ANALYSIS OF THE BLOOD HYPERCOAGULATION RISK IN PATIENTS WITH ISCHEMIC ATHEROTHROMBOTIC STROKE DEPENDING OF THE VDR GENE POLYMORPHISMS.

OBJECTIVE: Aim: of our study was the analysis of the blood hypercoagulation risk in patients with ischemic atherotrombotic stroke depending of the VDR gene polymorphisms. PATIENTS AND METHODS: Materials and Methods: Blood of 170 patients with ischemic atherothrombotic stroke (IATS) and 124 healthy individuals (control group) was used for genotyping. Four polymorphisms (FokI, BsmI, ApaI, TaqI) of gene VDR were examined with PCR-RFLP methodology. Statistical analysis was performed by using SPSS-17.0 program. RESULTS: Results: Among patients with IATS who are carriers of the f/f genotype, FokI polymorphism of VDR gene by high thrombin time and a decrease in the rate of spontaneous fibrinolysis was registered. In individuals with the B/B genotype homozygous for the polymorphic variant, BsmI had significantly lower mean values of prothrombin and thrombin time and increased the rate of spontaneous fibrinolysis. The homozygotes for the A-allele ApaI polymorphism have 2.7 times higher risk of developing blood hypercoagulation than homozygotes for the a-allele was found. CONCLUSION: Conclusions: Biochemical signs of hypercoagulation syndrome among patients with IATS who are carriers of the f/f genotype of the FokI polymorphic variant and among B/B homozygotes of the BsmI polymorphic variant and homozygotes for the A-allele of the AрaI polymorphism of the VDR gene were registered.

EFFECTIVENESS OF THE MAGNESIUM APPLICATION IN OBSTETRICAL PRACTICE.

OBJECTIVE: The aim: Conducting an evaluation of the effectiveness and safety of the use of magnesium in pregnant women. PATIENTS AND METHODS: Materials and methods: A comprehensive examination of 60 pregnant women was conducted, of which 30 were taking a magnesium preparation in a daily dose of 2473.72 mg of magnesium citrate and 40 mg of pyridoxine hydrochloride (the main group) and 30 pregnant women who were not taking a magnesium preparation (сomparison group). The analysis of the clinical course of the first half of the pregnancy with the determination the frequency and structure of complications, blood pressure levels, indicators of ultrasound, general and biochemical blood tests, urinalysis, lipid status and carbohydrarate metabolism. RESULTS: Results: The main complications of the first half of pregnancy were: threatening miscarriage, abortion in progress, early gestosis, anemia, respiratory viral infection, exacerbation of extragenital pathology, hypertension. During the analysis of carbohydrate and lipid metabolism increased atherogenic potential. Analyzing the results of ultrasound studies reliably earlier comes down the local hypertonus. CONCLUSION: Сonclusions: The correction of chronic magnesium deficiency, performed by the drug magnesium has allowed to reduce cases of threat of abortion, the abortion that was started, the symptoms of early preeclampsia, anemia of pregnant women, symptoms of respiratory viral infection, reduces the number of bed-days in the case of hospitalization. The use of magnesium helped to normalize blood pressure, carbohydrate and lipid metabolism, reduces hypertonus of the myometrium.

THE MICROBIOLOGICAL STRUCTURE OF OTOMYCOSIS: SENSITIVITY PROFILE OF AGENTS TO ANTIFUNGAL DRUGS.

OBJECTIVE: Aim: To study the species composition of microorganisms isolated from patients with otomycosis, and to control the sensitivity of isolated microorganisms to the most commonly used antifungal drugs. PATIENTS AND METHODS: Materials and methods: The main group of study was 132 patients with a preliminary diagnosis of Otomycosis was carried out in the period 2020-2022.To study the sensitivity of isolated microorganisms to antifungal drugs, the Himedia paper disk method (India) was used. RESULTS: Results: Analysis of studies showed that among 132 patients, fungal infection was found in 101 patients (76%), the cultural method - in 31 patients (23.5%); of them women - 56 (42.4%), men - 60 (45.5%) aged 16 to 76; children - 16 (12.1%) aged 6 to 12 years. However, among all patients (n = 132) with otomycosis, fungal lesions of the outer ear prevail, which were detected in 85 (64.4%) patients, that is, fungal otitis was detected in 47 (35.6%). CONCLUSION: Conclusions: The general structure of the species spectrum of etiologically significant pathogens of otomycosis: Candida spp. (78.0%) of the total spectrum of isolates. The sensitivity of isolated micromycetes to antifungal drugs varied in different fungal species and in different antifungal drugs.

