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

Neuromechanical characterization of brain damage in response to head impact and pathological changes

Alexander Zolochevsky — 2020-09-08

Traumatic injuries to the central nervous system (brain and spinal cord) have received special attention because of their devastating socio-economical cost. Functional and morphological damage of brain is the most intricate phenomenon in the body. It is the major cause of disability and death. The paper involves constitutive modeling and computational investigations towards an understanding the mechanical and functional failure of brain due to the traumatic (head impact) and pathological (brain tumor) events within the framework of continuum damage mechanics of brain. Development of brain damage has been analyzed at the organ scale with the whole brain, tissue scale with white and gray tissue, and cellular scale with an individual neuron. The mechanisms of neurodamage growth have been specified in response to head impact and brain tumor. Swelling due to electrical activity of nervous cells under electrophysiological impairments, and elastoplastic deformation and creep under mechanical loading of the brain have been analyzed. The constitutive laws of neuromechanical behavior at large strains have been developed, and tension-compression asymmetry, as well as, initial anisotropy of brain tissue was taken into account. Implementation details of the integrated neuromechanical constitutive model including the Hodgkin-Huxley model for voltage into ABAQUS, ANSYS and in-house developed software have been considered in a form of the computer-based structural modeling tools for analyzing stress distributions over time in healthy and diseased brains, for neurodamage analysis and for lifetime predictions of diseased brains. The outcome of this analysis will be how the neuromechanical simulations applied to the head impact and brain tumor therapies may assist medical specialists with their decisions during planning and application of medical surgeries.

Analysis of frequency and structure of indications to cesarean section by M.S. ROBSON criteria

Olga Gryshchenko — 2020-09-08

Annotation. In 2001, M. S. Robson proposed a classification based on criteria to identify pregnant women whose birth is not possible naturally. The purpose of the study is to analyze the frequency and structure of indications for caesarean section to determine promising ways to optimize the management of labor.

Materials and methods. Based on the final diagnoses, an analysis of the structure of the absolute and percentage number of women groups M.S. Robson, the caesarean section frequency in each group, and the caesarean section structure for individual groups in 2071 women giving birth in the Kharkov city perinatal center, including 726 (35,1 %), by caesarean section.

Results. The most promising in terms of reducing the frequency of cesarean section are women of the 1st, 2d and 3rd groups. In most cases, caesarean section in these groups was performed due to complications of childbirth or in connection with obtaining new data on the risk of complications during childbirth. Among these women, a rather frequent indication for emergency surgery is primary weakness of labor (in the 1st and 3rd groups) or weakness of labor after unsuccessful induction of labor (2a and much less often – 4a group). It is this contingent of pregnant women and women in childbirth that requires special attention. On the one hand, it is a reserve to reduce the frequency of cesarean section, on the other hand, in some cases, the operation is performed late, which leads to severe depletion of the woman in labor during childbirth, complete suppression of the contractile function of the uterus with a lack of sensitivity to oxytocin and to severe hypoxic-ischemic complications in the fetus.

Conclusions. To substantiate a decrease in the frequency of cesarean section, the most promising is the group of women with first or repeated births with full-term single-term pregnancy and head presentation of the fetus (groups 1 and 3 according to M.S. Robson), and with planned induction of labor (groups 2a and 4a), that make up more than 20 % of women after cesarean section. Planning the optimal tactics of labor management for these women on the basis of identifying risk factors and determining the contingent of women for whom a set of preventive and therapeutic measures is appropriate is to reduce the frequency of cesarean section.

