Aim. To determine the effectiveness and safety of early enteral protein nutrition (ЕEPN) using the clinical nutrition «FontActiv Forte Protein» to correct dysproteinemia and hypoalbuminemia in patients with esophageal variceal bleeding, gastric variceal bleeding in the context of liver cirrhosis during the post-hemorrhagic and postoperative periods. Materials and methods. The results of treatment of 71 patients who were treated in the Kyiv City Clinical Emergency Hospital were retrospectively analyzed. The first group of the study consisted of 34 patients who were treated between 2020-2024. The second control group of the study consisted of 37 patients treated between 2015 and 2019. All patients were admitted on an emergency basis for bleeding from esophageal varices in the setting of liver cirrhosis and were operated on after stabilization of hemodynamic parameters. Surgical treatment included porto-azigal disconnection: devascularization of the proximal stomach, distal esophagus, and hardware transection of the esophagus with or without splenectomy. Patients in the first study group received early enteral protein nutrition (EEРN) with protein mixtures (FontActive Forte Protein). Patients of the second control group received parenteral nutrition with Hepasol A, Hepasol Neo, enteral nutrition was started on day 6 of the postoperative period. Results. The intergroup comparison showed that all laboratory parameters, including the levels of total protein and albumin in the posthemorrhagic and early postoperative periods, decreased significantly in all patients of both groups and recovered slowly. Patients in the first group of the study who received REPX had a faster recovery of total protein and albumin, fewer complications, and shorter hospital stay after surgery (p<0.05). Conclusions. The administration of early enteral protein nutrition (FontActive Forte Protein) does not increase the risk of recurrent bleeding compared to delayed enteral nutrition. Nutritional support of protein homeostasis with liquid protein mixtures (FontActive Forte Protein) in patients with bleeding from esophageal/ gastric varices in the post-hemorrhagic/postoperative period is a safe method of correcting amino acid imbalance, reducing protein catabolism, maintaining protein synthesis function of the liver and serum albumin synthesis, which improves the results of surgical treatment, reduces the number of postoperative complications and the length of hospital stay.

Aim. To determine the morphological features of the musculus masseter in patients with extra-articular post-immobilization contractures of the mandible. Materials and methods. The research material was fragments of the musculus masseter, which were divided into three groups. Group 1 included musculus masseter fragments from 8 people, whose autopsy did not reveal any pathology of the head and neck. Group 2 included fragments of the macroscopically altered musculus masseter from 6 people who underwent immobilization of the lower jaw using a double-jaw splinting during the first hospitalization, and metal-osteosynthesis during the second hospitalization. Group 3 included fragments of the macroscopically altered musculus masseter from 6 people who underwent immobilization of the lower jaw using a parieto-chin sling bandage during the first hospitalization, and metal-osteosynthesis during the second hospitalization. In patients of groups 2 and 3, an average of 37.6 days passed between the use of conservative immobilization methods and metal-osteosynthesis. Microslides stained with hematoxylin and eosin, picrofuchsin according to van Gieson were subjected to morphometric examination. Results. In patients with post-immobilization extra-articular contractures of the mandible, changes in the morphofunctional state of the parenchymal and stromal components of the musculus masseter were recorded. In the parenchymal component, wave-like deformation, ischemic-dystrophic and atrophic changes in muscle fibers were noted. The stromal component was characterized by the presence of focal-diffuse polymorphic cellular infiltration; excessive content of connective tissue fibers with the presence of adipocytes between them; a decrease in the number of vessels with the presence of dystrophic-necrotic and desquamative changes in endothelial cells, sclerotic changes in all layers of the vascular wall; dystrophic-sclerotic changes in nerve fibers. Conclusions. The structural changes in the musculus masseter identified by the authors, which are more pronounced in cases of using a parieto-chin sling bandage and less pronounced in cases of using a double-jaw splinting, may underlie the development of post-immobilization extra-articular contractures of the mandible.

