patients with coronary heart disease.

Objective. To evaluate the effectiveness and safety of ademol for oxidative stress in the brain of rats with traumatic brain injury (TBI). Materials and methods. In 260 male-rats weighing 160-180 g, the preclinical efficacy of ademol was studied against the background of the actual developed TBI model. Several groups of animals were formed: pseudo-operated (TBI + 0.9 % NaCl intravenously), control pathology (TBI + 0.9 % NaCl intravenously), TBI + ademol 2 mg/kg intravenously, comparison drug (TBI + amantadine sulfate). The experimental model was induced by the action of a stream of carbon dioxide under pressure using a gas-balloon air pistol “Baikal MR-654K”, evaluated only severe trauma (the air pistol hole is close to the center of the trepanation hole in rats). Ademol (Ademol-Darnytsia, Ukraine) was administered in several doses to determine the conditionally effective dose, and the reference drug amantadine sulfate (PC-Merz, Switzerland) was administered slowly with infusomate for 2 h after 12 h for 8 days, 60 min after injury. Biochemical processes in traumatically damaged brain (in homogenates and postnuclear supernatant) were studied on the 8th day, oxidative stress parameters were evaluated by the content of malonic dialdehyde (MDA) by reaction with thiobarbituric acid, carbonyl groups of proteins (CGP) – by reaction with dinitrophenylhydrazine, activity of antioxidant enzymes – by reaction with superoxide dismutase (SOD), glutathione peroxidase (GPO) and catalase. Statistical processing was performed according to StatPlus programs, by parametric and nonparametric criteria, the differences were considered significant at p

Objective. To carry out a comparative assessment of the efficacy and safety of monotherapy with a new-generation antidepressant (venlafaxin, agomelatine, or fluvoxamine) and complex antidepressant therapy using one of these antidepressants in combination with acetyl-L-carnitine (ALC, Carnicetin) for the treatment of depression in elderly patients in a gerontology psychiatric out-patients clinic. Materials and methods. Two groups of patients (aged 60–79 years) with mild or moderate depression, comparable in terms of the main demographic and clinical characteristics, received antidepressant mono- or complex (antidepressant and ALC) therapy for eight weeks. Results. The use of complex therapy including the neuroprotector Carnicetin, which has neurotrophic and energotropic mechanisms of action, was found to provide a faster-onset therapeutic response and a stronger effect than antidepressant monotherapy, which was supported by a significant reduction in depressive disorders, including measures of the severity of anxiety, along with improvements in the patients’ cognitive functioning. Use of complex therapy was accompanied by a decrease in the frequency of adverse events. Conclusions. The results obtained here allow inclusion of Carnicetin into the complex antidepressant treatment to be recommended for use in gerontology psychiatric out-patient clinics.

To search for correlations between platelet cytochrome c-oxidase (COX) activity and the quality of therapeutic outcomes and other clinical parameters of depression in elderly patients.Twenty elderly women, aged 55-78 years, with depressive episodes in recurrent depressive disorder (RDD) or bipolar affective disorder (BD) were studied. COX activity and severity of depression were evaluated twice: before the beginning of antidepressant treatment and at the 28-th day of the therapy, using the Hamilton Depression Rating Scale (HAMD-17) and the Hamilton Anxiety Rating Scale (HAM-A).Significant correlations were revealed between platelet COX activity and some clinical parameters of the disease and the severity of depression in patients after treatment. The baseline level of the platelet COX activity was correlated with the age of disease onset (R= -0.63,This pilot study has revealed a link between platelet COX activity and the severity of depression and anxiety after a 28-day antidepressant therapy. The results indicate the prospects for further study of COX as a biomarker of therapeutic outcomes in elderly patients with depression.Поиск связей активности тромбоцитарной цитохромОбследованы 20 госпитализированных женщин пожилого возраста (55—78 лет) с депрессивными эпизодами в рамках рекуррентного депрессивного (РДР) и биполярного аффективного (БАР) расстройств по МКБ-10. Активность ЦО и тяжесть депрессии оценивались дважды: до начала (0 день) и на 28-й день курса терапии антидепрессантами с использованием шкал Гамильтона для оценки депрессии (HAMD-17) и тревоги (HAMA).Выявлены достоверные корреляции,базовой активности тромбоцитарной ЦО с отдельными клиническими параметрами заболевания и выраженностью депрессии после курса лечения. Базовый уровень активности ЦО (0-й день) коррелировал положительно с возрастом манифестации (R=–0,63,Пилотное исследование выявило связь активности тромбоцитарной ЦО с выраженностью депрессии и тревоги после 28-дневного курса антидепрессивной терапии. Полученные результаты свидетельствуют о перспективности дальнейшего изучения ЦО в качестве биомаркера эффективности терапии депрессии у больных пожилого возраста.