Puncture methods of treatment of patients with fluid formations of the pancreas and liver

Yevgen Khvorostov — 2020-09-08

Summary. Diagnosis and treatment fluid formations of the liver and pancreas non-parasitic genesis remains a controversial issue, despite current advances in minimally invasive surgery. The aim of the study is to improve the results of surgical treatment of patients with fluid formations of the liver and pancreas non-parasitic genesis through the integrated use of mini-invasive methods of diagnosis and surgical treatment. Patients were carried out clinical, instrumental, laboratory methods of examination, in the course of which liquid formations were revealed. With the help of ultrasound of the apparatus the liquid structure was elucidated, then dopplerography determined the non-vascular zone for passing the puncture needle. For punctures we used special nozzles on the ultrasonic sensor. The puncture was performed under local anesthesia. Chiba-type needles were used for the puncture, and Pig tail catheters from 6 to 9 F were used for drainage. The timing of the puncture was determined individually, taking into account clinical and sonographic signs, with the average time of drainage of pancreatic cysts being 24 ± 4,3 days, and drainage of liver cysts – 32 ± 1,6 days. Indications for puncture under the control of sonography and laparoscopic treatment were determined. Puncture-draining interventions were performed in 53 patients with non-parasitic liver cysts, of which 30 patients were drained under ultrasound control, and 23 patients underwent video laparoscopic drainage. Also punctuation-drainage interventions were performed in 72 patients with pseudo-pancreatic cysts, of which ultrasonic drainage was performed in 48 patients, 24 patients had video laparoscopic drainage. In the case of puncture treatment of liver cysts and pancreas, narcotic analgesics were not used for pain relief. The postoperative period was more favorable in patients where percutaneous puncture interventions were used. Immediately after percutaneous interventions under ultrasound control and from the second day after videolaparoscopic operations, patients returned to their usual diet and volume of physical activity. Thus, comparing different methods of surgical treatment of non-parasitic fluid formations of the liver and pancreas it was established that application of puncture-draining methods allowed to improve significantly medical and social indices of this group of patients.

Minimally invasive interventions in the treatment of patients with cholelithiasis complicated by obstructive jaundice

Yevgen Khvorostov — 2020-09-08

One of the most threatening complications of cholelithiasis (cholelithiasis) is obstructive jaundice (MF), which leads to the development of hepatic-renal failure. The results of surgical treatment of 386 patients were analyzed for various forms of cholelithiasis complicated by breast. The use of a combination of ultrasound, endoscopic, and radiation studies in the diagnostic program to visualize the cause of the mammary gland against the background of the complicated course of the cholelithiasis made it possible in almost 100 % of cases to make a correct diagnosis and conduct a staged minimally invasive surgical treatment: stage I included endoscopic retrograde cholangiopancreatography, papillosphincterotomy with choledocholithotraction, debridement and nasobiliary drainage of the common bile duct; at the II stage, 83,94 % of patients underwent laparoscopic cholecystectomy. The tactics of widespread use of a combination of highly informative diagnostic methods and staged minimally invasive treatment is characterized by high efficiency and good results.

Polymorphism of clinical phenotypes and heterogeneity of autoimmune targets of myasthenia gravis

Olena Klimova — 2020-09-08

Abstract. The aim of the study was to evaluate the presence of autoantibodies to different subunits of nAChR and nuclear antigens at different myasthenia phenotypes. The work has investigated the presence of antibodies to α1- and α7-subunits of nAChR, the repertoire and frequency of occurrence of antinuclear autoantibodies in different clinical phenotypes of myasthenia to understand the mechanisms of pathogenesis of various forms of the disease. Additional factors of autoimmunization were identified that affect certain mechanisms of pathogenesis in thymus-independent and thymus-dependent myasthenia gravis. Autoantibodies to α1 and α7 subunits of nAChR were detected in case of thymus-independent myasthenia gravis and thymus-dependent myasthenia gravis with thymus hyperplasia or locally spread thymoma, as well as the presence of antinuclear antibodies in case of thymoma on the background of myasthenia gravis. Autoantibodies to the α1 subunit of nAChR are available in all patients with thymus-independent and thymus-dependent myasthenia gravis; the maximum titer was in patients with myasthenia and thymus hyperplasia. The presence of autoimmune antibodies to another target – to the α7 subunit of nAChR was found in patients with thymus-independent myasthenia gravis and with myasthenia and thymus hyperplasia. Detected anti-nuclear antibodies (ANA) in patients with thymoma, are preferably antibodies to structures that are directly involved in mitotic cell division, that is to centromere, to centromeric protein F, to the centrosomal protein of achromatin spindle – NuMa and MSA-2 antigen mitotic spindle that affects the course of cell proliferation, reparative and regenerative processes in tissues. The selectivity of antibody damage by the subunit of NAHR in different myasthenia phenotypes and the presence of ANA in thymus-dependent myasthenia with thymoma has great diagnostic and prognostic value. The presence of specific autoantibodies to certain nuclear structures of the cell, along with other autoimmunization mechanisms, affects various metabolic mechanisms and can be used to select targeted therapy taking into account individual pathogenic targets of the autoimmune process.

