MANAGEMENT OF RISKS OF ADVERSE DRUG REACTIONS ACCORDING TO ADR REPORT FORM DATA FROM LVIV REGION HEALTHCARE FACILITIES IN 2022.

The study aimed to analyse the adverse drug reactions report form data received by the State Expert Center of the Ministry of Health of Ukraine from healthcare professionals in the Lviv region in 2022. Regarding specific types of medicines, the ones with proven cause-and-effect relationships that caused the highest frequency of adverse drug reactions incidents were chemotherapeutic agents (35.5%), medicines affecting the cardiovascular system (20.3%), and non-steroidal anti-inflammatory drugs (8%). Within the penicillin class, amoxicillin potentiated by clavulanate (67%) and amoxicillin (29%) were the dominant drugs showing the highest incidence rate of adverse reactions. Among cephalosporins, ceftriaxone (46%) and cefixime (15%) were found to take the lead in terms of adverse reaction frequency. The highest proportion among all adverse drug reactions caused by penicillins and cephalosporins was attributed to allergic reactions. To confirm or rule out immediate or delayed type allergies in patients, as well as in patients with a history of immediate-type allergic reactions to ß-lactams and planned administration of another ß-lactam, it is necessary to conduct skin testing (skin prick test, or, in the case of parenteral administration, intradermal test) with the planned ß-lactam antibiotic. The second highest proportion of induced adverse drug reactions was attributed to drugs affecting the cardiovascular system (20.3%). The leading medications in the angiotensin-converting enzyme inhibitors category were enalapril (47%) and the combination of lisinopril with hydrochlorothiazide (24%). In the angiotensin II receptor blockers category of medications, valsartan (30%) and telmisartan-hydrochlorothiazide combination (20%) ranked highest. In the category of CCB drugs, amlodipine (66%) and nifedipine (20%) held the leading positions. among angiotensin-converting enzyme inhibitors, enalapril caused the most prevalent and predicted adverse reaction, that of cough, affecting 10.5% of patients, whereas, with the combination therapy of lisinopril and hydrochlorothiazide, the cough was observed in only 5.2% of patients. Angiotensin II receptor blockers have a better safety profile, particularly concerning cough. Analysis of adverse drug reactions reports for angiotensin II receptor blockers showed no cases of cough with valsartan and telmisartan-hydrochlorothiazide combination. Among calcium channel blocker medications, amlodipine emerged to rank highest, causing one of the predicted adverse drug reactions, that of lower extremity oedema in 64% of patients. The second position was taken by the combination of amlodipine with valsartan, which showed a statistically significant reduction of 14.3% (p≤0.05) in the incidence of oedema. Using amlodipine at a dose of 5 mg in combination with sartan medicines as angiotensin receptor blockers is an effective therapeutic alternative not only for enhancing blood pressure control in hypertensive patients but also for improving the safety profile of amlodipine. Among all the non-steroidal anti-inflammatory drugs prescribed to patients in the Lviv region in 2022, the highest number of adverse reactions was associated with the administration of diclofenac, ibuprofen, paracetamol, and nimesulide, causing adverse drug reactions in 22%, 19%, 17%, and 10% of cases, respectively. The most common systemic manifestations of adverse reactions with these non-steroidal anti-inflammatory drugs were allergic reactions (63.4%) and gastrointestinal disorders (26.8%). From an evidence-based medicine perspective, the most justified approach for primary and secondary prevention of gastrointestinal complications is the use of proton pump inhibitors.

[Infectious mononucleosis in practice of otorhinolaryngologist]. / Infektsionnyi mononukleoz v praktike vracha-otorinolaringologa.

Infectious mononucleosis (IM) is an acute viral infection that usually occurs with fever, acute tonsillitis, affects lymph nodes, liver, spleen, and with specific changes in the hemogram. One of the most frequent symptoms of the disease is sore throat which leads people to otorhinolaryngologist. Several pathogens may be the cause of IM, but Epstein-Barr virus(EBV) plays a key role. EBV is a γ-herpes virus and about 90% of world`s population is infected with this one. Severe IM can lead to potential life-threating conditions, for example upper airway obstruction, spleen rupture. In addition to acute IM, EBV-infection can lead to a number of neoplastic and autoimmune diseases. Due to the non-specificity of IM symptoms and the emerging difficulties in laboratory and serological diagnosis of this disease, the problem of timely diagnosis and treatment in this category of patients remains very relevant.

[ENT care in the context of the new coronavirus infection COVID-19]. / Aktual'nye voprosy okazaniya spetsializirovannoi lor-pomoshchi v usloviyakh novoi koronavirusnoi infektsii COVID-19.

