ЗМІНИ МОРФОГЕНЕЗУ КІСТКОВОЇ ТКАНИНИ ПІД ВПЛИВОМ ВАЖКИХ МЕТАЛІВ (огляд даних наукової літератури)Анотація.Важкі метали та їх солі часто використовуються в промисловості і входять до складу неорганічних і органічних сполук, гербіцидів, інсектицидів, пального і медичних препаратів.В довкілля солі кадмію та свинцю можуть надходити зі сталеливарних заводів, при спалюванні різних відходів, при зварюванні металоконструкцій та виготовленні пластмас.Високі концентрації кадмію містяться у тютюновому димі.Солі кадмію та свинцю здатні накопичуватись в довкіллі на різних рівнях екологічної піраміди.Потрапляючи до організму вони виступають у ролі поліорганних токсикантів акумулюються в печінці

ЕКСПЕРИМЕНТАЛЬНІ ДОСЛІДЖЕННЯ ІЗОЛЬОВАНОГО ВПЛИВУ СВИНЦЮ ТА У КОМБІНАЦІЇ ЗІ СПОЛУКАМИ ЦИНКУ НА ОРГАНІЗМ ВАГІТНИХ

The purpose of the study was to develop an optimal model of simulation and practical examination stations “hygiene and ecology” as components of objective structured clinical examination for the actualization of the formation of a preventive way of thinking among students of higher medical training. The paper analyzes the Passports of the simulation and practical stations of the objective structured clinical examination, their methodological and logistical support, which will allow to fully perform all the tasks and methods provided by the algorithms for mastering special professional competencies. The simulation station reproduces a number of real-life situations in specific tasks (25 options in total), the solution of which allows to assess the student's mastery of the professional competencies provided by the higher education standard, in particular: determining the risks to public health from the consumption of poor-quality drinking water, determining the nutritional status of the patient and the appropriateness of the prescription of therapeutic nutrition for the prevention of “diseases of civilization”, determining the requirements for compliance with sanitary and epidemiological requirements in health care facilities. The practical station is equipped with modern analytical instruments which allows the student to demonstrate their practical skills, in particular: bacterial air testing with evaluation of the results, research and evaluation of indoor microclimate parameters, research and evaluation of light environment parameters, measurement and evaluation of ionizing radiation, professional hand hygiene in health care facilities. To ensure high-quality training of students to perform the tasks of a practical station additional educational video guides were created, which are posted for general access on the department's page on the website of the University. Conclusion. Ukraine has now formed its own complex set of social, technogenic and environmental problems, which necessitates the development of appropriate skills and abilities in preventive medicine in future general practitioners. Objective structured clinical examination is a modern type of assessment of students' practical knowledge and skills, designed to test their acquisition of clinical skills and competencies that cannot be assessed by traditional forms of examinations. For the practical implementation of the preventive part of objective structured clinical examination in institutions of higher medical education, it should be taken into account that the traditional methods of protection and prevention, which have been developed by mankind over the centuries for the prevention of mass infectious, environmentally dependent, occupational and lifestyle diseases, in modern conditions are insufficient and/or ineffective

