The Journal of V. N. Karazin Kharkiv National University, series "Medicine"

Quantum, molecular and continuum modeling in nonlinear mechanics of viruses

Alexander Zolochevsky — 2022-04-13

Introdution. Viruses are a large group of pathogens that have been identified to infect animals, plants, bacteria and even other viruses. The 2019 novel coronavirus SARS-CoV-2 remains a constant threat to the human population. Viruses are biological objects with nanometric dimensions (typically from a few tens to several hundreds of nanometers). They are considered as the biomolecular substances composed of genetic materials (RNA or DNA), protecting capsid proteins and sometimes also of envelopes. Objective. The goal of the present review is to help predict the response and even destructuration of viruses taking into account the influence of different environmental factors, such as, mechanical loads, thermal changes, electromagnetic field, chemical changes and receptor binding on the host membrane. These environmental factors have significant impact on the virus.

Materials and methods. The study of viruses and virus-like structures has been analyzed using models and methods of nonlinear mechanics. In this regard, quantum, molecular and continuum descriptions in virus mechanics have been considered. Application of single molecule manipulation techniques, such as, atomic force microcopy, optical tweezers and magnetic tweezers has been discussed for a determination of the mechanical properties of viruses. Particular attention has been given to continuum damage–healing mechanics of viruses, proteins and virus-like structures. Also, constitutive modeling of viruses at large strains is presented. Nonlinear elasticity, plastic deformation, creep behavior, environmentally induced swelling (or shrinkage) and piezoelectric response of viruses were taken into account. Integrating a constitutive framework into ABAQUS, ANSYS and in-house developed software has been discussed. Conclusion. Link between virus structure, environment, infectivity and virus mechanics may be useful to predict the response and destructuration of viruses taking into account the influence of different environmental factors. Computational analysis using such link may be helpful to give a clear understanding of how neutralizing antibodies and T cells interact with the 2019 novel coronavirus SARS-CoV-2.

Dynamics of kidney disorders in children with juvenile idiopathic arthritis taking into account therapy resume

Ludmila Bogmat — 2022-04-14

Introduction. In the study of the course and consequences of rheumatic diseases much attention is paid to comorbid conditions that significantly affect the function of internal organs, including kidneys. According to the concept of cardiorenal ratios, even minor renal impairment can be an independent risk factor for cardiovascular events and death. Objective. To determine the features of functional disorders of the kidneys in children and adolescents with juvenile idiopathic arthritis (JIA), taking into account the nature of the disease and therapy. Materials and methods. 85 children (8–18 years) with JIA, oligo- (61.5 %) and polyarthritis (38.5 %), 63 girls and 22 boys were examined. The average duration of the disease was 84.13 ± 6.28 months. The study was conducted twice with an interval of one year. Determination of renal status included studies of urinary sediment, concentration and nitrogen excretion capacity of the kidneys (fluctuations in specific weight during the day, daily proteinuria, creatinine and urea in the blood, glomerular filtration rate (GFR)). Statistical processing of the material was performed using parametric (Student's t-test (p), Fisher's angular transformation) and non-parametric parameters (Wilcoxon-Mann-Whitney), correlation and regression analysis. Results. Changes in renal function did not depend on the sex of patients and included proteinuria (9.09 %), namely microalbuminuria, which occurred in all variants of arthritis; reduction of GFR (8.26 %) – only in polyarthritis and uveitis-associated variants. Comparison of the frequency of renal changes in patients with varying degrees of disease activity showed their absence in the inactive stage of JIA. With active inflammatory process functional disorders of the kidneys occurred from 16.67 % to 26.32 % of cases, regardless of the degree of activity One year later there are positive changes: increased glomerular filtration rate (p ≤ 0.05), a tendency to decrease serum creatinine (p ≤ 0.1) on the background of basic methotrexate therapy up to 15 mg/m2/week. The combination of methotrexate therapy with the anti-TNF immunobiological drug (adalimumab) showed greater efficacy in improving renal function, a significant increase in GFR (p ≤ 0.05), a decrease in serum creatinine (p ≤ 0.05) and proteinuria (р ≤ 0,05). Conclusions. Children with JIA have changes in renal function, more often with uveitis-associated arthritis and methotrexate over 15 mg/m2/week. The inclusion of immunobiological drugs in the treatment not only reduces the activity of the disease, but also reduces the risk of concomitant comorbid lesions of internal organs, including kidneys.