A MEDICAL AND SOCIOLOGICAL STUDY AMONG DOCTORS ON THE MOTIVATIONAL COMPONENT OF ENSURING THE QUALITY OF MEDICAL CARE IN HEALTH CARE FACILITIES.

OBJECTIVE: Aim: To analyze the impact of medical reform on the motivational component of improving the quality of medical care in health care facilities in Sumy based on the results of a medical and sociological study of doctors. PATIENTS AND METHODS: Materials and Methods: The study involved 154 doctors working in inpatient and outpatient departments of health care facilities in Sumy. Sumy in June-August 2023. The study used a systematic approach, bibliosemantic, comparative and statistical analysis, and logical generalization. The data were processed and statistically analyzed using Google Forms and Microsoft Excel 2010 for Windows. RESULTS: Results: The study showed that 49 respondents (31.8%) are satisfied with the material and technical support at the workplace and working conditions. Almost all doctors (138 people (89.6%)) said that the actual amount of their salary does not correspond (partially or fully) to the workload at the workplace. Only 4.5% of them said that they receive extra payments for the quality of healthcare services, 21.4% of them said that they receive extra payments periodically, and 74.1% said that they do not receive extra payments at all. Despite the high level of workload and dissatisfaction with salaries, the majority of respondents (109 people (70.2%)) would not agree to change their profession to another one, even if the salary was higher. According to doctors, the most important incentives for improving the quality of healthcare services are: moral satisfaction from work and well-coordinated teamwork (76.6% of answers), financial incentives (74.7% of answers), opportunities for professional and career growth (48.7% of answers), respect from patients and society (46.8% of answers), and management recognition (13.6% of answers). CONCLUSION: Conclusions: The study has shown that today, in the context of health care system reform, there is practically no effective motivational component to improve the quality of health care in health care facilities in Sumy: 40.9% of people gave negative answers, 42.2% of people indicated only its partial existence. Regardless of the length of service, for all respondents, one of the most important motivational incentives is not only material but also moral factors and public recognition.

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.

ULTRAMORPHOMETRIC CHARACTERISTICS OF ACINI AND MICROVASCULATURE OF THE PANCREAS IN THE PRESENCE OF MODERATE DEHYDRATION.

OBJECTIVE: The aim: The objective of our study was to evaluate the features of ultramorphometric characteristics of exocrine parenchyma and microvasculature of the pancreas in the presence of moderate dehydration by means of an experiment in laboratory rats. PATIENTS AND METHODS: Materials and methods: The experiment involved 20 mature white male rats divided into 2 groups: control and experimental (10 rats each). In the experimental group, moderate dehydration was simulated, i.e. the animals were deprived of water for 7 days, while the control rats were provided with a normal water supply during the study. Pancreatic parenchyma samples were fixed in phosphate-buffered glutaraldehyde solution and post-fixed in osmium tetroxide solution, dehydrated and embedded in a mixture of epoxy resins. Ultrastructural analysis was performed using JEOL JEM-1230 transmission electron microscope (Japan). RESULTS: Results: Pancreatic electron microscopy in the presence of moderate dehydration demonstrated statistically significant changes in exocrinocytes area and exocrinocyte nucleus area which increased by 8.02% (p = 0.028) and 40.28% (p < 0.001), respectively. Among the vessels of microcirculation, the largest changes occurred in the capillaries: their lumen narrowed by 22.34% (p = 0.002) as compared with the control group. The cytoplasm of endothelial cells contained a large number of vacuoles and micropinocytotic vesicles. CONCLUSION: Conclusions: Among the organelles of exocrinocytes, mitochondria appeared the most vulnerable to the effects of dehydration. They demonstrated polymorphic changes: a part of the mitochondria was hypotrophic and had partially reduced cristae, and another part was hypertrophic.

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.

MEDICAL AND ECONOMIC ANALYSIS OF THE CHOICE OF THERAPEUTIC PLASMAPHERESIS METHOD TO OPTIMIZE THE TRANSFUSION CARE QUALITY.

