Danylo Halytsky Lviv National Medical Research Articles

IN MEMORY OF PROFESSOR YAREMA TOMASHEVSKYI – SCIENTIST, DOCTOR AND TEACHER

We are deeply saddened to inform that on August 12, Yarema Illich Tomashevskyi, a distinguished professor of the Danylo Halytsky Lviv National Medical University, passed away at the age of 94.
 Professor Tomashevskyi was born on December 3, 1929, in the village of Stetseva in Pokuttia area. In 1953, he graduated with honors from Lviv Medical Institute and then studied in the clinical residency program for internal medicine from 1953 to 1955. In the following three years, he chaired the therapeutic departments of Kamianka-Buzka District Hospital and the 4th Hospital in Lviv. In 1958, he commenced employment as an assistant at Lviv Medical Institute and was subsequently promoted to Associate Professor of therapeutic departments. He started and chaired the Department of Endocrinology and Clinical Pharmacology, where he worked for 44 years, from 1978 to 2022. Yarema Illich created and developed the Lviv endocrinological school, the regional endocrinological dispensary, and headed the regional association of endocrinologists. He was a member of the Ukrainian Scientific Society of Endocrinologists.
 Professor Tomashevskyi’s scientific and research endeavors are centered around the issues of cardiology, rheumatology, gastroenterology, balneotherapy, clinical vitaminology, and endocrinology. He deemed the prevention of diseases to be of paramount significance. He founded the Academy of Preventive Medicine at the Shevchenko Scientific Society. He has worked on programs aimed at preventing iodine deficiency disorders and early diagnosis of diabetes, which he diligently implemented in practice. Professor Tomashevskyi is the author and co-author of over 350 publications, including seven monographs and textbooks and many methodological recommendations. Under his leadership, two doctoral and 15 candidate theses were successfully defended.
 The professor’s professional activities included membership in the Ukrainian Medical Association, the European Association for the Study of Diabetes, and editorial boards of the journals “Endocrinology” and “International Endocrinology Journal.” He also contributed to the compilation of scientific works “The Phenomenon of Human. Healthy lifestyle,” “Medical Collection of The Shevchenko Scientific Society.” He was a full member of the Shevchenko Scientific Society and headed the Medical Commission of the SSS for several years. He was respected and known in the medical scientific community of Ukraine. In 1985, Yarema Illich was awarded the badge “Excellence in Healthcare.”
 Professor Yarema Tomashevskyi was an excellent teacher and lecturer, a highly qualified doctor who was loved and respected by students, colleagues, and patients. He was a respected citizen. The professor led a respectable life full of tireless work and care. His favorite sayings from the ancient sacraments, which he steadfastly adhered to, were: “Rush to do good, as human life is fleeting; do everything in moderation; and never express anger.” He was always cheerful, smiling, and friendly.
 Eternal and bright be his memory!
  
 Chairman of the Medical Commission
 of Shevchenko Scientific Society,
 Doctor of Medicine, Professor Valentyna Chopyak

I INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE “DOCTORS AND NURSING – MEDICAL FRONT IN UKRAINE AND THE WORLD”

On May 11–12, 2023, the I International Scientific Practical Conference “Doctors and Nursing – Medical Front in Ukraine and the World” took place in Lutsk, Ukraine. The conference was dedicated to the 150th anniversary of the Shevchenko Scientific Society (SSS).
 The conference was organized by the Municipal Institution of Higher Education Volyn Medical Institute of Volyn Region Council, in collaboration with Danylo Halytsky Lviv National Medical University, I.Y. Horbachevsky Ternopil National Medical University, Vilnius University (Lithuania), Higher Private Educational Institution Lviv Medical University, the Shevchenko Scientific Society, and Health Tech Without Borders (Switzerland, USA). The conference was held with the support of the State Institution “Center for Nursing Development of the Ministry of Health of Ukraine”. Partners in conference organization also included Volyn Orthodox Theological Academy, Maastricht University (the Netherlands), Volyn Region Emergency Medical Center and Disaster Medicine Municipal Enterprise, German-Ukrainian Association of Nurses, NeanderklinikHarzwald (Germany), “Myloserdia” Association of Volyn Nurses PO and Lviv Association of Allergists, Immunologists, and Rehabilitologists Charitable Organization.
 During the course of the event, a total of over 100 speeches were delivered by medical scientists and practicing physicians, as well as researchers in diverse disciplines from Ukraine, the United States, Great Britain, Poland, Lithuania, Germany, the Netherlands, and Switzerland. Workshops were conducted on relevant issues in medical practice in times of war.
 A total of approximately 1100 individuals participated in the conference, comprising physicians from diverse disciplines and nurses, emergency medical professionals and disaster medicine specialists, scientific and pedagogical personnel, employees of the State Emergency Service, physical rehabilitation specialists, psychologists, representatives of the clergy and public organizations, and young scientists.
 A new interdisciplinary format of scientific dialogue has been started between representatives of medical and nursing specialities, the education sector, psychologists, and clergy. It helps find ways to address relevant issues in the medical sector in complex conditions of the present day.