Nose bleeding on the background of antithrombotic therapy: features of the clinical picture and stopping of bleeding

Nataliia Bychkova — 2022-04-14

Introduction. At present, an increase in the number of patients with pathology of the cardiovascular system in need of antithrombotic therapy is stated. Features of the clinical picture of nosebleeds against the background of antithrombotic therapy are little studied and there are isolated reports on the effectiveness of various methods of stopping bleeding in this category of patients. Objective. Study of the features of the clinical picture and improvement of methods for stopping nosebleeds during antithrombotic therapy. Materials and methods. A study was made of the features of the clinical picture and the effectiveness of various methods of stopping bleeding in 156 patients with epistaxis, which developed against the background of antithrombotic therapy. All patients were divided into two groups: the main group (104 patients), in which nasal bleeding was stopped by a combined method, including the use of a two-chamber hydrotampon of our own design in combination with Nozochem gel and thermal exposure, and a control group (52 patients) where classical gauze tamponade of the nasal cavity was used. Results. Against the background of antithrombotic therapy, bleeding from the anterior parts of the nasal cavity was noted in 144 (92.3 %) patients. Bleeding from the posterior parts of the nasal cavity was diagnosed in 12 (7.7 %) patients. In the majority of patients (80.1 %), epistaxis had a diapedetic character of varying intensity. Against the background of antiplatelet therapy, epistaxis had a less intense character and a tendency to recurrence than in patients receiving anticoagulant therapy. Among anticoagulant therapy, a more intense and recurrent nature of epistaxis was noted in patients treated with warfarin. The method proposed by us showed its effectiveness in stopping nosebleeds in 100 (96.1 %) patients of the main group. In the control group of patients, gauze tamponade of the nasal cavity provided stable hemostasis in 44 (84.6 %) patients. Conclusions. Nosebleeds during antithrombotic therapy most often occur in the anterior parts of the nasal cavity and are predominantly diapedetic in nature. Against the background of antiplatelet therapy, nosebleeds are less intense and prone to recurrence than in patients undergoing anticoagulant therapy. The combined method proposed by us for stopping nosebleeds is more effective and safe in comparison with traditional gauze tamponade and can be recommended as a choice for stopping nosebleeds during antithrombotic therapy.

Determination of vestibular function in children with purulent otitis media

Iuliia Lozova — 2022-04-14

The aim of the study is to assess the vestibular function of children with acute purulent otitis media by computer static stabilometry compared with typically developed peers. Materials and methods. In the course of the study 52 children aged 4 to 7 were examined by static stabilometry on the device «MPFI Stabilograph 1» (Kharkiv, Ukraine). 22 of them were diagnosed with purulent otitis media and their 30 peers were found to be practically healthy. Indicators of variations and forms of pressure center distribution, spectral-correlation indicators of stabilograms, as well as integral indicators of stability (length, velocity and angle of postural oscillations) and quality of equilibrium function in two sensory states (open and closed eyes) calculated in StabiliS software were taken into account. Results. Purulent otitis media causes posterior displacement of absolute coordinates of the pressure center. In the state with closed eyes, children with purulent otitis differ from their healthy peers in 14 of 24 stabilometric parameters, including stabilogram length, speed, angle and amplitude of oscillations, inferior to them in the balance. Children with purulent otitis media are more sensitive to the visual canal of postural control than their peers. Involvement of visual afferents in postural control significantly improves balance in children with purulent otitis by reducing deviations, postural fluctuations, which is reflected in the probable changes of 9 out of 24 stabilometric parameters compared to control. Conclusion. In preschool age, purulent otitis media leads to latent vestibular dysfunction, which is manifested by a violation of the stability of the vertical posture with the closed eyes and is compensated by visual-vestibular-proprioceptive integration in postural control.

