[Justification of the need to normalize vitamin D status for immunoprophylaxis].

Currently, there is an increase in the resistance of microorganisms to the available arsenal of antimicrobial drugs, which makes it necessary to maintain and stimulate the body's own immune-protective properties. The main extraskeletal effect of vitamin D activity is associated with the homeostasis of the immune system. The role of vitamin D in reducing the risk of infection with infectious agents has been studied for a long time. Literature search on the effective use of vitamin D for immunoprophylaxis was carried out in Scopus, Web of Science, PubMed, clinicaltrials.gov databases over the past 10 years for related keywords: vitamin D, immunoprophylaxis. Vitamin D stimulates the synthesis of antimicrobial peptides, cathelicidins and defensins, which exhibit broad-spectrum activity against viruses, bacteria and fungal infections; reduces the concentration of pro-inflammatory cytokines; increases the concentration of anti-inflammatory cytokines. Vitamin D is also involved in cell differentiation, maturation and proliferation of immune cells. The article presents the literature review in order to justify additional intake of vitamin D in case of diagnosis of its deficiency and insufficiency for the purpose of immunoprophylaxis in children and adults, especially in risk groups (elderly age, pregnant women, patients with chronic diseases of respiratory, endocrine and urinary systems, gastrointestinal tract, and infectious diseases). Inclusion of vitamin D in the diet as a dietary supplement, as well as fortification of products with it, can be an effective measure to reduce the risk of both morbidity and mortality, especially during the period of quarantine measures.

[EPIDEMIOLOGY, STRUCTURE AND ALGORITHM OF MANAGEMENT OF PREGNANT WOMEN WITH EXTRAGENITAL PATHOLOGY OF THERAPEUTIC PROFILE].

Purpose of the study - the study of the extragenital pathology (EGP) structure in pregnant women according to the requests for medical help. The screening survey was attended by 742 pregnant women. Average age was 28,4±5,5 years. A retrospective analysis of the causes of calls to pregnant ambulance carriages was carried out for 2012-2013. On the basis of obtained data was suggested an algorithm of pregnant women with EGP management. In the structure of EGP in one profile led hematology - 306 cases (41.2%), followed by nephrology - 290 (39.1%) and gastroenterology (38.8%) - 288 cases, respectively. In the structure of requests for emergency medical care for pregnant first place occupied by respiratory diseases (2012 r - 28%, 2013- 30%), followed by urinary system diseases (2012 - 19.6% 2013 - 17.2% r ). Obtained data formed the basis for the algorithm to identify risks and provide medical care for pregnant women with extragenital pathology. In the structure of the screening study prevailed hematology profile diseases, and respiratory system diseases often were the reason for emergency medical care. The result of this study became the creating of the algorithm for medical care delivery.

[The possibilities of serum cystamine C in diagnostic of pyelonephritis in pregnant women Hematology.]

The cystamine C is considered as one of markers of functional condition of pregnant women. The actual study was carried out to assess possibility of applying cystamine C as a biological marker of pyelonephritis in pregnant women. The sampling consisted of 126 pregnant women with various terms of gestation. The participants were separated in two groups. The group I included 64 women with pyelonephritis and the group II included 62 women without pyelonephritis. Te serum values of cystamine C were detected using enzyme-linked immunosorbent assay. The statistical analysis was implemented using non-parametric methods, including Kruskal-Wallis criterion for comparison of 3 independent groups and Mann-Whitney (Wilcoxon) criterion for a posteriori comparisons. The comparative analysis of values of cystamine C in pregnant women discovered, depending on term, increasing of its level since term II - 0.815 (0.622; 0.914) and even higher values in term III - 1.076 (0.917; 1.463) (p=0.0007). This trend repeats at minute analysis of indices of cystamine C in each group separately. The differences in values of cystamine C in two groups in total and between terms were lower statistically significant levels. However, in the group of women with pyelonephritis its values in terms I and III were higher than in the group of women without pyelonephritis. The highest values of content of cystamine C in pregnant women (p=0.0007) were observed in term III. The inter-group differences of serum values of content of cystamine C were absent that does not allow to recommend it as a early marker of damage of kidneys in pregnant women with pyelonephritis.

[Nephrotic syndrome in a female patient with Rapunzel syndrome].

The Rapunzel syndrome is a rare complication of gastric trichobezoar, which may be long insidious. Systemic hair eating gradually leads to bezoar growth, gastritis, gastric mucosal ulcerations, and evacuatory disorders. The Rapunzel syndrome may cause acute and chronic bowel obstruction, peritonitis, pancreatitis, appendicitis, anemia, hypoalbuminemia, and allergic manifestations. Neither proteinuria nor nephrotic syndrome is depicted in any of the 38 Rapunzel syndrome cases described in the literature. The authors present the first case of gastric trichobezoar extending to the small bowel (its total length was 118 cm), which gave rise to chronic recurrent partial bowel obstruction, causing intoxication nephrotic syndrome in a 20-year-old women with trichotillomania. The nephrotic syndrome became a reason for her admission to a nephrology department and had specific features: it was unaccompanied by hypercholesterolemia, it rapidly regressed and completely disappeared after surgical removal of the trichobezoar weighing 1980 g.