The training of foreign specialists in the field of medicine is one of the priorities of the development of higher educational institutions of medical education today. The issue of maintaining the quality of educational services is particularly acute. The main difficulties in providing high-quality educational services to students of other countries are overcoming linguistic, cultural and traditional features and the need to adapt the educational process to the specified requirements. Therefore, it becomes necessary to analyze methodical and methodological approaches used in education and to establish their effectiveness and compliance with the specified requirements. The purpose of the study was to establish the conformity of the methodology of teaching human anatomy to foreign students at the Department of Human Anatomy, Clinical Anatomy and Operative Surgery of the Dnipro State Medical University with the modern needs of the educational process. This article highlights the peculiarities of methodological approaches to teaching human anatomy to foreign students, which are used at the Department of Human Anatomy, Clinical Anatomy and Operative Surgery of the Dnipro State Medical University. Also, in order to determine the effectiveness of mastering the material from the subject, the academic performance of students of the foreign faculty for 5 years was analyzed, taking into account the indicators of absolute and qualitative success according to standard ECTS criteria, which made it possible to assess the adequacy of methodological approaches and formulate recommendations for improving the effectiveness of education. Conclusion. Methodological approaches and measures introduced at the department are adequate and sufficient to achieve a fairly stable and high level of success among foreign students. The specified methodical approaches can be used both for face-to-face and distance learning without loss of quality, which is confirmed by the absence of significant deviations of quality indicators in any direction when switching from face-to-face to distance form and vice versa. In order to achieve high results, a consistent approach to the presentation of the material, full provision of students with methodical material, and the implementation of consistent, systematic and adequate methods of monitoring the assimilation of the material is necessary, which is especially relevant among students of foreign faculties. The overall success rate also largely depends on the basic training of students, which must be taken into account when selecting foreign students for universities

The combined use of physiologically active compounds is aimed at optimizing their combined pharmacotherapeutic effect, which provides for reducing adverse reactions of ingredients, reducing their doses under conditions of potential synergism of the used components and increasing the convenience of taking ready-made medicinal forms. The purpose of this study was to assess the possibility of combined use, effectiveness and safety of azathioprine and methylprednisolone in the treatment of myasthenia gravis. Possible chemical reactions of the compounds were predicted based on the presence and reactivity of the functional groups included in their structure. The analysis of the acid-base properties of the compounds was carried out using the ACD/pKaDB and ChemAxon programs. Analysis of physicochemical properties and data on the interaction with enzyme systems for methylprednisolone and azathioprine suggests the absence of possible interactions between these drugs at the chemical and pharmacokinetic levels (with the need to adjust dosage regimens). At the pharmacological level, the combined therapeutic effect of methylprednisolone and azathioprine is expected to contribute to more effective treatment of multiple sclerosis by inhibiting the development and course of inflammatory reactions.

Purpose – to evaluate the low-dose effect of lead on the microelement state and the pre-nosological indicators of the health in preschool children living in conditions of its permanent impact. Materials and methods. Hygienic monitoring of lead, copper, and zinc in air, water, and foodstuffs was carried out in two industrial districts of Dniprо city and a “conditionally clean” district of a non-industrial city. To assess the prenosological state of health in the child contingent, 46 and 57 children from pre-school institutions in the observation areas city, aged 5 to 6 years and 20 children from the control area were examined in a similar way. Results. The average blood lead content in 70–100 % of children in industrial areas is 1.6–5 times higher than the normative and 9.5–30 times the control. In 33–66 % of the children examined in the industrial areas and 12 % of the controls, the urine lead concentration is 6.4–12.8 times higher than the standard. Hair lead concentration in preschoolers corresponds to the permissible level, but is 2–3.5 times higher than in the children from the control region, which was found in 73–78 % of the examined. Tooth lead concentration in the children from industrial areas is 4.6 times higher than the standard level recommended by WHO, and in the nail is 3.2 times the background values. The copper content in all biosubstrates of children is determined at the physiological level, and zinc – lower by 49–80 %. The elevated lead content in biosubstrates is accompanied by 1.2 and 1.9 times increase in urinary δ-ALA activity in the children from industrial areas as compared with the recommended norm, which was observed in 51–89 % of the children examined. Conclusions. The biochemical abnormalities identified in the body of children indicate the beginning of microsaturnism development, which in case of microelemental status violations, is the rationale for finding effective means of reducing the "lead pressure" on the child population health.

International scientific and practical conference «New trends and unresolved issues of preventive and clinical medicine» : Conference proceedings, September 25–26, 2020. Lublin : Izdevnieciba «Baltija Publishing», 2020. 428 pages.