PROVISION OF CLINICAL PHARMACY SERVICES THROUGH THE TELEGRAM GROUP UNDER THE CONDITIONS OF THE FULL-SCALE WAR IN UKRAINE

The research aims at studying the requirement for clinical pharmacy services offered through the activity of a Telegram group after the imposition of martial law in Ukraine.
 Materials and Methods. The staff of the Department of Healthcare Management, Pharmacotherapy and Clinical Pharmacy together with the Centre of Pharmaceutical Care and Innovations in Healthcare of Danylo Halytsky Lviv National Medical University created a "Clinical Pharmacy" group on Telegram (free of charge messenger) on March 3, 2022. The object of research is represented by the requests of the created group members. The subject of research is represented by special needs for clinical pharmacy services and the provision of pharmaceutical care after the imposition of martial law in Ukraine.
 Results and Discussion. A total of 206 participants joined the newly-created Telegram group and sent 338 requests from March 3 to June 8, 2022. Notably, 88.8% of requests were sent in March 2022. The requests involved the identification of medicines and medical products by the group administrators. Medicines and medical products were identified based on the photos of the secondary or primary packaging with labels mainly in a foreign language. The administrators answered the questions in Ukrainian. The results of the data analysis showed that 54.1% of requests were related to medicines, 16.6% to medical products, 16.6% to dietary supplements, 11.8% to cosmetic products, and 0.9% to other. The administrators of the Telegram group identified the product as medicine or attributed it to other categories when they received requests. Later, they identified the composition of active pharmaceutical ingredients, pharmacotherapeutic group and / or indications for use. The requests included narcotics and psychoactive agents, while their distribution is limited in Ukraine. The administrators also identified medicines that were not registered in Ukraine (28.4%). It may be necessary to provide more complete pharmaceutical care to ensure the rational use of them. In our opinion, the obtained results should become a part of the academic process. It should be noted that case management based on the received requests and responses to them must also be included.
 Conclusions. The obtained results prove that a part of the vital clinical pharmacy services can be provided by professional groups using free messengers in the state of emergency, namely the imposition of martial law. The provision of accurate information about drugs and medical products was prioritized among other clinical pharmacy services. We consider it relevant to enforce the development of e-clinical pharmacy, especially while implementing crisis management in Ukraine.

WINTER SPECIALIZED IMMUNOLOGY SCHOOL, “INBORN ERRORS OF IMMUNITY”

On December 15–17, 2022, the Winter Specialized Immunology School, “Inborn Errors of Immunity,” was held in Uzhgorod of Zakarpattia Region with the support of Danylo Halytsky Lviv National Medical University, the International Interdisciplinary Association of Medical Professionals, the All-Ukrainian Association of Pediatric Immunology NGO, and the International European University. This school aims to analyze new approaches to the early diagnosis of primary/congenital disorders of the immune response in the context of the multidisciplinary approach, as well as to discuss the strategy of therapeutic tactics of such patients. The scientific event was held in the case marathon and direct communication formats. At the beginning of the event, a round table was held with the participation of regional experts in pediatric and adult immunology from different parts of Ukraine. More active cooperation with European colleagues and the creation of a national registry of immunodeficient patients with impaired antibody synthesis were noted. More than 20 speeches by clinical immunologists/pediatric immunologists were presented during two days of intensive work. During this school, results of Biopharma activities, a domestic producer of immunoglobulins, and plans for the future were presented in the field of domestic immunology development and diagnosis of patients with inborn errors of immunity. Discussions during the Winter School revealed the need to actively protect persons with congenital disorders of the immune system against infections by means of timely systematic seasonal vaccination, replacement immunoglobulin therapy, prophylactic antimicrobial therapy, and coordinated activities of specialists from various fields to provide immunological aid to patients in war conditions. At the end of the “Inborn Errors of Immunity” Winter School, organizers expressed confidence that most efforts and ideas highlighted during the professional meeting will be successfully implemented.

The significance of morphological verification of calcifications in differential diagnsis of the mammary gland pathology

Relevance of the research. An important advantage of radiological imaging methods is their ability to detect areas of calcification in tissues, even in the form of microcalcifications, measuring up to 1 mm. These microcalcifications are formed under the influence of various factors and serve as important diagnostic criteria for a number of pathologies. Microcalcifications, detected during mammographic examination, are considered reliable markers of breast cancer. The classification of breast microcalcifications is based on their radiological and histological characteristics, which are evaluated during the diagnostic process to identify breast pathology. The aim of the study is to determine the frequency of detecting calcifications in the breast through mammographic examination and verify their significance as diagnostic criteria for breast cancer.Materials and methods. The study utilized a processed randomized sample of anonymized archival mammograms from 100 women of mature and elderly age who underwent screening or preventive examinations at the mammography room of the CNE "6th city polyclinic of Lviv". The examinations were conducted using the Fujifilm Amulet Innоvality machine (Japan) in the craniocaudal (CC) and mediolateral oblique (MLO) projections. Histological slides from the archives of the Histology, Cytology, and Embryology Department of Danylo Halytsky Lviv National Medical University and anonymized archival preparations of DOBRA DIAGNOSTYKA LLC were used for the study.The slides were examined under a UlabXSP-137TLED microscope at various magnifications and photographed using an XCAM 1080P camera.Results. It has been established that the frequency of detecting calcifications during screening/preventive examinations of mature and elderly women was 69% of the total number of subjects examined, more than half of them bilaterally. The detected calcifications had different localization, shape, size, and quantity. The analysis of scientific literature sources indicates the existence of different views on the presence of calcifications in breast tissue - some authors consider them to be a characteristic radiological sign of the breast, while others assert that the frequency of malignant neoplasms increases, including in cases of calcification of the glandular tissue. The results of mammary glands histological studying in mature and elderly women indicate that calcifications can be visualized in the context of age-related changes in the stroma or parenchyma of the organ, which don`t exhibit morphological signs of neoplastic development. These calcifications can be manifestations of age-related involution and are possibly formed as a result of calcification of blocked secretions. Conclusion. The presence of calcifications can`t be considered a definitive diagnostic criterion for breast cancer. The final verification of the diagnosis can only be made after conducting a histological examination.

