PREECLAMPSIA AND ITS EFFECT ON THE STATE OF CARDIOVASCULAR SYSTEM IN WOMEN.

OBJECTIVE: The aim: To determine the features of the impact of preeclampsia on the development of cardiovascular disorders in women in the future. PATIENTS AND METHODS: Materials and methods: The study involved an assessment of literary sources, which were published mainly in the last five years, using scientometric and specialized databases Pubmed, Science direct, Scopus, Web of Science, Google Scholar and V.I. Vernadskyi NLU "Scientific Periodicals of Ukraine". CONCLUSION: Conclusions: Cardiovascular disorders are not only a medical problem, but also a social one. Preeclampsia is a dangerous condition that contributes to the development of CVDs, increases the rate of mortality and disability among women. All this makes it absolutely necessary to study the features of the pathogenesis in detail, to understand exactly how, through which mechanisms, the preeclamptic state affects the woman's body, and this will allow doctors to indirectly influence its pathogenesis and reduce negative consequences and improve the quality of life.

THE ROLE OF LEPTINRESISTANCE IN THE PATHOGENESIS OF OBESITY IN PREGNANT WOMEN.

OBJECTIVE: The aim: To investigate the relationship between leptin resistance, lipid and carbohydrate metabolism, blood pressure in obese pregnant women. PATIENTS AND METHODS: Materials and methods: Under observation were 65 women (main group) with obesity (I degree -27 women, II degree - 24 women, III degree - 14 women) in the II trimester of pregnancy, who were hospitalized in the Department of Pathology of Pregnancy KNP «Maternity Clinical house №1 "in Lviv during 2017-2020 on preeclampsia of varying severity, which were sent for inpatient treatment by women's clinics. The control group consisted of 30 healthy pregnant women without obesity. RESULTS: Results: Serum leptin in obese women was directly correlated with BMI (r = 0.66, p<0.001), body weight (r = 0.29, p<0.05), total cholesterol (cholesterol) (r = 0, 37, p<0,009), low density lipoproteins (LDL cholesterol) (r = 0.33, p<0.05) and inversely with high density particles (HDL cholesterol) (r = -0.37, p<0.02 ). Studies of carbohydrate metabolism indicate the following correlation coefficients of BMI with glucose level r = 0.351; p<0,001, BMI with the level of C-peptide r = 0,450; p<0,001, BMI with HOMA index r = 0,1504; p = 0.036. Inverse correlations of C-peptide were detected with the level of P (r = -0.169; p = 0.025). CONCLUSION: Conclusions: The discovery of the relationship between leptin resistance, lipid and carbohydrate metabolism, blood pressure indicates the possibility of using signs of leptin resistance to prevent complications during pregnancy in the second trimester.

IMPACT OF VACCINATION ON THE COVID-19 PANDEMIC:BIBLIOMETRIC ANALYSIS AND CROSS COUNTRY FORECASTING BY FOURIER SERIES.

OBJECTIVE: The aim: Is to build a forecast of the COVID-19 disease course, considering the vaccination of the population from particular countries. PATIENTS AND METHODS: Materials and methods: Based on the analysis of statistical data, the article deals with the topical issue of the impact made by vaccination on the prevention of the COVID-19 pandemic. The time series, showing the dynamics of changes in the number of infected in Chile, Latvia, Japan, Israel, Australia, Finland, India, United States of America, New Zealand, Czech Republic, Venezuela, Poland, Ukraine, Brazil, Georgia for the period 07.08. 2020-09.09.2021, are analyzed. Trend-cyclic models of time series are obtained using fast Fourier transform. The predicted values of the COVID-19 incidence rate for different countries in the period from September 10, 2021 to February 2, 2022 were calculated using the constructed models. RESULTS: Results and conclusions: The results of the study show that vaccination of the population is one of the most effective methods to prevent the COVID-19 pandemic. The proposed method of modeling the dynamics of the incidence rate based on statistical data can be used to build further predictions of the incidence rate dynamics. The study of behavioral aspects of trust in vaccination is proposed to be conducted within the theory regarding the self-organization of complex systems.

PECULIARITIES OF THE PREVALENCE OF INTRAUTERINE INFECTIONS AT THE PRESENT STAGE.

OBJECTIVE: The aim: According to the literature sources to summarize statistics on the prevalence of intrauterine infection and its impact on pregnancy and the condition of newborns at the present stage. PATIENTS AND METHODS: Materials and methods: The article analyzes 35 literature sources (scientific publications) from 2000 to 2021, indexed in international scientometric database and covers the incidence of intrauterine infections in countries with different income levels, as well as their impact on pregnancy, childbirth and the condition of newborns. CONCLUSION: Conclusions: The main task of obstetrics and gynecology at the present stage is to reduce reproductive losses, which necessitates further study of the etiology of IUI, especially in low- and middle-income countries. The screening for IUIs during pregnancy is cost-effective because treatment of the effects of IUIs requires disproportionately greater resources.