Introduction. It is now generally recognized that the co-occurrence of cognitive and depressive disorders is highly prevalent. War is associated with constant emotional tension and stress, which causes excessive arousal of the nervous system. This leads to an increased risk of acute cerebrovascular accident and cognitive function. Aim. To identify the features of cognitive and anxiety-depressive disorders in patients who suffered cerebral ischaemic stroke during martial law by testing using modern scales. Materials and methods. The total of 50 patients with cerebral ischaemic stroke in the early recovery period of the disease we examined in the Department of Neurology of the ZSMPhU. The median age of the patients was 61 (57; 66) years. There were 27 men (54%) and 23 women (46%). The patients were divided into the main group, which consisted of 25 patients (women (48%), men (52%), median age – 63 (58.5; 67.5) years) who had suffered cerebral ischaemic stroke during martial law; and a comparison group – 25 patients (women (44%), men (56%), median age – 61 (57; 63) years) who had suffered a cerebral ischaemic stroke during peacetime. All patients were evaluated through a comprehensive clinical and neurological examination, with the assessment of cognitive and psycho-emotional impairments using modern scales. Results. A comparative analysis of the study groups revealed statistically significant differences in the Beck's Depression Inventory and the Patient Health Questionnaire (PHQ-9) (p<0.05). A significant difference in the PHQ-9 scores was determined in the domains of "interest" (p=0.16), "sleep" (p=0.030), "appetite" (p=0.015), "slowed speech" (p=0.02). The correlation analysis of the main group indicators revealed a significant relationship between the NIHSS and mRS scales (p<0.05) and a medium correlation between the MoCA scale and the PHQ-9 (p<0.05). Conclusions. Patients who had suffered cerebral ischaemic stroke during martial law require early diagnosis of cognitive and affective disorders using modern scales to provide timely qualified medical care and prevent adverse consequences for their lives.

Aim. To investigate the antifungal and anti-adhesive activities of Monarda fistulosa essential oil and cinnamon essential oil on clinical strains of fungi of the genus Candida obtained from patients with pharyngomycosis. Materials and methods. The object of the study was essential oil of Monarda fistulosa and essential oil of cinnamon, the subject of the study was clinical strains of Candida albicans and Candida glabrata isolated from patients with pharyngomycosis. Antifungal effect of essential oils was determined by micromethod of serial dilutions with determination of minimum inhibitory concentration and minimum fungicidal concentration according to the recommendations of International Standards Organisation. The viability of micromycetes was determined by crossing the suspension from the test and control wells on Sabouraud dense nutrient medium with subsequent determination of colony-forming units/ml. Adhesion of Candida fungi was determined according to the method of Brilis V. I. and co-authors. Results. Our studies proved the antifungal effect of essential oil of Monarda fistulosa and essential oil of cinnamon on the studied clinical strains of Candida fungi. The range of subinhibitory concentrations of essential oils that inhibited the viability and adhesive activity of clinical strains of C. albicans and C. glabrata was established. Under the conditions of our experiment, the greatest suppressive ability of subinhibitory concentrations affecting the biological properties of Candida spp. was demonstrated by essential oil of Monarda fistulosa. Conclusions. The antifungal effect of essential oils on clinical strains of micromycetes differed in the strength of effect. The maximum expression of antimycotic effect was demonstrated by the essential oil of Monarda fistulosa. Under the conditions of action of subinhibitory samples of essential oil of Monarda fistulosa and cinnamon essential oil, the viability indices of Candida spp. were significantly lower than those of the culture control, which was not exposed to the action of essential oils. Clinical strains of C. albicans and C. glabratа isolated from patients with pharyngomycosis were characterised by medium-adhesive and low-adhesive activity, respectively. Essential oils in subinhibitory concentrations led to inhibition of the adhesive potential of the studied Candida spp isolates, namely, there was a decrease in the adhesive activity of C. albicans strains from the category of ‘medium-adhesive’ to the category of ‘non-adhesive’ and ‘low-adhesive’, and of C. glabrata isolates – from the category of ‘low-adhesive’ to the category of ‘non-adhesive’.

Aim. To identify the reparative processes mediation and improvement by growth factors from platelets automesoconcentrate (AMC) in the treatment of gunshot wounds. An additional aim was to perform a comparative analysis of the AMC-therapy efficacy with and without the wound defect area autodermatoplastic closure. Materials and methods. The clinical case of the wounded V., who was admitted for rehabilitation treatment following gunshot wounds to both hands from a gas cylinder explosion, is presented. As a result of the explosion, there were objectively observed residual skin wounds on both hands in the regenerative period. Dynamic monitoring was carried out in the form of photo-fixation of the results of treatment of wound defects of the palmar and back surfaces of the left and right hands. Results. A wounded person entered rehabilitation treatment with wound defects in the regeneration phase and foci of weak marginal epithelisation. The wounded received classical treatment (in the form of staged debridement) of 2 wounds of the left hand (without the AMC), 1 wound of the left hand was treated only with AMC, the thenar wound on the right hand was decided to be closed by the autodermatoplastic method according to Thirsch with the use of AMC. Complete epithelisation of all wound defects was achieved within 21 days. The use of AMС therapy made it possible to avoid rejection and necrosis of transplanted skin grafts, to achieve rapid epithelisation of wounds without the formation of a pathological scar at the edge of the wound defect, to restore skin sensitivity in the affected area, to achieve regression of interstitial edema and contractures in the phalanges of the fingers. Conclusions. AMC-therapy improves the results of treatment, allows to shorten significantly both treatment and rehabilitation duration, improves the quality of life by wound healing acceleration which is also an economically important when the need for further treatment, long-term dressings and work capacity restoration disappears. We consider the use of automesoconcentrate of platelets to be justified and expedient from a fundamental, scientific, clinical and economic point of view within the framework of our proved multimodal approach to the soft tissues’ gunshot defects reconstruction in the aspect of majority of military personnel suffering from gunshot wounds comprehensive recovery.

