УДК: 616.89-008.46/.47-057.36-056.83-039.51:616.89-008.19]-07

Cognitive impairment, which in most cases are not considered by the doctor, and thus remain outside the scope of medical care, are characteristic for almost all patients with mental illness. Ignoring the manifestations of cognitive impairment is primarily due to the fact that the range of cognitive abilities has individual characteristics for each person and therefore their definition does not have clear criteria for evaluation. The article presents the traditional methods of psychodiagnostics studies for identifying cognitive disorders, depressive states, individual typological features in the military with mental and behavioral disorders due to alcohol consumption to improve the quality of diagnosis and further medical support for patients in this category. Typical symptoms in this group of patients were: sleep disturbances; low mood; unexpected attacks of anger, indignation, unreasonable fear; anxiety; irritability, autonomic disorders, depression. According to the informed consent, we used several standardized neuropsychological tests, which had high characteristics of validation and reliability, to study the individual psychological differences of patients. Emotional disturbances were assessed before and after treatment using the Mini Mental State Examination (MMSE) scale, which determined short-term and long-term memory in patients; auditory functions were studied according to the method of A.Luria; to conduct a clock drawing test, the subject was asked to draw a clock, the results of which indicated that the patient had clinically significant cognitive impairment; G. Eisenko's questionnaire was used to identify the main individual personality traits; Spielberger-Hanin questionnaire was used to assess the manifestations of reactive and personal anxiety; the level of depression was determined by the Tsung scale. To objectively assess the pain response, dynamic recording of pupil diameter (pupillometry) was used to determine the human autonomic response and a visual analog scale (VAS). According to the results of the study, it was found that in patients of both groups - 86 people (main and control) revealed up to 50% borderline cognitive impairment, which can be considered a reliable prognostic informative sign of the mental state of patients. Low anxiety on the Spielberger-Hanin scale has been reported in patients with depressive symptoms. All other screening diagnostic scales revealed borderline cognitive impairment in all patients. Thus, it has been proven that borderline cognitive impairment in patients with mental and behavioral disorders due to alcohol use interacts with depression, which significantly affects cognitive abilities. To eliminate cognitive impairment (CI), patients of both groups were offered a comprehensive traditional treatment with the additional use of the metabolic drug cytoflavin. Literature sources confirm the expediency of using a complex metabolic neuroprotective drug, the action of which is directed at the synthesis of energy complexes through various receptor, enzymatic and mediator systems. Cytoflavin can be attributed to metabolic drugs, which acts as an inducer of major metabolic pathways in cells, promotes the utilization of free oxygen and prevents ischemic changes in organs and tissues by reducing the level of peroxide processes. Complex therapy of treatment of borderline cognitive states with a course of cytoflavin is pathogenetically justified, which provided in our study an improvement in the psychological state of soldiers of both groups.