Correction of hepatorenal syndrome with the use method of indirect electrochemical detoxification in oncological patients on the background of enteral insufficiency after multi-organic surgeries

Oleksii Pavliuchenko — 2022-04-14

Introduction. Enteral insufficiency syndrome accompanies the development of many acute diseases of the abdominal cavity. According to statistics, as a result of advanced and multi-organ surgery in oncosurgery for 2019–2020, enteral insufficiency was a complication in 39 % of all cases, regardless of anatomical and physiological area, and complications such as hepatorenal syndrome – in 50–80 % cases. The aim of the work is to study the effectiveness of correction of hepatorenal syndrome on the background of enteral insufficiency in cancer patients after multiorgan surgery. To do this, we used the method of indirect electrochemical detoxification with a solution of sodium hypochlorite. Materials and methods. 71 patients with oncopathology who underwent multiorgan surgery in different anatomical and physiological areas were examined. Patients were divided into two groups: the main group (n = 36), in which indirect electrochemical detoxification was performed with sodium hypochlorite solution at a concentration of 0.03 ; the comparison group (n = 35) – treatment was carried out according to standard schemes. The groups were compared by age and anatomical and physiological areas that were operated on (surgery was performed on the chest and mediastinum and abdominal organs). Results and discussion. For the treatment of patients with enteral insufficiency used the method of electrochemical detoxification with sodium hypochlorite, which reduces the indicators that reflect blood toxicity and the degree of intoxication. This was evidenced by a decrease in the concentration of bilirubin by 23.1 %, urea by 20.6 %, creatinine by 23.4 %, ALT by 57.2 % alkaline phosphatase by 69.5 %. When using this method for the third day managed to get a detoxifying effect. Conclusions. The expediency of including sodium hypochlorite in the complex postoperative therapy is shown. This is proved by the results of a comprehensive study of cancer patients after multiorgan surgery with the development of hepatorenal syndrome on the background of enteral insufficiency. It was found that the use of infusions of 0.03 % NaClO solution has a detoxifying effect: significantly reduces elevated concentrations of bilirubin by 23.1 %, creatinine by 20.6 %, urea by 23.4 %, improves the rheological properties of the blood. Therefore, given the relatively low effectiveness of conservative and insufficient availability of surgical treatment along with high mortality, prevention of hepatorenal syndrome in patients with enteral insufficiency by indirect electrochemical detoxification can significantly reduce its incidence.

Characteristics of mental capacity of secondary schoolchildren in the conditions of implementation of various educational programs

Zhanna Sotnikova-Meleshkina — 2022-04-14

Introduction. The growth of information load in the context of the introduction of the latest educational programs puts forward increased demands on the psychophysiological capabilities of the organism of schoolchildren, creates serious emotional, cognitive and physical problems. Mental capacity is considered as a characteristic of an individual’s ability to perform educational activities and a prognostic criterion for the development of fatigue. Purpose: to determine the dynamic features of mental capacity indicators in the implementation of traditional and meritocratic educational program. Materials and methods. The research involved 56 students of the 9th year of study, divided into 2 groups depending on the educational program. The level of mental capacity was assessed with the help of V. Anfimov’s proofreading samples throughout the cycle of studying subjects of different levels of severity and educational industries with a simultaneous assessment of the study schedule. One-factor analysis of variance and t-test in the IBM SPSS Statistics 20 software package were used for statistical data processing. Results. An analysis of the mental capacity of students of different gender groups revealed a higher level of it in girls in terms of quantitative (437.75 ± 5.14 signs), qualitative (7.20 ± 0.24 errors) and complex indicator (38.23 ± 0.53 units; p < 0.01). The degree of influence of the educational program on accuracy and performance was determined; type of subject – the number of traced signs and errors, the coefficient of productivity of mental work; day of the week – on the initial and final level of the volume and accuracy of the test (p < 0.001). It was found that the most productive lessons are from the 2nd to the 4th, the day is Monday, the subjects are Ukrainian Language and English. The lowest productivity of mental l work was revealed in the lessons of Geometry and Computer Science, the 7th lesson and days with the maximum study load were determined to be the most critical. Under the meritocratic system, a lower level of accuracy was recorded regardless of the educational field and the severity of the subject (p < 0.01) and work productivity with its significant decrease in the educational fields «Languages and Literature» and «Natural Science» and an increase of 10 % after the lessons of a mathematical profile. Conclusion. The gender characteristics of mental capacity for work, as well as the influence of the educational program, the type of subject in the educational field and difficulty, the place of the lesson in the daily and weekly schedule on the quality and productivity of work have been established. With the introduction of the meritocratic system, a more favorable schedule of training sessions was formed, which ensures more effective assimilation of educational material. The motivation of students and a reasonable approach to their selection for training in a specific educational program with a certain prospect of acquiring basic knowledge for a future profession ensures an increase in the intensity and productivity of mental work of schoolchildren at the stage of transition to specialized education.

