PROBLEMS OF MEDICAL EXPERTISE FOR DISEASES THAT BRING TO DISABILITY AND DEATH AS A RESULT OF RADIATION EXPOSURE INFLUENCE IN CONDITIONS OF THE CHERNOBYL CATASTROPHE IN REMOTE POSTACCIDENTAL PERIOD. / PROBLEMY MEDYChNOÏ EKSPERTYZY ZAKhVORIuVAN', ShchO PRYZVELY DO VTRATY PRATsEZDATNOSTI TA SMERTI VNASLIDOK VPLYVU IONIZUIuChOGO OPROMINENNIa V UMOVAKh ChORNOBYL'S'KOÏ KATASTROFY U VIDDALENOMU PISLIaAVARIINOMU PERIODI.

BACKGROUND: The Chornobyl catastrophe (ChCt) resulted in radiation exposure of great quantity of people. Amongthem there were personnel of Chernobyl NPP (ChNPP) and workers of supporting enterprises, radiation protectionprofessionals, clean-up workers of different specialties including military personnel that were send for liquidationof its consequences, inhabitants of the Prypyat city and Chernobyl 30km exclusive zone (including children) thatwere evacuated during first days after accident and population of radioactive contaminated territories. Loss ofhealth, disability and death as a result of radiation exposure influence in conditions of the ChCt under discharge ofprofessional, military or official duties and/or living on radiation contaminated territories not by his own fault callfor developing of special form of medical expertise as part of medical social protective system for this contingents.The objective of the study was to analyze the state of medical and social expertise for the interdependence of thediseases that bring to the disability and death with the impact of the Chornobyl accident consequences for the adultpopulation and to determine the main directions for improvement of this system. MATERIALS AND METHODS: The analysis of the medical expertise state for the interdependence of the diseases thatbring to the disability and death by the effect of the Chornobyl accident consequences for the adult population ina remote post-accidental period during 2013-2017 years (26142 personal medical expert investigations) was per-formed. RESULTS AND CONCLUSIONS: It was determined that the total number of population suffered from ChCt during 2007-2018 years reduced for 26.05 % or by 657,988 persons. At the same time, there has been rapid increase in the num-ber of victims with disability who received positive medical expertize certificate about interdependence of diseasewith effect of ChCt (the 1st category according Ukrainian legislation) - from 40,106 in 1995 to 107,115 in 2018. Theincrease in the frequency of medical expertise cases of oncological diseases - 51,49 %, as well as cases concerningthe interdependence of diseases that caused the deaths of the victims - 34,99 % were shown. The outstandingissues of the medical expertise of diseases interdependence with ChCt effects for certain categories of victims (thy-roid cancer in persons who have lost their status after reaching adulthood, the definition of the legitimacy of thestatus of victims for inhabitants of territories that undergone radiation ecological control (the 4th-V category) thatrequire changes and additions to the legislative framework are discussed.

The morphological changes of mucous membrane of stomach and duodenum of contractor organization personnel, which works in radiation hazard conditions at the object Shelter of Chornobyl NPP. / Morfologichni zminy slyzovoi obolonky shlunka ta dvanadtsiatypaloi kyshky u personalu pidriadnykh pidpryiemstv, iakyi pratsiuie u radiatsiino-nebezpechnykh umovakh na ob'iekti Ukryttia Chornobyl's'koi AES.

UNLABELLED: Аim: The determination of morphological features of stomach and duodenum mucous of membrane (MM) damage at a personnel that works in radiation hazard conditions at the object of "Shelter" of Chornobyl NPP (OS) by the endoscopic monitoring with biopsy material inspection from a gastro-duodenal zone on the stages of check - in (InC) and the special medical control (SpC). MATERIALS AND METHODS: the complex clinical-endoscopic and morphological examination with the biopsy of MM of stomach and duodenum in 126 workers of OS (man in the age from 20 to 59) was carried out. Doses of external radiation exposure were from 0,14 to 79,6 mSv, доза internal radiation exposure were from 0,1 to 3 mSv/Results: For the personnel of OS contract organisations differently directed pathomorphological changes of MM at InC and increase of frequency of their exposure at an inspection during SC, that generally correspond to chronic H.pylori-associated pangastritis with violation of microcirculation and trophism, disregeneration changes of epithelial layer. CONCLUSIONS: for the personnel of contract organizations, which participated in radiation hazard works on ОS a presence of chronic H.pylori-associated pangastritis with the increase of frequency of atrophic changes of MM (nonmetaplastic or metaplastic type) and development of erosive-ulcerous defects of gastro-duodenal zone was founded out.For workers, who had previous influence of ionizing irradiation the greater frequency of disregeneration (hyperplasia / intestinal metaplasia) changes of epithelium that accordingly promotes the risk of neoplasmes transformations was clarified.Providing of EGDFS (at a necessity with the biopsy of MM) is at InC and next stages of medical control for personnel, that executes radiation hazard works on ОS is the highly informative evidential and necessary method of inspection for determination of form and degree of pathological changes of overhead departments of gastrointestinal tract for warning of progress of disease and development of complications, maintenance of workers health and workability.