Когнітивні порушення, які в більшості випадків не враховуються лікарем і, отже, залишаються поза сферою медичної допомоги, характерні майже для всіх пацієнтів з психічними захворюваннями. Ігнорування проявів когні­тивних порушень пов’язано насамперед з тим, що діапазон когнітивних здібностей має індивідуальні особливості для кожної людини і тому їх визначення не має чітких критеріїв оцінки. У статті представлені традиційні методи психодіагностичних досліджень для виявлення когнітивних розладів, депресивних станів, індивідуальних типологічних особливостей у військовій частині з психічними та поведінковими роз­ладами внаслідок вживання алкоголю для підвищення якості діагности­ки та подальшої медичної підтримки пацієнтів цієї категорії. Типови­ми симптомами у цієї групи пацієнтів були: порушення сну; знижений настрій; несподівані напади гніву, обурення, необгрунтований страх; тривожність; дратівливість, вегетативні розлади, депресія. Згідно з інформованою згодою, ми використовували кілька стандартизованих нейропсихологічних тестів, які мали високі характеристики валідації та надійності, для вивчення індивідуально-психологічних відмінностей пацієнтів. Емоційні порушення оцінювали до та після лікування за допомогою шкали Мінімального обстеження психічного стану (MMSE), яка визначала короткочасну та дов­готривалу пам’ять у пацієнтів; слухові функції вивчали за методикою A. Luria; для проведення тесту на малювання годинника випробовува­ного попросили намалювати годинник, результати якого вказували на наявність у пацієнта клінічно значущих когнітивних порушень; Опитувальник Г. Айзенка був використаний для виявлення основних індивідуальних рис особистості; Анкета Спілбергера-Ханіна була використа­на для оцінки проявів реактивної та особистої тривожності; рівеньдепресії визначався за шкалою Цунга. Для об’єктивної оцінки больової ре­акції для визначення вегетативної реакції людини та візуальної ана­логової шкали (VAS) використовували динамічний запис діаметра зіниці (пупілометрія). За результатами дослідження було встановлено, що у пацієнтів обох груп - у 86 осіб (основної та контрольної) виявлено до 50% прикордонних когнітивних порушень, що можна вважати надійною прогностичною інформативною ознакою психічного стану пацієнтів. Повідомлялося про низьку тривожність за шкалою Спілбергера-Ханіна у пацієнтів із симптомами депресії. Всі інші скринінгові діагностичні шкали виявили прикордонні когнітивні порушення у всіх пацієнтів. Таким чином, було доведено, що прикордонні когнітивні порушення у пацієнтів з психічними та поведінковими розладами через вживання ал­коголю взаємодіють з депресією, що суттєво впливає на когнітивні здіб­ності. Для усунення когнітивних порушень (ДІ) пацієнтам обох груп було запропоновано комплексне традиційне лікування з додатковим використанням метаболічного препарату цитофлавіну. Літературні джерела підтверджують доцільність використання складного ме­таболічного нейропротективного препарату, дія якого спрямована на синтез енергетичних комплексів через різні рецепторні, ферментатив­ні та медіаторні системи. Цитофлавін можна віднести до метаболічних препаратів, який діє як індуктор основних метаболічних шляхів у клітинах, сприяє утилізації вільного кисню та запобігає ішемічним змінам в органах і тканинах за рахунок зниження рівня перекисних процесів. Комплексна терапія лікування прикордон­них когнітивних станів курсом цитофлавіну є патогенетично виправ­даною, що забезпечило в нашому дослідженні поліпшення психологічного стану солдатів обох груп.

The incidence of miscarriage has been increased all over the world. In this situation more often children need artificial ventilation of the lungs (AVL) and form risk group for recurrent and chronic bronchopulmonary pathology development . Interconnection of prematurity – acute pulmonary disorders – the further formation of bronchopulmonary disease is no longer in doubt. It is observed a correlation between the administration of artificial ventilation in the neonatal period and the subsequent formation of bronchopulmonary pathology.  Our studies have shown that in the case of developing bronchial asthma in a child born prematurely and suffering from acute pulmonary disorders in the period of newborn birth, the risk of developing a severe variant of the disease is extremely high . The obtained data showed that asthma in such children is characterized by a severe course, often the so-called variant "difficult asthma" (with frequent exacerbations in the form of an asthmatic condition) is often observed [5, 10]. We have been followed up 27 children with bronchial asthma, whom after birth prolonged ventilation (more than 7 days) was performed due to pulmonary sickness.
The course of asthma in these children is characterized by frequent exacerbations and perscription of high doses of β2-agonists and hormonal drugs. This cohort of patients requires special care both on the part of parents and nursing staff.
      The reason should be sought, analyzing the features of the ante and perinatal period of the child's development [1, 4]. Frequent causes of miscarriage are inflammatory processes of diverse nature and etiology. In the process of inflammation, the number of cytokines, oxidants, and lytic
enzymes increases in the mother's body. In immature children, control over the inflammation process is inadequate [8, 12]. Low levels of antioxidants, antiprotease and anti-inflammatory cytokines can negatively affect the balance between inflammatory and anti-inflammatory cytokines, which in turn causes persistent inflammatory reaction and damage . Chronic inflammation causes hyperreactivity of the respiratory tract, which can not but affect the development and progress of bronchial asthma in the future . It is precisely this situation that determined the relevance and purpose of our study.
        Aim is to study the frequency and the features of the course of broncho-pulmonary pathology in young children who were on artificial ventilation of the lungs in the neonatal period.

