The aim: to determine the specificity of changes in carbohydrate metabolism in rats with experimental type 1 (DM1) and type 2 (DM2) diabetes mellitus and to analyze correlations of their modification under administration of the amino acids L-arginine and N-acetyl-L-cysteine. Materials and methods. DM1 was induced in old male Wistar rats by a single 45 mg/kg streptozotocin. In rats with DM2, insulin resistance was first induced (high-fat mixed feed for 8 weeks), after which 30 mg/kg streptozotocin was administered once. After 6 weeks, animals with DM were divided into 3 subgroups: without amino acid administration, rats with L-arginine and with N-acetyl-L-cysteine. Results. Experimental modeling of DM1 resulted in persistent hyperglycemia and hypoinsulinemia, which significantly altered metabolic indices. In rats with DM2, hyperglycemia developed with hyperinsulinemia, indicating established insulin resistance. Administration of L-arginine and N-acetyl-L-cysteine to rats with both types of diabetes lowered glucose levels and increased insulin concentrations, although no statistically significant difference was found between the effects of these amino acids. L-arginine significantly increased the HOMA-β index in rats with DM1 and moderately increased it in rats with DM2. In addition, it caused a significant increase in the HOMA-IR index in the group with DM1, indicating improved insulin sensitivity. N-acetyl-L-cysteine also improved HOMA-β and HOMA-IR indices in rats with DM1, although its effect on DM2 was less pronounced and did not reach statistical significance. Conclusions. In rats with type 1 diabetes, both amino acids cause a decrease in glucose concentration, which is due to improved pancreatic β-cell function due to increased insulin concentration, the HOMA-β index compared to the subgroup without correction, but also causes an increase in the HOMA-IR index, and the listed indicators do not return to control values. These changes were accompanied by profound disruption of metabolic relationships, which is confirmed by correlation analysis. Against the background of the development of type 2 diabetes mellitus, both amino acids reduce glucose concentration and increase insulin compared to the subgroup without correction, however, the HOMA-β index improves only in rats with L-arginine, and the preserved hyperinsulinemia in all 3 subgroups leads to an increase, compared to the control, in the HOMA-IR index without a significant difference between the effects of amino acids. Correlation analysis revealed greater preservation of metabolic relationships of carbohydrate metabolism indicators compared to rats with type 1 diabetes mellitus.

Involvement of small intrahepatic bile ducts is a characteristic but underexplored feature of autoimmune liver diseases (AILD) in children. A distinctive aspect of pediatric AILD is the overlap between autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC), which complicates differential diagnosis – especially in cases with isolated small-duct injury and absence of typical PSC features on MRCP. The aim of the study was to assess the spectrum and frequency of biliary injury in children with autoimmune hepatitis, autoimmune sclerosing cholangitis, and primary sclerosing cholangitis using the modified Nakanuma scoring system and additional morphological criteria of cholestasis. Materials and methods. Sixty-nine children with AILD were included: 26 with AIH, 29 with ASC, and 14 with PSC. Liver biopsies were evaluated using the Nakanuma classification. Additional features assessed included periductal fibrosis and signs of cholestasis (biliary interface, rosettes, ballooning / feathery hepatocyte degeneration, portal / periportal edema, and mucobilia). Results. The median age at diagnosis was 11 years (IQR: 8–14). Advanced liver fibrosis (F3–F4) was present in 54 % of AIH, 79 % of ASC, and 43 % of PSC cases. Cirrhosis was observed in 24 % of ASC, 19 % of AIH, and 7 % of PSC patients. Inflammatory bowel disease was common in biliary phenotypes – detected in 72 % of ASC and 71 % of PSC patients, and in only 3.8 % of AIH cases. According to MRCP, large-duct involvement was seen in 71 % of PSC and 72 % of ASC patients, while isolated small-duct injury was found in 29 % and 28 %, respectively. ASC and PSC patients showed a broader range of biliary lesions compared to AIH. Statistically significant differences were observed in the frequency of ductopenia ≥ grade 2 (ASC – 52 %, PSC – 64 %, AIH – 19 %), advanced periductal fibrosis ≥ grade 3 (ASC – 62 %, PSC – 71 %, AIH – 8 %), and mucobilia (ASC – 66 %, PSC – 36 %, AIH – 4 %; p < 0.001). Cumulative scoring of biliary features reliably distinguished AIH (mean 3.4 ± 1.4) from ASC (6.4 ± 1.6) and PSC (6.7 ± 1.9, p < 0.001). Conclusions. Extended morphological analysis using the Nakanuma classification and additional biliary injury criteria improves diagnostic accuracy for identifying the biliary phenotype of AILD in children, including small-duct variants of ASC and PSC. This approach supports more precise diagnosis and individualized treatment strategies.

