COVID-19-induced coagulopathy: Experience, achievements, prospects

The presence of coagulopathy as part of the systemic inflammatory response syndrome is a characteristic feature of severe coronavirus disease 2019 (COVID-19). Hematological changes (increased DD-dimer, prolonged activated partial thromboplastin clotting time [APTT] and prothrombin time [PT], high fibrinogen levels) have been observed in hospitalized patients with COVID-19, which characterize the 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 to 71.4% 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 coagulopathy is 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 DD levels of more than 3-4 times was associated with higher in-hospital mortality. Therefore, COVID-19 requires assessment of the severity of the disease for further tactics of thromboprophylaxis. The need for continued thromboprophylaxis, or therapeutic anticoagulation, in patients after inpatient treatment for two weeks using imaging techniques to assess of thrombosis assessment.

[ESTIMATION OF THE QUALITY OF DRINKING PIPELINED WATER BY THE DEGREE OF CONTAMINATION WITH MICROSCOPIC FUNGI]

The analysis of literature and water data on the presence of microbiological safety indicators of micromycetes was conducted, that are able to exist and reproduce in tap water entering the consumer. Microscopic fungi (Penicillium, Rhodotorula, Fusarium, Cladosporium, Aspergillus) in the amount of 10 to 303,3 CFU/dm3 were detected in the samples of tap drinking water studied. At the same time, tap water in 50.0% of cases is contaminated with pathogenic micromycetes, the structure of which is represented by: Penicillium spp. (40.0%), Aspergillus (28.75%), Rhodotorula spp. (17.5%), Fusarium (10.0%), Cladosporium spp. (3.75%). In terms of quantitative traits, micromycetes of the genus Rhodotorula dominated in drinking water - 150.0±23.3 CFU/dm3, Penicillium, on average, was detected in the amount of 87.0±7.7 CFU/m3, Fusarium - 60.0±6.4 CFU/dm3, Aspergillus - 22.0±4.9 CFU/dm3, and Cladosporium - 10.0±3.3 CFU/dm3. The presence of micromycetes in water was monitored depending on the season of the year. A direct strong correlation was established between the average monthly air temperature and the total frequency of detection in drinking tap water of all types of micromycetes. The results indicate that the water samples do not meet the requirements of DSTU 4808-2007 for the presence of micromycetes. At the same time, according to the requirements of DSanPiN 2.2.4-171-10 and Council Directive 98/83/EC, microscopic fungi are not regulated at all in tap water. Therefore, we propose to revise the standards, namely, to include micromycetes in the indicators of microbiological safety, which will make it possible to improve water quality control.

COMPREHENSIVE BACTERIOLOGICAL STUDY OF THE VAGINAL DISCHARGE DURING BACTERIAL VAGINOSIS

Along with sexually transmitted infections opportunistic pathogens and normal microbiota are becoming increasingly clinically important. Opportunistic pathogens can lead to purulent-inflammatory process of the genitals The aim of the current work was to detect qualitative and quantitative composition of vagina contents in non-specific bacterial vaginosis. Vaginal microbiota of 298 women aged from 16 to 64 years old was analyzed. Examination was provided by polymerase chain reaction. In normocenosis with domination of enterobacteria the prevalence index of conditionally-pathogenic microflora wasn't more than 3 lg GE/sample. With absence of mycoplasmas the quantity of conditionally-pathogenic microorganisms wasn't more than 104,5. At same time in patients with dysbiosis of I and II levels index of conditionally-pathogenic microflora was from 3 to 1 and less than 1 lg GE/sample accordingly; there was diagnosed a significant decrease of the total bacterial mass. Simultaneously, decreasing of Lactobacillus quantity (more expressed in dysbiosis-II) meanwhile appearance of mycoplasmas and utmost constant quantity of Candida was revealed. A comprehensive determination of a wide range of opportunistic pathogens on the background of normal flora in the vaginal discharge of women of different ages had been studied.

JUSTIFICATION OF THE NECESSITY OF INTEGRATED MEDICAL CARE FOR PATIENTS SUFFERING FROM SOCIALLY SIGNIFICANT DISEASES (BASED ON THE RESULTS OF THE TARGET GROUP SURVEY)

The diseases of social significance are one of the biggest threats of people's health and well-being all over the world and a great burden for the healthcare system and community in general. It is widely known that the consequences of most of such diseases include temporary or permanent loss of working ability and continuous significant investments of money in the prediction, curing, and rehabilitation measures. The increase in the number of individuals with deviant behavior, especially among teenagers and young people, social disadaptation, migration of people, insufficient government funding for healthcare and social sphere concerning prevention of diseases of social significance and diseases linked with social status - all these factors create the background for the further complication of the STIs epidemic situation in Ukraine. It is scientifically proven that raising the quality of help given people with STIs and increasing its accessibility for different social strata, particularly for the representatives of the target groups, is an effective method for decreasing the rate of parenteral hepatitis and HIV infections in society. The aim of the current research is to assess the quality of the specialized help given patients with STIs (on the example of HIV-infected persons) in order to implement the integrated system of medical and social rehabilitation considering the features of the target group. The survey was conducted on the basis of designed questionnaires which included questions regarding the level of education, social status, necessity and frequency of appeals for medical help, particularly for dermatovenereological help, the affordability and comprehensiveness of the latter, the level of satisfaction with the received medical care, the respondent's assessment of quality and modernity of medical equipment. 389 questionaries' served as material for the research. Each questionnaire was composed of 15 questions. The respondents included 201 males and 188 females diagnosed with HIV-infection, who permanently live in Odessa region. Methods of research: analytical, descriptive, and statistical. The majority of HIV-infected respondents received incomplete secondary, complete secondary or vocational secondary education, 10,28% of them (40 respondents) received incomplete or complete higher education, which characterized the cohort of respondents as people with low level of education, social and sexual awareness. 24,16% of respondents (94 persons) were permanently employed; the others - were unemployed due to different reasons, and, consequently, had low social security level. More than half of respondents (220 individuals - 56,56%) were dissatisfied by the quality of dermatovenereological medical help due to the lack of medical equipment. Only 76 respondents (19,54%) were completely satisfied and positively characterized the latter. The necessity of the establishment of the specialized center of dermatovenereological help for HIV-infected patients was pointed out by 226 respondents (58,10%). The vast majority of HIV-infected respondents (80,98%) expresses quite strong opinion regarding the necessity of the establishment of multiprofile health care institution, which would provide the whole spectrum of medical services, taking into consideration the specific features of HIV-infected patients.

MODERN ETIOLOGICAL STRUCTURE OF ACUTE GASTROENTEROCOLITIS IN THE SOUTHERN UKRAINE

The etiological structure of the acute diarrhoeal infections among the population of the Odessa region during 2015-2017 was analyzed. Based on the registered cases, an assessment of the frequency of hospitalization of sick persons from different age groups was undertaken. The most frequent pathogens from 18 detected bacterial causative agents were St. aureus, Kl. pneumoniae, Ps. aeruginosa, E. coli, Pr. vulgaris, Ent.cloacae. During 2016-2017 the mixed infection was detected in 54 fecal samples. Bacterial-virus associations were detected in 20 samples and were presented in St. aureus, Kl. pneumoniae, Ps. Aeruginosa and Rotavirus. During the summer period of 2016, the detection rate of rota-, noro-, adenovirus antigens in the examined fecal samples of adult patients was 13.60%. According to the results of genotyping of the circulating rotaviruses strains in 2016, strains G1P[8] (46.70%) and G3P[8] (26.70%) are most commonly detected.