Krym. Rossiya…navsegda? Critical junctures, critical antecedents and the paths not taken in the making of Crimea’s annexation

Russia’s annexation of Crimea in 2014 is widely framed as an outside-in process, not only enabled but also enacted by the Kremlin. Prevailing accounts privilege geopolitical analysis and place those developments in a broader narrative of tension and competition between the West and Russia. Such a narrative downplays the involvement of local actors and the importance of the choices they made prior to and during those events. This article revisits the period leading up to March 2014 through a focus on critical junctures, critical antecedents, a near miss, and the path not taken. It argues that a full account of Crimea’s incorporation into Russia – while acknowledging Moscow’s role – cannot ignore the local contingencies that preceded and shaped it. We understand the region’s annexation as a key moment of institutional change in Ukraine and focus our attention on explaining how that outcome was determined, identifying the path to such a political outcome. Yanukovych’s decision to “catapult” political-economic interest groups from Makeevka and Donetsk into the peninsula led to the marginalization of the local elite. Regime change in Kyiv and a slow and cumbersome response from the new authorities in February-March 2014 triggered, but did not cause, Crimea’s exit option.Publisher PDFPeer reviewe

ВПРОВАДЖЕННЯ У ПРОЦЕС НАВЧАННЯ ФАХІВЦІВ ПЕРВИННОЇ ЛАНКИ МЕДИЧНОЇ ДОПОМОГИ ВОЛИНСЬКОЇ ОБЛАСТІ СУЧАСНИХ ЗНАНЬ З ІНТЕГРОВАНОГО ВЕДЕННЯ ВИПАДКІВ ГІПЕРТЕНЗІЇ ТА ЦУКРОВОГО ДІАБЕТУ

Purpose: analysis of means and training organization of primary care specialists of the Volyn region on the prevention of NCDs and integrated management of patients with hypertension and diabetes. Materials and Methods. The study involves a complex of specific methods of social medicine research, as well as scientific pedagogy: systemic approach and systemic analysis, medical-statistical, modeling, organizational experiment, content analysis, instrumental, empirical, educational-didactic and scientific knowledge. Results. A two-day training course ‘Integrated Management of Hypertension and Diabetes was developed by a national expert panel with WHO’s technical support and proposed for further implementation in Ukraine. This course is optimal for training primary care specialists. Methods of the training include interactive lectures, workshops, clinical cases study and practical skills. It is mandatory to evaluate the classes, coaches, and training as a whole. Educational materials include multimedia lecture presentations, handouts for each training participant. At the same time, there are plans to introduce the developed online training courses on NCDs, for the successful completion of which family doctors will be able to earn points of continuous professional development. Conclusions. In order to ensure the availability of highly qualified and high quality medical care, it is necessary to have enough professionals trained to provide it. A key role in the prevention of NCDs (particularly, hypertension and diabetes) is played by primary care workers. If they receive quality training on the above issues, there is a real possibility that will have a positive impact on the outcomes of NCDs prevention for their patients.Мета: проаналізувати можливості організації навчання фахівців первинної медичної допомоги Волинської області з питань профілактики неінфекційних захворювань та інтегрованого ведення пацієнтів із гіпертензією та цукровим діабетом. Матеріали і методи. У роботі використано комплекс специфічних методів досліджень соціальної медицини, а також наукової педагогіки:  системного підходу та системного аналізу, медико-статистичний, моделювання, організаційного експерименту, контент-аналізу, інструментальний, емпіричний, навчально-дидактичний та наукового пізнання. Результати. Дводенний навчальний курс «Інтегроване ведення випадків гіпертензії та діабету» розроблено національною групою експертів за технічної підтримки ВООЗ і запропоновано для подальшої імплементації в Україні. Цей курс є оптимальним для підготовки фахівців первинної медичної допомоги. Методики тренінгу включають інтерактивні лекції, практичні заняття, розгляд клінічних випадків та відпрацювання практичних навичок. Обов’язковим є оцінювання занять, тренерів, тренінгу в цілому. До навчально-методичних матеріалів входять мультимедійні презентації лекцій, роздаткові матеріали для кожного учасника тренінгу. Водночас заплановано запровадити розроблені дистанційні курси з питань неінфекційних захворювань, за успішне проходження яких сімейні лікарі зможуть отримувати бали безперервного професійного розвитку. Висновки. Для забезпечення існування висококваліфікованої та якісної медичної допомоги необхідна наявність достатньої кількості професіоналів, навчених її надавати. Ключову роль у системі профілактики неінфекційних захворювань (зокрема гіпертензії та цукрового діабету) відіграють працівники, які працюють на первинній ланці медичної допомоги. Якщо вони пройдуть якісну підготовку з вищезазначених питань, існує реальна можливість того, що це матиме позитивний вплив на результати їхньої роботи з профілактики неінфекційних захворювань у пацієнтів