Peculiarities of pharmacotherapy of chronic heart failure with retained left ventricular efficiency and associated atrial fibrilation depending on the method of heart rhythm control

Tetiana Zolotarova — 2022-04-14

Introduction. Only small studies in selected centers have examined the effect of rhythm control strategy, including catheter ablation, on major cardiovascular events, mortality in patients with long-term atrial fibrillation and concomitant chronic heart failure with preserved left ventricular ejection fraction and features of pharmacotherapy. The aim. To study the peculiarities of pharmacotherapy in patients with heart failure with preserved left ventricular ejection fraction and concomitant atrial fibrillation over a long period of observation, depending on the implementation of a rhythm control strategy: radiofrequency ablation or pharmacotherapy and their impact on endpoints. Materials and Methods. The study included 194 patients with a mean age of 59.3 ± 8.5 years with atrial fibrillation and concomitant heart failure with preserved left ventricular ejection fraction I–III of the NYHA functional class. Patients were divided into 2 groups: 136 patients who underwent radiofrequency ablation, and 58 patients in the control group who did not undergo intervention and continued antiarrhythmic pharmacotherapy. The patients were compared according to the main clinical and demographic indicators. An assessment was made of the characteristics of pharmacotherapy and different stages of observation by group and its impact on endpoints. Results. In the control group, the use of antiarrhythmic drugs other than amiodarone and oral anticoagulants at the baseline of the study was associated with the primary endpoint. The chance of its occurrence was 3.9 times higher among patients taking other antiarrhythmic drugs (odds ratio–3.949, 95 % confidence interval 1.198–13.013) and 1.8 times lower among patients taking anticoagulants (odds ratio - 0.556, 95 % confidence interval 0.399–0.965). In the ablation group, the chance of a primary endpoint event occurring was 3.1 times higher among patients taking diuretics at 2-year follow-up (odds ratio –3.130, 95 % confidence interval 1.111–8.824), and beta-blockers were associated with 3.4 times lower chance of these events (odds ratio – 0.296, 95 % confidence interval 0.128–0.688). In the ablation group, there was a statistically significant decrease in the percentage of patients requiring diuretics 2 years after inclusion in the study compared with the 3-month stage (p < 0.001) and the inclusion stage (p < 0.001). Conclusions. Long-term use of beta-blockers after intervention is associated with a reduced risk of primary endpoint events in the ablation group. Taking diuretics, beta-adrenergic receptors, and renin-angiotensin-aldosterone system inhibitors during the first 3 months after the intervention reduces the risk of atrial fibrillation recurrence in the long-term follow-up period in the ablation group.

Modern methods of surgical hearing prosthesis

Tetyana Panchenko — 2022-04-14

Resume. In recent years, the number of patients with hearing impairments around the world is constantly increasing. The WHO estimates that the unresolved problem of hearing loss costs the world 980 billion US dollars annually. Currently, the number of children and adults with sensorineural hearing loss has increased significantly. The aim of the work is to investigate the consequences of hearing loss in humans, and to describe current surgical methods of solving the problem based on scientific analysis of modern literature. Materials and methods. A comprehensive search of relevant literature sources was conducted in December 2021 using such electronic databases as RubMed, EMBASE, MEDLINE, U.S. National Library of Medicine Clinical Trials, Research Gate and Cocharane Library. Results. Despite the high-tech diagnostic capabilities of modern medicine, the study of etiology, prevention and correction of various hearing impairments in people of all ages take a paramount role in the modern medical community. Hearing aids are not able to transmit the full range of the sound palette to a person who is hard of hearing. In the analysis of the studied literature, modern surgical methods of correction of hearing disorders are cochlear implantation, bone-conducting system of sound conduction and brain-stem implantation. Each method has advantages, indications and features of rehabilitation. Restoration of hearing for a deaf child / adult is the result of the teamwork of psychologists, audiologists, otosurgeons/neurosurgeons, anesthesiologists, engineers and rehabilitation specialists. Conclusion. Hearing plays one of the most important roles in the formation and development of any society, transfer of accumulated knowledge from generation to generation through the formation of speech and communication skills. For timely detection of hearing impairment, on-time correction and rehabilitation measures, pediatricians and family doctors must know how to correct hearing impairment, taking into account modern medical and digital technologies.