During pregnancy, several complications have been associated with hyperhomocysteinemia (HHcy) and elevated homocysteine (Hcy) levels have been shown to play a role in the etiology of preeclampsia, placental abruption, intrauterine growth retardation, and neural tube defects and associated with the neurological consequences. In the present work, we investigated the effects of chronic maternal HHcy on the development and neurobehavioral maturation of the offspring. We analyzed classical parameters of development such as body weight, eyelid opening, ear unfolding, incisor eruption, and the appearance of hair, and subjected the pups to various tests that reflected the neurobehavioral maturation extending from 4th to 20th postnatal days (righting reflex, negative geotaxis, cliff avoidance, head shake, acoustic startle reflex, free-fall righting, cliff avoidance caused by visual stimulus, olfactory discrimination). We have shown that newborn animals were characterized by lower body weight and higher mortality. Besides, the delay in neurobehavioral maturation of the pups from the Hcy group was observed. The obtained results indicate that early developmental impairments of brain maturation induced by prenatal HHcy may underlie long-term deficits in the learning and memory behaviors.

У статті наведено результати комплексного клініко-економічного аналізу (КЕА) фармацевтичного забезпечення хворих на пептичну виразку шлунка і дванадцятипалої кишки. За результатами частотного аналізу лікарських призначень встановлено, що найбільша кількість призначень припадає на лікарські засоби (ЛЗ), що впливають на функції органів травлення (44,98%). За даними АВС-аналізу визначено, що частка найвитратніших ЛЗ становить 25,71%. VEN-аналіз показав, що 24 (68,57%) ЛЗ за INN із 35 призначених є життєво необхідними та важливими. Результати проведеного комплексного КЕА показали, що найбільша частка витрат (66,21%), які пов’язані з фармацевтичним забезпеченням хворих із пептичною виразкою, припадає на 7 ЛЗ за INN зі статусом А/Е, загальна кількість призначень яких складає 349 або 53,04% від усіх призначень., The results of the clinical and economic analysis of pharmaceutical providing of patients with peptic ulcer of the stomach and duodenum are given in the article. According to the results of the frequency analysis of the physicians’ prescriptions it has been found that most of the prescriptions (44.98%) are medicines affecting the functions of the digestive organs. According to the ABC analysis it has been determined that the proportion of the most consumable medicines is 25.71%. The VEN-analysis has shown that 54.29% of the total range of medicines is essential. The results of a comprehensive clinical and economic analysis have shown that the largest share of the costs (66.21%) associated with pharmaceutical providing of patients with peptic ulcer of the stomach and duodenum is accounted for 7 medicines with the A/E status according to INN, the number of their prescription is 349 or 53.04% of the total prescriptions., В статье представлены результаты клинико-экономического анализа фармацевтического обеспечения больных с пептической язвой желудка и двенадцатиперстной кишки. По результатам частотного анализа лекарственных назначений установлено, что наибольшее количество назначений (44,98%) приходится на лекарственные средства (ЛС), влияющие на функции органов пищеварения. По данным АВС-анализа определено, что доля наиболее затратных ЛС составляет 25,71%. VEN-анализ показал, что 24 (68,57%) ЛС (INN) среди 35 назначенных являются жизненно необходимыми и важными. Результаты проведенного комплексного клинико-экономического анализа показали, что наибольшая часть расходов (66,21%), которые связаны с фармацевтическим обеспечением больных с пептической язвой, приходится на 7 ЛС по INN со статусом А/Е, общее количество назначений которых составляет 349 или 53,04% от всех назначений.