Neutralization of SARS-CoV-2 by highly potent, hyperthermostable, and mutation-tolerant nanobodies

Monoclonal anti-SARS-CoV-2 immunoglobulins represent a treatment option for COVID-19. However, their production in mammalian cells is not scalable to meet the global demand. Single-domain (VHH) antibodies (also called nanobodies) provide an alternative suitable for microbial production. Using alpaca immune libraries against the receptor-binding domain (RBD) of the SARS-CoV-2 Spike protein, we isolated 45 infection-blocking VHH antibodies. These include nanobodies that can withstand 95°C. The most effective VHH antibody neutralizes SARS-CoV-2 at 17–50 pM concentration (0.2–0.7 µg per liter), binds the open and closed states of the Spike, and shows a tight RBD interaction in the X-ray and cryo-EM structures. The best VHH trimers neutralize even at 40 ng per liter. We constructed nanobody tandems and identified nanobody monomers that tolerate the K417N/T, E484K, N501Y, and L452R immune-escape mutations found in the Alpha, Beta, Gamma, Epsilon, Iota, and Delta/Kappa lineages. We also demonstrate neutralization of the Beta strain at low-picomolar VHH concentrations. We further discovered VHH antibodies that enforce native folding of the RBD in the E. coli cytosol, where its folding normally fails. Such “fold-promoting” nanobodies may allow for simplified production of vaccines and their adaptation to viral escape-mutations

Features of the frequency of occurrence of T-330G <i>IL2</i> gene polymorphism in patients with COVID-19

SARS-CoV-2 infection is the etiopathogenetic factor of the new coronavirus infection. Susceptibility to the virus and, accordingly, the incidence differs in children and adults. On the one hand, this reflects the age-related features of the immune response. On the other hand, it is realized through the production of a number of cytokines, including IL-2, and reflects the genetically determined features of cytokine production. The aim of the study was to analyze the frequency of occurrence of T-330G polymorphic variants of the IL2 gene in patients with a new coronavirus infection. A total of 145 patients were examined, including 31.0% of children (n = 45) and 69.0% of adults (n = 100). The diagnosis of a new coronavirus infection was verified by RT-PCR confirming the presence of the SARS-CoV-2 virus and identifying clinical symptoms of an upper respiratory tract infection. The control group consisted of 50 healthy volunteer donors. Allele-specific PCR with electrophoretic detection in 3% agarose gel (Litech, Russia) was used to analyze the T-330G polymorphism of the IL2 gene. To compare the frequencies of allele combinations, the χ2 test and the odds ratio OR and (95% CI) were used.The dominant genotype in patients with COVID-19 was the heterozygous GT genotype of the T-330G polymorphism of the IL2 gene. In the group of children at risk of developing a new coronavirus infection, the GG genotype of the T-330G polymorphism of the IL2 gene was associated (31.1% in children and 18.0% in the control group, p &lt; 0.05, OR = 2.047). While the homozygous TT genotype of the T-330G polymorphism of the IL2 gene was a protective genotype (its occurrence rate was 26.7% in patients, 54.0% in the control group, p &lt; 0.05, OR = 0.315). In adults, the heterozygous GT genotype of the T-330G polymorphism of the IL2 gene was associated with the risk of developing a new coronavirus infection (in the group of patients – 44.0% versus control – 28.0%, p = 0.028, OR = 2.020). A low risk of developing the disease was associated with the homozygous TT variant of the T-330G polymorphism of the IL2 gene (in the group of patients 37.0% versus control – 54.0%, p = 0.024, OR = 0.500).The T-330G polymorphism of the promoter zone of the IL2 gene differently affects its production. The direction of the immune response and its effectiveness depend on the level of IL-2. Understanding the individual factors that determine the features of the immune response can help in understanding the mechanisms of development of COVID-19-associated diseases and the selection of approaches to personalized methods of their treatment