OBJECTIVE: The aim: To analyze the medical and economic aspects of the manual and different types of automatic plasmapheresis (manual, automatic centrifugal, automatic membrane, plasmapheresis with plasma therapy and mixed) used for therapeutic purposes. PATIENTS AND METHODS: Materials and methods: The Baxter Auto-C, Haemonetics PCS2, Haemophenics, Baxter CPDA anticoagulant and saline, Baxter 16GA needles were used. Total protein was examined by the biuret method, hemoglobin by the Sally method, total bilirubin by the colorimetric photometric method, cell fragments by the Goryaev camera microscopy method; patient comfort - with a 10-point scale. Healthy blood donors participated in the study. Manual plasmapheresis was performed in 31 people, automatic plasmapheresis with centrifugal technology - 36 people, with membrane technology - 21 people, mixed technology - 36 people. RESULTS: Results: An analysis of the different technologies impact on hematological, psychological and medical and economic indicators was performed. Native hemoglobin was absent in the bloodstream and in the final plasma with all technologies. Bilirubin index was within normal limits. There were no cell fragments. It was proved the absence of significant differences in various technologies on hematological parameters. The lower level of patient comfort by manual plasmapheresis was established. CONCLUSION: Conclusion: All therapeutic plasmapheresis technologies have the same effect on the patient's blood hematological parameters and did not have a negative impact on the body by the indicators: hemolysis, the presence of cell fragments, patient discomfort and citrate reactions during the standard procedure of sampling 800 ml of plasma. The most effective are plasmapheresis machines with centrifugal technology by medical and economic parametres.

EPIDEMILOGY OF ENT DISORDERS IN ADULT POPULATION OF AGRICULTURAL REGION.

OBJECTIVE: The aim:TostudyandanalyzeSumy region population morbidity dynamics taking into account current stage of medical reform. Sumy region here is represented as one of the main agricultural regions of Ukraine. The prevalence of ENT disorders (otolaryngologic diseases) was studied. PATIENTS AND METHODS: Materials and methods: During the study we used data of statistical report of Public Health Board, Sumy State Administration for the period from 2015 to 2019 years by administrative territories. Obtainedresults wereprocessed, usinggeneral statistics methodsandanalyzed, usingstructural-logicalanalysis. CONCLUSION: Conclusions: The study found that the morbidity rates of ENT disorders in adult population during the study period increased and had levels of 2113.0 and 122.1 per 100 thousand adult population, respectively, and the prevalence rates and the prevalence rates ofENT disorders among the adult population decreased , respectively to 167.7; 2113,0; 665.1 and 389.9. All indicators have reliable differences in terms of administrative territories of the region. The results of the study should be taken into account in the process of reforming the otolaryngological service in the region.

HEALTHCARE IN UKRAINE DURING THE EPIDEMIC: DIFFICULTIES, CHALLENGES AND SOLUTIONS.

OBJECTIVE: The aim: Of this research was to investigate the impact of quarantine restrictions on the health care system in Ukraine, quality of providing and accessibility of health care services for population during quarantine; analyze the influence of economic and social outcomes of epidemy on state of health care. PATIENTS AND METHODS: Materials and methods: For this paper was made a retrospective analysis of COVID-19 morbidity statistics, economic indicators and governmental decrees aimed at resolving the problem of the spreading of coronavirus and ensuring the proper work of medical institutions at all levels of health care. This work includes analysis of data for the period since the beginning of quarantine on the territory of Ukraine in March 2020 till present time. CONCLUSION: Conclusions: The complexity of the socio-political and economic situation in Ukraine and the conduct of hostilities in the east of the country have significantly complicated the fight against the spread of coronavirus in the country. Negative changes in the indicators of hospital security were observed both at the secondary level - treatment of patients with COVID-19, and the primary level - primary contact with the patient, primary care, prevention measures. In the long run, this will have significant implications for the individual health of those who have not been able to receive quality care, as well as for public health in general.

BEHAVIORAL, SOCIAL, ECONOMIC AND LEGAL DIMENSION OF THE PUBLIC HEALTH SYSTEM OF UKRAINE: DESCRIPTIVE, CANONICAL AND FACTOR ANALYSIS.

