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Annual congress of the European Society of Cardiology was held on August 27−31, 2016 in Rome, where 4 new texts of Clinical Guidelines for the diagnosis and treatment of acute and chronic heart failure, prevention of cardiovascular disease in clinical practice, treatment of dyslipidemia and atrial fibrillation as well as a consensus document on cardiovascular toxicity in cancer treatment were presented. The greatest interest was aroused by the results the newly presents 28 specially selected clinical trials, which are traditionally presented at Hot Line sessions. Hot Line I, Heart failure and Innovative Approaches, stressed that the predictive efficacy of preventive use of implantable cardioverter−defibrillator was proved only in patients with systolic chronic heart failure of ischemic origin. Hot Line II, Preventive Strategies 1, considered preventive strategies in patients after percutaneous coronary intervention. In particular, the need for individualization of antiplatelet therapy was emphasized, the hypothesis about the possibility of limiting the size of myocardial infarction with a combination of N−acetyl cysteine and nitroglycerin was studied. Hot Line III, Prevention and Lipids, noted that after acute coronary syndrome high−intensity statin therapy was recommended. Hot Line IV, Coronary Artery Disease and Imaging presented the first randomized study that assessed the value of optical coherence tomography, compared the findings of positron emission tomography, single photon emission computed tomography, coronary computed tomography. Hot Line V, Coronary Artery Disease and Stenting, presented the largest randomized study of modern drug−coated stents. Hot Line VI, Preventive Strategies 2, demonstrated the results of testing of drugs for alternative treatment of patients with non−valvular atrial fibrillation undergoing electrical cardioversion, andexanet alpha, used to control major bleeding associated with administration of factor Xa inhibitors and estimated modified algorithm of pulmonary thromboembolism diagnosis.

The purpose of the work was to study daily blood pressure features in patients with hypertension combined with dyslipidemia and without it, to assess the combination therapy effect of perindopril (ACE−inhibitor), nebivolol (beta−blocker) and atorvastatin (statin) on daily blood pressure profile and lipoprotein levels. The study involved 60 hypertensive patients aged 60−80 who were randomized into two groups according to the presence of dyslipidemia. Clinical efficacy of the treatment was assessed using a standard method of daily blood pressure (BP) monitoring before and 12 weeks after the treatment onset. There were four types of daily BP profiles: dipper, non−dipper, night−peaker, over−dipper. The level of cholesterol, HDL−cholesterol, triglycerides (TG) was determined using enzyme colorimetric method. VLDL−cholesterol level was calculated using the formula (Friedewald W.T.): TG ? 0.45; LDL−cholesterol level was calculated using the formula: LDL−cholesterol = cholesterol (HDL−cholesterol −− VLDL−cholesterol). The patients received perindopril 8 mg/day, nebivolol 5 mg/day, atorvastatin 10 mg/day. Statistical data processing was carried out using Statistica 6.0 for Windows. Combination of dyslipidemia and hypertension occurred in 30 (50 %) patients (group 1), hypertension without dyslipidemia was diagnosed in 30 (50 %) patients (group 2). Hypertension in patients lasted for 12,5±1,2 years. The initial level of daily systolic BP in group was 153.0 [145.0; 163.0] mmHg, after 12 weeks of treatment it reached 127.0 mmHg [118.0; 132.0] (p = 0.002), the average level of diastolic BP decreased from 93.0 [87.0; 98.0] to 78.0 [69.0; 84.0] mmHg (p = 0.003). In group 2 after 12 weeks of treatment, the average systolic BP decreased from 149.0 [142.0; 158.0] to 125.0 [118.0; 131.0] mmHg (p = 0.004), and diastolic BP from 89.0 [83.0; 95.0] mmHg to 73.0 [67.0; 82.0] (p = 0.003). Target BP (< 130/90 mmHg) was achieved in 24 patients of group 1 (80 %) and 25 patients 2 groups (83 %). The findings of monitoring blood pressure and lipid metabolism in patients with hypertension and dyslipidemia demonstrated that significantly reduced percentage of daily physiological CAT profile of the dipper ide4creased and the percentage of pathological types of night−peaker and non−dipper increased; the latter had a direct correlation with increased content lipid profile indicators. Combination therapy with perindopril, nebivolol, atorvastatin normalizes circadian rhythm of blood pressure and reduces atherogenic potential of blood plasma, which makes appropriate and pathogenically substantiated its use and allows reducing cardiovascular risk.