The immune system and the nature of immune disorders in patients with seasonal allergic rhinoconjunctivitis (sark) with moderate and severe

Alexey Kuznetsov — 2020-09-08

Introduction. Seasonal allergic rhinitis is allergic diseases (AD) of mucous membranes (primarily the conjunctiva of the eye and nasal mucosa), due to hypersensitivity to aerosol allergens of plant pollen and fungi spores, the concentration of which in the air periodically becomes causal. The leading clinical manifestation of SAR is considered as allergic conjunctivitis. According to statistics, about 70–90 % of patients with SAR develops Pulawy conjunctivitis, characterized by itching of eyes, eyelids, their redness, photophobia, lacrimation. Clinically important is the combination of SAR and conjunctivitis. Although the SAR attention usually emphasize on nasal symptoms, more than 80 % of patients, as practice shows, suffer from symptoms from the eyes. According to the European and North American researchers, more than 70 % of patients with SAR suffer from eye and nasal symptoms, and their severity the majority of patients assessed as moderate or severe.

Materials and methods. Were examined in 120 patients with seasonal allergic rhinitis in combination with conjunctivitis: 58 patients with moderate and 62 patients with severe disease.

Research results. The patients of the 1st group the level of total IgE was increased 5.6 times, patients of group 2 – 7.1 times in comparison with the control group. The level of specific IgE in group 1 was 37.7 KU/L in group 2 – 46.9 KU/L, when reference levels – 0 – < 0,35 KU/L in the study, the CІC was established an increase of their concentration in patients of groups 1 and 2 groups. However, patients 1st group mainly increased levels of high molecular weight, the CІC, and in patients 2 groups – mainly the level of low molecular weight CІC.

Discussion of research. The study of the population structure of the lymphatic peripheral blood of patients SARK revealed changes in T-cell link of immunity, characterized by a decrease in the content of CD3⁺-cells from patients 1 group by 10,7 %, in patients of group 2 – by 19,0 % in comparison with similar indicators of control group.

Conclusions. Certain disorders in patients with severe disease are more profound than in patients with the moderate course of the disease. In patients with severe, in contrast to patients with moderate to severe flow disturbances and in the phagocytic link of immunity. In patients with severe as reduced the absorption activity of phagocytes and their ability in induction of reactive oxygen species. In patients with severe marked increase in the level of low molecular weight CІC, in patients with moderate to severe over – mainly high molecular weight of the CІC, which have less toxic than low molecular weight.

Clinical characteristics of patients with atrial flutter before radiofrequency ablation

Daiana Pavlova — 2020-09-08

Introduction. Radiofrequency ablation (RFA) is today the method of choice for the ineffective medical treatment of atrial fibrillation (AF), but its course is often complicated by comorbid pathology. The predicted great impact of these nosologies on the effectiveness of radiofrequency ablation of the arrhythmia substrate requires additional study before RFA.

Objectives – to analyze the clinical characteristics of patients with isolated atrial fibrillation and combination with of atrial fibrillation with atrial flutter (AF + AFib) that underwent radiofrequency ablation of the arrhythmia substrate.

Materials and methods. 84 patients aged 65 ± 9 (82.3 % of men) were examined, who underwent RFA of the arrhythmia substrate: cavo-tricuspid isthmus (CTI) or combined with pulmonary veins isolation (CTI + PV) strategy for patients with AFib. Before radiofrequency ablation, the following clinical indicators were assessed: forms of AF + AFib, the presence of chronic heart failure (CHF) and functional classes (FC) according to NYHA classification, the forms of chronic coronary syndromes (CCS): postinfarction cardiosclerosis, syndrome-X, functional classes of stable angina (SA), stages of arterial hypertension (AH), the presence of type 2 diabetes or stroke in the anamnesis.