MIOEPITHELIAL CELLS: STRUCTURE, FUNCTION, AND THEIR ROLE IN NORMAL AND NEOPLASTIC TRANSFORMATION OF THE BREAST

Abstract. Myoepithelial cells (MECs) are characteristic of exocrine glands and are responsible for synthesizing the extracellular matrix, particularly the structural components of the basal membrane. MECs are of epithelial origin and exhibit contractile function, which aids in milk ejection from the ducts during lactation. Scientific literature suggests that MECs act as suppressors of tumors and play an important diagnostic role in mammary gland pathology, especially in distinguishing diff erent neoplastic processes.Research objective: T o elucidate the histological features and immunohistochemical verifi cation of myoepithelial cells in normal breast tissue and their role in neoplastic transformation of the mammary gland.Materials and Methods. The histological examination of myoepithelial cells of the mammary gland was conducted on archival slides from the Department of Histology, Cytology, and Embryology, Danylo Halytsky Lviv National Medical University. Histological sections, stained with hematoxylin and eosin, as well as immunohistochemical markers p63 (Clone 4A4, Masterdiagnostica) and cytokeratin 5/6Ab-2 (D5/16 B4, Thermoscientifi c) for confi rming the myoepithelial origin of the cells, were analyzed under a light microscope (UlabXSP-137TLED) with 10x and 40x objectives and a 10x eyepiece. Photographs were taken using an XCAM 1080P camera.Research Results. The structural units of the mammary gland (MG) are ductal-l obular formations, the terminal portions of which have an alveolar shape and are formed by secretory exocrine cells with underlying myoepithelial cells – basket-like cells. Identifi cation of myoepithelial cells using conventional histological staining techniques such as hematoxylin and eosin does not always provide a clear understanding of their topography. All myoepithelial cells are located on the basal membrane and contribute to the synthesis of its components (laminin, entactin, etc.). The myoepithelial cell layer, which is consistently present in the normal mammary gland, can appear diff erently: resembling smooth muscle or epithelioid cells, having a stellate or spindle- shaped form, or not being visualized at all. It has been shown that p63 is a sensitive and specifi c nuclear myoepithelial marker, expressed in myoepithelial cells of the normal mammary gland, in residual lobular acini, sclerosing adenosis, carcinoma in situ, and not detected in invasive carcinomas. It can be included in immunohistochemical panels aimed at identifying myoepithelial cells in diagnostically challenging breast pathologies.Conclusions. Myoepithelial cells in the mammary glands play a key role in their function, facilitating the process of milk secretion. However, in certain cases, they also play an important role in the development of neoplastic transformations. Intercellular connections between secretory and myoepithelial cells indicate that the last ones suppress both the progression of carcinoma in situ to invasive breast cancer and the carcinomainduced angiogenesis. The use of the immunohistochemical marker p63 is mandatory in the panel of antibodies to identify myoepithelial cells in the mammary gland and diff erentiate between benign and malignant lesions.

MICROSTRUCTURAL ORGANIZATION OF THE SUBMANDULAR GLAND UNDER CONDITIONS OF 5-WEEK OPIOID INFLUENCE

The use of opioids is an effective method of treatment for severe and acute pain; however, when they used inappropriately, in addition to their powerful pain-relieving properties, opioids cause significant side effects. The initial changes in the human body caused by the use of narcotic substances (opiates) are detected in the oral cavity, in particular, in the salivary glands. The earliest manifestations of pathological changes in the oral cavity are caries, stomatitis, gingivitis, periodontitis and xerostomia. Based on the results of our research and the study of the effect of opioids on other organs, we can conclude that long-term use of opioids has a significant negative effect on the structure of the submandibular gland and homeostasis of the oral cavity as a whole. The presence of a number of unsolved questions regarding the problems of structural reconstruction of the salivary glands during the use of narcotic agents, as well as the possibility of selecting the most effective methods of treatment and prevention of salivary gland diseases determined the choice of this research topic.
 Materials and methods. The research was performed on 15 mature, white, male rats with body weight 200–220 g, aged 4.5–6 months, which were kept under standard conditions at the vivarium of the Danylo Halytsky Lviv National Medical University. Animals were divided into two groups: experimental and control. In the experimental group, animals (10 rats) were daily administered an opioid analgesic (nalbuphine) intramuscularly according to the following schedule: 1st week – 8 mg/kg, 2nd week – 15 mg/kg, 3rd week – 20 mg/kg, 4th week – 25 mg/kg, V week – 30 mg/kg. Controls were 5 rats that were injected with 0.9% sodium chloride solution in a volume of 1 ml for 5 weeks. We used the histological method to conduct the research.
 Results. Damage to the organs of the oral cavity and the submandibular gland, in particular, is an element of comorbid pathology caused by long-term use of opioids. During the 5-week administration of the opioid, we observed irreversible destructive changes in the structural organization of the submandibular gland, which was characterized by the dilation of the vessels of the microcirculation, dystrophic and necrotic changes of the final serous and mucous secretory acini, necrosis of serocytes. Such pathological processes in the structural organization of the submandibular gland can cause an imbalance in the quantitative and qualitative composition of saliva and, as a result, a violation of the homeostasis of the oral cavity and the upper parts of the gastrointestinal tract.
 Conclusions. The results of the research demonstrate the negative impact of long-term opioid exposure on the structural organization of the submandibular gland and are similar to changes in other organs and body systems during long-term opioid exposure. The damage to microcirculation vessels is the starting and primary mechanisms in this process with the subsequent increase of irreversible destructive changes of the submandibular gland. The data of the scientific work have a wide practical and theoretical significance for morphologists, pathomorphologists and dentists in the aspect of developing new methods of diagnosis, prevention and treatment of salivary gland pathology in patients with opiomania and make it possible to establish safe terms of use of «nalbuphine».