OBJECTIVE: The aim is to develop an integrated indicator that characterizes the degree of satisfaction of the population with medical services. PATIENTS AND METHODS: Materials and methods: integrated indicator was formed in terms of three stages for 24 regions of Ukraine and Kyiv. At the first stage, the expediency of using five influential groups of input indicators (behavioral, physical, economic, social and legal orientation) with a total of 59 features using descriptive modeling is substantiated. At the second stage, canonical correlation models were developed for the most correlated complex features, which form an indicator of the population satisfaction degree with the received medical services: physical condition features, social and behavioral orientation qualities. The third stage of factor modeling (using orthogonal transformation methods Varimax, Quartimax and Equimax) allowed identifying the five most influential factors for the formation of an integrated indicator and the development of econometric models for the healthcare state. RESULTS: Results: the necessity to improve the medical service quality and innovation in healthcare reform is confirmed since there were no regions where citizens were fully satisfied with the medical service level. The population of most Ukrainian regions (76% of regions), including Kyiv, is rather dissatisfied with the received medical services. CONCLUSION: Conclusions: the study results provide ample opportunities for healthcare workers, medical professionals, and public authorities to ensure quality and timely adjustment of existing rules and regulations within the Health Care Reform, improving the level of public satisfaction with the received medical services, and the immediate improvement of the nation's health.

SOCIO-ECONOMIC PATTERNS OF LABOR MARKET FUNCTIONING IN THE PUBLIC HEALTH: CHALLENGES CONNECTED WITH COVID-19.

OBJECTIVE: The aim: To form a methodological basis for assessing socio-economic trends in operation of the labor market in the health care. PATIENTS AND METHODS: Materials and methods: The article analyzes the scientific methods of the investigation the labor market, determines their main advantages and disadvantages. The proposed model is based on the evaluation of supply and demand for the vocational medical professionals. Both for all indicators, the study initially set the calculation base and then this parameter was multiplied by a number of correction determinants. CONCLUSION: Conclusions: The market of the vocational medical professionals became the most influenced from the pandemic tendencies. The list and scope of educational services provided by regional vocational educational institutions should clearly correspond to the needs of regional level in the condition of the pandemic COVID-19.

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.).

RESULTS OF THE ULTRAMICROSCOPIC RESEARCH OF ADENOID VEGETATIONS ACCOMPANIED BY THE PATHOLOGIES OF NASAL CAVITY AND PARANASAL SINUSES IN ADULTS.

OBJECTIVE: The aim: Grounding on the electronic microscopy of PT make conclusions about the tonsil activity in adults depending on the accompanied pathology of nose and PS. PATIENTS AND METHODS: Materials and methods: Ultramicroscopic examination of 111 patients with PT hypertrophy aged 18-55 was done. Depending on the nose and PS pathology (inflammatory, non-inflammatory) patients' PS biopsic materials were distributed into 2 groups: 58 cases on inflammatory and 53 on non-inflammatory background. The control group consisted of 24 patients aged 18 without nose and PS pathology. The images of ultrathin PT sections were received with the help of transmission electronic microscope PEM - 125 with digital camera (SELMI, Sumy). RESULTS: Results: Great variations in PT cell condition, depending on the pathology were distinguished. Features of the adenoiditis in inflammatory and non-inflammatory diseases of nose and PS were proved. CONCLUSION: Conclusions: 1. PT ultra-microscopy in control group shows great activity of lymphocytes and high energy exchange of cells, with prevailing B-lymphocyte population. 2. The complex of PT ultra structural changes while nose and PS inflammatory diseases shows the activation of immune reaction in competent cells with T-lymphocyte increase in patients older than 25, which witnesses chronic inflammation. 3. In group with nose and PT non-inflammatory diseases, activity of PT B-lymphocytes is unchanged accompanied by the T-lymphocytes growth, which is also characteristic for chronic inflammation.

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.

The impact of an educational institution on development of healthy lifestyle skills for prevention of obesity in adolescents.