Results. Radiofrequency ablation of isolated atrial fibrillation was more often performed for persistent arrhythmia in patients with stable angina III FC, arterial hypertension stage 2 and 3, radiofrequency ablation of combination of atrial fibrillation with atrial flutter – equally often for persistent or paroxysmal form in patients with SA I and II class, AH stage 2 and 3; in both cases patients with chronic heart failure II and III FC more often needed radiofrequency ablation of the arrhythmia substrate.

Conclusions. Given the lack of correlation between clinical and demographic characteristics, it is advisable to continue studying their prognostic effect on the course of comorbid pathology and treatment of patients after radiofrequency ablation of the arrhythmia substrate of atrial fibrillation and combination of atrial fibrillation with atrial flutter.

Characteristic of acute illness of higher education students

Oleksandr Reznichenko — 2020-09-08

Abstract. The problem of student health has become of great importance in recent decades and remains unresolved at the current time. The article presents the data of the study of acute morbidity of students of higher educational establishments, its frequency and structure, the gender peculiarities and the state of resistance of their organism are analyzed. Highlighted the priority diseases groups, their specificity and differences. According to the results of the study, the state of adaptation of the students' body in the first year of study was revealed. At the same time, there are signs of tension and breakdown of these mechanisms, decrease in body resistance may be primarily due to sudden changes in the habitual environment of students, impaired diet and quality of work-rest cycle, the presence of a large number of students who have bad habits, constant increase of educational and information load in the present conditions. Only 18.46 ± 1.16 % of medical high schools and even fewer students of technical high schools have 7.81 ± 0.63 % satisfactory indicators of resistance to the body, which indicates a possible discrepancy between the impact of the educational complex and external factors to the adaptive capacity of the student body. In the structure of acute morbidity prevail respiratory diseases in both study groups (KhNMU − 80.16 ± 2.58 %, KhNURE − 80.37 ± 2.61 %). Also, quite a large part was taken by diseases of the digestive system and urogenital system. Students of a technical university had worse indicators of body resistance compared to students of a medical university. It was also found that boys had poorer body resistance compared to girls in all groups. In future all this has negative social and economic consequences for the country as a whole.

Intestinal oxygen exchange at condition of anemia

Oleksandr Rotar — 2020-09-08

Relevance. Although disorders of oxygen delivery is one of the main factors in the development of intestinal dysfunction and bacterial translocation, the critical level of anemia and possibilities of it lowering remain unclear.

Aim. Тo study changes of the system as well as the regional mesenterial oxygen exchange in conditions of normovolemic anemia of different severity.

Material and methods. In experiment on 60 white rats under the general anaesthesia by ketamine 50 mg/kg stage-by-stage blood donation and it normovolemic replacement by hydroxyethyl starch were performed, gradually reducing haematocrit to 0,30, 0,25 and 0,20 l/l. Arterial, mixed venous, and mesenteric venous PO₂, PCO₂, and pH were measured. Systemic and intestinal oxygen transports and consumptions (DO₂ and VO₂) were calculated by standard equations. The content of lactic acid in the intestinal tissues is additionally determined to assess the degree of activity of local anaerobic metabolism.

Results. At mild anemia reduction СаО₂ by third of initial size essentially did not influence on system and regional DО₂ to tissues. Compensation of oxygen deficiency at haematocrit 0,30 л/л was carried out by rising of a cardiac index due to reduction of viscosity of blood. At moderated anemia concentration hemoglobin and СаО₂ decreased twice, changes in system DО₂ to tissues led to reduction of Са-vО₂ by 32,1 % (р < 0,05). Physiological adaptation was carried out through the increasing of О₂ЕR by tissues and was effective. In experimental animals with severe degree of anemia (Hb 58,8 ± 2,4 g/l) СаО₂ decreased in 2,5 times what led to occurrence of haemic hypoxia according to level of gases contents of blood. The concentration of lactic acid in intestinal tissues increased on 36.1 % (p = 0.05), deficiency of buffer bases till -8,2 ± 1,7 (p = 0.05).