Aim. To analyze the epidemiological data on the incidence of rabies among animals and people in the Dnіpropetrovsk region, to evaluate the effectiveness of the implemented animal vaccination system, to assess the quality and timeliness of anti-rabies assistance in order to select priority areas in planning, monitoring, forecasting, and carrying out preventive measures in the implementation of the anti-rabies program. Materials and methods. The paper presents data from an analysis of statistical indicators of the State Institution “Dnipropetrovsk OCFDCAP Ministry of Health of Ukraine", Department of Animal Health and Welfare of the Department of Food Safety and Veterinary Medicine of the State Food and Consumer Service, the annual frequency of rabies epizootics and the incidence of rabies among people in the Dnіpropetrovsk region over the past 5-10 years. Also used were regulatory documents (orders, instructions, guidelines on rabies), reviews of literature and scientific articles (including foreign ones). Results. Analysis of rabies epizootic indicators reveals an unfavorable situation with rabies among animals in the Dnipropetrovsk region, which has been observed over the past four years. An analysis of rabies epizootics depending on the animal species found that in the wild, foxes are the most dangerous reservoir of lyssaviruses, and in anthropurgical foci the main danger is cats and dogs. The frequency of registration of rabies among people in Ukraine and the Dnipropetrovsk region over the past 20 years has been sporadic. The highest rates of rabies cases among humans were recorded during the second decade of the current century, with a definite downward trend in recent years. Of the total number of people who sought rabies medical care, 87,94% received a full course of rabies vaccination. Conclusions. The epidemiological situation regarding rabies epizootics in the Dnipropetrovsk region requires the continuation of the wild and domestic animal vaccination program in order to eliminate rabies foci among wild and domestic animals. The implementation of a program of combined anti-rabies care with the simultaneous use of anti-rabies vaccine and anti-rabies immunoglobulin is a positive fact for the medicine of the Dnipropetrovsk region.

Aim. To determine the activity of superoxide dismutase and catalase, the content of SH groups in the blood serum of patients with generalized periodontitis in patients with diabetes mellitus 2 type and in their combination. Materials and methods. The study involved 68 people with a clinically established diagnosis of type 2 diabetes mellitus, as well as 32 patients with confirmed generalized periodontitis, divided into 4 groups. The concentration of superoxide dismutase and catalase and the content of SH groups in the blood serum of patients were determined using a biochemical method. Statistical processing of data was carried out using the Shapiro-Wilk criterion. The level of statistical significance of differences between samples was assessed using the nonparametric Mann-Whitney test. Results. The highest levels of catalase activity and the lowest levels of superoxide dismutase activity were found in patients of group 4 with generalized periodontitis against the background of type 2 diabetes mellitus. The indicator of catalase activity in the subjects of the 4th group exceeded by 45.2% the results of the 2nd group and by 28.1% – of the 3rd group. At the same time, the SOD activity of the 4th group was not only lower than the control data, but also 26.8% of the results of the 2nd group (p<0.01) and practically did not differ from the indicators of the 3rd group. It should be noted that the combination of generalized periodontitis and type 2 diabetes causes a decrease in the content of SH groups by 12.7% relative to group 3. This indicates that against the background of type 2 diabetes, the development of combined pathology is accompanied by inhibition of the functional capabilities of antioxidant defense. Conclusions. In the comorbid course of generalized periodontitis and type 2 diabetes mellitus, the intensity of free radical oxidation processes in the blood serum increases with an increase in the concentration of catalase and superoxide dismutase, which indicates the strain of enzyme antioxidant processes with inhibition of functional glutate reserves.