OBJECTIVE: The aim: To determine that nature of perception of an educational institution has on degree of risk as to development of bad habits in eating and daily routine. PATIENTS AND METHODS: Materials and methods: We have conducted surveys among 1015 students of educational institutions, residing in a large industrial center through special questionnaire was developed by SI «ICAHC NAMS¼. According to answer to the question about their attitude towards school, schoolchildren have been divided into 6 groups. RESULTS: Results: Studying the health-shaping behavior of children has shown the greatest regularity of engagement in sports activities among students of the 1st group. Schoolchildren of the 4th group were characterized by the risk of development of obesity, due to the highest (among the other groups) level of consumption of chips, crackers, street food, sparkling water, against insufficient acquirement of key sources of protein and vitamins. The same groups also differed in self-esteem of their own health and perception of school environment. CONCLUSION: Conclusions: The most safe group as to development of obesity and other diseases has been the 1st group, students of which attended an educational institution with pleasure and had a high level of physical activity and had certain eating habits. Children of the 4th group with indifferent attitude towards any occupation should be included into the risk group. Outstanding remains the issue in-depth study of prevalence of healthy lifestyle skills and bad habits among various gender groups of adolescents.

Method of forensic assessment of risk factors of treatment failure outcomes as an element of quality management of medical care.

OBJECTIVE: The aim: The aim of this research was to study causes of the development of adverse outcomes in isolated femоral diaphyseal fractures. PATIENTS AND METHODS: Materials and methods: A retrospective analysis of the protocols of clinical and radiological examination of 21 patients was performed. Based on the initial expert assessment, these patients have not been established the severity of injuries due to the development of complications in the postoperative period. CONCLUSION: Conclusions: Patient-dependent, implant-dependent, and surgery-dependent causes that caused a violation of the stability of osteosynthesis (95.2%) were identified. This led to a secondary displacement of bone fragments (71.4%), delayed fracture consolidation (61.9%), the formation of pseudarthrosis (38.1%), the development of post-traumatic osteomyelitis (14,3), migration of screws from the osseous plate (47.6%), and the development of post-traumatic contracture of the knee joint (81.0%).

Morphogenesis of maxillary sinuses in infants, during early and first childhood.

OBJECTIVE: The aim: To study the peculiarities of the structure and to see the development of maxillary sinuses in infants, during the early and first childhood periods of human ontogenesis. PATIENTS AND METHODS: Materials and methods: The study of the peculiarities of the development and formation of the maxillary sinuses' wall was carried out on 50 species of the upper jaws, turtles and sections of the head of the human corpses during different periods of ontogenesis (in infants, during early and first childhood) with the help of histological examination, preparation, CT scan, radiography and morphometry. RESULTS: Results and conclussions: In infants and during the early and first childhood periods of human ontogenesis in the MS there are changes in both quantitative and qualitative nature. In infants (10 days - 1 year), maxillary sinuse is located more lateral to the basis of the lower nasal concha. In this period, it begins to form its lower wall, which in the form of a narrow strip invaginates into the alveolar process. The growth of the sinus is due to the protrusion of the external wall in the direction of the zygomatic bone. The wall of the maxillary sinuse is covered with mucosa (respiratory mucous membrane), which is lined by pseudostratified columnar ciliated epithelium, which is located on the basement membrane. X-ray examination of maxillary sinuse in infants shows that it is a pear-shaped in the anterior projection. Clearly the following walls of the sinuses are visible: the upper, the lower, one, which is arched-shaped, the front and the median, which in lower part are crossed as arch to each other. Investigation of biological specimens of the maxillofacial area of the early childhood period (1-3 years) showed that maxillary sinuses in all specimens are determined more laterally to the basis of the lower nasal concha. Its vertical dimension is 7.5-8.0 mm, transverse - 5.7-6.0 mm, anterior-posterior - 13.9-14.5 mm. X-ray examination of maxillary sinuse in early childhood in the front projection shows that it has an oval shape. There are the following walls of the sinus: upper, lower, front and middle. The study of biological specimens of the facial area in the period of the first childhood (4-7 years) has been established that the configuration of maxillary sinuse is changing. All walls are determined, but the upper wall is rather short, and the front wall is narrow. The median wall has the most prominent development. On X-rays in the anterior projection, a slight extension of the maxillary sinuse is noted laterally. Therefore, one should thoroughly study the peculiarities of the development and structure of the walls of the maxillary sinuses in order to prevent the development of complications and to achieve the treatment of inflammatory diseases of the MS in an optimal term.