У статті наведені результати моніторингу вартості застосування засобів для перитонеального діалізу в лікуванні хворих на хронічну хворобу нирок. Станом на вересень 2015 р. за даними реєстру оптово-відпускних цін на лікарські засоби розраховані показники вартості проведення постійного та автоматизованого ( інтермітуючого, циклерасоційованого і приливного) перитонеального діалізу. Встановлено, що найбільші витрати при наданні діалізної допомоги припадають на приливний перитонеальний діаліз. Враховуючи значні витрати на надання медичної та фармацевтичної допомоги хворим нефрологічного профілю, проблема забезпечення її доступності у вітчизняній охороні здоров’я має вирішуватись за комплексом напрямків. Одним із зазначених напрямків є розробка та упровадження механізмів відшкодування витрат центрам гемодіалізу за надані послуги з лікування хворих за рахунок державного і місцевих бюджетів., The results of monitoring of the cost of medicines used for peritoneal dialysis in patients with chronic kidney disease are given in this article. As of September 2015, according to the register of wholesale prices for medicines, the indexes of the cost of the permanent and automatic (intermittent, the cyclerassociated and tidal) peritoneal dialysis have been calculated. It has been found that the largest share in the cost of dialysis care is for a tidal peritoneal dialysis. Taking into account the significant costs of providing medical and pharmaceutical care to patients with the renal profile the problem of its availability in the national healthcare should be settled by the complex of directions. One of these directions is development and implementation of the mechanisms of drug reimbursement to provide dialysis care for patients at the expense of state and local budgets., В статье приведены результаты мониторинга стоимости применения средств для перитоне- ального диализа в лечении больных хронической болезнью почек. По состоянию на сентябрь 2015 года по данным реестра оптово-отпускных цен на лекарственные средства рассчитаны показатели стоимости проведения постоянного и автоматизированного (интермиттирую- щего, циклерассоциированного и приливного) перитонеального диализа. Установлено, что наибольшие затраты при оказании диализной помощи приходятся на приливной перитонеальный диализ. Учитывая значительные расходы на оказание медицинской и фармацевти- ческой помощи больным нефрологического профиля, проблема обеспечения ее доступности в отечественном здравоохранении должна решаться по комплексу направлений. Одним из указанных направлений является разработка и внедрение механизмов возмещения расходов на предоставление диализной помощи за счет государственного и местных бюджетов.

To search for the immunological features of depressions in elderly patients, select certain immunophenotypes and analyze their possible connection with clinical and psychopathological features of depression of old age.The study included 55 inpatients of old age (median 68 years) with a depressive episode of mild or moderate severity. The control group consisted of 41 elderly people (median 67 years) without depressive disorders. Clinical, psychometric, immunological and statistical methods were used. The rating scales were HAMD-17 and MMSE. The activity of inflammatory and autoimmune markers, including enzymatic activity of leukocyte elastase (LE), α1-proteinase inhibitor (α1-PI), level of autoantibodies to neurospecific antigens S-100B and myelin basic protein, in the serum of patients and control subjects was determined.The scatter in the immunological parameters both in the direction of exceeding the average values and their decrease was shown in the group of depressed elderly patients compared to the controls. Cluster analysis revealed two immunophenotypes of elderly patients with depression. Immunophenotype A is a group of patients with increased PE activity and immunophenotype B is a group of patients with decreased LE activity (p0.0000). Immunophenotype A includes patients with complex depressions, comorbid with anxiety and senesto-hypochondriac disorders. In immunophenotype B, patients with prolonged apatic/adynamic depressions (p0.05), with an earlier onset and longer duration of the disease, with incomplete remissions and more burdened with cardiovascular diseases were more common (p0.05).Цель исследования. Поиск иммунологических особенностей депрессии при у пожилых больных, выделение определенных иммунофенотипов и анализ возможной их связи с клинико-психопатологическими особенностями депрессий позднего возраста. Материал и методы. Исследуемая выборка состояла из 55 госпитализированных больных позднего возраста (медиана 68 лет) с депрессивным эпизодом легкой или умеренной выраженности. Контрольную группу составил 41 человек пожилого возраста (медиана 67 лет) без депрессивных расстройств. Обследование больных проводили c использованием клинического, психометрического, иммунологического и статистического методов. Оценочными шкалами являлись шкала депрессии Гамильтона (HAMD-17) и краткая шкала оценки когнитивных функций (MMSE). В сыворотке крови больных и лиц контрольной группы определяли активность воспалительных и аутоиммунных маркеров: энзиматическую активность лейкоцитарной эластазы (ЛЭ), α1-протеиназного ингибитора, уровень аутоантител к нейроспецифическим антигенам S-100B и основному белку миелина. Результаты и заключение. В группе депрессивных больных пожилого возраста выявлен разброс изучаемых иммунологических показателей как в сторону превышения средних значений, так и их снижение по отношению к контролю. С помощью кластерного анализа было выявлено два иммунофенотипа больных пожилого возраста с депрессией. Иммунофенотип А - группа пациентов, у которых активность ЛЭ была повышена, и иммунофенотип В - группа пациентов с понижением активности ЛЭ (р0,0000). В иммунофенотипе А преобладали больные со сложными депрессиями, коморбидными с тревожными и сенесто-ипохондрическими нарушениями. В иммунофенотипе В чаще встречались больные с затяжными апатико-адинамическими депрессиями (p0,05), более ранним началом и большей продолжительностью заболевания, неполными ремиссиями и большей отягощенностью сердечно-сосудистыми заболеваниями (p0,05).