ГАНГРЕНОЗНАЯ ЭКТИМА – ФАТАЛЬНАЯ ФОРМА СИНЕГНОЙНОЙ ИНФЕКЦИИ У РЕБЕНКА ВОСЬМИ МЕСЯЦЕВ

The clinical features of the onset and dynamics of ecthyma gangrenosum caused by Pseudomonas aeruginosa with the development of sepsis are observed in an eight-monthold child. The article incudes a detailed description and corresponding photo images of skin manifestations of the disease in the form of solid hemorrhagic fast-growing papules with a cyanotic halo and developing necrosis in the centre of the elements followed by the formation of ulcers or blisters. The diagnosis was made on basis of clinical manifestations and Pseudomonas aeruginosa culture from the contents of the blisters and blood. In spite of being treated intensely and being given antibacterial preparations possessing anti-Pseudomonad activity, the girl died on the 17th day after hospitalization.Рассмотрены клинические особенности дебюта и динамики гангренозной эктимы, протекающей с развитием сепсиса у ребенка 8 месяцев. Подробно описаны и представлены на рисунках кожные проявления заболевания в виде плотных геморрагических быстро расширяющихся папул с синюшным ореолом и развивающимся некрозом в центре элементов, с последующим формированием язв или пузырей. Диагноз устанавливался на основании клинических проявлений и высева Pseudomonas aeruginosa из содержимого пузырей и крови. Несмотря на проводимую интенсивную терапию и использование антибактериальных препаратов, обладающих антипсевдомонадной активностью, девочка умерла на 17-й день от момента госпитализации

Analysis of Cases of Pneumocystis Pneumonia in HIV-infected Children in the Autonomous Republic of Crimea

The article analyzes the development of pneumocystis pneumonia in 8 HIV-infected children under the age of 2 years. Characteristics of main clinical and laboratory parameters and treatment are provided

Invasive Pulmonary Aspergillosis in HIV-Infected Children

В статье описаны особенности течения аспергиллеза легких у ВИЧ-инфицированных детей и приведен клинический случай из собственной практики

Prevalence of e-cigarettes use among Ukrainian youth: new challenge for public health?

Introduction There is lack of e-cigarettes regulation in Ukraine. They are available for everyone without age restriction. Aggressive marketing and delay with adoption of necessary laws contribute in increase of e-cigarettes prevalence among adolescents. New electronic products appear at the market and lack of regulatory measures may eliminate all tobacco control efforts and lead to serious challenges for public health. Methods First questions about e-cigarettes use by youth were included into ESPAD (age of respondents was 15-17 years). In 2017, GYTS (age of respondents was 13 - 15 years) also revealed some data about e-cigarettes. Another data were got due to research about e-cigarettes marketing and regulation conducted with support of WHO and JHU. Results ESPAD found that in 2015 in Ukraine the share of young people (15-17 years old) who were current users of e-cigarettes was 5.5%. However, in 2017 according to GYTS results, overall 18.4% of young people (13 - 15 years old) were current users of e-cigarettes (in contrast to 9.2% who smoked regular cigarettes). Research on the e-cigarettes marketing demonstrated that e-cigarettes are actively promoted, especially for young people. At the same time, the market of e-cigarettes is not regulated in Ukraine resulted in lack of control for quality of devices and liquids which are sold to users, including minors. Conclusions Lack of any e-cigarettes regulation in Ukraine and aggressive promotion of these products result in high percentage of adolescents (13-15 years old) who are current smokers of e-cigarettes. Also it causes problems with quality control so these products can be a direct threat to health and life of people and become new challenge to the public health of Ukraine