Conclusions. In case of severe anaemia, hypoxia of the intestinal tissues develops, which is accompanied by an increase in the local levels of lactic acid and deficiency of base buffers with the development of subcompensated metabolic acidosis

Exercise tolerance and physical activity in children with most common cardiovascular diseases

Kateryna Shtrakh — 2020-09-08

Summary: The cardiovascular system is actively involved in the adaptive reactions of the body. The deterioration of adaptive processes decreases the functional capabilities of the heart. Arterial hypertension is often known as the main cause of fatal cardiovascular events in adults. The aim of our study was to determine the adaptive capabilities of the cardiovascular system of adolescents with non-inflammatory cardiomyopathies depending on physical activity’s level. There were examined 92 patients with arterial hypertension and connective tissue dysplasia, the mean age was 15,4 ± 1,33 years. In order to study tolerance to the minimum physical activity and its influence on the state of the cardiovascular system in children, the Ruffier test was conducted. The vegetative reactions of central nervous system were performed by the orthostatic test. The functional state of the myocardium was assessed according to the results of the ultrasonic Doppler study of the heart. As a result of the study, it was found that in connective tissue dysplasia and arterial hypertension adaptation mechanisms were affected, accompanied by a weakening of cardiac functional capabilities. This happens against the background of a decrease in the functioning of the left ventricle. These changes are accompanied by hyperactivation of the autonomic nervous system in patients in the studied groups. The physical activity and physical development of children affect the adaptive capabilities of a growing organism. This is due to the fact that the children in group with AH and CTD were less physically active than children without myocardial pathology. Adolescents who showed the reduced results of Ruffier's test and had regular sports sections need change of a mode of training and further inspection.

Pathomorphological peculiarities of liver of fetuses and newborns born in conditions of hypertensive disease in the mother

Аlla Zotova — 2020-09-08

Aim. The article is devoted to the study of pathomorphological features of fetal liver and newborns affected by chronic intrauterine hypoxia, which developed against maternal hypertension.

Materials and methods. The studies were performed on liver preparations of 18 fetuses and newborns from mothers with physiological pregnancy (group I) and 36 fetuses and newborns from mothers with stage II hypertension (group II) at the age of 37 weeks of gestation - the 1st day of postnatal life. In each case, three fragments were excised from the liver, and then the material was fixed in 10 % formalin solution. Formalin-fixed tissue compaction was achieved by conducting, through alcohols, increasing concentrations, celloidin, chloroform, and paraffin embedding. From the prepared blocks for serial color serial sections with a thickness of 4–5 microns were prepared. Micropreparations were stained with hematoxylin and eosin, picrofuxin by the van Gizon method, and by the Mallory method. The diameter of the hepatocytes and their nuclei, NPP, were calculated, and the number of single and double-nucleated hepatocytes was calculated. The material was studied on an «Olympus BX-41» microscope with a digital camera.

Results. The results of our study showed that the influence of chronic intrauterine hypoxia on the background of stage II hypertension led to the development of destructive-dystrophic changes in the liver tissue of the fetus and newborn. Structural and functional disorders, in turn, led to the activation of cellular regeneration mechanisms. In group II, the recovery of structural and functional integrity of the liver occurred due to an increase in the number of double-nucleated hepatocytes and manifested by an increase in their number almost 2-fold.

Conclusions. During the study of pathomorphological features of fetal liver and newborns it was found that stage II hypertension in the mother leads to the development of significant destructive-dystrophic changes in the tissue of fetal liver and newborns. The diameter of hepatocytes of fetuses and newborns of group II was significantly increased compared with group I (24.3 ± 2.4 μm and 18.71 ± 2.8 μm, respectively). The number of hepatocytes in the field of view in the fetuses and newborns of group II significantly decreased compared with group I (214.8 ± 22.80 and 268.1 ± 24.11 cells, respectively). The ratio of the number of binucleate hepatocytes to the number of binucleate hepatocytes in fetuses and newborns of group II compared to group I increased 2.5 times (0.08 ± 0.02 and 0.03 ± 0.02, respectively)