Increasing the effectiveness of treatment of elderly depressed patients in the conditions of the gerontopsychiatric hospital by augmentation of actovegin to antidepressants of new generations (fluvoxamine, venlafaxine or agomelatine).The efficacy of the therapy was compared in two groups of 21 patients aged 60 to 79 years with mild to moderate depression in ICD-10 receiving 8-week antidepressant mono- or combined therapy with actovegin. The effectiveness criteria were changes in the mean total scores on the HAMD-17, HARS, CGI scales, as well as the proportion of respondents and the quality of getting out of depression. Cognitive activity was assessed using MMSE, 10 word memory tests and drawing of clock.It has been established that the use of complex antidepressants therapy with the inclusion of actovegin allows for a more rapid and pronounced therapeutic effect compared to monotherapy with antidepressants. This is confirmed earlier (by the 4th week) and significant reduction of depressive and anxious symptoms (p0.01), a greater number of responders and better quality of depressive outcomes by the end of treatment. In patients with complex therapy, there was also a faster improvement in cognitive functioning.Obtained results allow us to recommend the inclusion of actovegin in the antidepressant therapy regimen of elderly in-patients with the aim of achieving a faster and fuller therapeutic response and shortening hospitalization.Цель исследования. Повышение эффективности антидепрессивной терапии в условиях геронтопсихиатрического стационара путем включения актовегина в схему лечения пожилых больных антидепрессантами новых поколений (флувоксамин, венлафаксин или агомелатин). Материал и методы. Сравнили эффективность терапии в двух группах больных (по 21 человеку в каждой) в возрасте от 60 до 79 лет с легкой и умеренной степенью депрессии по МКБ-10, получавших в течение 8 нед антидепрессивную монотерапию или лечение теми же антидепрессантами в сочетании с актовегином. Критериями эффективности являлись изменения средних суммарных оценок по шкалам HAMD-17, HARS, CGI, а также доле респондеров и качеству выхода из депрессии. Когнитивная деятельность оценивалась с помощью MMSE, тестов запоминания 10 слов и рисования часов. Результаты. Установлено, что применение комплексной терапии с включением актовегина позволяет добиться более быстрого и выраженного терапевтического эффекта по сравнению с монотерапией антидепрессантами. Это подтверждается достоверно более ранней (уже к 4-й неделе) и значимой редукцией депрессивной и тревожной симптоматики (p0,01), большим числом респондеров и лучшим качеством выхода из депрессии к концу лечения. У больных с комплексной терапией также отмечалось более быстрое улучшение когнитивного функционирования. Заключение. Полученные результаты позволяют рекомендовать включение актовегина в схему антидепрессивной терапии у пожилых больных геронтопсихиатрического стационара с целью достижения более быстрого и полного терапевтического ответа и сокращения сроков госпитализации.

