UDC: 616. 24-06: 616.248+616.33-002.44)-092: 612.015.11.-08

Bronchial asthma (BA) and stomach ulcer are among the most common human diseases which remain important medical and social problems in the XXI century. There are combinations of pathologies that burden each other in the practical work of the doctor.
The aim of this study was to establish the peculiarities of changes in the processes of lipoperoxidation and antioxidant protection in the lungs with the development of experimental bronchial asthma (EBA) and experimental stomach ulcer (ESU).
Material and research methods. Experimental studies were performed on 55 guinea pigs (males) weighing 180 — 220 g, divided into 5 groups of 9 animals each, except the first (10 animals). Group I (control) included intact guinea pigs, II — animals with experimental asthma and ESU (5th day), III — guinea pigs on the 19th day of the combined model process, IV — animals with EBA and ESU (26th day), V — guineapigs on the 33rd day of EBA and ESU. For the purpose of detailed analysis and interpretation of indicators of prooxidant and antioxidant systems (AOS) in different days of experiment two periods of development of EBA and ESU were conditionally distinguished: early (5th and 19th days of experiment) and late (26th and 33rd days).
The experimental asthma model was reproduced in guinea pigs by the method of VI Babich, gastric ulcer was simulated according to the method of VI Komarov. Condition of free radical oxidation in the lungs was determined by the content of diene conjugates by the method of VG Gavrylov, MI Myshkorudna, and malonic dialdehyde by the method of EG Korobeynikov. The degree of antioxidant system activity was estimated by the content of enzymes — superoxide dismutase by the method of R. Fried, catalase by the method of R.Holmes, C. Masters, glutathione peroxidase — by the method of OG Arkhipova. Statistical processing of the obtained data was carried out according to the Student’s method.
Conclusions. So, the research of the functional state of the prooxidant system in stomach and lungs of animals in different periods of combined experimental asthma and ulcer showed their gradual increasing with the greatest severity in the 33rd day. It might indicate the intensive accumulation of free radical oxidation products and initial compensatory growth of antioxidant system enzymes. In the later period of EBA and ESU modeling (26th, 33rd days) there is an elevation in the lipoperoxidation on the background of AOS depression, which can be seen as the result of depletion of compensatory reactions aimed at decontamination of LPO products. This leads to a violation of cellular homeostasis and the development of oxidative stress.

The article presents the features of the morphologic structure of intracoronary thrombi and the prognosis of acute ST segment elevation myocardial infarction (STEMI) in patients of different age groups.
Methods: Histological analysis of the aspirated intracoronary clots was performed in 97 patients with STEMI. The patients were divided into two groups: 11 patients aged under 44 (young group) and the remaining older than 45 (older group). The short-term prognosis was determined by: ST-segment resolution, achievement of good coronary flow, myocardial blush, indices of myocardial contractility, and QS wave formation on ECG. The study’s endpoints determined the long-term prognosis: The onset or worsening of angina symptoms, coronary revascularization (PCI or CABG), AMI, and death.
Results: Elderly patients were substantially more likely to have a history of coronary artery disease, as well as angina attacks, or their equivalents, at rest a few days before the onset of STEMI and arterial hypertension. Dyslipidemia was significantly more common in young patients. Formation of microchannels within the thrombi was significantly more common among older patients. Achieving the target quality of microcirculation was substantially more frequent among young patients (p=0.007). The long-term prognosis was better in young patients due to the lower prevalence of the combined endpoint.
Conclusions: Elderly patients were more likely to have intracoronary thrombi with microchannel formation, indicating a longer duration of the thrombotic process. The long-term prognosis after STEMI was significantly better in young patients.
Keywords: Myocardial infarction, coronary reperfusion, coronary occlusion, blood clot, cardiovascular risk factors.

The presence of coagulopathy as part of the systemic inflammatory response syndrome is a characteristicfeature of severe coronavirus disease 2019 (COVID-19). Hematological changes (increased D-dimer [DD],prolonged activated partial thromboplastin clotting time [APTT] and prothrombin time [PT], highfibrinogen levels) have been observed in hospitalized patients with COVID-19, which characterizethe risk of thrombotic events. Against the background of COVID-19 there is endothelial dysfunction,hypoxia and pulmonary congestion, mediated by thrombosis and microvascular occlusion. Up to71.4% of patients who died from COVID-19 had disseminated intravascular coagulation syndrome,compared with only 0.6% of survivors. The main manifestation of COVID-19-associated coagulopathyis a significant increase in DD without a decrease in platelet count or prolongation of APTT and PT,indicating increased thrombin formation and the development of local fibrinolysis. An increase in DDlevels of more than 3–4 times was associated with higher in-hospital mortality. Therefore, COVID-19requires assessment of the severity of the disease for further tactics of thromboprophylaxis. The need forcontinued thromboprophylaxis, or therapeutic anticoagulation, in patients after inpatient treatment fortwo weeks using imaging techniques to assess of thrombosis assessment.

