Long-term effects of hysterectomy due to uterine fibroids in women of reproductive age

The article presents an analytical assessment of long-term postoperative consequences in women of reproductive age after hysterectomy for uterine fibroids. The aim of the study to determine the structure of long-term results of hysterectomy for uterine fibroids in women of reproductive age using different approaches to the possibility of optimizing the diagnostic algorithm in the preoperative period in the future. Materials and methods – 160 women aged 40 to 50 years with symptomatic uterine fibroids, who underwent hysterectomy performed by vaginal, laparoscopically assisted vaginal, abdominal, were examined. Research methods are the following: physical examination of patients, assessment of pelvic floor (cough test, Valsalva maneuver, “Stop Test” with Kegel cones), diagnosis of urogenital dysfunction using a standardized POP-Q system; instrumental examination:, complete urodynamic testing, cystometry, (for assessment of the severity of urinary incontinence the classification of the International Continence Society (ICS) was used); assessment of the patient’s quality of life on the 10th day after surgery, 3, 6, 12 months and three years after surgery using the international standard questionnaire MOS SF-36; study of the local infectious status of the female body (bacteriological and bacterioscopic examination of discharge from vagina and urethra, determination of vaginal pH Results and their discussion. The structure of distant postoperative manifestations was determined (after 36 months of postoperative monitoring): clinical manifestations of intestinal function discomfort in the same degree in patients of three subgroups, 2.4 and 2.9 times less often in group I patients indicated chronic pelvic pain, in 1.7 times less often - for genitourinary disorders, vaginal prolapse in a third of cases, especially in women with abdominal HE and classic vaginal HE (30.0±5.0 % and 37.8±5.0 %, respectively, against 17.8±4.0 % – in the group with laparotomically assisted HE). Conclusions. Given the data on genitourinary disorders and vaginal prolapse in almost a third of observations after hysterectomy for uterine fibroids, it is advisable to consider additional examination of latent signs of genitourinary syndrome at the preoperative stage to optimize the choice of access, the volume of surgical treatment

INTENSITY OF INFECTION AND MEANS OF GIARDIASIS PREVENTION AT THE FARMS OF UKRAINE

G. duodenalis is the most widespread among the six generally recognized species of giardiasis affecting the gastrointestinal tract of mammals. Destruction of Giardia intestinalis oocysts in the environment mitigates the risk of infection for animals and humans. The objective of the study. The research is aimed at establishing the effectiveness of disinfectants against Giardia intestinalis cysts. Methods. The research involved twelve farms in Ukraine. Fecal samples were taken from the tested calves aged from 1 to 3 weeks. Giardiasis was diagnosed on the basis of laboratory tests of calf feces by the Fulleborn's method. The object of study was represented by cysts of Giardia intestinalis obtained from the feces through combined flotation methods. After exposure for a period of 30 and 60 minutes, the supernatant was drained and the precipitate applied to a glass slide to be stained with Lugol's solution. Cysts were subject to evaluation in terms of their morphological features. Their shape, size, color, nuclei location and axon were determined under a microscope at a magnification of about 10x400. Yodosol, Kontavir, Biocontact and Bioluft were used as a disinfectant. Results. The study carried out at dairy farms of various forms of ownership revealed that 25–50 % of calves at the holdings and 50–75 % of those at the farms were infected with Giardia intestinalis. Experiments established that Kontavir at a concentration of 1 %, as a disinfectant, produced a cytotoxic effect (compressed the cyst membrane) on Giardia intestinalis for 60 minutes. If the drug concentration increases to 2–3 %, Kontravir destroys the cyst shell releasing its contents within 30-60 minutes. Conclusions. The prevalence of Giardia intestinalis has been established through studying dairy farms in four regions of Ukraine. As a disinfectant, Kontavir at a concentration of 1 % produces a cytotoxic effect (compresses the cyst membrane), at a concentration of 2–3 %, it completely destroys the cyst membrane

PROTO-HORMONES LEVELS OF ADIPOSE TISSUE, INTERLEUKIN-6 AND INDICATORS OF DETOXIFYING FUNCTION OF THE LIVER IN PATIENTS WITH HYPERTENSION AND OBESITY COMBINED WITH NON-ALCOHOLIC FATTY LIVER DISEASE