FEATURES OF FORMING SELF-EDUCATIONAL COMPETENCE OF FUTURE DOCTORS.

The aim: To analyse the self-educational competence formation for future doctors in higher education institutions. The process has to be analyzed from the presence of motives regarding the educational activity of the individual to personal need for self-improvement. Materials and methods: The diagnostic stage, which was conducted in 2020-2021, included 300 sixth-year students from three higher educational institutions: I. Horbachevsky Ternopil National Medical University, Danylo Halytsky Lviv National Medical University, Ivano-Frankivsk National University. Results: Comparative analysis shows that the level of self-educational competence formation for future doctors in higher education institutions depends on the form of educational activityto a large extent. It was established that 196 (65%) future doctors prefer practical training at the patient's bedside, 92 medical students (31%) study in simulation centers, and 12 young people (4%) consider combined classes and generalizing conferences to be important. Conclusions: Research and experimental verification of the effectiveness of the self-educational competence formation for future doctors took place during the training of sixth-year students at a higher educational institution. Innovative methods of developing critical thinking, information and interactive tech¬nologies were used.

STUDY OF IMMUNE-INFLAMMATORY RESPONSE CHANGES IN ORAL FLUID IN PATIENTS WITH DISEASES OF PERIODONTAL TISSUES IN COMBINATION WITH GENERAL SOMATIC PATHOLOGY.

The aim: To determine the concentration of markers of the immune-inflammatory response (IL-1β, IL-10, IL-1β / IL-10, hsCRP) in oral fluid in patients with diseases of periodontal tissues in combination with general somatic pathology. Materials and methods: The study was conducted at Danylo Halytsky Lviv National Medical University, Department of therapeutic dentistry FPGE, Lviv, Ukraine. The patients were divided into two groups: the main group - 144 patients (with periodontal tissue diseases on the background of general somatic pathology) and the control group - 30 somatically and dentally healthy persons, in whose oral fluid was determined the concentration of IL-1β, IL-10, hsCRP by the enzyme immunoassay method. Results: As a result of our research, it was found that in people with periodontal tissue diseases, against the background of general somatic pathology, there is an activation of the immune-inflammatory response, which aggravates the course of general somatic and dental diseases in this contingent of patients. Conclusions: Therefore, in patients with periodontal tissue diseases on the background of somatic diseases, a significant increase in the level of the pro-in-flammatory cytokine IL-1β and hsCRP was determined against the background of a decrease in the anti-inflammatory cytokine IL-10 in the oral fluid compared to the values in the control group.

6ᵗʰ INTERNATIONAL SYMPOSIUM “SMART LION”. MEDICINE AND WAR, OCTOBER 14, 2022

On October 14, 2022, the 6ᵗʰ International Symposium “SMART LION” (Science Medicine Arts Research Translational Lviv International Opportunity Network) was held in Lviv with the support from Danylo Halytsky Lviv National Medical University, the Medical Commission of the Shevchenko Scientific Society, Lviv City Council and Lviv Conference Bureau. It was no coincidence that the time of the conference coincided with the Day of Defenders of Ukraine, which include military medical professionals and scientists who equip them with knowledge and skills enabling them to save lives on the battlefield.
 The purpose of the symposium was to analyze the new experience of medical professionals and volunteers of Ukraine and its allies, which they acquired during russia's war against Ukraine, develop new methods in medical education, and establish close cooperation between military medical professionals, volunteers, and scientists.
 The scientific event was held online via ZOOM. It was also streamed on the Facebook page of the journal “Proceedings of the Shevchenko Scientific Society. Medical Sciences”. The event featured more than 20 speeches by international and domestic scientists and highly qualified specialists. Subsequently, they will serve as a scientific and practical foundation for the development of both military and general medicine. Discussions during the conference clearly showed the need for systemic changes in medical education, supplementing educational programs taking into account the vast experience of military medical professionals, and improving teaching methods.
 At the end of the symposium, organizers expressed confidence that most of the deliverables and ideas highlighted during the conference will be successfully implemented. We sincerely thank all defenders and allies of Ukraine, volunteers and medical professionals who save people's lives, sometimes pulling them out of the death grip. With hope for and belief in a bright future, with faith in an upcoming victory and plans to meet again live in Lviv at SMART LION 2023.

RELATIONSHIPS BETWEEN LIPID PROFILE AND COMPLETE BLOOD CELL COUNT PARAMETERS

Aim. Given that blood cells play an important role in both atherogenesis and lipid metabolism, the research aimed to assess the specifics of the relationship between the parameters of the blood lipid spectrum and the complete blood count (CBC).
 Materials and Methods. A total of 475 individuals (245 female and 230 male) were included in the study, who simultaneously underwent CBC and determination of lipid profile, namely: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Statistical processing of the obtained data was carried out using the "Statistica for Windows 6.0" software package (Statsoft, USA).
 Results. An increase in levels of TC and LDL-C was associated with an increase in the count of lymphocytes and erythrocytes. A rise in VLDL-C and, accordingly, TG levels, as well as a decrease in the level of HDL-C, were associated with an increase in the total leukocyte count in the blood without a significant change in the ratio of their different types, and an increase in erythrocyte sedimentation rate. The count of platelets was directly related to the level of LDL-C and increased in the case of a combination of elevated levels of LDL-C and TG.
 Discussion. The obtained results indicate that the disposal of excess lipoproteins is based on various types of immune reactions. An increase in the levels of VLDL-C and TG is associated with the development of a nonspecific leukocyte reaction, and an increase in LDL-C levels is associated with a more specific platelet-lymphocytic response. A simultaneous increase in LDL-C and TG levels can be associated with the development of both specific and non-specific immune reactions. An increase in the level of HDL-C leads to a decrease in the intensity of innate and adaptive immune responses. Therefore, the lipid profile of patients should be evaluated by taking into account the blood cell counts, especially in the process of hypolipidemic treatment.
 Conclusions. An atherogenic lipid profile is associated with increased counts of all blood cells, reflecting specific and nonspecific immune reactions in response to elevated levels of various lipid groups. Platelets play an important role in lipid metabolism.
 Connection of the research with scientific programs, plans, and topics. The study is a fragment of the planned scientific research of the Department of Internal Medicine No. 2 of the Danylo Halytsky Lviv National Medical University: "Peculiarities and markers of the course of internal diseases under conditions of combination with metabolic syndrome and metabolically associated fatty liver disease", state registration number: 0122U000165.