The aim of this work is to describe a clinical case of acquired perforating dermatosis within the context of an interdisciplinary approach to patient management, taking into account a comprehensive therapeutic and dermatological diagnostic and therapeutic algorithm. Materials and methods. A personal observation is described of a 70-year-old patient with clinical manifestations of acquired perforating dermatosis and multimorbid somatic pathology, the verification of which was carried out taking into account the results of laboratory and instrumental diagnostic methods. The dermatological diagnosis was established based on the morphological assessment of a skin biopsy. Results. A clinical case of a patient with skin lesions of the trunk and upper extremities is described. Visual manifestations of dermatosis are represented by a papular rash with a central depression, erosions, hyperkeratotic changes, and pronounced itching, which in general mimic a wide range of nosologies: from lichen planus, prurigo to multiple keratoacanthomas. Given such clinical non-specificity of the pathological process on the skin, only morphological diagnostics can contribute to the final verification of the dermatological diagnosis. In addition, an important aspect was the assessment of the patient’s somatic status, which revealed the presence of multimorbidity, in particular concomitant cardiovascular pathology, chronic kidney disease, cryptogenic liver cirrhosis, and portal hypertension. The general therapeutic direction of this disease is to compensate for the underlying somatic pathology. That is why, given the clinical complexity of the condition, patients in this category require the mandatory involvement of physicians from related specialties. In this case, the patient requires constant therapeutic support, including in the conditions of an inpatient ward. Given the severe general status of the patient, it was decided, in parallel with the treatment of somatic pathology, to have a rather gentle effect on the efflorescence, only with the use of systemic antihistamines and topical therapy with glucocorticosteroids. The positive dynamics within the skin justify the expediency of continuing the planned comprehensive therapeutic tactics. Conclusions. Morphological examination is the gold standard for verifying pathological processes in the skin. Considering the rather variable nosologies in the context of multimorbidity in one patient, as well as the clear dependence of the course of dermatosis on somatic pathology, a mandatory stage in the management of such patients is the joint interdisciplinary work of specialists of both dermatological and therapeutic profiles.

Aim: to summarize and analysis of current literature data on the pathophysiological mechanisms of the relationship between osteoporosis, coronary heart disease and obesity in postmenopausal women. Materials and methods. A systematic analysis of scientific publications presented in the databases PubMed, Scopus, Web of Science, Google Scholar, as well as in national medical information resources of Ukraine was conducted. The work included scientific articles that met the inclusion criteria for the topic, completeness of the text, and relevance. Results. Osteoporosis, coronary heart disease, and obesity are the three most common diseases among postmenopausal women, which have a high level of medical and social significance due to their chronic course, high incidence of complications, and impact on functional capacity and quality of life. Estrogen deficiency in postmenopausal women is a key trigger for pathological changes in bone, metabolic, and vascular homeostasis. Recent studies demonstrate the presence of common pathogenetic links for these conditions, such as chronic low-level inflammation, endothelial dysfunction, estrogen deficiency, insulin resistance, lipid metabolism disorders, and adipokines imbalance. Decreased bone mineral density (BMD) correlates with atherosclerotic vascular lesions, and vascular calcification is often accompanied by bone loss. Osteotropic proteins are also found in vascular walls, indicating a biological transition between bone and vascular tissues. Low BMD is associated with an increased risk of cardiovascular mortality, especially in the elderly. Obesity also has a systemic negative impact on bone and cardiovascular health through activation of pro-inflammatory cytokines and stimulation of bone resorption. However, the current literature contains conflicting data on the impact of obesity on BMD: moderate excess body weight may have a protective effect on BMD loss, but obesity of II–III degree is significantly associated with an increased risk of osteoporotic fractures. This necessitates the need for risk stratification taking into account the degree of obesity and concomitant cardio-metabolic pathology. Conclusions. The presence of common pathogenetic mechanisms of osteoporosis, coronary heart disease, and obesity confirms the feasibility of developing comprehensive approaches to the prevention, early diagnosis, and treatment of these conditions in postmenopausal women.