The impact of systemic inflammation on anemia in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The aim of our work was to study the indicators of systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) with anemia of chronic disease (AHD). PATIENTS AND METHODS: Materials and methods: The study included 144 COPD patients (1 group) without anemia (hemoglobin> 120 g/l for women and> 130 g/l for men), and 33 patients (2 group) with COPD and ACD (hemoglobin <120 g/l for women and <130 g/l for men, soluble transferrin receptors (sTFR) - 8.7 - 28.1 nmol/l). The control group included 62 practically healthy people. All patients were evaluated for the content of ferritin, C-reactive protein (C-RP) and hepcidin. Statistical processing of the results was performed by using the SPSS-21 program. RESULTS: Results: Patients with COPD and ACD have a significantly higher ferritin level (p <0.001) compared to COPD patients without anemia and patients in the control group. The content of C-RP and hepcidin in patients with COPD and ACD is also significantly (p <0.001) higher compared to patients without anemia and patients in the control group. CONCLUSION: Conclusions: Determination of the content of ferritin, C-RP and hepcidin in patients with COPD may allow adequate treatment for this group of patients.

SNPs and transcriptional activity of genes of innate and adaptive immunity at the maternal-fetal interface in woman with preterm labour, associated with preterm premature rupture of membranes.

OBJECTIVE: The aim is to identify mRNA expression of innate (TLR2 and TLR4) and adaptive (IL1 ß, IL17A, FoxP3, Tbet, Roryt) immunity in maternal-fetal interface and evaluate the contribution of SNP genes of IL1ß (rs1143627), TNFα (rs1800629), IL4 (rs2243250), IL10 (rs1800896, rs1800872) and RLN2 (rs4742076, rs3758239) to PTB, associated with PPROM in 26-34 weeks of gestation. PATIENTS AND METHODS: Materials and methods: We had done open cohort randomized research during period 2016-2018 years. The case group consisted of 50 women with PPROM in preterm pregnancy, 26-34 weeks of gestation. For the control group we collected samples from 50 women without previous history of PTB. To determine the level of mRNA target genes we used thermocycler CFX96™Real-Time PCR Detection Systems ("Bio-Rad Laboratories, Inc.", USA) and set of reagents Maxima SYBR Green / ROX qPCR MasterMix (2x) (Thermo Scientific, USA). RESULTS: Results: In the population of the Zaporizhzhia region, there is no reliable clinical association between the IL1ß and TNFα genes and a high risk of PTB. We obtained high reliable data on SNP genes RLN2 rs4742076 and rs3758239 in Zaporizhzhia women. The distribution of the rs2243250 gene polymorphism alleles of the IL4 gene of the main study group - TT homozygotes were determined in 2 (4%) cases, CT heterozygotes were found in 11 (22%), CC homozygotes in 37 (74%) cases. In the study of polymorphism rs1800872 of the IL10 gene, the main group of homozygous TT studies was identified in 7 (14%) cases, TG heterozygotes were found in 18 (36%), GG homozygotes in 25 (50%) cases. The range of all obtained values of the relative normalized expression of TLR2 gene in the placenta of 0.79-163.44 (median - 31.06), in the fetal membranes - 1.1-126.06 (median - 10.22). The placement of all obtained values compared to mRNA expression of the TLR4 gene was lower than the TLR2 in the placenta, which was 0.39-43.85 (median - 7.74) and higher in the fetal membranes - 0.18-216.01 (median - 40.04). We observed an 8.33-fold decreased expression in FoxP3 in decidua, especially in 31-32 weeks of PPROM manifestation (27.03-fold). In amniotic membranes a similar trend of reduction of FoxP3 expression was found, overall level decreased in 2.33 times, especially in 31-32 weeks of PPROM manifestation (10.64-fold). CONCLUSION: Conclusions: Among Zaporizhzhia population, combination of IL4 (rs2243250), IL10 (rs1800896 and rs1800872), RLN2 (rs4742076 and rs3758239) supports the role for functional polymorphisms in immunoregulatory genes in the susceptibility to PTL, associated with PPROM. Marked increased transcriptional activity of components of innate (TLR2, TLR4), adaptive (Th1, Th17) immune system and conversely decreased expression of Treg (FoxP3) in the maternal-fetal interface are involved in immune pathways of PTB and contribute in the fetal inflammatory response syndrome.