Maternal high levels of the redox active amino acid homocysteine—called hyperhomocysteinemia (hHCY)—can affect the health state of the progeny. The effects of hydrogen sulfide (H2S) treatment on rats with maternal hHCY remain unknown. In the present study, we characterized the physical development, reflex ontogeny, locomotion and exploratory activity, muscle strength, motor coordination, and brain redox state of pups with maternal hHCY and tested potential beneficial action of the H2S donor—sodium hydrosulfide (NaHS)—on these parameters. Our results indicate a significant decrease in litter size and body weight of pups from dams fed with methionine-rich diet. In hHCY pups, a delay in the formation of sensory-motor reflexes was observed. Locomotor activity tested in the open field by head rearings, crossed squares, and rearings of hHCY pups at all studied ages (P8, P16, and P26) was diminished. Exploratory activity was decreased, and emotionality was higher in rats with hHCY. Prenatal hHCY resulted in reduced muscle strength and motor coordination assessed by the paw grip endurance test and rotarod test. Remarkably, administration of NaHS to pregnant rats with hHCY prevented the observed deleterious effects of high homocysteine on fetus development. In rats with prenatal hHCY, the endogenous generation of H2S brain tissues was lower compared to control and NaHS administration restored the H2S level to control values. Moreover, using redox signaling assays, we found an increased level of malondialdehyde (MDA), the end product of lipid peroxidation, and decreased activity of antioxidant enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GPx) in the brain tissues of rats of the hHCY group. Notably, NaHS treatment restored the level of MDA and the activity of SOD and GPx. Our data suggest that H2S has neuroprotective/antioxidant effects against homocysteine-induced neurotoxicity providing a potential strategy for the prevention of developmental impairments in newborns.

Госпітальна пневмонія (ГП) утримує одну з лідируючих позицій у структурі внутрішньолікарняної захворюваності та смертності. ГП є одним із найнебезпечніших інфекційних ускладнень тяжкої черепно-мозкової травми (ЧМТ). Клінічна діагностика пневмонії при травмі досі залишається складним завданням, яке продовжують вирішувати.Мета дослідження – з’ясувати особливості клініко-лабораторної діагностики ГП, що розвинулася на тлі тяжкої ЧМТ.Матеріали і методи. Усього обстежено 166 хворих, в т. ч. 58 хворих з ізольованою тяжкою ЧМТ (перша група) і 108 пацієнтів із ЧМТ, перебіг якої ускладнився розвитком ГП (друга група). У всіх хворих другої групи ГП було підтверджено наявністю інфільтратів на рентгенограмі органів грудної клітки (РГ ОГК). Діагноз ГП встановлювали згідно з міжнародними рекомендаціями та чинним Українським протоколом діагностики та лікування пульмонологічних захворювань у дорослих (наказ МОЗ України №128 від 19.03.2007 р.). В обох групах ураховували скарги, фізикальне обстеження хворих та лабораторні дослідження, загальноприйняті в діагностиці ГП.Результати досліджень та їх обговорення. Отримано такі показники. Середній бал за шкалою коми Глазго (ШКГ) у першій групі склав (12,0±3,0) бала, в другій – (10,3±3,3) бала. Середня тривалість штучної вентиляції легень (ШВЛ) у першій групі була (4,2±2,7) доби, а в другій – (9,7±6,8) доби.Середня частота серцевих скорочень (ЧСС) виявилася в першій групі (77,9±10,3) та (95,0±11,3) другій групах. Середній показник температури тіла був(37,1±0,5) у першій та (38,7±0,8) – у другій групах. В першій групі показник швидкість осідання еритроцитів (ШОЕ) був (8,8±4,9) мм/год, лейкоцити – 8,0х109±3,3, лейкоцитарний індекс інтоксикації (ЛІІ) (2,0±0,8) од. У другій групі показник ШОЕ був(30,6±13,4) мм/год, лейкоцити – 20,4х109±6,6, ЛІІ (5,9±3,4) од.Висновки. Загальноприйняті клінічні та лабораторні методи діагностики госпітальної пневмонії мають різний (часто низький) рівень чутливості й специфічності, внаслідок чого жоден, окремо взятий критерій, не може бути золотим стандартом діагностики ГП. Беручи до уваги клінічну значимість ГП і високий ризик її розвитку в пацієнтів із ЧМТ, на сьогодні актуальним є питання дослідження нових методів діагностики ГП з урахуванням найбільш чутливих показників та їх комплексного застосування.