UNIVERSITY MEDICAL CENTER SCHLESWIG-HOLSTEIN – CONTRIBUTION IN DEVELOPMENT OF UKRAINIAN MEDICINE AND SUPPORT IN THE WAR TIME

The key areas of scientific and practical cooperation between the University of Lübeck, the University Clinic of Schleswig-Holstein (Germany), Danylo Halytsky Lviv National Medical University and hospitals of Ukraine are presented. The active position of the University Clinic Schleswig-Holstein (UKSH) made it possible to organize the transfer of significant humanitarian aid to Ukraine during the full-scale invasion of Russia.

Cytokine profile in seminal fluid of infertile men with concomitant pathologies

The mechanisms of formation of male infertility are increasingly becoming immune dependent. This study aims to study the role of pro-inflammatory and anti-inflammatory cytokines in seminal fluid to clarify their role in spermatogenesis. This research is carried out at rheumatology and urology departments of Danylo Halytsky Lviv National Medical University (Ukraine). 45 infertile men aged 22–48 were examined. They were divided into 2 groups: first group – 22 men with a systemic autoimmune disease – rheumatoid arthritis; second group – 23 somatically healthy patients with idiopathic infertility. The control group included 27 fertile healthy men aged 22–48 years. Student's t-test was used to compare the significant difference in mean values between groups. Patients with autoimmune diseases (rheumatoid arthritis) had the highest rate of leukocytospermia, indicating a possible long-term inflammatory process. The TGF-β1 level was higher in men with idiopathic infertility, and in patients with autoimmune pathology was reduced compared to the control group, however these changes were not significant. At the same time in patient of both group the level a pro-inflammatory cytokine IL-18 increased approximately by 2.5 times. In patients with idiopathic infertility and patients with autoimmune pathology, a simultaneous increase in the IFN-γ level and a decrease in the IL-1β level were found. The ІL-6 level in seminal plasma of infertile men of both groups was increased. The ratio IL-10/TNF-α was decreased in seminal plasma of infertile men with rheumatoid arthritis. It was found that in autoimmune pathology, the increased level of IL-1β in blood serum compared to controls was associated with its reduced level in seminal fluid (r=-0.51, p<0.05). In idiopathic infertility, a low level of IL-1β in seminal fluid was also associated with a low concentration of this cytokine in blood serum (r=0.62, p<0.05). The functioning of the immune and reproductive systems of the male body is closely related and interdependent. Disorders of immune reactivity, which accompany the development of autoimmune pathology associated with disorders of reproductive function in men. The largest number of deviations of immune reactivity was found in infertile men with concomitant autoimmune diseases. Keywords: cytokines, male infertility, idiopathic infertility, rheumatoid arthritis.

CONCEPTUAL FEATURES OF OCCLUSAL BALANCE IN THE DEVELOPMENT AND PATHOLOGY OF LOCALIZED AND GENERALIZED DISEASES OF PARODONTAL TISSUES IN PATIENTS WITH PARTIAL TOOTH LOSS DURING ORTHOPEDIC REHABILITATION BOTH ON THE NATURAL TEETH AND THOSE ON DENTAL IMPLANT

The biomechanical component is an important aspect of orthopedic rehabilitation in the case of parodontal tissue pathology, which involves the most accurate reproduction of not only the shape of the tooth but also the location (functional axis) and the relationships of occlusal surfaces. At the same time, it is important to understand that the functional axis of the tooth and the areas of occlusal contacts are very dynamic and depend on the strength and character of masticatory movements. Therefore, the force vectors on the tooth axis continuously change in the articulation cycle, which helps to change the force of the occlusal interaction of the dentitions and the direction on the periodontium itself and the bone tissue of the jaws.
 Aim: To explain the importance of restoration of functional occlusal relationships in patients with localized and generalized diseases of parodontal tissues, on the example of partial tooth loss with rational orthopedic rehabilitation on natural teeth and dental implants.
 Materials and methods. Clinical examination of patients with localized and generalized parodontal tissue diseases. Orthopantomography – for visualization of the general state of the dentofacial system. In complicated cases, computer tomography with 3D replication was used to make a diagnosis and choose a treatment method. Adjustable articulators have been configured for individual functions together with CAD/CAM technology for the production of rational orthopedic restorations.
 Study results and discussion. 10 patients after orthopedic treatment (13 orthopedic restorations on their natural abutment teeth and dental implants) were admitted to the Dental Medical Center of Danylo Halytsky Lviv National Medical University with complaints of difficult mastication, increased mobility of orthopedic restorations, and halitosis. During clinical examination and taking history, it was found that all patients with parodontal tissue pathology underwent local orthopedic treatment on their natural abutment teeth consisting of 3 bridgework (23% (p<0.05)) and 4 single (31% (p<0.05)) orthopedic restorations and 9 dental implants, which corresponded to 3 bridgework (23% (p<0.05)) and 3 single (23% (p<0.05)) orthopedic restorations, which were used from 6 to 12 months. The signs of disocclusion and overloading were found on the laterotrusion side when checking the static and dynamic occlusion according to the concepts of group management and canine protection. As a result of orthopedic rehabilitation in a virtual articulator adjusted for individual function, functional occlusion was normalized, pathological dental mobility, signs of peri-implantitis, and inflammatory processes of the supporting teeth were eliminated for 10 patients (13 orthopedic restorations) with localized and generalized diseases of parodontal tissues and partial loss of teeth. After 12 months, control clinical examination with additional examination methods of patients with parodontal tissue pathology corresponded to the stabilization of the pathological process both on their natural abutment teeth and on dental implants with normative osseointegration.
 Conclusion. Therefore, the shape and size of restored functional occlusal relationships in adjustable articulators configured for individual function using modern CAD/CAM technologies ensure the balancing of force vectors on teeth and dental implants in parodontal tissue pathology.
 Directions for future research. Unfortunately, modern technologies are not available to all patients and medical institutions of health care of Ukraine due to their high cost. Consequently, a significant number of orthopedic restorations are manufactured in commercial technical laboratories or manually by dental technicians in municipal health care facilities. Therefore, scientific publications must be aimed at attracting and implementing modern technologies in health care educational institutions for further scientific and practical development.