Buccal epithelial cells play an important role in immune response of the macroorganism at contact with Candida albicans, but its adhesive properties in patients depending on the disease severity has not been established. The aim of the investigation was to study the ability of buccal epithelial cells to adhesion of the reference strain Candida albicans in patients with candidiasis of the mucosa of the upper portion of the digestive tract depending on the depth of its damage and interrelation with the indices of the system of antifungal resistance. The investigation involved 66 patients divided into three groups: with oropharyngeal candidiasis and superficial growth of fungi in biopsy materials of the esophagus and stomach; with fungi invasion to the mucous membrane; without oropharyngeal candidiasis and without fungi growth in biopsy materials. The findings demonstrated that average number of Candida on one epithelial cell was within the range of average degree of adhesiveness. The index of the number of involved in the adhesion cells was significantly higher in patients of group 2 compared with the group 1 (р < 0.05). Index of adhesiveness of buccal epithelial cells in patients with fungi invasion was higher compared with patients with oropharyngeal candidiasis and superficial candidiasis (р < 0.05). The increase of this index depended on the level of seromucoids, level of immunodeficiency with correlation leukocytes/T−lymphocytes, immunoglobulin level and negatively correlated with lactoferrin in the saliva and gastric juice as well as ceruloplasmin. Thus, the obtained findings suggest an important role of buccal epithelium as an integral part of mucosa antifungal resistance.

The increase in the number of vascular reconstructions performed in infrainguinal segment results in increase of the number of patients requiring reoperation for long−term complications after surgical revascularization of the extremities. To determine the optimal amount of re−intervention in thrombosis of femoropopliteal bypass, or at its inadequate functioning at stenotic lesion of the outflow pathways, the authors analyzed the results of surgical treatment of 75 patients. In 100 % of cases of atherosclerotic occlusion of the superficial femoral artery, the first stage of the distal femoropopliteal bypass was performed. As repeated operation, endovascular dilatation of stenoses of the distal zone (below the level of the distal anastomosis), tibial or (single, double) tibial artery bypass grafting, thrombectomy from the graft supplemented by the second level (tibial or (single, double) tibial bypass surgery); regrafting (repeated femoropopliteal or distal tibial) were performed. Determining the amount of re−intervention in the bloodstream included maximum possible number of tibial arteries and collaterals. Maximum use of the reserves of the peripheral channel when performing repeated operation for thrombosis of the graft ensured positive results in 82.7 % of cases; the results of repeated reconstruction were better than at preventive endovascular dilatation; preservation of shunt unloading at the level of the intermediate anastomosis with popliteal artery proved to be effective.

In recent years, increasing sexual culture and public awareness has led to the number of patients who wish to obtain an adequate treatment for penile deviations, including congenital ones. Until now, a perfect standard method of surgical correction of deviations of the penis has not existed. Selection of the surgical method should to be determined together by physician and patient depending upon the type and degree of deviation, the length of the penis and the patient's preferences. Aim of study was to develop and investigate the effectiveness of new technique of tunica incision and tunicoplication vs. other techniques of penile deviation correction. The study involved 18 patients who underwent tunicoplication with ellipse resection of the longitudinal (external) layer of the tunica albuginea. The follow−up period lasted for 0.5−2 years. The investigation demonstrated absence of deviation in 16 patients. All patients had an adequate sexual life and were satisfied with it. The combined method of tunica placation in combination with ellipsoid resection of the longitudinal (external) layer of tunica albuginea in patients with congenital isolated penile deviation allows to achieve good results at the expense of minimizing development of possible postoperative complications, which are observed after resection of all layers tunica albuginea and tunica placation as an independent method of operative correction.