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, which affects both children and adults. Although most cases of COVID-19 in children have a mild course, sometimes the disease is severe. Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of COVID-19, characterized by pronounced cardiovascular, gastrointestinal, and skin-mucosal signs and symptoms that, in particular, may meet the criteria for atypical or typical Kawasaki disease (KD). This article represents a clinical case of a 13-year-old boy with an atypical course of SARS-CoV-2-
Induced Kawasaki-Like Multisystem Hyperinflammatory Syndrome, who was treated with intravenous immunoglobulin, corticosteroids, and aspirin. Equally, it presents a thorough description of carrying out a differential diagnosis between MIS-C and Kawasaki disease and a review of the application of drugs needed for MIS-C treatment, the main goal of which is to ensure the best protection against CA aneurysms and avoid long-term sequelae.

Summary

Among patients with acute abdominal pathology who were hospitalized in surgical hospitals, about 5% are patients with acute pancreatitis. Moreover, in recent decades there has been a multiple increase in the incidence rate. According to many studies in industrialized countries, the incidence of acute pancreatitis is in the range of 200 to 800 new cases of acute pancreatitis per 1 million population per year. According to many researchers, one of the main factors causing severe acute pancreatitis is the invasion of gram-negative bacteria from the colon, through pathological bacterial translocation. This mechanism may play a major role in the development of septic complications - "death begins in the colon, which in acute abdominal pathology turns into an undrained abscess." The article presents and analyzes the results of ultramicroscopic study of changes in the structure of the mucous membrane of the colon in patients with destructive forms of acute pancreatitis. 75 microphotographs were analyzed. It was found that in acute pancreatitis, the main foci of destruction were localized in the surface layers of the mucous membrane of the colon. The changes found at the ultrastructural level are considered to be a morphological manifestation of pathological bacterial translocation in the studied pathology.

Keywords: pancreas, colon, pathological bacterial translocation

Abstract: Introduction: Nowadays, the coronavirus disease COVID-19 is a global problem for the population of the whole world which has acquired the character of a pandemic. Under physiological conditions, in a healthy person, erythrocytes make up 96% of all blood cells, leukocytes 3%, and hrombocytes about 1%. In healthy individuals, erythrocytes are mostly shaped like a biconcave disc and do not contain a nucleus. The diameter of the erythrocyte is 8 microns, but the peculiarities of the cell structure and the membrane structure ensure their great ability to deform and pass through capillaries with a narrow lumen of 2-3 microns. Therefore, the study of the morpho-functional state of blood cells, namely erythrocytes, in this category of patients is relevant and deserves further research.

The Aim: To figure out the effect of the coronavirus disease COVID-19 on the ultrastructural blood cell changes, in particular erythrocytes, in patients with ischemic heart disease (IHD) and diabetes mellitus type 2.

Materials and Methods: Twelve patients with COVID-19 who had an acute myocardial infarction were examined. The comparison group consisted of 10 people with acute myocardial infarction without symptoms of COVID-19. The average age of the patients was 62 ± 5,6 years. The functional state and ultrastructure of blood cells were studied using electron microscopy.

Results: In the presence of COVID-19, we detected both calcification and destruction of erythrocytes and platelets. Reticulocytes were detected much more often in these individuals than in the comparison group. In patients with acute myocardial infarction in the presence of type 2 diabetes and COVID-19, a significant number of markedly deformed, hemolyzed erythrocytes or with signs of acanthosis, which stuck together and with other destructively changed blood cells, were found. We also detected «neutrophils extracellular traps» (NETs).

Conclusions: Morphological changes of blood cells in COVID-19 varied according to the disease course and severity especially in the background of a weakened immune system in older and elderly people, in the presence of diabetes, excessive body weight, cardiovascular diseases and occupational hazards. Under the influence of COVID-19, blood cells are destroyed by apoptosis and necrosis. Therefore, hypoxia and ischemia of vital organs of the human body occur.