Sleep and wakefulness disorders are commonly seen in patients with Parkinson's disease, Lewy body dementia and Alzheimer's disease. Sleep provides a lot of functions which sustain normal condition of the brain and sleep disturbances can be one of the factors contributing to the development of neurodegenerative diseases. Sleep and wakefulness disorders can worsen the course of the neurodegenerative process and lead to an increase of symptoms, including cognitive dysfunction. In this review, the relationship between sleep and wakefulness disorders and cognitive impairment as well as clinical forms of sleep and wakefulness disorders and treatment methods in such patients are discussed.Нарушения сна и бодрствования при таких заболеваниях, как болезнь Паркинсона, деменция с тельцами Леви и болезнь Альцгеймера, встречаются у большей части пациентов. Сон выполняет множество функций, обеспечивающих нормальную работу мозга, и его нарушения могут являться одним из факторов, способствующих развитию нейродегенеративных заболеваний. Нарушения сна и бодрствования могут ухудшать течение нейродегенеративного процесса и приводить к нарастанию симптомов, в том числе когнитивных нарушений. В статье приведен подробный анализ литературы, касающейся связи нарушений сна и бодрствования и когнитивных нарушений при нейродегенеративных заболеваниях, а также феноменологии и методов коррекции нарушений сна и бодрствованиях при этих заболеваниях.

Comparative evaluation of the efficacy and safety of antidepressant monotherapy and complex antidepressant therapy in combination with carnicetine in the treatment of depression in elderly patients in a psychiatric hospital.Two groups of hospitalized patients, aged from 60 to 79 years, with mild or moderate depression (according to ICD-10), comparable in basic demographic and clinical characteristics, received mono- or complex (in combination with carnicetine) antidepressant therapy for 8 weeks. Treatment efficacy was assessed with HAM-D, HARS, CGI-S and CGI-I; the level of cognitive activity was assessed with MMSE, the 10-word memory test and clock drawing test.It has been established that the use of complex antidepressants therapy with the inclusion of carnicetine allows to achieve a more rapid and pronounced therapeutic response compared to antidepressant monotherapy. This is confirmed by the earlier (by the 4th week) and significant reduction of depressive and anxiety symptoms (p0.01), a greater number of responders and better quality of depressive outcomes to the end of treatment and a more rapid improvement in cognitive functioning.The results allow us to recommend the inclusion of carnicetine for the augmentation of antidepressant therapy in elderly patients of the psychiatric hospital to achieve a more rapid and complete therapeutic response and reduce the duration of hospitalization.Цель исследования. Сравнительная оценка эффективности и безопасности антидепрессивной монотерапии и комплексной антидепрессивной терапии с применением аналогичных антидепрессантов в сочетании с карницетином при лечении депрессий у больных пожилого возраста в условиях психиатрического стационара. Материал и методы. Две группы госпитализированных больных в возрасте от 60 до 79 лет с легкой и умеренной депрессией (по МКБ-10), сопоставимые по основным демографическим и клиническим характеристикам, в течение 8 нед получали моно- или комплексную (в сочетании с карницетином) антидепрессивную терапию. Эффективность терапии оценивали по шкалам HAM-D, HARS, CGI-S и CGI-I; уровень когнитивной деятельности - по шкале MMSE, тесту запоминания 10 слов и тесту рисования часов. Результаты. Установлено, что применение комплексной антидепрессивной терапии с включением карницетина позволяет добиться более быстрого и выраженного терапевтического ответа по сравнению с антидепрессивной монотерапией. Это подтверждается достоверно более ранней (уже к 4-й неделе) и значимой (p0,01) редукцией депрессивной и тревожной симптоматики, большим числом респондеров, лучшим качеством выхода из депрессии к концу лечения и более быстрым улучшением когнитивного функционирования. Заключение. Полученные результаты позволяют рекомендовать включение карницетина для аугментации антидепрессивной терапии у пожилых больных геронтопсихиатрического стационара с целью достижения более быстрого и полного терапевтического ответа и сокращения сроков госпитализации.