Today, ultrasonography is one of the most informative methods of examination in obstetrics. The areas of its use in obstetric practice is extensive: fetometry of the fetus, diagnosis of developmental defects; evaluation of fetus condition in different periods of pregnancy; control of invasive procedures. The use of ultrasonography in obstetrics for prenatal diagnosis contributed to a significant reduction in perinatal mortality. Doppler mapping made it possible not only to evaluate the function of the cardiovascular system of the fetus but also placental circulation. Ultrasonography is also informative in the diagnosis of ectopic pregnancy. Since the method safety to the mother's body, and especially the fetus, causes a lot of questions in the patients, the American Society of Obstetricians and Gynecologists and the National Institute of Health formulated the main indications for it. It is important to note that although the risk to the fetus is minimal, it should be used when indicated. Two types of ultrasonography in pregnant are distinguished: standard and target. In practice, the method is most often used in non−compliance of the uterus and pregnancy term, suspected intrauterine fetal growth retardation, poly− and oligohydramnios, which may be the signs of the disease of the central nervous system, kidney or gastrointestinal tract of the fetus, Regular ultrasonography can prevent many complications of pregnancy, helps to clarify the period of pregnancy and to evaluate development of the fetus, delivery time and choose the drugs for medical treatment (tocolytics, drugs to accelerate fetal lung maturation, etc.). It is emphasized that the quality of ultrasound depends not only on the three−dimensional modern hardware, but also the qualifications of the doctor, his capacity for scrutiny of what he saw on the screen of the device.

In the structure of hyperplastic processes of the myometrium nodular leiomyoma occurs in 25−30 % of women of reproductive age and is the most common benign tumor of the female reproductive system. Today the leading role in the diagnosis of hyperplastic processes of the myometrium is played by ultrasound color Doppler mapping. To study the differential criteria of ultrasonography and clinical efficacy of microencapsulated diindolylmethane (DIM), a derivative of indole−3−carbinol, Balansid ™ (Naari, Switzerland) as monotherapy for small nodular leiomyoma of the uterus, a clinical ultrasound investigation was done in women of reproductive age. The analysis of the results of clinical investigation and the findings of transvaginal ultrasonography with color Doppler shows that Balansid ™ produces a pronounced anti−proliferative effect on the cells of the myometrium due to direct interaction with estrogen receptors, normalizes the metabolism of estrogen, stimulates the process of phosphorylation of estrogen−receptor proteins and aid in production of effective 2−hydroximetabolotes. Balansid administration as monotherapy in a cyclic mode at least for 6 months in women of reproductive age with small nodular uterine leiomyoma is pathogenetically substantiated and appropriate. The drug is safe, has no side effects and can be recommended for use in clinical practice.

Treatment of men with pathospermia against a background of metabolic syndrome (MS) depends on the body mass index (BMI), severity of the common manifestations of MS, its duration, disorders of sexual function. The existing schemes of therapeutic recovery of androgen function in men with metabolic syndrome are ineffective in the majority of cases, thus justifying the search for new methods of treatment for pathospermia. Analysis of treatment for pathospermia in men with metabolic syndrome with the drugs that improve and stimulate testicular blood circulation was performed. Besides the lifestyle correction, administration of vasoactive drugs and statins, human chorionic gonadotropin was added to the treatment protocol. The treatment quality was assessed by comparison of baseline levels of hormones and lipid profile before and 12 weeks after the prescribed therapy. The hormone levels before and after treatment (combination of cardiovascular drugs, statin, human chorionic gonadotropin), normalization of lipid metabolism, adherence to strict guidelines on the weight loss, correction of the lifestyle demonstrated the prospects of the method of pathogenetic treatment for pathospermia in men with MS and increased BMI. The increase in total testosterone in patients with hypogonadism is an additional advantage of this type of therapy.

