ANALYSIS THE METABOLIC STATUS OF PATIENTS WITH CORONARY ARTERY DISEASE AND NONALCOHOLIC FATTY LIVER DISEASE DEPENDING ON BODY MASS INDEX.

OBJECTIVE: The aim: To analyze the metabolic status of patients with coronary artery disease and nonalcoholic fatty liver disease depending on body mass index. PATIENTS AND METHODS: Materials and methods: The cohort of patients included 107 people with coronary artery disease (CAD), nonalcoholic fatty liver disease (NAFLD) and over¬weight (n=56) or obesity (n=51). In all patients glucose, insulin, HbA1c, HOMA-IR, hsCRP, transaminases, creatinine, urea, uric acid, lipid profile, anthropometric parameters and ultrasound elastography were measured. RESULTS: Results: During the analysis of serum lipid spectrum in patients with obesity: lower levels of HDL and higher TG concentration compared with patients who had overweight. The insulin level was almost twice as high as in patients with overweight and the HOMA-IR index was 3.49 (2.13;5.78), where as in patients with overweight it was 1.85 (1.28;3,01), p<0.01. In patients with coronary artery disease and overweight, the of hsCRP was 1.92 (1.18;2.98) mg/l and was significantly different from the hsCRP level in obese patients, which was 3.15 (2.64;3.66) mg/l, p=0,004. CONCLUSION: Conclusions: In patients with coronary artery disease, non-alcoholic fatty liver disease and obesity, the metabolic profile was characterized by a more unfa¬vorable lipid spectrum: lower levels of HDL and higher triglicerid concentration. Carbohydrate metabolism in obese patients included disorders such us impared glucose tolerance, hyperinsulinemia and insulin resistance. There was also a correlation between body mass index with insulin and glycated hemoglobin. Higher concentration hsCRP in obese compared with patients with overweight was observed. This confirms the role of obesity in the patogenesis of coronary artery disease, non-alcoholic fatty liver disease and systemic inflammation.

RHINOSINUSITIS IN PATIENTS IN POST-COVID-19 PERIOD: ETIOLOGY, CLINICAL AND MORPHOLOGICAL CHARACTERISTICS.

OBJECTIVE: The aim is to identify the etiology, clinical and morphological features of rhinosinusitis in patients in post-COVID-19 period. PATIENTS AND METHODS: Materials and methods: In the present study, it was carried out the analysis of 11 cases of rhinosinusitis, which developed after COVID-19 infection. The diagnosis of rhi¬nosinusitis was established on the basis of anamnesis, clinical and laboratory examination, specialized instrumental examination (rhinoendoscopy, X-ray, magnetic resonance imaging, spiral and 3D computed tomography). All patients underwent endoscopic sanitation of the nasal cavity, expansion of the maxillary anastomosis, maxillary sinusotomy, sanitation of the maxillary sinuses and removal of pathologically altered tissues. Microbiological examination of the swab from the nasal cavity was carried out in all patients. Histological and morphometric research methods were used during the morphological study of surgical material. The nonparametric Mann-Whitney U test was used to compare the means in the groups. RESULTS: Results: The conducted comprehensive study made it possible to identify chronic atrophic rhinosinusitis at the stage of exacerbation caused by associations of bacteria and fungi in patients in post-COVID-19 period. Among bacteria, the authors most often noted Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumonia, Streptococcus pneumonia and Enterococcus faecalis. Among fungi, there were Aspergillus, Candida, Mucor and Coccidioides. Fungal infection was characterized by invasion into the mucous membrane of the nose and paranasal sinuses. In patients in post-COVID-19 period the invasive bacterial-fungal chronic atrophic rhinosinusitis at the stage of exacerbation was predominantly bilateral, characterized by the involvement of several or all paranasal sinuses in the process. Patients with such pathology complained of periodic fever, headaches and malaise; nasal congestion and constant difficulty in nasal breathing; yellowish-greenish-reddish discharge from the nasal cavity, sometimes with a fetid odor; discomfort and pain in the area of paranasal sinuses; immobility of the eyeball, hyposmia or anosmia; reduction or complete loss of vision. Frequent risk factors for the development of invasive bacterial-fungal chronic atrophic rhinosinusitis at the stage of exacerbation in patients in post-COVID-19 period were the information about moderate or severe course of this infection in anamnesis; comorbidities (predominantly diabetes mellitus, hypertensive disease and ischemic heart disease). CONCLUSION: Conclusions: The study conducted by the authors made it possible to identify the etiological, clinical and morphological features, as well as risk factors of rhinosinusitis in patients in post-COVID-19 period. This information will contribute to a better understanding of such pathology by the doctors and improve the diagnostic and treatment process.

CORRUPTIVE INCOMINGS LAUNDERING IN THE MEDICAL SPHERE.