УДК: 616. 5-018.74-007.14:616.13/.16

Objective. Determination of morphological features of skin lesions in patients with widespread psoriasis, study of the level of expression of immunohistochemical markers of vascularization.
Materials and methods. 80 patients with psoriasis were under observation. The control group consisted of 20 practically healthy people (control group) of the same age. All patients underwent a skin biopsy with a histological evaluation of the biopsy material to determine the form and severity of the course of psoriasis in accordance with the requirements of the morphological section of the modern classification.
Results and discussion. Applying the scale of intensity of skin vascularization according to Amin M.M. et. al. (2012), it was detected that damaged dermal areas due to psoriasis, on average, had 17.25±5.34 micro vessels at magnification (×400), which corresponds to the level of moderate vascularization (11-20 capillaries). Normal skin in control group had mean index 4.32±2.01 at (×400) at the level of weak vascularization (4-10 capillaries), which statistically reliably differs from general group (р˂0.05). Analysis of the condition of vascular bed at different levels of severity of psoriasis course showed that a number of cells at moderate degree of severity (22.65±5.87) was considerably higher than at mild psoriasis (10.09±3.22), and even more numerous than in CG (4.32±2.01). Statistically reliably both groups differ between them (р<0.05), and with CG (р<0.05). According to Fisher’s exact test, distribution of absolute meanings of monitoring of intensity of cytoplasmic staining with VEGF marker in all groups between them had a reliable difference (р<0.05). We detected a moderate correlation connection between increased intensity of VEGF expression and amplification of the severity of psoriasis course (r=+0.430). According to Fisher’s exact test, distribution of monitoring of intensity of cytoplasmic staining with MMP-9 marker in all groups between them had a reliable difference (р<0.05); a moderate correlation connection between increased intensity of MMP-9 marker expression and amplification of the severity of psoriasis course was detected (r=+0.532).
Conclusions. The results of conducted clinical, morphological and immunohistochemical investigations enable to consider importance of neoangiogenesis processes in pathogenesis of this dermatosis and need in elaboration of therapeutic measures with direct influence on this aspect of pathogenesis.
Key words: psoriasis, immunity, neoangiogenesis.

УДК 616.13-002-036-053.2-07:616.155.02

Kawasaki disease (KD) is an acute systemic vasculitis that is the most common cause of acquired heart disease in children under 5 years of age with hyperthermia. Diagnosis of KD is a clinical challenge, given the wide range of clinical manifestations and similarities with many viral and bacterial diseases. Purpose - to describe a clinical case of refractory КD in a three-month-old girl with an emphasis on the importance of echocardiography and coronary angiography for the final verification of the disease, urgent initiation of treatment with minimal suspicion of КD. Clinical case. The article reports on a three-month-old patient with a difficult diagnosis of refractory form of КD. The disease debuted with hyperthermia, enterocolitis, obstructive bronchitis, and hepatoliver syndrome. The manifestations of skin exanthema were initially considered as an allergic dermatitis to the use of a cephalosporin antibiotic. Multisystemic inflammatory syndrome associated with SARS-CoV-2 infection was suspected. After the use of immunosuppressive therapy with mega-doses of dexamethasone and intravenous human immunoglobulin 2 g/kg/day for 3 days, clinical improvement was achieved. Subsequently, the haemogram showed an increase in neutrophilic hyperleukocytosis to the appearance of blast cells, hyperthrombocytosis and severe anaemia. A differentiation was made between a leukemic reaction, the debut of myeloproliferative disease, juvenile myelomonocytic leukaemia. Against the background of a rapid decrease in the number of leukocytes, the girl developed hyperthermia, migratory intermittent maculopapular rash, and foots edema. Laboratory findings included thrombocytosis and an increase in acute-phase parameters. Echocardiography revealed left ventricular dilation, a small amount of excess fluid in the pericardium, dilatation of the left coronary artery evenly to the bifurcation. Computed tomography revealed giant coronary artery aneurysms, which gave grounds to diagnose KD