Retrograde ejaculation (RE) is a major psychological and reproductive problem for men. To treat functional RE (administration of adrenoblockers, diabetes, polyneuropathy) alpha−adrenomimetics or correction dose of adrenoblockers are usually used traditionally. The treatment of organic RE (prostate anomaly, status after TURP) is still an unsolved problem. A comprehensive examination and treatment of 27 patients with RE were performed to compare the efficacy of different methods of treatment. The dose of adrenoblockers correction with imipramin, midodrine, slow−absorbable gel of hyaluronic acid in the posterior segments of the prostatic urethra were used. The findings of the investigation demonstrate that introduction of slow−absorbable gel hyaluronic acid in the posterior segments of the prostatic urethra is an effective, noninvasive method for treatment of functional RE, especially when the traditional treatment is ineffective.

Malignant tumors of the head and neck are extremely important problem of modern oncology. However, there is still no correct and optimal approach to the treatment of such patients. One of the ways to improve the results of treatment is intra−arterial chemotherapy, which was introduced in 1950 by American oncologists as a part of palliative treatment in combination with radiation therapy. With the advent of implantable subcutaneous ports the interest in this technique has increased significantly. Many authors have noted reduction in complications associated with arterial approach; different options of catheterization have been suggested. Introduction to the clinical practice of angiography and CT angiography has improved the performance and simplified certain aspects of intra−arterial chemotherapy. Despite the 60−year period of its use, randomized prospective studies that would objectively demonstrate the benefits of intra−arterial chemotherapy are lacking. At the meantime, the number of publications about this technique in malignant tumors of the head and neck allow to consider it an effective and prospective method, which requires further study.

Prostate cancer is one of the most common forms of malignancy. An important parameter of its successful treatment is improvement of the quality of life of patients. With this purpose, the indicators of health−dependent quality of life of patients with metastatic hormone−naive prostate cancer treated with combination chemohormone therapy based on mitoxantrone, were investigated. FACT−P questionnaire was used as a research tool. The pain was characterized using an abridged version of BPI−SF questionnaire. The questionnaires were filled in 9, 20, 28 and 44 weeks after starting the course of treatment. Analysis of the results of investigation of health dependent quality of life showed advantages in patients of the group with combined chemohormone therapy at assessing the dynamics of the total score of four general domains and proportions of patients with noticeable improvement. These differences were statistically significant at week 28 and 44. The main advantages were recorded in the domains of «social condition» and «emotional condition» at all time points. Dynamics of the mean score of pain, as well as analysis of the proportion of patients reported improvement according to the BPI questionnaire, showed distinct priorities of combination chemohormone therapy during the observation period.

Breast cancer (BC) is the most common tumor in women; in 12 % of cases it is revealed at the age of 20−34, that is at the height of reproductive function. Given that the treatment for breast cancer often includes chemotherapy and hormone therapy, which negatively impact the reproductive function, its evaluation is important. It is more likely for those women who were did not have pregnancy before the diagnosis. The test of ovarian reserve, which includes determining the level of follicle−stimulating, luteinizing anti−Mullerian hormones, estradiol, inhibin B, and antral follicle count on days 2−5 of the menstrual cycle, is one of methods to assess fertility. But performing these tests after chemotherapy for breast cancer shows that they do not reliably predict the response to ovarian stimulation. Numerous studies on the use of tamoxifen as hormone therapy have indicated possible teratogenic effects of this drug. Although the data are inconsistent due to the fact that a single strategy of hormonal therapy, taking into account the dose, duration, combination preparations. The search for chemotherapy regimens and hormonal therapy for treatment of pregnant women who are diagnosed breast cancer goes on.