The research estimates the state of liver detoxifying function and analyzes the changes in the levels of leptin, adiponectin and interleukin-6 in patients with arterial hypertension in combination with obesity and non-alcoholic fatty liver disease. Aim. The aim of the study is to evaluate levels of proto-hormones adipose tissue, interleukin-6 and indicators of detoxifying function of the liver in patients with hypertension and obesity combined with non-alcoholic fatty liver disease (NAFLD). Materials and methods. The study involved patients with arterial hypertension combined with obesity and NAFLD. All patients underwent anthropometric, general clinical, laboratory (blood lipid profile) and instrumental diagnostics (electrocardiography, echocardiography, ultrasonography, 13C-metacetin breath test, ELISA (adiponectin, leptin, IL-6). The patients’ height and weight were measured, the body mass index was calculated according to standard formulas. Results. Patients with arterial hypertension combined with obesity and NAFLD at the stage of steatohepatitis showed an increase in the levels of leptin and IL-6 and a decrease in the level of adiponectin. This group also revealed a moderate decrease in liver detoxifying function, as indicated by the results of 13C- MBT due to a 46.7 % decrease in the metabolic rate and a decrease in cumulative doses of CUM40 by 40 % and CUM120 by 46.8 %, respectively. Conclusions. The elevated levels of leptin and IL-6 and lowered adiponectin levels can be used to determine the degree of activity of non-alcoholic steatohepatitis and predict the course of NAFLD in combination with hypertension and obesity. An increased level of leptin and IL-6 and a low level of adiponectin in patients with such a comorbid pathology lead to an increase in the left ventricular myocardial mass index and aggravate the course of arterial hypertension

MOLECULAR MARKERS OF ENDOGENOUS NEUROPROTECTION IN THE BRAIN OF RATS WITH EXPERIMENTAL PARKINSON'S DISEASE AND ON THE BACKGROUND OF USING NEW PHARMACOTHERAPY SCHEMES

Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the elderly. The aim of the study. To study apoptotic processes and their role in the formation of dopaminergic neurodegeneration and to develop new treatment regimens with a specific neuroprotective effect on the dopaminergic system. Materials and methods. The study was carried out on 90 Wistar rats at the age of 6 months weighing 220–290 grams. Parkinsonism was induced by the administration of the neurotoxin MPTP (N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) to experimental rats with neuroprotective treatment: I – Intact (passive control); II – animals with experimental Parkinson's disease (PD, active control); III – PD + Amantadine (AM) IV – PD + AM + Cerebrocurin; V – PD + AM + Pramistar; VI – PD + AM + Gliatilin; VII – PD + AM + Noofen; VIII – PD + AM + Pronoran; IX – PD + AM + Melatonin. Results. The obtained data indicate that neuroprotective therapy of PD with drugs such as melatonin, cerebrocurin, pronoran and gliatilin in combination with amantadine leads to an increase in the expression of the HIF-1α, HIF-3α, HSP70 genes, bcl-2 proteins and decrease c-fos proteins with caspase-3 as markers of apoptosis and can also serve as a molecular marker for the activation of endogenous neuroprotection mechanisms under the conditions of an experimental PD. Conclusions. The study experimentally demonstrated a new target of neuroprotection in PD conditions – apoptosis of dopamine-producing neurons and substantiated modulators of this process – drugs for combined therapy with amantadine (melatonin, cerebrocurin, pronoran and gliatilin) ​​as promising drugs for the treatment of PD

THE TACTICS OF ANTIVIRAL THERAPY FOR CHRONIC VIRAL HEPATITIS B IN PREGNANT WOMEN

The aim of the study.Analysis of tactics of antiviral therapy for chronic viral hepatitis b in pregnant women. Methods. Theoretical analysis of scientific literature; analysis and generalization. Statistics and comparisons. Classification of theoretical material and development of recommendations. Research results.Today, there are about 2 billion people in the world ill with a chronic infection caused by the hepatitis B virus, 350 million of whom suffer from chronic hepatitis B, and most are asymptomatic carriers of the Australian antigen (HBsAg). Up to 50 % of all new cases of hepatitis B virus infection are due to vertical infection. Despite the lack of increase in viral load during pregnancy, alanine aminotransferase tends to increase in late pregnancy and in the postpartum period. A sharp drop in postpartum corticosteroids may create favourable conditions for hepatitis B virus activation. It is emphasized that the current treatment of hepatitis B virus includes the use of antiviral drugs, where Peg-IFN is absolutely contraindicated in pregnancy, lamivudine and entecavir are classified by the FDA as category C, and tenofovir and telbivudine are classified as category B. During pregnancy, it is recommended to use mainly category B drugs. Conclusions. The use of antiviral therapy in combination with immunoprophylaxis of new-borns is the optimal strategy for implementation as a universal program, as the success of such an intervention can make a significant contribution to achieving the ultimate goal of global elimination of hepatitis B virus

