Навчально-науковий медичний інститут (НН МІ)
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Item Стратегічні програми громадського здоров’я у сфері протидії ВІЛ-інфекції/СНІДу на регіональному рівні в Україні (на прикладі Сумської області)(Хмельницький університет управління та права імені Леоніда Юзькова, 2022) Деміхов, Олексій Ігорович; Demikhov, Oleksii Ihorovych; Панасенко, Л.; Мотречко, В.; Деміхова, Надія Володимирівна; Demikhova, Nadiia VolodymyrivnaНа сьогодні, згідно з оцінкам ВООЗ та ЮНЕЙДС, серед країн Східної Європи та Центральної Азії Україна досі залишається регіоном із високим рівнем поширення ВІЛ-інфекції та посідає одне з перших місць за кількістю ВІЛ-позитивних осіб. За даними державної установи «Центр громадського здоров’я МОЗ України» тільки за період 1987–2020 роки серед громадян України зареєстровано понад 350 тис. випадків ВІЛ-інфекції, зокрема офіційно виявлено майже 120 тис. випадків захворювання на СНІД та зафіксовано понад 50 тисяч випадків смерті від захворювань, зумовлених СНІДом. На сьогодні під медичним наглядом у країні перебуває майже 240 тис. ВІЛ-позитивних осіб. Аналіз джерел висвітлив той факт, що епідемія продовжує поширювати масштаб серед загального населення, перш за все, за рахунок збільшення епідемічної значимості статевого шляху передачі ВІЛ (саме статевий шлях на сьогодні становить 65,6 % тих, хто вперше захворів на ВІЛ) і відповідно за рахунок представників ключових груп ризику (люди, які вживають наркотики ін’єкційно, особи, які надають сексуальні послуги за винагороду, чоловіки, які мають статеві зносини із чоловіками, та їхні партнери) та їхньої провідної ролі у поширенні збудника ВІЛ-інфекції. У сучасних умовах реформування системи охорони здоров’я України вкрай важливим залишається питання щодо досягнення глобальної мети боротьби з ВІЛ/СНІДом «95–95–95», яка полягає в тому, щоб до 2030 року 95 % ВІЛ-інфікованих знали про свій діагноз, 95 % з них — отримали лікування, а 95 % цих людей мали невизначальний рівень вірусного навантаження. Також пріоритетним напрямом діяльності є забезпечення рівного доступу населення до лікувальних та профілактичних послуг з ВІЛ, у тому числі представників ключових груп ризику. Метою дослідження є розроблення стратегічних програм громадського здоров’я у сфері протидії ВІЛ-інфекції/СНІДу та визначення пріоритетних напрямків діяльності щодо подальшого запобігання поширенню ВІЛ/СНІДу на регіональному рівні. Проаналізовано наукові джерела, вивчені різні підходи до стратегічного управління громадським здоров’ям, обрані напрями подальшого дослідження. Для розв’язання окреслених завдань та досягнення мети дослідження використано загальнонаукові теоретичні методи: вивчення й аналіз наукових джерел з проблеми охорони здоров’я, ВІЛ-інфекції/СНІДу, дані статистичної та облікової документації, дані наукових досліджень та припущень. Результати дослідження дозволили науково обґрунтувати пріоритетні напрямки державної політики у сфері протидії поширенню ВІЛ-інфекції/СНІДу та визначити фінансовий складник заходів з протидії поширенню ВІЛ/СНІДу. Надалі науковцям доцільно зосередитись на вивченні стратегічних напрямів у сфері боротьби з ВІЛ-інфекцією/СНІДом та їх фінансового складника задля ефективної реалізації управлінських задумів у цій сфері.Item Management aspects of children's health: dysplastic-dependent pathology of the bronchopulmonary system and ecological heterogeneity of the environment(Azerbaijan Medical Journal, 2022) Деміхов, Олексій Ігорович; Demikhov, Oleksii Ihorovych; Dehtyarova, I.; Motrechko, V.; Коленко, Оксана Іванівна; Kolenko, Oksana Ivanivna; Yurchenko, Alla Vladyslavivna; Юрченко, Алла Владиславівна; Деміхова, Надія Володимирівна; Demikhova, Nadiia Volodymyrivna; Kroitor, V.Population stratification of the pediatric population was performed in the study, taking into account a set of regional-ecological factors relevant for the assessment of the health of children with dysplastic-dependent pathology of the bronchopulmonary system. The study was conducted using methods of systematic population modeling of a multi-factorial public health system under the influence of regional and ecologic factors. For each of the 30 environmental factors we have studied, its prognostic value, pathometric and sanologic value have been determined, which ensured the performance of population-personalized risk assessment of the dysplastic-dependent pathology of the bronchopulmonary system.A new methodology for environmental quality assessment has been substantiated, proposed and tested, the application of which allows to determine the differentiation of regional preventive programs of bronchopulmonary dysplasia and the dysplastic-dependent pathology of the bronchopulmonary system in childhood. Personalized regional population stratification of children with bronchopulmonary dysplasia and the dysplastic-dependent pathology of the bronchopulmonary