Paraganglioma of the nasal cavity. case report

Mykola Popov — 2020-09-08

Paraganglioma is one of the tumors that is rarely found in the practice of an otorhinolaryngologist. Approximately 90% of tumors from nonchromaffin paraganglia occur in the adrenal glands. Nevertheless, 5 – 10 % of paragangliomas have different localization: 85 % - in the abdominal cavity, 12 % - in the chest, 3 % - on the head and neck. Paraganglioma grows slowly, but there is a risk of its degeneration into a malignant neoplasm. Diagnosis of paraganglioma includes CT, MRI; Ultrasound scintigraphy, arteriography, biopsy, histological examination. The main treatment for this education is surgical. As this tumor occurs rather rarely, we present a clinical observation of a paraganglioma of the nasal cavity.

Purposes. The purpose of this article is to describe a rare clinical case of paraganglioma of the nasal cavity to determine diagnostic measures and treatment tactics to help a practical doctor.

Materials and methods. On 01/18/2019 patient M., 52 years old, with complaints of recurrent nosebleeds, difficulty breathing in the right half of the nose was received at the ENT Center «V. T. Lisovets Dynasty». Bleeding from the nasal cavity has been disturbing the patient twice a week for 6 months, for no apparent reason. An increase in the frequency of bleeding up to 4–5 times a week has been noticed for the last month. On a series of MRI tomograms dated 12.24.2019, in the front sections of the nasal concha, on the right, a volumetric pathological formation with dimensions of about 10 × 12 mm, with tuberous contours, an inhomogeneous MR structure was determined. Bone structures were not affected. The neoplasm narrowed the lumen of the nasal cavity on the right. Conclusion: MR-picture of the pathological volumetric formation (of blastomatous nature) of the nasal cavity on the right.

Results. On 01/21/2019 the patient underwent surgical removal of the neoplasm within healthy tissues using a radioknife. An anterior nasal tamponade with a hemostatic preparation was performed. The postoperative period was without complications. A morphological examination of surgical material N 330/2019 yielded the following results: a microscopic examination determined a tumor with the same histological picture in the form of alveolar and solid areas, a branched network of blood vessels of capillary type, fibrous tissue of various thicknesses. Tumor parenchyma was represented by epithelioid morphology cells with pronounced eosinophilic cytoplasm, a large nucleus with granular chromatin. Cells with a weakly expressed eosinophilic cytoplasm, with small monomorphic nuclei were also found.

Conclusions. The patient was diagnosed with a rare tumor of neuroectodermal nature, which in most cases has a benign nature, slow growth and develops from nonchromaffin ganglia, which are scattered throughout the body. As the formation grows, the arterial and venous network of vessels develops. The clinical picture of a neoplasm of the nasal cavity is often masked by the symptoms of chronic polypousrhinosinusitis, vasomotor and chronic hypertrophic rhinitis.

Based on the foregoing, this clinical cases valuable for the practitioner in terms of the features of localization, diagnosis and these lection of the correct therapy for this category of patients.

Arthritis as a manifestation of infective endocarditis

Karyna Uvarova — 2020-09-08

Introduction. Diagnosis of infective endocarditis is a challenging task for clinicians. The issue of early infective endocarditis detection is topical, since the mortality rate of this pathological condition is high; also, along with the classic symptoms of the disease, its atypical manifestations, so-called "masks" of infective endocarditis, often occur.

Objectives. The purpose of the work is to investigate one of infective endocarditis manifestations in the form of monoarthritis on the clinical case basis.

Materials and methods. The medical history, the laboratory and instrumental findings, Guidelines for the management of infective endocarditis 2015; Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications, AHA 2015 (including update 2016).