RELEASING HORMONE AND VITAMIN EFFICIENCY IN THE TREATMENT OF OBSTETRIC AND GYNECOLOGICAL PATHOLOGIES IN BREEDING SOWS

Reproduction is a crucial issue at the present stage in the pig husbandry development. Infertility of breeding sows leads to excessive use of feed, increased costs associated with failed inseminations, insufficient breed and early culling of sows. Aim of the research. Study of infertility types and prevention of postpartum diseases in sows in order to develop methods to control them. Methods. A two-stage experiment was carried out in 2019–2020 at the LLC "Ryasnyanske" farm in Sumy region, Ukraine. The first stage involved development of a method for prevention and control of infertility in sows. The second stage focused on the method of postpartum pathology prevention. Results. The conducted research established that surfagon and vitamins manifested the highest efficiency in case of alimentary infertility as they increased fertilization by 20.8 %. In terms of symptomatic infertility, the best results were achieved through a combined use of surfagon and gonadotropic hormone for both primary and multiple fertilization of sows, especially considering extremely low values ​​in the control group - 15 % and 6.5 % of piglets, respectively. Aminazine proved to be the most effective remedy for immune infertility, the obtained results were 17.2 % higher than in the control group. Surfagon at a dose of 5 ml together with estrofan twice a day fully prevented inflammatory postpartum pathologies in sows. Conclusions. Pathologies of the reproductive organs in sows are widespread at pork-producing farms. Individual use of surfagon was justified for treatment of alimentary, symptomatic and immune infertility of sows and prevention of postpartum pathologies. A combined use of tissue therapy and biologically active drugs proved to be the most effective. The treatment regimens described above reduce infertility and prevent postpartum pathologies in sows

FORECASTING THE BURDENED COURSE OF SURGERIES AND EARLY POSTOPERATIVE PERIOD IN PATIENTS WITH PULMONARY TUBERCULOSIS ON THE BASIS OF DENSITOMETRIC ANALYSIS OF PREOPERATIVE COMPUTER TOMOGRAPHY OF CHEST ORGANS

Topicality – the success of the use of densitotometry in computed tomography of the lungs to assess the condition of the lungs prompted to determine the possibility of predicting the course of the disease in the surgical treatment of patients with pulmonary tuberculosis. The aim – to determine densitometric criteria for prognosis of burdened intra- and postoperative course in patients operated on for pulmonary tuberculosis. Methods – the analysis of preoperative densitometry indices in CT of the lungs in the upper and lower pulmonary fields on the side of the operation in 40 patients operated on for chemoresistant pulmonary tuberculosis with a burdened intra- and postoperative period and the effect of densitometric abnormalities on intra-operative period. Results – in all examined patients the deviation of values of densitometry from conditional norm was revealed. In most patients with high parenchymal density there was obliteration of the pleural cavity and between the lobular fissures, fibrous changes in the root of the lung, with low density in most cases there was bleeding and insufficient tightness of the parenchymal suture, which together aggravates the early postoperative period. Conclusions – the relationship between deviations in the density of the lung parenchyma before surgery and the possibility of aggravating factors in the process of surgical treatment of patients with pulmonary tuberculosis was discovered; it was determined that predicting the occurrence of certain aggravating factors in the process of surgical treatment of patients with pulmonary tuberculosis can help prevent complications of the operation or significantly reduce their manifestations