The aim was to recreate an experimental model of insulin resistance in male Wistar rats by using a diet with a high fat content of combined origin. Materials and methods. 42 male Wistar rats were taken into the experiment and divided into 2 groups: 1st – control (n = 7) and 2nd – experimental (n = 35). For modelling the insulin resistance (IRS) the rats were fed with a commercial compound feed with a fat content of 40 % for 8 weeks. To control the dynamics of metabolic changes, the rats of the experimental groups were weighed weekly, fasting glucose was measured once every 2 weeks, a glucose tolerance test (GTT), blood pressure measurement (BP) and body composition bioimpedance analysis (BIS) were performed once every 4 weeks, and an insulin tolerance test (ITT) was performed once at 8 week after receiving convincing changes in the glucose tolerance test. Results. In rats of the IRS group, compared to the control group, body weight exceeded the control group by 13 % on the 4th week and by 9 % on the 8th week; fasting glucose concentration was higher by 11 % on the 4th week and by 37 % on the 8th week; GTT revealed changes towards impaired glucose tolerance at both periods, however, the hyperglycemic type of curve was detected on the 8th week, which was combinated by the absence of significant glucose changes during ITT; on the 4th week – systolic BP increase by 27 % and diastolic – by 6 %, and on the 8th week – by 21 % and 20 %, respectively; BIS on the 4th week revealed an increase in body fat mass, against which latent general dehydration with redistributive extracellular hyperhydration is formed, on the 8th week – progression of obesity and dehydration, but with redistribution of fluid towards intracellular hyperhydration. Conclusions. Feeding animals a high-fat diet of combined origin for 4 weeks led to obesity, as evidenced by increased body weight and body fat mass with altered fat distribution. This was accompanied by latent general dehydration and extracellular hyperhydration. However, 4 weeks was insufficient to induce insulin resistance. Extending the diet to 8 weeks resulted in further obesity progression and the development of insulin resistance, characterized by fasting hyperglycemia, a hyperglycemic-type curve on the GTT, the absence of significant glucose fluctuations during ITT, and persistently elevated BP. These metabolic disturbances contributed to a relative total body water deficit, driven by extracellular dehydration with fluid redistribution towards intracellular hyperhydration.