Among the xenobiotics of diverse nature, heavy metals are especially dangerous for the human reproductive system in case of excessive intake. Cadmium, which is one of the most common toxic substances for the environment and production, can pose a potential threat to human health. An increasing amount of cadmium in the environmental objects and in nutrition is believed to be related to a poor semen quality. The purpose of the study was to determine the impact of cadmium on the reproductive potential of men who live in ecologically contrasting conditions. Material and methods. Clinical and hygienic assessment of the reproductive health was carried out among 2 experimental groups: the 1st group consisted of fertile men living in the city of Dnipro (62 respondents), the 2nd group included men with normal fertility living in the control city (37 respondents). To determine the cadmium concentration, venous blood samples and ejaculate were selected according to the standard methods. Biological samples were transferred to aliquots, frozen and stored at -20 ° C until analysis. The research was carried out using inversion voltammetry on the device AVA-2. Statistical processing of the results was carried out using statistical software packages of statistical analysis Statistica v.6.1 (StatsoftInc., США, licence NAJAR909E415822FA), Microsoft Excel. Results and discussion. Cadmium content in the blood and in the sperm of the fertile men of industrial city 1.3-5.8 times higher than the results of research in the control city and literature data. Differences between the cadmium content in the blood and semen of fertile men was shown to be unlikely, suggesting that the hematotesticular barrier is insufficient to protect the male reproductive organs from the toxic effects of the metal. The ejaculate in the fertile men of the studied cities is characterized by normosospermia and meets the standards. However in the residents of the industrial city the ejaculate quality indices were mostly at the lower level of the norm and were significantly worse than in the residents of the control city. Cadmium contained in male biosubstrates affect the hormonal status and quality of semen. Conclusion. Violations of spermatogenesis can serve as a rapidly-responding and reliable criterion for assessing the adaptation and maladaptation processes of men under the influence of xenobiotics of the environment, in particular cadmium. In this case, the markers of influence are the total number of sperm in the ejaculate, their concentration, mobility and the number of pathological forms, semen viscosity

Disorder of the relationship between biotic and abiotic elements against the background of anthropogenic stress on the human body affects the course of bone remodeling. It is bone tissue in the human body that has the greatest cumulative properties with respect to many xenobiotics, lead in particular. The accumulation of lead in the bone leads to the replacement of calcium ions by ions of the abiotic element and causes further changes in the bone structure: inhibition of growth processes, decreased density, the development of osteopenia and osteoporosis. In the article, a comparative hygienic analysis of bone mineral density levels (according to T-score) in industrial (n=68) and control (n=70) areas was conducted. The T-score, calculated at the LI-LIV level obtained by the method of dual-energy X-ray absorptiometry was used and was evaluated according to the recommendations of the WHO. The formation of a homogeneous sample of persons for the study was conducted according to the place of residence, age, sex, absence of diseases and regular intake of drugs leading to a decrease in bone mass. Summarizing the results, it should be noted that the population of Dniprо city has a more negative and significant decrease in the bone mineral density (according to the T-score) compared to the same values of the control areas – 2.15-4.6 times and Ukraine's – 1.39-4.21 times. According to WHO recommendations, T-score indices for residents of industrial territory indicate to the presence of osteopenia, while among residents of the control area, the norm for this indicator is noted. Consequently, there is an effect of man-made including lead, pollution of the environment on the level of bone mineral density in the industrial city this contributes to the development of osteoporotic changes in the population.