Neurophysiological correlates of treatment efficacy in late-onset depression were identified by analyzing EEG spectral parameters, the peak latencies of the “late” components of cognitive auditory evoked potentials, and sensorimotor reaction times during antidepressant treatment in two groups of older patients (53‐72 years) with long-lasting psychogenic depressive reactions (ICD-10 F43.21) and endogenous depression (ICD-10 F33.1 and F31.3). The initial severity of depression was associated with EEG signs of decreases in the functional status of the anterior parts of the left hemisphere and increased activation of the right hemisphere (particularly the temporal areas). Improvements in patients’ mental status in response to antidepressant medication were accompanied by decreases in the peak latencies of the “late” components (P2, N2, and P3) of cognitive auditory evoked potentials and acceleration of sensorimotor reactions, and were linked with improvements in EEG measures of the functional status of the posterior areas of the cerebral cortex and increases in inhibitory processes in the right hemisphere (particularly its frontal-central-temporal areas). These data are consistent with views of the systems nature of impairments to brain activity in depression and the predominant involvement of the left hemisphere in regulating positive emotions and of the right hemisphere in regulating negative emotions, including the pathogenesis of depression.

The results of the clinical and economic analysis of pharmaceutical provision of patients with depressive disorders in the departments of the specialized healthcare institution in 2015 are presented. It has been found that drugs for the pathogenetic treatment of depression account for the greatest number of medical prescriptions in the structure of drug consumption. Thus, according to the results of studies the greatest number of prescriptions and the highest amount of drug consumption are per three antidepressants. More than half of the resource has been spent on consumption of drugs that are essential by the requirements of the regulatory framework regulating the issues of medical care to patients with depressive disorders. Taking into account the fact that a significant number of the patients who underwent inpatient treatment had a recurrent nature of the disease further pharmacoepidemiological studies of the drug consumption should be expedient, namely determination of the rationality of prescribing drugs with the antidepressant action using the ATC-DDD methodology., Представлены результаты клинико-экономического анализа фармацевтического обеспечения больных с депрессивными расстройствами в отделениях специализированных учреждений здравоохранения в 2015 году. Установлено, что в структуре потребления препаратов наибольшее количество врачебных назначений приходится на лекарственные средства для патогенетического лечения депрессии. Так, по результатам исследований на три лекарственных средства антидепрессивного действия приходится наибольшее количество назначений и наибольшие затраты. Более половины ресурсов было потрачено на потребление препаратов, которые являются необходимыми по требованиям нормативно-правовой базы, регулирующей вопросы оказания медицинской помощи больным с депрессивными расстройствами. Учитывая тот факт, что значительное количество больных, которые находились на стационарном лечении, имеет рецидивирующий характер течения заболевания, в дальнейшем необходимы фармакоэпидемиологические исследования потребления лекарственных средств, а именно определение рациональности назначений лекарственных средств антидепрессивного действия с помощью АТС-DDD методологии., Представлені результати клініко-економічного аналізу фармацевтичного забезпечення хворих на депресивні розлади у відділеннях спеціалізованого закладу охорони здоров’я у 2015 році. Встановлено, що у структурі споживання препаратів найбільша кількість лікарських призначень припадає на лікарські засоби для патогенетичного лікування депресії. Так, за результатами досліджень на три лікарських засоби антидепресивної дії припадає найбільша кількість призначень та найбільші витрати. Більше половини ресурсів було витрачено на споживання препаратів, необхідних за вимогами нормативно-правової бази, яка регулює питання надання медичної допомоги хворим на депресивні розлади. Враховуючи той факт, що значна кількість хворих, які перебували на стаціонарному лікуванні, має рецидивуючий характер перебігу захворювання, у подальшому необхідні фармакоепідеміологічні дослідження споживання лікарських засобів, а саме визначення раціональності призначень лікарських засобів антидепресивної дії за допомогою АТС-DDD методології.