The aim to analyze the prevalence of classic and electronic cigarette smoking among patients with coronary artery disease of different ages, taking into account gender. Materials and methods. The study included patients with CAD (n = 3674), both male (n = 3061) and female (n = 613). The material for analysis was anamnestic data on smoking classic or electronic cigarettes. The research design is based on the patient’s age group according to the WHO classification and gender. Results. It was found that men with coronary artery disease smoke classic cigarettes significantly more often than women (p = 0.0001, χ2 = 37.37). It was established that female patients smoke electronic cigarettes significantly more often than male patients (p = 0.008, χ2 = 7.12). It was determined that the frequency of women who have never smoked is significantly higher than the frequency of male patients (p = 0.005, χ2 = 8.03). It was found that in young male patients, the frequency of smoking classic cigarettes is significantly lower than the frequency in age groups: middle age (р = 0.0001, χ2 = 48.27), old age (р = 0.0001, χ2 = 64.80); oldest age (p = 0.0001, χ2 = 24.04). It was found that middle-aged female patients smoke classic cigarettes significantly less than men of the same age (p = 0.0001, χ2 = 56.02); respectively, in the old age group (p = 0.0001, χ2 = 40.47) and in the oldest age group (p = 0.0001, χ2 = 35.70). When analyzing smoking cessation, it was found that the frequency of individuals significantly increased with age in male patients. As for female patients who quit smoking, the reverse trend was established: with age, the proportion of people who quit smoking reliably decreased. Conclusions. It was found that men with coronary heart disease smoke classic cigarettes significantly more often (р = 0.0001, χ2 = 37.37). It was established that among young men, the frequency of smoking classic cigarettes is significantly lower than the corresponding frequency among middle-aged men (р = 0.0001, χ2 = 48.27) and old men (р = 0.0001, χ2 = 64.80) and oldest age men (p = 0.0001, χ2 = 24.04). It was found that female patients smoke electronic cigarettes significantly more often than men (p = 0.008, χ2 = 7.12). It was found that female patients smoke classic cigarettes significantly less in: middle age (p = 0.0001, χ2 = 56.02), old age (p = 0.0001, χ2 = 40.47) and oldest age (p = 0.0001, χ2 = 35.70).

Following the principles of image-enhanced endoscopy and using standardized endoscopic classifications, it is possible to predict the morphological diagnosis of colorectal neoplasms with high accuracy. The large size and uneven surface of lesion significantly complicates a thorough examination, and routine biopsy is still widely practiced, despite its drawbacks. This makes it necessary to compare the results of optical and forceps biopsy and determine the expediency of performing the latter for different types of colorectal laterally spreading tumors (LST). Aim. To compare the pit and vascular pattern, determined endoscopically, with histopathological findings in LST, with the calculation of the diagnostic accuracy of optical evaluation and forceps biopsy. To ascertain the relationship between lesion size, morphological type, and the presence of malignant changes. Materials and methods. 80 LST ≥20 mm were included in the study. Expert image-enhanced endoscopy with NBI and utilizing Paris, Kudo, JNET and Hiroshima classifications was employed for optical evaluation and stratification of lesions. Target forceps biopsy was obtained from areas showing the most progressive changes. The data from optical biopsy and the pathohistology of forceps biopsy specimens were compared with the results of the pathohistological findings of removed LST. Statistics were calculated in the Statistica 13. Results. Group 1 comprised 30 patients with non-granular type LST, while group 2 consisted of 50 patients with granular type LST. The median diameter was 20 mm (IQR, 20; 25) and 40 mm (IQR, 25; 50), adenocarcinoma loci were found in 10 % and 32 % in the first and second groups, respectively. Correlations between lesion localization and LST subtype were assessed, as well as between the presence of malignant changes and the size and morphological type of the lesions. Comparative indicators of sensitivity (80.0 % / 81.8 % in the first and 76.7 % / 80.0 % in the second group), diagnostic accuracy (93.3 % for both methods in the first and 84.0 % / 86.0 % in the second group), and also predictive values were revealed for optical evaluation / forceps biopsy, respectively. The specificity was identical and amounted to 100 % in the first and 95 % in the second group. In all cases, p < 0.01. Conclusions. Mixed type LST-G lesions occur more often in the rectum, whereas flat elevated LST-NG lesions – in the transverse colon. The presence of adenocarcinoma correlates with the morphological type of tubulovillous adenoma and the larger size of the tumor; larger LSTs are more frequently tubulovillous adenomas. Optical and forceps biopsies demonstrate higher accuracy for non-granular types of LST compared to granular types. Forceps biopsy does not confer any advantages over optical biopsy and is not recommended for routine use.

Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn). Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient. Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis. Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.