system were performed, and regional clusters (administrative districts of the regions) were identified with an alternative level of environmental quality. The use of pathometric and sanometric assessments (different levels) of environmental factors can be significant to substantiate the structure of targeted health, social, and regional environmental programs for promoting the health of the pediatric population.Item Aspects of somatogenic asthenic syndrome in patients with high cardiovascular risk(Oxford University Press, 2022) Деміхов, Олексій Ігорович; Демихов, Алексей Игоревич; Demikhov, Oleksii Ihorovych; Деміхова, Надія Володимирівна; Демихова, Надежда Владимировна; Demikhova, Nadiia Volodymyrivna; Руденко, Тетяна Миколаївна; Руденко, Татьяна Николаевна; Rudenko, Tetiana Mykolaivna; Орловський, Олександр Вікторович; Орловский, Александр Викторович; Orlovskyi, Oleksandr ViktorovychAim: To study frequency and nature of psychopathological symptoms in various forms of somatogenic asthenic syndrome in patients with high cardiovascular risk (CVR). Methods: The quantitative anamnestic analysis of medical history, the variational statistics, the probabilistic allocation of clinical signs with estimation of reliability of the results. Among the 199 persons with high CVR and non-psychotic mental disorders: 31 patients had somatogenic asthenic syndrome (SAS), stratified by clinical variants: asthenic (1n2=14); asthenic-anxious (2n2=8); asthenic-subdepressive (3n2=6) and dyssomniac (4n2=3).Item Dental status and oxidative homeostasis state in patients exposed to occupational vibration: superoxide dismutase and catalase content in oral fluid(Medpress, 2022) Cherkashyna, L.; Haidash, I.; Hlazkova, N.; Деміхова, Надія Володимирівна; Демихова, Надежда Владимировна; Demikhova, Nadiia Volodymyrivna; Shklyar, A.; Sukhonosov, R.; Barchan, G.; Куц, Лариса Вікторівна; Куц, Лариса Викторовна; Kuts, Larysa Viktorivna; Деміхов, Олексій Ігорович; Демихов, Алексей Игоревич; Demikhov, Oleksii IhorovychAim: The aim of the research involved determination of catalase and superoxide dismutase content in oral fluid of patients exposed to occupational vibration depending upon their dental status. Materials and methods: The assessment of dental status (DS) and superoxide dismutase (SOD) and catalase (CAT) content in oral fluid (OF) was performed in three groups of patients: control group (n0=129) included the persons exposed to occupational vibration and whose results of combined medical examination excluded the presence of vibration disease (VD); the second (n1=63 patients with VD stage I) and the third (n1=66 patients with VD stage II) groups consisted of the patients, who underwent treatment at the clinical department of the Research Institute of Occupational Hygiene and Occupational Diseases of Kharkiv National Medical University of the Ministry of Health of Ukraine. DS determination was carried out according to the method of K. M. Kosenko (Patent No. 57512, Ukraine) for in-patients and controls (during medical checkups) using the following indices: PMA, OHI-S, DMFT, with assessment of vacuum-pressory resistance of gingival capillaries (VPRC) (according to V. I. Kulazhenko) and community periodontal index of treatment needs (CPITN). SOD content was determined by the nonenzymatic method; CAT content was revealed spectrophotometrically. Primary data were statistically processed with the determination of accuracy by Student's test. Results: SOD content depending upon PMA intensity in VD patients ranged from 14.1±0.2 U/min to 15.7±0.5 U/min , was reliably (p<0.05) lower in patients with VD versus the controls (17.8±0.2 U/min and 14.2±0.2 U/min respectively, when PMA>2.1) and did not differ depending upon VD severity (15.7±0.5 U/min in VD stage I and 15.3±0.3 U/min in VD stage II, respectively). SOD content in OF in patients depending upon their OHI-S ranged from 13.5±0.3 U/min to 16.3±0.2 U/min and was reliably (p<0.05) lower in patients with OHI-S≥1.7 U. A comparative analysis showed that the activity of the enzymatic protection of the periodontal membrane could be also determined by the state of hard tissues, in particular by such DS index as DFTM. The activity of SOD in VD stage II was found to be reliably (p<0.05) reduced in patients with DFTM index exceeding 15 pts. A somewhat different pattern of SOD activity was found in OF in patients with VD stage I: SOD activity in OF was similar in all DFTM indices and it became reduced depending upon an increase of DFTM index. SOD content depending upon VPRC index in patients with VD ranged from 10.7±0.5 U/min to 16.8±0.3 U/min and was reliably (p<0.05) lower in cases with VPRC index ≤40 sec. CAT content depending upon PMA intensity in VD patients ranged from 4.6±0.4 U/min to 11.3±0.3 U/min and was reliably (p<0.05) higher in patients with VD stage I versus the controls and differed