RESULTS OF MEDICAL-SOCIAL RESEARCH ON MEDICAL CARE QUALITY FOR PATIENTS WITH COVID-19 OF INPATIENT HOSPITAL DEPARTMENTS IN SUMY REGION.

OBJECTIVE: The aim: The aim of the study is to assess the quality of medical care and determine the relationship between treatment outcomes of patients and acute respiratory viral infectious disease caused by SARS-CoV-2,depending on patients` age, the time from onset of symptoms to hospitalization, and the presence of comorbidity. PATIENTS AND METHODS: Materials and methods: According to the specially designed form, a retrospective analysis of primary accounting documents was carried out (f. No. 103/o) in 158 patients with COVID-19. The research was carried out in specialized inpatient infectious diseases wards of health institutions of the Sumy region during the period from April to September 2020. The study used a systemic approach, bibliosemantic, comparative and statistical analyses, logical generalization methods. RESULTS: Results: Among the study group of patients, namely 158 people, a bigger number of women (56.33±3.95%) than men (43.67±3.95%) were recorded. Patients of working age (from 18 to 64 years old) took 70.89±3.61% of all patients, and people aged 65 years and older - 29.11±3.61%. The time from the beginning of symptoms to hospitalization in each second patient (49.37±3.98%) lasted 5-7 days. In most cases, the patient's stay in the hospital equaled 13-15 bed-days - 32.28±3.72%. The index of patients with severe and critical state was 20.89±3.23% (33 patients). In 8.23±2.19% (13 people) of treated cases of hospital stay ended in death. A large index of patients with a severe course of the disease, the treatment of which ended in discharge, were in hospital for more than 13 bed days - 12.03±2.59% (19 people). All of these patients were older, had CNCDs (chronic non-communicable diseases), half of them were hospitalized on day 7 and later from the onset of symptoms. CONCLUSION: Conclusions: In older people, the disease progresses faster and complications are developing more often. Also, the severity of the SARS-CoV-2 pattern and the length of staying in the hospital are affected by the time starting the onset of symptoms till hospitalization and the presence of CNCDs. The hereinafter data allows to increase knowledge about spreading of COVID-19, to improve the quality of organizational and preventive events in the provision of medical care, and reducing mortality.

FEATURES OF THE COURSE OF PERINATAL INFECTIONS AT THE PRESENT STAGE.

OBJECTIVE: The aim: To characterize the course of the most common perinatal infections on the basis of assessment of the literature data. PATIENTS AND METHODS: Materials and methods: This article provides an assessment of 125 literature sources submitted to PubMed, Medline, Cochrane Library, CyberLeninka, Google Scholar and V.I. Vernadsky National Library of Ukraine. The description of the most common viral, bacterial and parasitic perinatal infections, transmission methods, clinical manifestations, methods of diagnosis and treatment, their clinical consequences are described. Perinatal infections are the leading cause of severe congenital pathology, a serious worldwide medical and social problem that needs to be addressed. CONCLUSION: Conclusions: Perinatal infections are a serious issue of today, requiring a multidisciplinary approach and the collaboration of doctors of different specialties. Their prevalence among the population, high rates of perinatal mortality, concealment under the mask of other disorders, and the absence of specific clinical symptoms in pregnant and newborns require careful consideration of this problem. Improving the quality of diagnosis and treatment of this pathological condition will help to minimize the risk of transmission of infection, as well as to avoid a number of abnormaalities in the neonatal period and the development of congenital infection.

BASIC PRINCIPLES OF BEHAVIORAL ECONOMICS AND PROSPECTS FOR THEIR APPLICATION IN THE PUBLIC HEALTH SYSTEM.

Behavioral economics is a branch of economic theory that studies the influence of psychological factors on people's decisions in various life situations. At the same time, much attention is paid to situations where people behave differently than predicted by classical economic theory with its assumption of rationality and selfishness. Interesting possibility of application of behavioral economic in various spheres of human life and society, for example, reforms introducing, insurance system, public health and medicine (healthy living, disease prevention, following-up to the doctor's recommendations, improving the quality of care, etc.).

Antibiotic resistance of the nasopharynx microbiota in patients with inflammatory processes.