Asthenic syndrome is a common state at chronic cerebral ischemia (dyscirculatory encephalopathy) especially at its initial manifestations. Ninety patients were investigated to evaluate and compare the effect of alpha−lipoic acid (Espa−lipon, Esparma) in ampoules and tablets on the dynamics of clinical changes in asthenic syndrome at chronic cerebral ischemia. The efficacy and safety of its application as antioxidant, metabolic neuroprotector in patients with chronic cerebral ischemia was confirmed. The state of cognitive functions was tested using Mini−study of mental status (MMSE) and Montreal scale on admission (visit 1), on day 10 (visit 2), day 30 (visit 3), day 60 (visit 4). Asthenic symptoms were evaluated using a subjective rating scale of fatigue (MFI−20), test ZAZZO−ZCT. Side effects of the drug were determined during the whole period of observation. Complex therapy with the alpha−lipoic acid was well tolerated by all patients. After the treatment, positive changes were noted in the cognitive status of the patients. The obtained findings indicate high performance, good tolerance and prolonged therapeutic effect of alpha−lipoic acid. The effectiveness of the drug in ampoules and tablets was similar at administration for 30 days. Administration of alpha−lipoic acid is fairly safe and is not accompanied by severe side effects.

One of the most important etiological factors of chronic hemodynamic disorders in the vertebrobasilar basin, especially in young people, is vertebral artery syndrome (SPA), (G 99.2 in ICD−10) including posterior cervical sympathetic syndrome, recurrent episodes of vertebrobasilar insufficiency, drop attacks and Unterharnscheidt's syndrome. There are a number of anatomical and physiological prerequisites for development of hemodynamic disorders in the vertebral artery system. An important feature of hemodynamics in the vertebrobasilar basin is that for development of disorders of blood circulation, persistent occurrence of functional blockades of the vertebral−motor segments is enough, which is possible even in children. However, despite the understanding of the pathogenetic mechanisms of the development of individual vertebral artery syndrome, to date the question the impact of myofascial dysfunction, neck and shoulder and localization biolocomotive spine disorders in general, the occurrence of symptomatic vertebral artery compression remains understudied. All these issues require further study and systematization. The leading pathogenetic mechanisms of vertebral artery syndrome, according to the majority of authors, are compression of the artery, vegetative plexus and narrowing of the lumen of the vessel due to reflex spasm resulting from the inferior oblique muscle tension in the head and anterior scalene muscle, which leads to reduction in the blood supply of the posterior division of the brain and development of circulatory insufficiency in the vertebrobasilar basin. However, the question about the impact of myofascial dysfunction of the neck and shoulder and biolocomotive spine disorders in general on the occurrence of symptomatic vertebral artery compression remains understudied. The criteria of pathobiomechanical changes that cause this syndrome have not been worked out, there is no differentiated therapeutic approach to treatment of such patients. All these issues require further study and systematization.

Alopecia areata (AA) is currently considered a tissue−specific autoimmune disease, which is mediated by autoactivated T−lymphocytes in conditions of immune tolerance (IT) impairment of the hair follicles and presentation of their own autoantigens. Melanocyte− and/or antigen−associated autoantigen of hair follicles (keratin 44/46 kDa and trichohyaline) are considered autoantigens in the majority of cases. Genetic predisposition and trigger factors lead to deactivation of immunosuppresive cytokines and factors of growth, which stimulate peripheral tolerance. Degranulation of mast cells and intensified production of TNF−? occur in the foci of AA. Active synthesis of IFN−? is observed, which stimulates expression of class II MHC molecules by follicular epithelium, which results in presentation of follicular autoantigens to CD8+ cells and loss of IT. IFN−? can also cause expression of class II MHC molecules by follicular epithelium, which leads to accumulation of CD4+ cells, which increase the activity of CD8+ cells due to synthesis of proinflammatory cytokines. During progressive stage of the disease a higher expression of adhesion molecules (ICAM−2 and ELAM−1) is recorded in perivascular and peribulbar zones of the involved area. Equally, the level of ligand Fas (a molecule which induces apoptosis of activated T−cells) is significantly decreased. Some genes associated with AA and other autoimmune diseases were identified. Increased emphasis is on ULBP3 (cytomegalovirus binding protein) (6q25), which codes activation of ligands of NK−cellular receptor NKG2D, which initiates autoimmune response.