according to the severity. CAT content in OF in patients depending upon OHI-S ranged from 5.2±0.2 U/min to 10.1±0.3 U/min, was reliably (p<0.05) lower in cases with OHI-S ≥1.7 U, did not differ from the indices observed in the control group and was also found to be reliably lower in patients with VD stage II versus those with VD stage I (7.3±0.3 U/min and 8.6±0.2 U/min, respectively, when OHI-S ranged within 0.7÷1.6 U). CAT content in OF depending upon VPSC index in patients with VD ranged from 5.8±0.2 U/min to 8.6±0.6 U/min and was reliably (p<0.05) lower in cases with VPSC index ≤40 sec. Thus, CAT activity in OF in patients was reliably (p<0.05) reduced (in VPRC>40 sec it was equal to 7.8±0.2 U/min, and in VPRC≤40 sec it was 8.6±0.1 U/ min) in VD stage I with decreased VPRC. Conclusions: A trend (p>0.05) towards an increase in SOD activity in VD stage I versus the controls was revealed, whereas VD stage II demonstrated a reliable (p<0.05) reduction of the above activity. At the same time, an unsatisfactory state of oral hygiene was shown to promote inhibition of the enzymatic protection of their periodontal membrane in patients with VD stage I. A trend (p>0.05) towards an increase of SOD activity in VD stage I versus the controls was revealed, whereas VD stage II demonstrated a reliable (p<0.05) reduction of the above activity. The assessment carried out in cases requiring combined treatment with surgical or non-surgical debridement and also in patients with supraor subgingival dental calculus found out that SOD activity was reliably reduced only in cases with VD stage II. CAT activity assessment in OF in VD patients having different levels of CPITN showed that the above activity in persons requiring combined treatment (including prosthodontic treatment; CPITN≥3.1points) was markedly and reliably reduced. All the above facts determine peculiarities in oral treatment strategies for this group of patients.Item The effect of the experimental chronic hyperglycemia on the kidney and myocardium(State Institution «Institute of Nephrology NAMS of Ukraine", 2021) Ярмоленкo, Ольга Сергіївна; Ярмоленко, Ольга Сергеевна; Yarmolenkо, Olha Serhiivna; Бумейстер, Валентина Іванівна; Бумейстер, Валентина Ивановна; Bumeister, Valentyna Ivanivna; Polak, S.; Гордієнко, Олена Володимирівна; Гордиенко, Елена Владимировна; Hordiienko, Olena Volodymyrivna; Приходько, Ольга Олексіївна; Prykhodko, Olha Oleksiivna; Деміхова, Надія Володимирівна; Демихова, Надежда Владимировна; Demikhova, Nadiia Volodymyrivna; Шкатула, Юрій Васильович; Шкатула, Юрий Васильевич; Shkatula, Yurii Vasylovych; Деміхов, Олексій Ігорович; Демихов, Алексей Игоревич; Demikhov, Oleksii Ihorovychhe number of patients with diabetes increases annually. Modern forecasts predict that diabetes will be the seventh leading cause of death in 2030. Despite many significant advances in the research of diabetes and the use of new modern treatments, the disease is still progressing, and it is necessary to continue to study the effects of diabetes on human systems and organs: kidney and myocardium.Methods. A total of 24 rats of reproductive age (6 months old) were involved in this experimental study. Experimental rats were injected with alloxan intraperitoneally once at a dose of 20 mg/100 g on an empty stomach. In addition, they received a 10% glucose solution 24 hours after alloxan injection and a 5% glucose solution during the experiment. We measured glucose level with Accu-Chek Advantage (Boehringer, Germany) after 2, 12, and 24 hours after alloxan injection, and then weekly. The subjects of the investigation were kidney and heart of the experimental (n=12) and control (n=12) animals for correct comparative analysis.Results. The average blood glucose level remained at 11 mmol/L ± 2 mmol/L. During the experimental period, the rats’ weight gain, dilation of both ventricles and relative renal weight gain were determined. By the histological examination of the myocardium, we revealed polymorphic nuclei, perinuclear cytolysis, fragmentation, wavy-like deformation of cardiomyocytes, stromal and perivascular edema, uneven filling of blood vessels, and local fibrosis. Thinning of fibrous capsule and cortical layer, destruction of nephrons, and hemorrhages were detected in the kidney. Conclusions. Our study confirms the robustness of alloxan-induced hyperglycemia in rats. We came to this conclusion because the early changes in the kidneys and heart are explained by the development of microangiopathies, which is a typical feature of the pathogenesis of diabetes. With prolonged exposure to chronic hyperglycemia, structural disorders of vital organs are worsened. This experimental model could be used for conducting comprehensive research aimed to study the mechanisms of diabetes mellitus, the effects of hyperglycemia on organs and tissues, and correct the complications.Item Chronic