COVID-19 у дітей: синдром мультисистемної запальної відповіді

Unlike adults, children are less likely to get infected SARS-CoV-2, their disease has a mild form and fatal cases are rather rare. However, a new disease associated with SARS-CoV-2, the multisystem inflammatory syndrome (MIS-C), has been described in children. Most children with MIS-C in the world are blacks or asians. Purpose - to analyze of peculiarities of MIS-C in children of Lviv Region. Materials and methods. We have analyzed medical records of 16 children who were treated in Communal Non-Commercial Establishment of Lviv Regional Council «Lviv Regional Children Clinical Hospital «OKHMATDYT» in the period from September 2020 to January 2021 with the diagnosis of MIS-C, associated with SARS-CoV-2. Results. MIS-C was diagnosed in 16 children (average age was 8,2±0,065 years, girls:boys = 1:0,6). None of our patients was the «primary source of SARS-CoV-2» in the household but contracted coronavirus disease after a contact with the sick relatives. The disease occurred in 4 (25%) children against the background of acute coronavirus disease, in 4 (25%) more children during the first month and 8 (50%) children more than a month after acute SARS-CoV-2 infection. All children has febrile fever and general weakness. Besides, in most of the patients clinical progression of MIS-C was characterized by typical skin rashes and conjunctivitis (13 children - 81,5%), facial swelling and edema of distal parts of extremities (11 children - 68,75%). Muscle pain was present in 9 (56%) children, hyperesthesia - in 4 (25%) children, gastrointestinal symptoms - in 8 (50%) our patients. Myocarditis was diagnosed in 4 (25%) children, linear dilatation of coronary arteries (2 children - 12,5%) and small aneurysms (1 child - 6,25%) - in 3 (18,75%) our patients. All these changes returned to normal 1 month after discharge from the hospital. Conclusions. The syndrome of multisystem inflammatory response before the 48th day after acute coronavirus disease and is characterized by typical clinical course. Treatment with human immunoglobulin at the dose of 1-2 g/kg, glucocorticosteroids at the dose of 1-2 mg/kg, aspirin 3-5 mg/kg against the background of antibacterial therapy is effective for the prevention of changes in the coronary arteries and for the recovery of all patients. The research was conducted in accordance with the principles of bioethics set out in the WMA Declaration of Helsinki and Universal Declaration on Bioethics and was approved by the Commission on Ethics of Scientific Research, Experimental Developments and Scientific Works of Danylo Halytsky Lviv National Medical University. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: COVID-19, pediatric inflammatory multisystem syndrome, pediatric multisystem inflammatory disease, COVID-19 related, MIS-C associated with COVID-19, PIMS-TS.

НАУКОВО-ПРАКТИЧНА КОНФЕРЕНЦІЯ X МІЖНАРОДНІ РІЗДВЯНІ ЧИТАННЯ У ЛЬВОВІ «COVID-19, LONG-COVID-19, ПОСТКОВІДНИЙ СИНДРОМ: ЇХ БАГАТОЛИКІСТЬ ТА ІМУННІ ПОРУШЕННЯ»

Traditionally, before the beginning of the Christmas season in Lviv, the Department of Clinical Immunology and Allergology of Danylo Halytsky Lviv National Medical Uni- versity, headed by the Honorary Doctor of Ukraine, Doctor of Medical Science, Pro- fessor Valentyna Chopyak, organizes inter- national conferences on clinical immunolo- gy, allergology and related disciplines. This year, which is the tenth anniversary of this tradition, the Conference, held on December 9-10, was dedicated to the most urgent issue of the year “COVID-19, LONG-COVID-19, POST-COVID-19: THEIR MULTIPLICITY AND IMMUNE DISORDERS”. The conference was organized jointly with the Ministry of Health of Ukraine, NAS of Ukraine and NAMS of Ukraine, Danylo Halytsky Lviv National Medical University, Department of Health of Lviv Regional Administration, Lviv Regional Clinical Diagnostic Center, LLC “Lviv Medical Institute”, Ukrainian Society of Immu- nology, Allergology and Immunorehabilitation and the Shevchenko Scientific Society.

