THE ROLE OF ENTEROVIRUSES IN THE DEVELOPMENT OF ISCHEMIC STROKE AND ITS OUTCOMES.

OBJECTIVE: The aim: To study the role of enteroviruses (EV) in the development of ischemic stroke and its outcome. PATIENTS AND METHODS: Materials and methods: The main group (MG) included 72 patients with acute cerebrovascular disorders were examined using the National Institutes of Health Stroke Scale and Barthel Index. The comparison group (CG) included 35 patients without cerebrovascular disease. Viruses were isolated from patients' sera and identified in neutralization test. EV genomes were detected in polymerase chain reaction (PCR). Serological diagnosis was performed by enzyme-linked immunosorbent assay. RESULTS: Results: EV genomes were more frequently detected in the patients' sera in MG than in CG (23.6 ± 5.9% and 2.9 ± 2.8%, p <0.05). The greater level of neurological deficits was in patients with positive PCR test results comparatively with patients with negative PCR test results (11.76 ± 0.31 and 10.97 ± 0, 27, p = 0.040). The regression of neurological deficit during the treatment was a worse in patients with positive PCR test results and presence of specific IgG compared with patients with positive PCR test results and absence of specific IgG (11.2 ± 2.6% and 19.6 ± 2.4%, p = 0.031). CONCLUSION: Conclusions: The trigger role of EV in the development of IS is established. PCR is recommended for diagnosis of EV in patients with IS.

ULTRASOUND EXAMINATION OF THE LUNGS IN THE INTENSIVE CARE UNIT IN OBSTETRIC PRACTICE.

OBJECTIVE: The aim: Diagnosis of bronchopulmonary pathology in the intensive care unit in patients with obstetric and gynaecological diseases and to implement aspects of the BLUE protocol in an intensive care unit for pregnant women with lung diseases. PATIENTS AND METHODS: Materials and methods: The study involved pregnant women admitted to the intensive care unit at the city centre for reproductive medicine. To study the bronchopulmonary system, an Aloka 3500 ultrasound scanner was used, a chest X-ray was performed, spirometry study of the function of external respiration. RESULTS: Results: Identified radiological changes in the lungs that were confirmed by ultrasound. Data on changes in external respiration indices showed the presence of respiratory failure by restrictive type and was not accompanied by a change in the gas composition of the blood (SpO2 and EtCO2). CONCLUSION: Conclusions: technique for ultrasound examination of the bronchi-pulmonary system in pregnant women was developed and introduced in the intensive care unit. Ultrasound profiles of lung diseases were identified, which allow determining the intra and extrapulmonary changes in pregnant women in the early stages of pathology.

SEASONAL FACTOR AND FREQUENCY OF DETECTION OF HERPES VIRUSES AND INFLUENZA VIRUS IN PATIENTS WITH ISCHEMIC STROKE.

OBJECTIVE: The aim: To determine the frequency of HSV1, HSV2, VZV, CMV, EBV, HHV6 and influenza virus detection in patients with ischemic stroke in different seasons. PATIENTS AND METHODS: Materials and methods: 144 patients with ischemic stroke were examined: 78 (54.2%) women and 66 (45.8%) men, mean age of 63.1 ± 0.8 years. Detection of the herpesvirus DNA and the influenza virus RNA was performed using PCR monthly in 12 patients. RESULTS: Results: A manifestation of a viral infection was detected in 32 (22.2%) and virus genomes were observed in 29 (90.6%) patients. Viral infection frequency is significantly lower in summer, compared to winter-autumn; p=0.033. HSV1 and HHV6 were the most common (19 (52.8%) and 16 (44.4%)); VZV was the least common (5 (13.9%)). Influenza virus RNA was detected in 10 (27.8%) patients. In winter-autumn the frequency of HSV1, HSV2, HHV6 viruses detection is significantly higher, compared to the spring-summer (p<0.05), and the difference is almost significant for the influenza virus (p=0.060) and the EBV (p=0.060). Association of stroke occurrence with the presence of two or more types of viruses is more common in winter, compared to the summer season: 11 (30.6%) vs. 3 (8.3%), p=0.017. CONCLUSION: Conclusions: Prevention and treatment of herpesvirus infections exacerbations, in particular HSV1 and HSV2, which significantly increase in winter, compared to summer, is an important direction of stroke prevention measures in risk groups.

Research of biological properties of enterovirus strains associated with ischemic stroke.

OBJECTIVE: Introduction: The research of biological properties of enteroviruses associated with ischemic stroke (IS) allows us to identify their intratypic differences. The aim: to identify genetic markers of strains of enteroviruses associated with IS. PATIENTS AND METHODS: Materials and methods: 11 strains of enteroviruses isolated from the serum of patients with IS were identified in the virus neutralization test. Genetic markers of isolated strains (Abent, marker S, marker rct40) were determined. RESULTS: Results: Eleven strains of enteroviruses were isolated from the serum of patients with IS. Eight viruses: Coxsackie B viruses (serotypes 2, 3, 4) and ECHO viruses (serotypes 6, 9, 27 (two strains), 29) were identified in these strains. Other three strains of enteroviruses were unidentified. Different combinations of genetic markers were found. Seven strains of enteroviruses (Coxsackie B2, B3, ECHO 6, ECHO 9, ECHO 27 (two strains) and one unidentified virus) had virulence markers: Abent-, rct40+ and S-. Three strains (Coxsackie B4, ECHO 29, one unidentified virus) had markers: Abent-, rct40+, S+. Another one unidentified virus had markers: Abent+, rct40+, S -. CONCLUSION: Conclusions: All 11 isolates of enteroviruses associated with IS had rct40+ marker, 10 of the 11 isolates had marker Abent- and 8 of 11 isolates had marker S-. The research of genetic markers allows to perform typic and intratypic differentiation of strains of enteroviruses associated with the IS.