The value of laboratory indicators estimation in patients with metabolically healthy obesity: analysis of a clinical case with literature review

Yevheniia Holubkina — 2022-04-14

Introduction. Obesity currently is a relevant issue of modern medicine due to its global prevalence, heterogeneity of clinical and laboratory manifestations, as well as the association with various comorbid conditions. Depending on the metabolic status, metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) are distinguished. MUO is defined with the presence of criteria for metabolic syndrome (MS) and is associated with an increased risk of cardiovascular and metabolic complications. MHO is characterized by a «metabolically healthy» profile, but the probability of a favorable course of the disease is controversial; many studies indicate the instability of the MHO phenotype and the possibility of further development of MUO. The aim of study: to analyze the features of laboratory indicators associated with MHO and determine the risk factors for the MUO development on the example of a clinical case. Materials and methods. A clinical case of 24 year old female patient diagnosed with alimentary-constitutional obesity class III. Objectively: height – 174 cm, weight – 124.7 kg, body mass index (BMI) – 41.21 kg/m², waist circumference – 107 cm, hips circumference – 144 cm; white striae on the abdomen; excessive subcutaneous fat stores, mostly distributed in the abdomen, thighs; blood pressure (BP) – 125/80 mm Hg. Investigation data: hyperleptinemia – 86.82 ng/ml, increased level of HOMA index – 4.6, hyperuricemia – 6.8 mg/dl, vitamin D deficiency – 9.19 ng/ml; lipid profile, fasting plasma glucose, glycated haemoglobin (HbA1c), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-thyroid peroxidase (anti-TPO) antibodies, cortisol, blood electrolytes, liver function tests – within normal limits. Electrocardiography (ECG), ultrasound of the heart and abdominal organs – without pathology. Results. Normal indicators of lipid metabolism, blood glucose and BP measurement in our patient are characteristic for MHO. However, the combination of hyperleptinemia with insulin resistance, hyperuricemia and vitamin D₃ deficiency indicate metabolic and hormonal imbalance and are considered as a risk factors for the development of MS and the further transition of MHO to MUO. Conclusion. MHO should be considered as a transient state, the management of such patients requires careful laboratory monitoring with early detection of metabolic disorders and its adequate and timely correction.

Biological effects of schisandra chinensis medicines and prospects of their use in clinical medicine (literature review)

Yatsyk Yelyzaveta — 2022-04-14

Introduction. The constant action of harmful factors, increased levels of neuropsychological stress and stress-associated decline in immunity increase scientific interest for studying the therapeutic properties of phytoadaptogens. In particular, the study of preventive use of drugs based on the adaptogen of oriental traditional medicine – schisandra (Schisandra chinensis) is now gaining relevance. The aim of the study. To analyze modern scientific sources of literature on the main characteristics and use of Schisandra chinensis, to identify the dominant biological effects and prospects for the use of adaptogen in the prevention and treatment of disorders of the nervous system. Materials and methods. The analyzed literature was searched using the following electronic databases: PubMed, Medline, ResearchGate and Google Scholar. Results. This review demonstrates a wide range of effects of S. chinensis chemical components on the activity of various human organ systems. Based on the available data, it was found that the antitumor, antioxidant and anti-inflammatory pharmacological effects of chinese magnolia-vine have been actively studied. Special attention was paid to the psychophysiological properties of adaptogens, in particular S. chinensis. Experimental use of S. chinensis in mice with neurodegenerative disorders has shown an improvement in animal mental activity. Clinical trials of adaptogenic drugs with a high content of chinese magnolia-vine components have shown improved cognitive activity, speed and accuracy of movement in tired people, although in the literature there are cases when the consumption of mixtures did not show the desired results. Conclusions. The analysis of literature data confirms the prospects of using S. chinensis as a mean of prophylactic treatment in clinical medicine. However, despite the large amount of scientific research on the adaptogenic potential of chinese magnolia, the results of S. chinensis influence on human cognitive abilities are contradictory and need further study in the future.