The incidence of HIV/AIDS infection in Ukraine has increased dramatically. Patients with HIV/AIDS infection, a lot of fungal infections are disease marker and recorded frequently. HIV infection is characterized by a long incubation period, polymorphism of clinical manifestations, among which the most common are skin lesions appearing even when the serological status is negative. Due to the fact that HIV/AIDS infection has gone beyond the vulnerable groups (sex workers, injected drug users, etc.) the knowledge and alertness of doctors about unusual clinical manifestations of dermatoses may be a factor in the early diagnosis of HIV/AIDS. Timely diagnosis, treatment and anti−epidemic measures will reduce the incidence of HIV/AIDS infection in Ukraine. Treatment of concomitant HIV−related fungal skin lesions can improve the effectiveness of antiretroviral therapy. The clinical presentation, diagnosis and treatment of fungal infections in HIV/AIDS−infected patients were investigated. The literature on the etiology, pathogenesis, clinical picture, diagnosis and treatment of the skin and mucous membranes caused by fungi associated with HIV/AIDS was analyzed. The diagnosis of fungal infections in patients with HIV/AIDS infection will allow timely diagnosis of HIV infection as well as optimizing the treatment of these patients.

Human health is crucial at different stages of life, especially at a young age when the basis of professional development are formed, the young people are involved in the public, family and reproductive spheres. The health status of students is one of the important parameters of generalized health of the nation. The priority of education is to develop a responsible attitude to the own health and that of the environment as the highest social and individual values, therefore, the purpose of this work was to study the lifestyle of the first−year students of Kharkiv National Medical University. To study the lifestyle of the students, map questionnaire was compiled and used to do a sociological study of freshmen in 2014−2015. The questionnaire included the following sections: medical and demographic characteristics of the students; lifestyle and its characteristics; personal health characteristics and attitude to it. The results of the study showed that the lifestyle of freshmen was tense, caused fatigue and contributed to the risk of stress, disease−like states due to non−compliance to regime of the day, nutrition, inadequate physical activity and the presence of harmful habits. Thus, the aspects of lifestyle of the first−year students that direct the attention of doctors and teachers to preventive character of medical check−ups, were identified. Based on the obtained findings, a model of monitoring the health of medical students was created in order to follow−up their health for their correction and management. Investigations of this type can highlight serious problems, not only of medical character. Monitoring the health should control the culture of health, structure of social values, behavior, aimed at preserving the health and capacity of students.

The article features the issues of global climate change and its socio−economic, environmental and biomedical consequences. The study of the climate change in the temperate zone of the north hemisphere over the past 30−40 years showed its ambiguity in different territories, which is connected with the topography, distance from the seas and oceans, changes in the circulation processes. Warming is evident mainly in winter and spring, with the rates increasing by the end of the twentieth century. It should be noted that in Kharkiv region winter temperatures in January−March has also gradually changed. It has resulted in increased population percentage of more efficient malaria carriers (An. atroparvus by 17.3 %, An. maculipennis by 21 %), capable of sucking blood in winter period [11]. Since 2001, tropical transmissible zooanthroponosis (dirofilariasis) has been recorded in Kharkiv region, the carriers of which are p. Anopheles, Aedes, Culex. Definitive hosts are stray and domestic dogs. Over the past 6 years, more than 150 Dirofilariasis patients were registered in Kharkiv region. Twenty−one natural foci of Lyme disease were revealed. The epidemic process involved 41 inhabited localities. It can be concluded that global climate changes result in increase of the number of places of breed of sanguivorous diptera and ticks, changing biology and ecology of the carriers, increase of the number of carriers. It also results in redistribution of species composition of components of midges and all groups of ticks (Ixodidae, Gamasidae, Dermatophagoides, Acariformes) with the replacement of less efficient to more efficient carriers.