HEPATITIS A. THE FEATURES OF DISEASE COURSE IN ADULTS.

OBJECTIVE: The aim: To analyze the incidence of Hepatitis A in Ukraine and Poltava region and to study the clinical and epidemiological features of the course of Hepatitis A in adult patients. PATIENTS AND METHODS: Materials and methods: The course of HA in 96 hospitalized patients was analyzed. The diagnosis of HA was established on the basis of clinical and epide¬miological data and confirmed by the results of laboratory studies (serological and molecular biological). RESULTS: Results: In 2019, in the Poltava region, there was an increase in the incidence of Hepatitis A with a predominance among sick people of working age, among the urban population. This part of people aged from 60 to 75 years old constitutes 9.4%. This study showed that the waterway was the dominant way of HA transmission. The course of the disease in most hospitalized patients was typical and cyclic, with a predominance of a mixed variant of the pre-jaundice period and jaundice. One third of patients survey that they had fever, which persisted with jaundice. CONCLUSION: Conclusions: The findings of this study indicates that the patients older than 40 years were more likely to have concomitant chronic pathology than younger patients, and Hepatitis A was more severe with the development of prolonged cholestasis, wave-like course and recurrence. In most patients under the age of 40, the course of Hepatitis A was mild, but splenomegaly and severe cytolytic syndrome were more common.

ACUTE KIDNEY DAMAGE AS A COMPLICATION OF MALARIA CAUSED BY PL. MALARIA AND PL. FALCIPARUM: CLINICAL CASES.

We have described two clinical cases of severe malaria caused by different pathogens: Pl. falciparum and Pl. malaria, common to which there was a severe course, complicated by acute renal failure and hemolytic anemia. In a detailed analysis of both clinical cases, Patient 1 had acute kidney damage arose after the increase of anemia and thrombocytopenia, in combination with hemoglobinuria. This shows that the leading mechanism of kidney injure in this case is acute tubular necrosis, due to the toxic effects of free hemoglobin and sequestration in the capillaries of the glomerulus. A Patient 2 had a significant increase of anemia after appears of acute kidney damage; there was no hemoglobinuria, however, significant leukocytosis was observed. It seems, that the leading mechanism in this case is immune-mediated kidney injure or due to hypoperfusion of kidney tubules with the development of acute interstitial nephritis or immune complex glomerular injure with the development of glomerulonephritis, or a combination of them. A detailed analysis of the described two clinical cases of severe malaria caused by Pl. falciparum and Pl. malaria, respectively, and complicated by acute renal failure and hemolytic anemia, suggests that the pathogenetic mechanisms and severity of kidney damage depend on the type of malaria.

BODY DYSMORPHOPHOBIC DISORDER AND OTHER NON-PSYCHOTIC MENTAL DISORDERS IN PERSONS WITH COSMETIC DEFECTS AND DEFORMITIES OF THE NOSE.

OBJECTIVE: The aim: To explore the features of non-psychotic mental disorders in people with cosmetic defects and deformities of the external nose in order to optimize their treatment and rehabilitation measures. PATIENTS AND METHODS: Material and methods: The authors examined 99 persons who reffered to a plastic surgeon for cosmetic rhinoplasty. The first group (Group I) included 30 individuals; they did not have cosmetic defects of the nose; however, these individuals fixed unreasonably great attention on the nose and persistently demanded to change its shape. The second group (Group II) included 69 individuals with visible defects and deformities of the external nose, which deviated from the established aesthetic norm, but did not distort the appearance and did not violate the physiological functions. A comprehensive clinical-anamnestic, clinical-psychopathological, psychodiagnostic and socio-demographic examination of patients was carried out. RESULTS: Results: Patients of Group I with dysmorphophobic disorder and without defects and deformities of the nose, who insisted on surgical correction, compared with persons of Group II with minimal defects and deformities, had a deeper severity of depressive symptoms and personal anxiety with a predominance of dysthymic character accentuation, low adaptability, complete intolerance of themselves and their appearance, a high level of emotional discomfort and internal control. CONCLUSION: Conclusions: It is necessary to improve a comprehensive system of psychotherapeutic measures in combination with pharmacotherapy, in order to reduce psychopathological symptoms, improve the level of psychosocial functioning of the patients and create the preconditions for decision to abandon surgery.

EFFICACY OF SPECIFIC PREVENTION OF INFLUENZA IN INDIVIDUALS WITH POLYMORPHISMS ARG753GLN OF TLR-2, LEU412PHE OF TLR-3, ASP299GLY OF TLR-4 GENES.