ЗДОБУТКИ В СФЕРІ НАУКОВОГО РЕДАГУВАННЯ ТА КОМУНІКАЦІЙ (ЧАСТИНА 4)

Traditionally, 2 webinars and a meeting of the editorial board of the journal “Рroceedings of the Shevchenko Scientific Society. Medical Sciences” took place online with the initiative and support of Danylo Halytsky Lviv National Medical University, the Shevchenko Scientific Society and the Council of Scientific Editors of Ukraine. The webinars took place in the first half of 2022 as a continuation of a series of lectures and workshops for Ukrainian scientists aiming to get acquainted with the latest trends in writing and editing qualified scientific publications. Researchers, who registered for the event, had the opportunity to join to Zoom meeting or watch the broadcast and its recording on the Facebook journal’s page “Рroceedings of the Shevchenko Scientific Society. Medical Sciences” or Youtube channel (https:// www.youtube.com/channel/UC40L7KlZ5UU4hrMj_--yqHw). All registered participants received certificates indicating a certain number of points of continuous professional development. After each webinar, participants had the opportunity to ask questions and join the discussion.

ЗАЯВА НА ПІДТРИМКУ АКАДЕМІЧНОЇ СПІЛЬНОТИ УКРАЇНИ

In 2017, I was invited by Dr. Zayachkivska, Chair of the Physiology Department in Danylo Halytsky Lviv National Medical University, to participate in a scientifi c conference at your institution in Lviv. I had the pleasure of discussing the neurobiology of PTSD, evaluating the work of your young scientists, and, of course, meeting many of you, I very fondly recall our time together in your beautiful city. Since then, we have maintained contact. I’m honored to be editor and reviewer for the Proceedings of the Shevchenko Scientifi c Society nowadays. Today I would like to express my unequivocal solidarity with you and with all Ukrainians, who are resisting the unprovoked, totally unjustified and brutal war being waged against you by the Russian Federation. Along with the rest of the civilized world, I recoil in horror at the indiscriminate bombing of hospitals, schools, and homes and the murder of so many innocents, including women and children. Know that I, and countless others like me, are with you in our thoughts and in our actions. We condemn the brutal and illegal acts of Putin’s regime. I call on members of the global academic community to recognize that, as scientists, we cannot sit idly in our laboratories or offices while war crimes are being committed in front of our eyes. We have a moral obligation to end this wanton killing and destruction. Let us urge our respective governments to continuously increase economic and political pressure on the Russian Federation to immediately stop the war. In the interim, we need to demand a no fly zone to allow those who wish to leave safe passage and allow humanitarian aid to reach those living under siege in basements and bunkers, often without food, water, and medical assistance. In parallel, our countries need to be prepared to receive refugees and to provide financial support to Ukraine as she fights for her existence. In addition, I call on all my colleagues to personally and through their institutions suspend all academic activity with scientists and institutions in the Russian Federation, with two exceptions. We should continue collaborations that impact direct clinical care. We cannot descend to the abject evil practiced by those who have lost their humanity. We should also recognize and reward those colleagues in the Russian Federation who declare their opposition to the systematic and wide-ranging violence their government is engaged in. The suspension of academic contacts must continue until the killing stops and the armed forces of the Russian Federation leave every part of Ukraine’s territory. I also have this appeal to academics and scientists in the Russian Federation. We know that Russia’s descent into its present autocracy has been gradual. We also know that many of you are quietly opposed to the ongoing crimes against humanity. There is no animus towards Russians as a people. There is, however, revulsion and righteous anger at the actions of the Russian Federation, which is supported actively or tacitly by many. Yes, I recognize that if one or two scientists or academics voice an objection, they may be demoted, fired, or even imprisoned. However, if thousands of you stand up at the same time, nothing will happen. Putin’s regime knows that Russia cannot function without its scientists and academics. Today, everything is transparent. When this nightmare Russia is trying to impose on the world ends, as it inevitably will, it will be apparent to all who profited and actively supported a criminal regime, who sat on their hands and waited, and who spoke out boldly against a totally unnecessary but increasingly brutal war that is being waged ostensibly in their name. If you all speak in a mighty voice together, Putin and his regime will be paralyzed. They need you. You do not need them. Let all of us, in academic institutions, hospitals and laboratories around the world work together for the cause of truth and justice and demand respect for the rights accorded to each person on our earth. In closing, I speak again to you, my dear Ukrainian colleagues. I pray that the war ends swiftly and that all of you, along with family, friends, and the entire Ukrainian nation, prevail. May the day soon arrive when we can meet, discuss science, plan possible collaborations, linger over a coffee, and just enjoy each other’s collegiality in your most wonderful country. March is the month of commemoration of the poet Taras Shevchenko. It is fitting to recall his words. “Fight – you’ll win the fight.” Glory to Ukraine! Glory to Herous! Slava Ukraini! Heroyam Slava! https://youtu.be/Q_f-aKUtAEY

Vydovyi spektr bakteriinykh chynnykiv shpytalnykh infektsii dykhalnykh shliakhiv u likarnianykh ustanovakh m. Lvova ta poshyrenist sered nykh antybiotykorezystentnosty