Results. The patient, born in 1952, complains of the right foot pain, fever with chills, general weakness. Considers herself ill for 3 weeks. In connection with the right foot pain intensification, the patient was taken to a multidisciplinary hospital by the ambulance team and hospitalized to the therapeutic department. The anamnesis vitae is notable for her undergoing a procedure for curettage of the uterine cavity for an endometrial polyp half a year before the admission. The main diagnosis: Active mitral valve endocarditis due to Streptococcus haemolyticus. Mitral valve regurgitation stage III. Chronic coronary syndrome. Heart failure with preserved ejection fraction (EF 68 %). NYHA class II. Concomitant diagnosis: Mild anemia. Reactive arthritis. Deforming osteoarthrosis of the ankle joint. The treatment included: meronem 1 g 3 times daily intravenously (IV) and linezolidine 600 mg 2 times a day per os during 4 weeks; detoxification, cardiotropic, antiplatelet and anticoagulant therapy; proton pump inhibitors, diuretics, antifungal drugs.

Conclusion. Diagnosis of infective endocarditis is very challenging despite the presence of the specially developed diagnostic criteria. Given the polymorphic clinical manifestations of the disease and multiple organ damage, clinicians should be wary of the presence of infective endocarditis in patients with corresponding risk factors.

Melatonin: clinical prospects in immunology

Tetiana Liadova — 2020-09-08

Introduction. For a long time, HIV has been associated with a number of inflammatory, infectious and neoplastic skin diseases. In the era of anti-retroviral therapy researchers have found even more about the relationship between skin disease and chronic immunosuppression. In particular, clinicians continue to face the trend of difficult-to-control viral infections, chronic skin inflammation and itching in people living with HIV.

Objectives. This article summarizes the latest updates in immunology, dermatology and HIV, revealing potential of the prospective substance melatonin and its efficacy in treating herpesvirus skin diseases as an alternative immunomodulator.

Materials and methods. A comprehensive literature search was carried out in July 2020 using electronic databases PubMed, EMBASE, MEDLINE, U.S. National Library of Medicine Clinical Trials, ResearchGate, and Cocharane Library.

Results. This review includes 24 articles, that demonstrated the modulating properties of melatonin and have established its effectiveness in the treatment of diseases associated with immunodeficiency conditions. Melatonin has been shown to have a regulatory effect on the immune system and directly enhance the immune response by improving the proliferation and maturation of natural killers, T and B lymphocytes, granulocytes and monocytes, and activates complement receptors.

Conclusions. Currently, the course of dermatological manifestations associated with herpes viruses, unfortunately, remains unfavorable and persists with high mortality coefficients, so the development of new approaches to the provision of medical care to HIV-infected patients is still relevant. Recent scientific studies indicate the high effectiveness of melatonin in the treatment of diseases accompanied by immunodeficiency. Researching of its effects in the dermatological manifestations of herpesvirus infections on the background of HIV is prospective and necessary for expand drug provision, treating comorbid conditions and improving the quality of life of each patient.

Differentiation of hypoglycemic states according to their heterogeneity (review and personal observation)

Tetiana Tykhonova — 2020-09-08

The article is dedicated to the problems of differentiated diagnostics of conditions, which are accompanied by the development of hypoglycemia. In clinical practice hypoglycemic syndrome usually associated with diabetes mellitus and considered as consequences of hypoglycemic treatment but causes of this conditions can be different. In the review possible causes of low blood sugar of endocrine and non-endocrine genesis are discussed, their pathogenetic mechanisms are explained.It is emphasized that often hypoglycemic states remain undiagnosed on the background of existing severe somatic pathology, while they can be the cause of deterioration, coma, and sometimes even death of the patient. Among the causes of hypoglycemic states of non-endocrine origin, malignant tumors occupy a special place, as illustrated by the clinical case from personal experience presented in the article.Analyzing this medical history, it should be noted that not always the diagnosis, which seemed obvious at first, is confirmed after a thorough examination of the patient. In addition, the genesis of hypoglycemic seizures often cannot be established as quickly as in our clinical case, especially in oncologic pathology. It may be due to the small size of the malignancy, difficult availability of the tumor for imaging by instrumental methods and other factors. Numerous diagnostic algorithms for determining the cause of hypoglycemic states have been described in the literature, but each of the following algorithms only complements the previous one, taking into account the results of new clinical trials. The article emphasizes that strict adherence to modern guidelines for the management of patients with hypoglycemia will not only promote the timely establishment of the etiological factor of this condition and adequate treatment of the underlying disease, but also improve the quality and sometimes save the patient’s life.