Aim. To examine the level of psychophysical development of cadets who were engaged in orienteering during their training compared to cadets who were engaged in other sports. Tasks: 1) to find out the attitude of cadets to orienteering during their training; 2) to conduct a comparative analysis of the level of development of motor skills in cadets who were engaged in orienteering and cadets who were engaged in other sports. Materials and methods. The research involved 346 male cadets aged 20-22 years. Of these, 32 cadets were engaged in orienteering and 314 cadets were engaged in other sports. Research methods: theoretical analysis and generalization of literary sources and Internet data, questionnaires, testing the level of development of motor skills, and methods of mathematical statistics. The level of psychophysical development was investigated by the results of the following tests: 100 m run, pull-ups, exercise on the combined-arms obstacle course (12 obstacles, 400 m), 3 km run, 5 km accelerated march, 6x100 m shuttle run. Results. It was found that more than 95 % of cadets noted that the qualities and skills developed and formed during orienteering training sessions are professionally important for every serviceman. The comparative analysis of the level of development of motor skills in cadets who were engaged in orienteering and other sports showed a positive effect of orienteering on improving the level of cadets’ psychophysical development. The results of the cadets engaged in orienteering were significantly better in most tests, except for the representatives of polyathlon and military pentathlon, where the test exercises are competitive. The most pronounced effect of orienteering training was found on cadets’ endurance. Conclusions. This suggests that orienteering training has a positive effect on improving the level of cadets’ psychophysical development, which will contribute to the effectiveness of their future professional and combat activities. Moreover, unlike other sports, orienteering is an effective means not only of developing cadets’ motor skills but also of forming military-applied skills in orienteering in unfamiliar terrain and quick decision-making skills against the background of high mental and physical stress.

Aim. To investigate the risk factors of knee joint osteoarthritis and to propose improvements in preventive technologies for this pathology. Materials and methods. Questionnaires of 105 patients (46 men, 59 women) of a private specialized orthopaedic clinic with knee joint osteoarthritis were selected as research materials. Methods: sociological, medical and statistical; graphic. Results. It was found that the average body mass index in the sample exceeded the norm and was 27.1±4.8 kg/cm3, in particular, in men it was 28.2±4.2 kg/cm3, in women it was 26.2±5.1 kg/cm3; 34 (32.4%) respondents performed labour functions mostly while standing; 61 (58.1%) respondents had a history of trauma to the affected knee. The food behaviour of respondents was irrational, as they preferred several undesirable food products in their diet at once: 48 (45.7%) respondents preferred fatty meat products, 46 (43.8%) – sweets, 33 (31.4 %) – fatty dairy products, 32 (30.5%) – fried products, 31 (29.5%) – smoked products, 23 (21.9%) – butter, 22 (21.0%) – hot spices, 15 (14.3%) respondents consumed excessive salt. All patients had concomitant diseases, in particular, 27 (25.7%) individuals had diseases of the circulatory system, 14 (13.3%) – diseases of the endocrine system, 20 (19.0%) – other diseases of the musculoskeletal system, in addition to knee joint osteoarthritis (OA), 38 (36.2%) patients had diseases of the digestive organs, 6 (5.7%) patients had other diseases. Active primary, secondary, and tertiary prevention of knee joint OA is proposed, taking into account the complex of risk factors at the individual level and the presence of concomitant diseases in the patients, with the involvement of public health specialists, medical workers of primary and secondary medical care. Conclusions. The results of the conducted research confirmed the data of the world scientific literature on the risk factors of OA of the knee joint. It is proposed to carry out active primary, secondary, tertiary prevention, taking into account the complex of managed individual risk factors and concomitant diseases of the patient at all levels of medical care and in the community with the involvement of a public health specialists, medical workers of primary and secondary medical care.

Aim. In order to study the disorders of the autonomic nervous system as a result of mine-blast trauma and combat stress, as well as to analyze the dependence of the manifestation of these disorders on the age and duration of the injury, 62 people were examined. Materials and methods. The main group consisted of 37 servicemen with mine-blast trauma (MBT) and surgical interventions, and the control group consisted of 25 civilian men. The age of the subjects ranged from 18 to 45 years. The state of the autonomic nervous system was determined using ANS Analysis equipment and included three main parameters: resting heart rate, sympathetic nervous system parameters, and parasympathetic nervous system parameters. The significance of the difference between the groups of results was checked using the Mann-Whitney test, and the relationship between them, the age of patients and the time interval from the injury was checked using the Spearman rank correlation coefficient. Results. According to the results of the study, changes in the autonomic nervous system indices were absent in the group of civilians, while significant changes in the ANS indices in the group of servicemen with combat trauma were found for all three parameters: heart rate, sympathetic and parasympathetic autonomic nervous system indices. Also, in the group with MBT, a pronounced dissonance between the indicators of the autonomic nervous system was revealed: against the background of a significant increase in sympathetic status, a significant decrease in parasympathetic status was observed (179,0 (57,5; 309,0) vs. 13,0 (10,0; 28,0). Changes in the indicators of autonomic nervous system with combat trauma did not depend on the age of patients. Instead, there was a weak but statistically significant positive correlation between the duration of the injury and the parasympathetic nervous system: rs=0.325 (p=0.049). Therefore, the early use of a set of measures that increase the activity of the parasympathetic nervous system is logical. Conclusions. There were no changes in the autonomic nervous system parameters in the civilian group, but significant changes in the ANS parameters were found in the group of military personnel with combat trauma.