The spread of the pandemic of the new coronavirus infection COVID-19 inevitably makes adjustments to the medical care. Given that the main route of transmission is airborne, otorhinolaryngologists are at increased risk of infection. Based on the literature data of leading otorhinolaryngologists, as well as their own experience working with patients with the new coronavirus infection COVID-19, the authors present relevant recommendations on the organization of specialized otorhinolaryngological care in the context of the COVID-19 pandemic. The authors consider the etiology, pathogenesis, and clinical manifestations of COVID-19. The features of the examination of ENT, diagnostic and therapeutic procedures, including the use of silicone hydrotamps to stop the front and rear nose bleeds, developed in L.I. Sverzhevskiy OHRIM, and indications for hospitalization in the ENT hospital. Features of operations on the otorhinolaryngological profile during a COVID pandemic are also described. Summing up, the authors indicate that during the pandemic of the new coronavirus infection COVID-19, otorhinolaryngologists need to adhere to two fundamental principles aimed at preventing the spread of infection: the use of modern effective personal protective equipment and the use of examination methods (surgical treatment methods) that prevent the formation of biological aerosols.

[The role of microbiota in chronic pharyngitis]. / Rol' mikobioty pri khronicheskim faringite.

This article describes the modern approaches to the diagnostics and treatment of fungoid conditions of the pharynx with special reference to the main methods for the detection of pharyngomycosis and its clinical manifestations based on the results of analysis of the investigations carried out during the period from 2012 till 2016. Among the 3,465 patients presenting with chronic inflammatory pathology of the pharynx who sought medical advice and treatment at the clinical departments of the Institute, 861 ones (25%) were found to have mycotic lesions of the pharynx. Erythematous (atrophic) chronic pharyngitis was the predominant form of the disease documented in 2,059 patients whereas the remaining 1, 406 ones presented with the hypertrophic forms. The fungal infection was diagnosed in 403 (19,5%) patients with erythematous atrophic chronic pharyngitis in comparison with 458 (32,5%) patients suffering from the hypertrophic forms of this pathology including pseudomembranous, hyperplastic (granulomatous), and erosive-ulcerative ones. The principal pathogenic agents responsible for the development of fungal pharyngitis in our patients were fungi of the genus Candida that accounted for 97 - 99% of all the cases of this disease. The currently available modalities for the treatment of pharyngomycosis are described.

[The peculiar features of epidemiology and clinical course of syphilis encountered in the otorhinolaryngological practice under the present-day conditions]. / Osobennosti épidemiologii i klinicheskogo techeniia sifilisa v otorinolaringologicheskoi praktike v sovremennykh usloviiakh.

The article was designed to report the available information about the main characteristics of epidemiology and pathomorphism of syphilis. It describes the process of development and clinical symptoms of syphilis, both classical and undergoing modification, under the present-day conditions, with special reference to the distinctive features and peculiarities of ENT organ lesions with the underlying syphilitic etiology.

[The clinical observation of NK/T-cell lymphoma of the nasal type]. / Klinicheskoe nabliudenie NK/T-kletochnoi limfomy nazal'nogo tipa.

The objective of the present work was to present the results of the clinical analysis of the patient presenting with natural killer (NK)/T-cell lymphoma of the nasal type. We undertook the analysis of the medical documentation concerning the case of interest. It was shown that the development of progressive perforation of the nasal septum and the pronounced destructive changes in the intranasal and adjacent structures following the endonasal surgical interventions made necessary differential diagnostics between the condition under consideration and certain latent disorders (such as Wegener's granulomatosis, leprosy, syphilis, leishmaniasis, dirofilariasis tuberculosis, etc.). The study has demonstrated that the negative results of the analysis imply the necessity of special attention to the possibility of development of oncological diseases including hematological disorders (e.g. NK/T-cell lymphoma) and the repeat careful follow-up examination of the patients by the experienced experts.

[Familial hypercholesterolemia: involvement of cerebral major arteries (communication 1)]. / Semeinaia giperkholesterinemiia: porazhenie magistral'nykh arterii golovnogo mozga.

Ultrasound dopplerography, MR tomography were performed to assess the brain, major cerebral arteries and audiometry was conducted to study cochleovestibular system in 38 patients aged 16-63 years with heterozygous family hypercholesterolemia. Vascular disorders and defects in the white brain matter (in patients with transitory hypertension) were registered. Complications of cerebral atherosclerosis (brain infarction, perception cochleovestibular alterations) contributed to aggravation of ischemic heart disease. Patients with heterozygous family hypercholesterolemia should be observed and treated by cardiologist, neuropathologist and psychoneurologist to prevent cardiocerebral complications.