OBJECTIVE:Introduction: On the pharmaceutical market of Ukraine, there are six international non-proprietary names of proton pump inhibitors (PPIs) - Omeprazole, Pantoprazole, Lansoprazole, Rabeprazole, Esomeprazole, Dexlansoprazole, which differ in a number of pharmacokinetic and pharmacodynamic parameters, safety profile, range of dosage forms and their cost. The aim: To investigate the competitiveness of proton pump inhibitors registered in Ukraine by comparing the parameters of their quality properties using the method of qualimetric analysis.PATIENTS AND METHODS:Materials and methods: Qualimetric analysis is based on the deductive-axiomatic approach, which allows quantifying the qualitative properties of drugs and determining the degree of competitiveness of each of them in the pharmaceutical market of Ukraine. The qualitative properties of PPIs in terms of consumer are efficacy, safety, convenience of use and cost. The subject of the study was 133 trademarks of PPIs registered in Ukraine.RESULTS:Results: The highest qualimetric values were obtained by omeprazole (Kk = 0.73) and its S-isomer esomeprazole (Kk = 0.66). Pantoprazole was inferior to them to a certain extent (Kk = 0.64). Lansoprazole (Kk = 0.53), rabeprazole (Kk = 0.50) and dexlansoprazole (Kk = 0.44) had the lowest values of the quality indices.CONCLUSION:Conclusions: According to the results of the study of the PPIs' competitiveness for parameters characterizing efficacy, safety, convenience of use and cost, assessed by qualimetric analysis, it has been established that the most completely and qualitatively satisfying consumer's needs are omeprazole and its S-isomer, esomeprazole.

OBJECTIVE:Introduction: The problem of preserving and strengthening of the reproductive health of the population in conditions of the industrial regions is becoming one of the key. The aim: Тo determine whether blood and semen concentration of lead in fertile and infertile men without occupational exposure to lead is associated with semen quality and reproductive outcome.PATIENTS AND METHODS:Materials and methods: Clinical and hygienic assessment of the reproductive health was carried out in 192 men of the Dnipropetrovsk region, living in the industrial and control, conditionally «clean» city.RESULTS:Results: In the pathogenesis of male fertility, an important role belongs to the level of lead in biosubstrates, which is 1,2-2,1 times higher in industrial cities as compared to the normative level. Therewith, fertilizing properties of the ejaculate of the fertile men living in the industrial region comply with WHO standards, while in the infertile group various forms of pathology was revealed.CONCLUSION:Conclusions: Violations of spermatogenesis can serve as a rapidly-responding and reliable criterion for assessing the adaptation and maladaptation processes of men underthe influence of xenobiotics of the environment, in particular lead. In this case, the markers of influence are the total number of sperm in the ejaculate, their concentration, mobility and the number of pathological forms, semen viscosity.

Pollution of the environment remains a pressing problem of the global level. The greatest concern is caused by heavy metals, especially lead, which to the greatest extent - up to 90–95 % accumulates in bone tissue of the human body. Aim. The establishment of the bioeffect type of low-dose lead and zinc combined action on bone tissue density by the calcium content in it in the experiment. Materials and methods. For experimental studies Wistar rats were divided into 5 groups. To determine the type of lead and zinc effect on the calcium level in femur bone tissue the content of the latter by the titration method was identified. To evaluate the relationship between low doses of zinc and lead, the combined action coefficient and change of combined action effect coefficient were determined. Results. The analysis of the results shows that the type of lead and zinc low concentrations combined action in their influence on bone tissue density by calcium content in it is characterized as an antagonistic, since the combined action coefficient value was 0.32–0.39. The effect of subacute combined action in binary systems "lead acetate – zinc chloride" and "lead acetate – zinc citrate" is weakened by 2.6 and 3.1 times, respectively. Conclusions. The type of lead and zinc low concentrations combined action provided that they affect the bone tissue density of rats by calcium content in it, which do not exceed the threshold of general toxicity, is characterized as antagonistic, since the combined action coefficient = 0.32–0.39. The effect of subacute combined action in binary systems, "lead acetate – zinc chloride" and "lead acetate – zinc citrate" is reduced by 2.6 and 3.1 times, respectively, compared with their isolated effects, indicating active inhibition of bone tissue lead accumulation by zinc compounds, which is especially characteristic of zinc citrate.

Conclusions: Nutrition of fertile age and pregnant women, residents of industrial regions of Ukraine, does not meet the requirements of rational nutrition due to violations in diet, in quantitative and qualitative nutritional budget, excessive intake of xenobiotics and deficiency of essential micronutrients.