No abstract

Cerebrospinal fluid (CSF) leak is a rare complication in of the prolactinomas treatment with dopamine agonists. In most cases CSF leak develops within the first three months of treatment starting. The article presents a rare clinical case – later development of CSF leak after pharmacological treatment of giant prolactinoma. Women 29 years with giant endo-supra-infra-laterasellar pituitary adenoma (8,7 cm in diameter), visual impairment, cachexia, secondary amenorrhea and prolactin level more than 2 million 200 thousand mU/l treated with cabergoline. On this background, complete regression of the tumor, recovery of visual function, body mass and normalization of prolactin level was marked. Nevertheless, after 6.5 years after beginning of cabergoline therapy CSF leak occured, which required endoscopic endonasal surgery with the plastic of a CSF fistula. All patients with large and giant prolactinomas which invade into skull base structures, receiving cabergoline even for a long time, should be aware of the possibility of such complications as CSF leak and, if necessary, should urgent appeals to the otolaryngologist and the neurosurgeon. In this case closure of skull base defect is a main tactics of treatment.

Дослідження значення поліморфізму rs1107946 гена COL1A1 щодо розвитку міопії у дітей Подільського регіону України Резюме. Серед механізмів патогенезу міопії важливе місце займають процеси, пов'язані з генетичними змінами структури і функції колагену. Колагенові волокна є найбільш численною складовою склери, на які припадає до 90 % сухої ваги фіброзної оболонки. При міопічному ремоделюванні склери експресія колагену, особливо колагену I типу, значно знижується. Частота алелей і розподіл генотипів за поліморфними варіантами rs1107946 гена COL1A1 серед досліджених дітей Подільського регіону України не відрізняються від середньоєвропейських значень цих показників. Частота варіантної алелі у дітей-міопів і дітей з еметропією становила 0,13 і 0,12 відповідно. Не виявлено вірогідної різниці в розподілі генотипів і частоті алельних варіантів rs1107946 гена COL1A1 між дослідженими групами. Для дітей Подільського регіону України поліморфізм rs1107946 гена COL1A1 не асоціюється з ризиком розвитку міопії.

Over the past decades, we have witnessed many remarkable advances in understanding the impact of vitamin D on human health. There is an exponential growth of new data covering both the fundamental biology of vitamin D and the clinical implications of deficiency and the effects of vitamin D supplementation. This literature review has been prepared to combine and interpret the current scientific evidence on the mechanisms of vitamin D absorption, with a focus on vitamin D absorption through the apical membrane of enterocytes in various pathologies of the gastrointestinal tract. Reviewed studies have identified some distinctive aspects of vitamin D bioavailability that should be considered in the treatment or prevention of vitamin D deficiency in patients with malabsorption syndromes, especially in the active phase of the disease. Moreover, recent in vivo experiments and in vitro studies have demonstrated that vitamin D absorption is not a simple diffusion process as previously thought, but rather a mechanism that also involves multiple membrane transporters. Maintaining or improving vitamin D intake through diet or increased sun exposure is problematic, so oral supplementation may be an effective and safe approach to improving vitamin D status. Vitamin D3 is the recommended form for both prevention and treatment of vitamin D deficiency, which is associated with more stable pharmacokinetics. Vitamin D absorption is improved when vitamin D is taken with a small amount of fat-containing food and medium chain triglycerides. In malabsorption syndromes, it is optimal to increase the general population doses of vitamin D by 2–3 times both for prevention and for the treatment of deficiency and insufficiency. While vitamin D deficiency is more common among people with gastrointestinal disease, data have not been able to establish whether the relationship is causal or the result of intestinal inflammation and malabsorption syndrome. However, owing to the understanding of the mechanisms of action of vitamin D, there is evidence that its deficiency can be directly related to the severity of the disease, and partly to the etiology or pathogenesis of the disease itself.

Background. Prevention of the diseases is the cornerstone of medicine. Preventing of the diseases improves the quality and life expectancy, and also reduces the costs for the diagnosis and treatment of diseases. The main preventive measures include maintaining a healthy lifestyle (proper nutrition and regular exercise) and vaccination.Purpose: to study the influence of distance learning programs on the knowledge of doctors about the vaccination.Materials and methods: a distance learning cycle of lectures was conducted on the vaccination of elderly patients. Before and after the course of lectures, an anonymous voluntary survey of the course participants was conducted. The questionnaires included questions for free completion, questions for assessing attitudes on a scale from 0 to 10 (where 0 strongly disagree and 10 strongly agree) and multiple choices questions. Physicians were informed before the survey that the data would be subsequently analyzed and published.Results: 556 people took part in the first stage of the survey, of which 469 (84.3%) were women. 328 people took part in the second stage of the survey, of which 271 (82.6%) were women. The experience of doctors was on average 27±11,8 years, specialists from 72 specialties took part. Before the course of the lecture, on average, the opinion of doctors on vaccination was 8.7±0.1 out of 10, after the course of the lecture it became 9.1±0.1 out of 10 (p < 0.05). Before the start of the course, on average, doctors assessed their knowledge at 6.9±0.1, after the end of the course 7.7±0.1 (p < 0.05). After a course of lectures, 95% of the respondents answered that they would recommend vaccination to their older patients and relatives.Conclusion: on-line learning course of lectures has been shown to be an effective method of improving the quality of doctors' knowledge about the importance and safety of vaccination of people of older and senile age.