OBJECTIVE: The aim: Characteristic of corruptive incomings laundering in the medical sphere and research of components for counteraction to this phenomenon. PATIENTS AND METHODS: Materials and methods: Some methods were used to ensure the completeness and complexity of scientific research: dialectical, formal, legal, epistemological, and systemstructural methods. CONCLUSION: Conclusions: It was concluded that corruptive incomings laundering in the medical sphere is becoming commonplace. New ways, means, and schemes for the commission of this crime are appearing. The authors analyze the main methods for corruptive incomings laundering in the medical sphere: during the purchase of medicines and medical equipment, during the procurements of medical preparations and medical equipment, building restoration and renovation, where health care facilities are located, price-fixing and gifting of chief medical officers. A comprehensive system of organizational, legal, and economic measures must be formed that will provide effective counteraction to the corruptive incomings laundering in the medical sphere.

FEATURES OF CRIMINAL LIABILITY OF A MEDICAL PROFESSIONAL FOR FAILURE TO PERFORM OR IMPROPER PERFORMANCE OF THEIR PROFESSIONAL DUTIES IN UKRAINE.

OBJECTIVE: The aim: Research of features of criminal responsibility of the medical worker for failure to performe or imptoter perfomance of their professional duties in Ukraine. PATIENTS AND METHODS: Materials and methods: The article uses general scientific and special scientific methods of cognition, which provided an objective analysis of the research goal. CONCLUSION: Conclusions: Criminal law, which provides for liability for improper performance of duties by a healthcare professional or pharmacist, must have a perfect design to ensure the rights and interests of both the patient and the medical worker.That is why, the existing construction of article 140 of the Criminal code of Ukraine requires a number of changes and additions.

Relevant issues of the criminal liability of the private doctors for corruption crimes.

OBJECTIVE: Introduction: Corruption, as a socio-economic problem, is characteristic of every society. The aim: To study relevant issues of criminal liability of the private doctors for committing corruption crimes. PATIENTS AND METHODS: Materials and methods: In the article general scientific and special-scientific methods of cognition wer eused which provided an objective analysis of the research purpose. RESULTS: Review: The article analyzes actual questions of relenant issues of criminal liability of the private doctors for committing corruption crimes. The authors propose to research the criminal responsibility of this specific subject through the prism of the crime, as well as it's elements. Thus, special attention is focused on the analysis of thees sence of the object of the crimes, the responsibility for which provided in. Art. 365-2 and 368-4 of the Criminal Code of Ukraine. Inaddition, the concept of "unlawful profit" is investigated, in the context of comparison with the "bribe". Thees sence of the objective side of corruption crimes, the subject of which is a private doctor, is explained in detail. In particular, the concepts of "authority", "offer", "promise", etc. Particul arattention is paid to analyzing the legal status of a private doctor as a person authorized to provide public services. The authors focus on the analysis of the subjective side of thes corruption crimes being studied by a private physician. All penalties that can be applied to a private doctor for committing corrupt acts are systematized. At the very end, the issue of the totality of crimes is investigated. CONCLUSION: Conclusions: Bringing a private doctor in the responsibility for committing a corrupt act is difficult in there gion, because the criminalization of corruptionactions of suchpersons took place relatively recently, therefore, pre-trial investigation bodies have not yet established a well-established system of tactical and methodological actions that would facilitate this process.

Comparison of metabolic profile of obese non-diabetic patients with coronary artery disease depending on atorvastatin dose.

OBJECTIVE: Introduction:Cardiovascular diseases (CVD) are one of the most important medical-biological and social problems in Ukraine and in the world because coronary artery disease (CAD) is a major cause of death and disability. Overweight and obesity are risk factor of CVD and type 2 diabetes mellitus (T2DM). Although statins have been shown to be beneficial in secondary prevention of CVD in a number of trials, current reports of increased risk of T2DM with statin use raise concerns. The aim: To compare the metabolic profile and therapeutic targets of non-diabetic obese patients with CAD depending on the dose of atorvastatin. PATIENTS AND METHODS: Materials and methods: The study included 107 patients (82 men and 25 women) with CAD and abdominal obesity. Patients were divided into two groups: those taking 20 mg and 40 mg of atorvastatin daily correspondingly. Glucose, insulin, HbA1c, HOMA-IR, lipids, hs-CRP and anthropometric parameters were measured for each subject. RESULTS: Results: For patients with CAD and obesity, who had taken atorvastatin in a 40-mg dose, we observed a significant increase in insulin resistance and impaired fasting glucose. Also we found a reliable correlation between the carbohydrate and lipid spectrum. These parameters reflect the mechanism of the formation of metabolic disorders as a result of intensive statin therapy. CONCLUSION: Сonclusions: Despite of the beneficial reductions in LDL and total cholesterol, atorvastatin treatment on a dose 40 mg resulted in significant increase of fasting glucose, insulin levels and insulin resistance pertaining to those patients.

The role of similarity cues in the development of trust in sources of information about GM food.

In evaluating complex new technologies, people are usually dependent on information provided by others, for example, experts or journalists, and have to determine whether they can trust these information sources. This article focuses on similarity as the basis for trust. The first experiment (N = 261) confirmed that a journalist writing about genetically modified (GM) food was trusted more when his attitude was congruent with that of his readers. In addition, the experiment showed that this effect was mediated by the perceived similarity of the journalist. The second experiment (N = 172) revealed that trust in a journalist writing about the focal domain of GM food was even influenced by him expressing a congruent attitude in an unrelated domain. This result supports a general similarity account of the congruence effect on trust, as opposed to a confirmatory bias account.