EVALUATION OF COGNITIVE FUNCTIONS IN NEURODEGENERATION

Cognitive functions and their disorders in patients with neurodegenerative diseases are an urgent problem of modern neurology. Such functions include memory, attention, praxis, gnosis, language, thinking, control functions. The study of the neuropsychological profile allows a more accurate picture of the involvement in the pathological process of various brain structures and thus facilitate the differential diagnosis.  The aim of the research: on the basis of studying of cognitive features of patients with neurodegenerative (demyelinating) pathology to consider possibilities of their psychoneurological adaptation.  Materials and methods. The survey data of 104 patients with remitting type of multiple sclerosis, who were treated at the state institution “Institute of Neurology, Psychiatry and Addiction of the National Academy of Medical Sciences of Ukraine” are presented. To study the disorders of verbal memory, the method of A. R. Luria “Memorization of 10 words” was used, which allows to estimate such parameters as the amount of direct memory and the strength of delayed memory (i.e. indicators of short-term and long-term memory). The Schulte Table method was used to study arbitrary attention disorders. This technique allows you to evaluate such characteristics of random attention as volume, functions of concentration distribution and switching of attention. Results. The data obtained indicate that, depending on the severity of relapses, there are significant differences in the course of mnestic processes. It was found that in severe variants of remissions in women with relapsing-remitting multiple sclerosis (RRMS) more pronounced than in men, there is a lack of ability to work and exhaustion. Conclusions. It is concluded that the assessment of cognitive deficit out of connection with personal characteristics and emotional and volitional disorders significantly reduces the informativeness and ability to correct cognitive dysfunction. Timely detection of cognitive and emotional-personal changes can not only improve the quality of life of patients with neurodegenerative diseases, but also act as an independent part of the psychoneurological model of adaptation of this category of patients

CLINICAL AND PHYSIOLOGICAL JUSTIFICATION OF WEANING FROM MECHANICAL VENTILATION IN CHILDREN WITH RESPIRATORY FAILURE

Children frequently are admitted to pediatric intensive care units due to acute respiratory failure and up to 64 % of them need to be mechanically ventilated and later weaned. The aim was to develop strategy of weaning from mechanical ventilation in children with different types of respiratory failure. Materials and methods. The work was based on results of treatment of 237 patients aged from 1 month to 18 years old, who were divided into control and study group. Patients of study group were randomized into group I (83 patients) and received traditional ICU monitoring and treatment and group II (79 patients), where was used proposed by us methods of monitoring and treatment. Results. There was supplemented data on the etiology of respiratory failure in children with taking into account function of diaphragm, changes in hemodynamics, nutritional status, electrolyte balance and central nervous system function. It was established new mechanisms of inadequacy of spontaneous breathing during mechanical ventilation and found causes of unsuccessful weaning from mechanical ventilation. In addition, it was developed a weaning strategy with goal-directed therapy for disorders treatment according the type of respiratory failure and children`s age. As a result, important scientific problem was solved and the results of treatment of children with respiratory failure was improved. Conclusions. It was found that proposed strategy of weaning from mechanical ventilation allowed to reduce the duration of mechanical ventilation and the frequency of complications (reintubations). There were no significant differences in the frequency of tracheostomy among patients of I and II groups

THE EFFICACY OF INTRATHECAL DEXAMETHASONE TO PREVENT EARLY COMPLICATIONS OF SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION

Spinal anaesthesia is commonly used for elective caesarean section. But it has some disadvantages and complications in intra- and postoperative period. The aim of this study was to explore the efficacy of intrathecal or intravenous dexamethasone to prevent some early complications of spinal anaesthesia such as arterial hypotonia, nausea, vomiting, bradycardia, shivering etc.  Material and methods: there were examined 154 healthy, not obese women, ASA I–II, 18–36 years old, 36–40 weeks of gestation, undergoing elective caesarean section under spinal anaesthesia. All patients were divided into three equal groups for randomized, prospective, double-blinded, placebo-controlled clinical trial. The women of each group received intrathecal hyperbaric bupivacaine 0.5 % 10 mg. Group B (n=51) additionally received intrathecal 1 ml of normal saline=placebo; Group BD (n=52) additionally received 4 mg (1 ml) intrathecal dexamethasone, and Group D (n=51) received 8 mg intravenous dexamethasone directly after spinal puncture. The patients were evaluated for blood pressure, heart rate, nausea, vomiting, shivering or other complications during intra- or postoperative period (24 h). The complications that required medicines correction were recorded and cured. Results: the addition of intrathecal dexamethasone in Group BD vs Group B significantly decreased frequency and manifestations of arterial hypotonia and nausea (Pearson's χ2 =0.486 and χ2=0.479, p<0.05) in intra- and postoperative period after the spinal anaesthesia in elective caesarean section. Intrathecal dexamethasone in Group BD vs Group B significantly reduced shivering (Pearson's χ2=0.316, p<0.05) in intra- and postoperative period, and significantly didn`t impact on vomiting and bradycardia. Conclusions: the addition of 4 mg intrathecal dexamethasone as an adjuvant for spinal anaesthesia can significantly decrease frequency and manifestations of arterial hypotonia and nausea, reduce shivering during perioperative period. The addition of 8 mg intravenous dexamethasone has not the same quality