Zaporizhzhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine

In patients with COVID-19, histological examination of the pulmonary vessels shows serious disorders (local thrombosis and microangiopathy), significantly different to those in the control group composed of patients with influenza. Some studies have shown that coronavirus enters cells by binding angiotensin-converting enzyme 2 which is found mainly on the alveolar epithelium and endothelium. The increase in D-dimer levels is typical for patients with COVID-19. Although many inflammatory processes can affect D-dimer levels, an increase in D-dimer during COVID-19 is more likely to indicate thrombosis. The aim. To analyze the patients who have suffered from COVID-19 and to determine possible risk factors for the development of thrombotic complications and define the surgical or medical therapy tactics. Material and methods. The study was conducted from October 2020 to April 2021 in Ukraine (Zaporizhzhia, Uzhhorod, Kherson and Kyiv). We analyzed 121 patients aged 46.9± 15.3 years, 64 (52.8%) men and 57 (47.1%) women. All the patients had positive PCR test for COVID-19. The changes in D-dimer were analyzed. Results. Forty-one (33.9%) patients had thrombotic complications. Pulmonary embolism (PE) was diagnosed in 14 patients, deep vein thrombosis (DVT) in 17, acute stroke in 2 and peripheral artery thrombosis in 8 cases. An increase in D-dimer level was observed in most patients and was not associated with clinical manifestations of thrombosis. At a D-dimer level of 11,000-10,564 ng/ml the patients had clinical symptoms of thrombotic condition which was confirmed by computed tomography or ultrasound examination. At an increase over 725-7000 ng/ml, there were no clinical signs of thrombosis. We performed standard medical therapy in patients with PE and DVT. In case of arterial thrombosis open surgery was performed in 4 patients and direct catheter thrombolysis in 1 case. Conclusion. In our opinion, anticoagulants should be prescribed for patients with a D-dimer level of more than 700 ng/ml. Full anticoagulation is prescribed for severe forms of COVID-19 or confirmed thrombosis. We didn’t find any correlation between the development of thrombotic complications in patients with COVID-19 and comorbidities, body mass index and other factors. Medical therapy was successful in all cases of PE and DVT, anticoagulants were prescribed for 1 year. Femoral artery thrombectomy was successfully performed in 4 patients. After direct catheter thrombolysis we got peripheral pulse. In all cases of arterial thrombosis, we prescribed anticoagulants for 2 months after discharge and acetylsalicylic acid for a long time.

Abstract. The goal of the study was to investigate the effect of magnesium orotate as a part of complex therapy in sinus rhythm restoring in patients with AF paroxysm, as well as to evaluate its effectiveness and effect on LQo with long-term use. Materials and research methods. We examined 56 patients (16 women and 40 men) with an average age of (61,5 ± 4,3) years with paroxysmal atrial fibrillation. All patients were divided into two groups. Patients of the 1st group (n=28) underwent medical cardioversion with amiodarone and magnesium orotate. Patients of the 2nd group (n=28) received only amiodarone. The time of sinus rhythm restoration, parameters of electrical instability of the atrial and ventricular myocardium after sinus rhythm restoration, patients life quality 3 months after discharge - were assessed in both groups. Results. The study allowed to reveal that the addition of magnesium orotate to the basic therapy of patients with atrial fibrillation increases the effectiveness of medical cardioversion and reduces the time of its onset. When using amiodarone and magnesium orotate, signs of electrical instability of the atrial myocardium (the number of paired and supraventricular extrasystoles) are significantly less according to the results of Holter electrocardiogram monitoring compared with amiodarone monotherapy. Atrial fibrillation caused a life quality parameters deviations in the form of an increase in the severity of the disease symptoms, physical activity limitation and psycho-emotional sphere disorders. 3 months after the treatment, it was noted that life quality in patients of the 1st group (complex therapy using magnesium orotate) was higher compared to patients of the 2nd group due to the improvement in the indicators of the "psycho-emotional" component. Conclusions. The addition of magnesium orotate to the basic therapy of paroxysmal atrial fibrillation can significantly improve the clinical course of the disease in patients and their life quality after 3 months treatment period.

The problem of cancer during the war and after the end of hostilities in Ukraine will worsen. According to some estimates, cancer incidence and mortality in our country may exceed the pre-war level. Along with exposure to carcinogens, important factors that influence the development of cancer in people after the war are the massive demographic movements of the population, which increase the risk of transmission of oncogenic bacteria and viruses, such as Helicobacter pylori, Epstein-Barr virus, hepatitis B and C viruses and human papilloma virus. Sexually transmitted infections, including as a result of violence against civilians, occupy a special place in this series. Today in Ukraine there is not only an urgent need for oncological screening, but all the possibilities for this. Self-sampling technology for cervical cancer screening is indispensable and has no alternative. They allow for mass surveys of the population, refugees and displaced persons affected by hostilities, without diverting health care resources for this. The Qvintip test from the Swedish company Aprovix can be used not only to detect oncogenic human papillomavirus DNA strains, but also for PCR diagnosis of most sexually transmitted infections - bacterial vaginosis, candidiasis, gonorrhea, chlamydia, detection of trichomonas, ureaplasma, mycoplasma, treponema. Screening in Ukraine is financed by the non-governmental non-profit organization of the charitable Foundation "World Against Cancer", created in the first days of the war.