OBJECTIVE: The aim: Is to study the efficacy of influenza vaccination for individuals with polymorphism Arg753Gln of TLR-2 gene, Leu412Phe of TLR-3 gene, and Asp299Gly of TLR-4 gene. PATIENTS AND METHODS: Materials and methods: 66 people with mutant genotypes and normal distribution of alleles of TLR-2, TLR-3, TLR-4 genes, aged 18-63, were inoculated with anti-influenza vaccine. The genotyping of Arg753Gln polymorphic site of TLR-2, Asp299Gly of TLR-4, and Leu412Phe of TLR-3 gene was carried out by polymerase chain reaction with oligonucleotide primers usage. The immunological efficacy of vaccination was evaluated by seroconversion, seroprotection, and dynamics of mean geometric titers of antibodies. RESULTS: Results: It has been established that individuals with mutant genotypes Arg/Gln of TLR-2, Leu/Phe, Phe/Phe of TLR-3, Asp/Gly of TLR-4 genes have a vaccinal response to administering anti-influenza vaccine at the level of subjects with normal distribution of TLR alleles, as evidenced by the growth in dynamics of mean geometric titers of antibodies to vaccine strains, the level of seroprotection and seroconversion. Clinical and epidemiological efficacy of vaccination in this category of people is characterized by: reduction of ARI cases in the postvaccinal period by 2,0-3,0 times; prevention of pneumonia in all vaccinated subjects; decrease in the frequency of bronchitis by 2,5-3,8 times. CONCLUSION: Conclusions: Effectiveness of influenza vaccination in individuals with Arg573Gln polymorphism of TLR-2, Leu412Phe of TLR-3, Asp299Gly of TLR-4 genes by immune and clinical epidemiological parameters is determined at the level of vaccinated subjects with normal distribution of TLR-2, TLR-3, TLR-4 alleles. Specific influenza immunization of people with polymorphic modified genotypes of TLR-2, TLR-3, TLR-4 genes can prevent the development of pneumonia and reduce the incidence of bronchitis.

Some clinical and epidemiological features of influenza-associated pneumonia depending on the etiological agent.

OBJECTIVE: The aim: To analyze the epidemiological data and clinical course of pneumonia as a complication of influenza in the Poltava region, depending on the etiological agent. PATIENTS AND METHODS: Materials and methods: We have analysed the data of the official reporting documentation provided by the State Institution "Poltava Regional Laboratory Center of the Ministry of Health of Ukraine" and the chart of patients with a laboratory confirmed diagnosis of influenza who were in inpatient treatment at the Poltava Regional Clinical Infectious Hospital (PRCIH) in 2016-2018 years. In more detail, we examined 95 patients with pneumonia, which complicated the course of the flu. There were 43 (45.26%) female patients, - 52 (54.74%) male patients, aged 18 to 80 years. RESULTS: Results: Studies have shown that despite a decrease in the incidence of influenza in recent years, the incidence of pneumonia, which complicated the course of the flu, remained consistently high (19.7% - 20.8%) with bacteriological isolation of S.pneumoniae (22.11%), S.aureus (13.68%), Haemophilus influenza (4.21%) and E.coli (3.16%). Severe course of pneumonia with bloody sputum, evident shortness of breath, bilateral lung damage, and need for oxygen support were significantly more frequently reported in patients with isolated S.pneumoniae and S.aureus. However, the severe course of the disease with the formation of abscesses in the lungs was observed only in the group S.aureus despite the relatively young age of such patients and significantly fewer risk factors for severe influenza and comorbidities. CONCLUSION: Conclusions: The study showed a consistently high incidence of pneumonia, which complicated the flu and caused by S.pneumoniae, S.aureus, Haemophilus influenza and E.coli. Pneumonia caused by S.pneumoniae and S.aureus, were characterizedthe most severe course; however, a severe course with the formation of abscesses in the lung tissue was observed only in the group of S.aureus.

Opisthorchiasis and viral hepatitis b: clinical cases.

OBJECTIVE: Introduction: Among the cases of biohelminthosis, which are registered in Ukraine, opisthorchiasis is the most common and constitutes the second largest centre in Europe. Due to the growth of migration processes and global tourism, opisthorchiasis is becoming increasingly relevant for the countries of the European Union and the United States. Under modern conditions, the clinical course of many infectious and parasitic diseases has changed. The aim: The present paper discusses and analyzes the cases of opisthorchiasis and hepatitis B virus which are challenging in terms of diagnostics and choice of treatment tactics. CONCLUSION: Conclusion: The course of acute infections, the formation of results and the effectiveness of treatment are influenced by a number of factors, among which mixed infections are of particular interest.