Introduction. Healthcare-associated infections (HAIs) are a pressing problem in the health care system. Respiratory tract infections (RTI) are the second most common group of HAIs. One of the determining factors in the development of nosocomial pneumonia, which is predominantly bacterial in origin, is the properties and level of virulence of microbial factors. Early nosocomial pneumonia occurs when the upper respiratory tract microbiota infects the respiratory tract. Late nosocomial pneumonia is caused by nosocomial strains of microorganisms, characterized by multidrug resistance to antibiotics and disinfectants high levels of virulence, which include P. aeruginosa, Acinetobacter spp., Enterobacteriaceae family, MRSA. Unfortunately, in Ukraine, the structure and prevalence of HAIs and the antimicrobial resistance of pathogens are extremely poorly studied. The aim of the study. Therefore, the study investigates the species spectrum and antimicrobial resistance of the main causative agents of respiratory tract infections. Materials and methods. A study of microbial factors of nosocomial respiratory tract infections in 4 hospitals in Lviv. 205 patients of intensive care units diagnosed with RTI (36.6 %) were examined. Statistical analysis of the results was performed using the standard package of the program “Microsoft Excel 2010”. Microbiological diagnostics were performed following current regulations in the specialty “Bacteriology and Virology” and “Guidelines for Clinical Microbiology” of the 12th revision of the American Association for Microbiology. Microbiological diagnostics is performed in the research laboratory of the Department of Microbiology of Danylo Halytsky Lviv National Medical University. Results. The species profile of the detected pathogens of RTI indicates that among 14 representatives of different taxa, the gram-positive microbiota predominates, but the quantitative level of seeding per gram-negative microbiota accounts for 70.17 %. Among the isolates – factors of HAIs, multidrug-resistant (MDR) share accounted for 62.8 %. 3 strains are classified as pan drug resistant (PDR): 2 – P. putida and 1 – P. aeruginosa. Of the gram-positive microbiota, Enterococcus spp., represented mainly by E. faecalis and E. faecium, was most often detected in clinical material. E. faecalis was most often detected in the clinical material of the gram-positive microbiota. E. faecalis isolates were characterized by pronounced resistance to penicillins (including oxacillin), cephalosporins, fluoroquinolones, erythromycin and azithromycin, clindamycin with preserved sensitivity to vancomycin and linezolid. Pseudomonas aeruginosa isolates showed absolute sensitivity to colistin. Among other antibiotics, the most effective in terms of the number of sensitive strains were carbapenems – imipenem (57.5 %) and meronem (55.0 %). Only 37.5 % of the cultures were sensitive to tobramycin and tegicillin, an inhibitor of the protected cephalosporin antibiotic, sulfperazone. The genus Staphylococcus was among the causative agents of pneumonia other than Staph. aureus subsp. aureus, will Staph. haemolyticus, Staph. lugdunensis. Moreover, only one strain of methicillin-resistant Staphylococcus was detected. Most cases of RTI (57.4%) of patients in intensive care units occurred within 48 hours after the installation of a tracheostomy or intubation tube. Conclusions. According to the results of microbiological diagnostics, it has been established that the main etiological factors of nosocomial pneumonia associated with medical care are opportunistic microorganisms – Pseudomonas aeruginosa and enterococci. 62.8 % of strains were MDR. Furthermore, the results of monitoring the antibiotic resistance of hospital strains of microorganisms show their differences in different institutions of Lviv and the connection exclusively with the hospital environment. Therefore, optimization of antimicrobial treatment of nosocomial pneumonia is possible only based on the broader use of microbiological research results, constant monitoring of the microbiological status of patients in intensive care units, hospitality (distribution and properties of pathogens in hospitals).

Vaktsyna Rudolfa Vaiglia u borotbi z vysypnym epidemichnym tyfom

Introduction. Vaccination has made a breakthrough in history by overcoming the infectious diseases that have plagued humanity for millennia. The twentieth century was marked by the invention of vaccines against epidemics typhus, which have become the only salvation in overcoming this disease. The history of the vaccine was developed on the example of the first effective vaccine against epidemic typhus, developed by a prominent Polish scientist, professor at the University of Lviv Rudolf Weigl, the history of vaccine development and the method of culturing R. Prowazekii in the intestine of Pediculus humanus corporis was studied. From Rickettsia Рrowazekii – the causative agent of epidemic typhus transmitted by aphids (Pediculus humanus corporis) in the history of mankind killed more people than in all known wars. Brazilian researcher Enrique da Rocha Lima differentiated described in detail and gave a specific name to the causative agent of typhus in 1916. In 1920, GW Epstein, as well as S. Burt Weilbach, John L. Todd and FW Palfrey in 1922 confirmed the etiological significance of R. Prowazekii in the presence of typhus. Biological and morphological characteristics, the life cycle of the pathogen and the impossibility of reproduction on artificial nutrient media were established. The aim of the study. According to the study of scientific sources to investigate the history of the technology of R. Weigl vaccine against epidemic typhus from its first series obtained in the laboratory and from 1930, when its production began, the period covering the 20-30s of the twentieth century. To establish that the scientific achievements of the scientists are not only the history of microbiology and virology, it is relevant today. Materials and methods. Content analysis, a method of systematic analysis of research on the typhus vaccine, was used. The implementation of scientific research began with a retrospective analysis of the scientific works of R. Weigl and his students. Selection of sources was carried out in the archives and scientific libraries of Lviv and the Research Institute of Epidemiology and Hygiene of Danylo Halytsky Lviv National Medical University, in scientometric databases PubMed, Medline, Web of Science, Google Scholar by keywords: lice, typhus, rubella, R. Prowazekii. 174 scientific works in English, Ukrainian, Polish, French and Russian were analyzed and sources were selected in which the issue of creating a vaccine against typhus, technology of its production, efficiency of application was covered. Results. The vaccine, developed by Professor Rudolf Weigl, author of the method of cultivating and accumulating the causative agent of this disease – R. Prowazekii in the intestine of the laboratory population of lice, despite the complexity of its preparation, for over 20 years was the only immunobiological drug to control typhus. Conclusions. We should be grateful to Rudolf Weigl and his students, who have often studied R. Рrowazekii at the cost of their lives and developed a vaccine against typhus, which has killed millions of people on our planet. Vaccination with a full dose of R. Weigl’s vaccine does not guarantee protection against infection, but reduces morbidity, completely eliminates mortality and facilitates the course of epidemic typhus.