The combination of thyroid and parathyroid gland pathology is a rather rare combination of diseases that occurs in 2.0–5.0 % of patients with thyroid pathology, and their combination in the population is less than 0.1 %. The aim of the study. To improve the diagnosis and treatment of patients with combined pathology of the thyroid and parathyroid glands. Materials and methods. The retrospective analysis covers the period from January 2013 to December 2023, during which 912 patients with thyroid pathology were examined and operated on. Examination of patients was carried out according to the method of diagnosis of combined surgical pathology developed by us (utility model patent No. 128139, Ukraine). The gender structure was dominated by female patients: 773 (84.8 %) and 139 (15.2 %). The average age of patients in the study group was 54.9 ± 11.7 years. Results. After the examination, combined surgical pathology was found in 201 (22.1 %) patients. In 36 (17.9 %) of them, the pathology of the prostate gland was detected as a concomitant disease. In the structure of parathyroid pathology in 35 (97.2 %) patients, a benign lesion of the prostate gland was detected, in 1 (2.8 %) – cancer of the parathyroid gland. In the structure of the main thyroid pathology, 14 (38.9 %) patients were diagnosed with multinodular euthyroid goiter, 4 (11.1 %) with mononodous euthyroid goiter, 9 (25.0 %) with diffuse toxic goiter, 3 (8, 3 %) – mononodous toxic goiter, 6 (16.7 %) – papillary thyroid cancer. Clinical symptoms of hypoparathyroidism were observed in 21 (58.3 %) patients after surgery. In 3 (8.3 %) patients, seroma of the neck wound was detected in the postoperative period. There were no fatalities. Conclusions. The use of the developed method of diagnosing combined surgical pathology makes it possible to detect concomitant surgical pathology in 22.1 % of patients with endocrine diseases, which requires simultaneous operative intervention. In the structure of combined surgical pathology, in 17.9 % of cases, a combination of diseases of the thyroid gland and parathyroid gland was observed. Simultaneous surgical intervention for combined thyroid pathology and diseases of the thyroid gland does not lead to an increase in perioperative complications and mortality.

Aim. To study the existence of a relationship between the density of bone tissue and the length of the edentulous part of the tooth row. Materials and methods. Evaluation of the density of the spongy substance of the jaws by the maximum and average value of HU. The density of cancellous bone was evaluated only in the areas available for implant placement. The groups consisted of the localization and extent of the dentition defect. Statistical methods included the estimation of the arithmetic mean (M), standard deviation (σ), error of the mean (m), confidence interval (95 % CI), estimation of the median (Me) and interquartile range ([Q1; Q2]), Student’s test (t criterion). Results. Maximum and average indicators of cancellous bone density in defects of the upper (562.4 [347.1; 777.8] and 301.5 [163.0; 439.9], respectively (р = 0.84) and lower (1379.0 [1116.2; 1641.9] HU and 848.6 [630.6; 1066.6] HU, respectively, p = 0.96) jaws in the areas of molars and premolars with “large” defects are significantly different from the indicators “small” defects (299.7 [176.9; 422.4] and 642.6 [470.4; 814.9], 1061.1 [866.5; 1255.7] and 608.3 [440.5; 776.1, respectively). The average bone density of the alveolar process of the upper jaw is almost the same in defects of different lengths. The average density of the cancellous bone of the alveolar part of the lower jaw in “large” defects has significant differences from “average” ones (p = 0.02) and “small” (p = 0.005) defects. Conclusions. The average density of cancellous bone of the alveolar part of the lower jaw in “large” defects has significant differences from “medium” (p = 0.02) and “small” (p = 0.005) defects, and regardless of the extent of the dentition defect corresponds to class D3 (350–850 HU) according to the Misch classification. The average density of cancellous bone of the alveolar process of the upper jaw in the areas of molars and premolars does not have significant differences depending on the extent of the dentition defect and corresponds to class D4 (150–350 HU) according to the Misch classification. Since one class includes a large range of values, the clinical classification of Misch does not allow taking into account individual bone density indicators that have statistically significant differences in different areas of the dentition.