Changes in the secretary ability of mononuclear cells in patients with atherosclerosis and accompanying pathology, depending on the C-peptide blood plasma.

OBJECTIVE: Introduction: Atherosclerosis is a trigger in the development of cardiovascular disease. Complications of atherosclerosis give reason to search for new criteria, diagnostic concepts, treatment methods and active preventive measures. The aim of our work is to study of the structural changes in the intima-media complex of the common carotid artery, pro-inflammatory cytokines (TNF-α, IL-6) secreted by mononuclear cells; the level of the intercellular adhesion molecule (according to sICAM-1), the level of the C-peptide of the blood, as well as the study of the relationship between these factors affecting the development of atherosclerosis. PATIENTS AND METHODS: Materials and methods: In the group of 110 patients are studied the levels of secretion of TNF-α, IL-6, the soluble intercellular adhesion molecule-1, the level of blood C-peptide, performed of duplex scanning of the brachiocephalic vessels, studied of biopsy of the skin. RESULTS: Results and conclusions: In the group of patients with atherosclerosis and the accompanying metabolic syndrome, endothelial activation is noted under the influence of risk factors (hyperinsulinemia, arterial hypertension, hypercholesterolemia), accompanied with the activation of mononuclear cells (with marked hyperproduction of proinflammatory cytokines (IL-6) and thickening of the intima-media complex of the common carotid artery with an increase in body weight. Patients with metabolic syndrome develop microangiopathy (edema of endothelial cells, thickening and reduplication of the basement membranes, focal reaction of the pericytes).

Public health and social supervision issues within public administration of ukrainian territories in the late 8th- early 9th centuries.

OBJECTIVE: Introduction: The public health system modernization history is based upon the progress in state country administration and administration of healthcare within the sectorwide approach. The WHO European Bureau pays much attention to the National Health Service systems development while implementing their basic policies. The Ukrainian state health service management was founded basing on the regulatory field of the Russian Empire, using the European healthcare promotion experience. Aim: of the article is the analysis of the regulatory field of police and amenity authorities of the Russian Empire and Ukraine within the medical and social service in the 18th-19th centuries. PATIENTS AND METHODS: Materials and methods: The structure of the article corresponds to the problem city and chronology principles, using the following methods and techniques of scientific learning: the systemic, historic, regulatory comparative, logical and structural-functional analysis of the studied medical-legal phenomena. The study sources are the scientific publications, collections of laws and executive orders of the Russian Empire and Ukraine in the 18th-19th centuries. RESULTS: Review: As a result of the performed work it can be determined were the main directions of the police competence in late 18th- early 19th centuries. CONCLUSION: Conclusion: Preserving health, treatment of the ill and injured, management of medical and social service of those in need, holding various preventive activities and supporting safe environment and regulating the safety of food were the main directions of the police competence in late 18th- early 19th centuries.

Changes of lipidic and the immunological state at patients with a metabolic syndrome in Ukraine.

INTRODUCTION: The metabolic syndrome has become pandemic nature and tends to rejuvenation in the world. Elucidation of the pathogenic mechanisms on membrane-cell level will optimize the treatment of patients with metabolic syndrome and prevention of metabolic syndrome on the level of pre-clinical manifestations. AIM: to study the immunological status and lipid metabolism in the patients with metabolic syndrome and the pathogenetic mechanisms of metabolic syndrome were established. MATERIAL AND METHODS: There were 4 groups of pacients (110) with: metabolic syndrome, ischemic heart disease and hypertension, hypertention; control group. General clinical, instrumental, laboratory and statistical methods were used. RESULTS: The levels of immune factors - interleukin-6 in supernatants of mononuclear cells by 65%, sICAM-1 by 20% is elevated in patients with metabolic syndrome compared with the control group. The increasing of the content of saturated fatty acids by 9.4% and polyunsaturated fatty acid by 36.6% lead to fundamental breach of structural and functional properties of membranes. There is significant common carotid artery intima media thickness on average twice at the patients with metabolic syndrome and with ischemic heart disease and hypertension. CONCLUSIONS: The immunoinflammatory reactions were more revealed in the group of patients with metabolic syndrome than in other groups. The lipid state at patients with metabolic syndrome was changed more than in patients with hypertension or patients with ischemic heart disease and hypertension both. Moreover our data indicate the presence of structural changes in the vessel wall in patients with metabolic syndrome.

Sonographic assistance in the process of internal jugular vein catheterization.

OBJECTIVE: Introduction: The use of ultrasound assistance of major vessels simplifies and facilitates vascular catheterization under conditions that significantly complicate gaining vascular access and reduces the risk of complications. The aim of the work is technical improvement of catheterization of major vessels, in particular, of the jugular vein, under guidance of ultrasound. PATIENTS AND METHODS: Materials and Methods:The result of catheterization of the internal jugular vein in 126 patients of intensive care unit, was analyzed. In 75 patients Seldinger's catheterization was used, taking into account anatomical markings, in 51 patients a method using ultrasound navigation was applied. RESULTS: Results: The advantages of catheterization of the main vessels under the guidance of ultrasound are established, in particular, control over the procedure and reduction of the time of its carrying out, the possibility of catheterization at the first attempt and the absence of complications associated with the procedure. CONCLUSION: Conclusions: The greatest effectiveness of internal jugular vein catheterization under the guidance of ultrasound assistency has been proved, which reduces the time of the procedure by 23.1%, reduces the number of attempts of catheterization, enables to monitor the progress of the procedure and prevent complications by using ultrasound navigation in 100% of the cases.