inflammation and progression of chronic kidney disease in patients with type 2 diabetes(State Institution "Institute of Nephrology NAMS of Ukraine", 2021) Мазур, Тетяна Станіславівна; Мазур, Татьяна Станиславовна; Mazur, Tetiana Stanislavivna; Деміхова, Надія Володимирівна; Демихова, Надежда Владимировна; Demikhova, Nadiia Volodymyrivna; Руденко, Тетяна Миколаївна; Руденко, Татьяна Николаевна; Rudenko, Tetiana Mykolaivna; Юрченко, Алла Владиславівна; Юрченко, Алла Владиславовна; Yurchenko, Alla Vladyslavivna; Єжова, Ольга Олександрівна; Ежова, Ольга Александровна; Yezhova, Olha Oleksandrivna; Бокова, Світлана Іванівна; Бокова, Светлана Ивановна; Bokova, Svitlana Ivanivna; Деміхов, Олексій Ігорович; Демихов, Алексей Игоревич; Demikhov, Oleksii IhorovychChronic inflammation, atherosclerosis, tubulointerstitial fibrosis, and vascular damage play a crucial role in the progression of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (DM). However, specific biomarkers that can determine the progression of diabetic kidney disease, including patients with minimal albuminuria, remain undefined. The present study aimed to determine markers of chronic inflammation as indicators of CKD progression in patients with type 2 DM. Methods. 45 patients with type 2 DM and stage 1-3 CKD were involved in this cross-sectional observational study. Analysis of cellular mechanisms of CKD progression was performed on the concentrations of endothelin-1 (ET-1), fibronectin (FN), tumor necrosis factor-alpha (TNF-α), transforming growth factor beta-1 (TGF-β1), and monocyte chemoattractant protein (MCP) -1) in the serum. Results. In patients with type 2 DM, an increasing trend in the majority of endothelial and proinflammatory mediators was found according to the CKD stages, despite normal albuminuria. Conclusions. Concentrations of TNF-α, ET, TGF-β1 and MCP-1 can be used to assess the progression of CKD in patients with type 2 DM with normal albuminuria. Further researches are needed to determine early indicators of diabetic kidney disease progression.Item Arterial hypertension prevention as an actual medical and social problem(Ibn Sina Medical College, 2020) Деміхов, Олексій Ігорович; Демихов, Алексей Игоревич; Demikhov, Oleksii Ihorovych; Дегтярьова, Ія Олександрівна; Дегтярева, Ия Александровна; Dehtiarova, Iia Oleksandrivna; Rud, O.; Khotyeev, Y.; Куц, Лариса Вікторівна; Куц, Лариса Викторовна; Kuts, Larysa Viktorivna; Cherkashyna, L.; Деміхова, Надія Володимирівна; Демихова, Надежда Владимировна; Demikhova, Nadiia Volodymyrivna; Орловський, Олександр Вікторович; Орловский, Александр Викторович; Orlovskyi, Oleksandr ViktorovychSocial changes, technological re-equipment, intensive formation of urban infrastructure have led to a constant increase in stress factors and an excessive growth of the nervous and psychological population burden. As a result of these processes in economically developed countries, acute diseases are becoming less and less significant, unlike the group of chronic disorders, such as arterial hypertension. Data from the review of the literature and the data we have received indicate that there is an increase in the level of cortisol in the blood in the phase of anxiety, which reduces in the resistance phase. A significant role is played by another hormone - insulin, which plays a key role in the development of the general adaptive syndrome. Through it the body implements numerous counter-defects in relation to the regulatory influence of catecholamines and cortisol. In conditions of prolonged stress, the level of insulin in the blood decreases and diabetes develops. The effect of cortisol and catecholamines in the resistance phase persists. The level of oxidative modification of blood plasma proteins indices depends on the behavior of the individual and changes in his psycho-emotional state, while a prolonged increase in the levels of catecholamines and cortisol in peripheral blood causes the development of psychosomatic pathology. It is proved that under the influence of complex action of risk factors there are significant changes in the psycho-emotional state that cause hypertension. This is confirmed by the presence of the highest level of reactive anxiety in patients with hypertension of the 1st stage on the background of the lowest personal anxiety which is the basis for the occurrence of the disease. With the progression of hypertension there are more profound changes in the personality of the patient, which is accompanied by the accumulation of personal anxiety, which can lead to a depressive state of neurotic genesis, which we observed with its complication. On the basis of a comprehensive study, the effect of stress on the occurrence of a syndrome of psychoemotional stress is shown, which leads to a steady increase in blood pressure - hypertension, and with its subsequent action complicates its course.