OBJECTIVE: The aim: To study the species composition of microorganisms isolated from patients with inflammatory processes of different localization and to monitor the sensitivity of isolated microorganisms to the most commonly used antibiotics. PATIENTS AND METHODS: Materials and methods: During 2017-2019, we examined 517 patients with acute inflammatory processes of the nasopharynx. To establish the etiological structure of pathogens of inflammatory processes, a microbiological study of nasopharyngeal washes was carried out using classical methods of isolation and identification of microorganisms. The sampling of the test material from patients was performed during the first visit to a doctor, before the appointment and implementation of etiopathogenetic therapy. To study the sensitivity of isolated microorganisms to antibacterial drugs, we used the method of paper disks (manufactured by "Pharmaktiv" Ltd. (Kyiv, Ukraine) and Himedia (India). RESULTS: Results and conclusions:The microflora of the mucous membranes of the nose and throat in patients with acute inflammatory processes of the nasopharynx is represented mainly by monoisolates of staphylococci and streptococci. The sensitivity of isolated microorganisms to antibiotics varied between different types of microorganisms and between different antibiotics.Cefazolin showed efficacy against all types of microorganisms. K. pneumonia strains showed the highest antibiotic resistance. Among the gram-positive cocci, 18 strains (4.2%) resistant to all antibiotics were isolated, which can be regarded as the circulation of hospital strains outside the medical institutions.

A rural-based medical and sociological study on the results of the primary care reform.

OBJECTIVE: The aim: To study the results of a medical and sociological research as to the attitude of rural population in amalgamated hromadas (AH), i.e. united territorial communities, of Sumy region to the results of primary care reform. PATIENTS AND METHODS: Materials and methods: The form of research - a survey with closed questionnaire. The study was conducted on a specially designed three-tier quota sample, which was calculated allowing for the territorial and socio-demographic indicators. A total of 320 respondents residing in the specified rural communities (hromadas) were surveyed with quota sampling. The theoretical sampling error makes 3%. The questionnaires were processed by the laboratory staff with the help of the "OСA" program. RESULTS: Results: Among the surveyed in Nyzhniosyrovatska AH (amalgamated hromada), 23.5% of the population emphasized that their authorities neglected medical problems, while in Bezdrytska AH this indicator was 6.7%, as evidenced by the difference in the industry financing from own assets (274 thousand less than in Bezdrytska AH). The survey revealed that in the communities where the population knows their family doctors better and trusts them, the satisfaction with the quality of medical care and the attitude to prophylaxis (prevention) is much higher. CONCLUSION: Conclusions: A significant part of the population demonstrates a low level of awareness of the course of the reforms, their goals and objectives. The specified trends may indicate a lack of communication or distortion of information on the implementation of medical reform. It is an information support that is one of the key instruments for effective introduction of medical reform. At the local level, this function is assigned to a family doctor who becomes a determining factor not only for providing medical services to patients, but also for communication, keeping the population informed and prophylaxis.

CURRENT STATE OF THE PROBLEM OFABNORMAL INVASION OF THE PLACENTA IN OBSTETRICS.

OBJECTIVE: The aim: On the basis of literature data, as well as a clinical case study, to assess the state of the problem of abnormal invasion of the placenta in obstetrics at the present stage. PATIENTS AND METHODS: Materials and methods: Based on the materials of the world's leading citation databases (MEDLINE, EMBASE, Cochrane), a brief review of the literature data over the past 5 years is presented, dedicated to the issues of abnormal placental invasion. The possibilities of a complex of diagnostic studies and clinical management of women with an anomaly of placenta attachment are considered. A clinical case study of abnormal placental invasion is presented. CONCLUSION: Conclusions: AIP is an extremely serious condition with not fully understood etiological and pathogenic mechanisms. Correct and timely verification of this pathological condition, based on the simultaneous use of a whole complex of diagnostic studies (history taking, 2D, 3D, energy and color Doppler mapping, MRI), contributes to the development of individual tactics for the management and delivery in women with AIP, making it possible to reduce maternal morbidity and mortality and improve perinatal outcomes.

Study of motivational factors in doctors in respect of healthcare quality improvement.

INTRODUCTION: The article presents the results of a survey among doctors with different certification categories and experience who work at inpatient and outpatient departments of Sumy healthcare institutions, in respect of the main factors that motivate them to provide quality healthcare. The aim of the study is to identify the factors that may be used as motivators to improve healthcare quality in terms of medical staff in order to ensure system construction of motivational component of healthcare quality management ("incentive picture"). MATERIALS AND METHODS: We conducted a survey among physicians working at inpatient and outpatient departments. A total of 167 respondents were interviewed. The obtained results were processed using OCA-program. CONCLUSIONS: We have found an association between the salary level and certification category of a physician. Despite heavy workload, most doctors were willing to work harder and better for some additional payment. Even though financial satisfaction was low, most doctors did not agree to change their profession for a more payable one. The study revealed that, in doctors' opinion, the introduction of incentive system in healthcare institutions was necessary to provide quality healthcare. Regardless of length of service and workplace, two of the main motivational factors for doctors were moral satisfaction from work and respect of people.