Structure of comorbid diseases in patients with non-alcoholic fatty liver disease, exposed to ionizing radiation as a result of the Chornobyl NPP accident. / Struktura komorbidnoi' patologii' u hvoryh na nealkogol''nu zhyrovu hvorobu pechinky, jaki zaznaly vplyvu ionizujuchogo vyprominjuvannja vnaslidok avarii' na ChAES.

Objective - to study of the structure of comorbid diseases in patients with nonalcoholic fatty liver disease (NAFLD), exposed to ionizing radiation due to the Chornobyl accident, and in the groups of comparison. Materials and methods. Array of surveyed males was divided into 4 groups: the main group - 136 patients with NAFLD affected by the Chornobyl NPP accident, the first comparison group (І CG) - 28 affected by Chornobyl NPP accident without liver disease, the second comparison group (II CG) - 50 patients with NAFLD not exposed to factors of the Chornobyl disaster, and the third comparison group (III CG) - 16 unexposed persons without liver disease. Results. A significant amount of co-morbid pathology was found in all studied groups but III CG: at the average from 4.1 ± 0.4 diseases in II CG to 5.2 ± 0.2 in the main group of patients (p < 0.05), among which in 6.6-7.1 % of cases more than 10 diseases were established. The most common disorders were cardiovascular and cerebrovascular and endocrine diseases. Structure of comorbid pathology in NAFLD in the main study group differed from this in II CG by a significantly greater frequency of detection of cerebrovascular diseases (73.5 and 56 %, p < 0.05). As for features of the metabolic syndrome in Chornobyl accident sufferers essential hypertension (71.3 % ), discirculatory encephalopathy (48.5 %) and thyroid diseases (47.1 %) were more frequent than in II GC: correspondingly 58 % (p < 0.001), 28 %, (p < 0.01), and 30 %, (p < 0.05). Essential hypertension in only 35.7 % patients without NAFLD (I CG) was detected (71.3 % in the study group, p < 0.01), and chronic cerebrovascular insufficiency in 71.4 % (39.7 % in the study group, p < 0.01). Conclusion. Structure of comorbid pathology in NAFLD patients sufferers of the Chornobyl NPP accident was different both in a large number of identified diseases and nosological structure. The most common disorders were cardiovascular, cerebrovascular, and endocrine diseases. Significantly higher incidence of essential hypertension, vascular encephalopathy, and thyroid disease was determined.

Radiation protection and health of personnel of contracting enterprises participating in works for transformation of the object "shelter" of SSE Chornobyl NPP into an ecologically safe system.

UNLABELLED: Transformation of the object "Shelter" (OS) of SSE Chornobyl NPP into an ecologically safe system is one of the most important state programs in Ukraine. Both medical and dosimetric measures on healthcare of personnel participating in these works ranks the main place among most actual problems of contemporary clinical radiobiology, radiation hygiene, and radiation protection. The study objective was to work out and implement the medical and biophysical checking of the health status and workability both with radiation protection of personnel executing works on transformation of OS into an ecologically safe system. MATERIALS AND METHODS. The interdependent complex program of medical and biophysical (for internal and external irradiation) control of personnel executing the production tasks under conditions of ionizing radiation impact and open sources of ionizing radiation. Realization of medical examination envisages the estimation of the status of haemopoietic, immune, endocrine, respiratory systems, organ of vision, nervous system, psychics status and psychophysiological adaptation, ear, both with circulatory, digestive, urogenital, and bone-muscular system. There were 19434 cases of medical control of personnel in total. RESULTS: Results of the input medical control testify to the following: 4698 (48.90%) were admitted to work, 4909 (51.10%) were rejected. Individual annual effective doses of irradiation in the major part of cases did not exceed 12 mSv. There were 1845 cases of 239+240Pu content in excrements exceeding the level of 1.5 mBq/sample at a current biophysical control. Individual doses of internal irradiation at that did not exceed 1 mSv. CONCLUSIONS: The program of medical and biophysical service for reconstruction works on the OS proved its necessity and efficiency as its results showed that under the unique radiation-hygienical conditions not engineering challenges and technical problems but issues of how to save the health and workability of people and prevent the overdose of personnel including due to an internal irradiation are most critical.