Medical perspectives (Medicni perspektivi)

4-11

Authors: Pertseva T.O., Shponka I.S., Tverdokhlib I.V., Pototskaya O.Yu.

One of the important tasks in modernization of Ukrainian medical education is to bring it in line with international assessment criteria, which has become especially relevant after the introduction of the International Basic Medicine Examination in 2018. The aim of this work was to identify the most significant differences between international medical exams (for example, The United States Medical Licensing Examination, USMLE) and the national system of licensed exams KROK, and based on this, determine the direction of modernization of Ukrainian medical education for its adequate adaptation to new systems of assessment. The most significant differences between the two exams are: format (on computers / on paper); presence / absence of digital files with images and audio data in tasks; thematic focus of tests within one / several subjects; different list of items by which tasks are distributed; in the case of USMLE, there is a much higher motivation to pass the exam with the highest possible result. To adapt the medical education system to such features, it is necessary: to provide students with high-quality illustrated textbooks and meaningful digital data bases for each specialized subject; to actively use images (audio, video files) from these sources during the analysis of the material and all types of control (including test ones); to establish cooperation between the fundamental and clinical departments in the process of creating test tasks, as well as the exchange of digital materials for practical classes. Of particular importance is the synchronization of methodological approaches to conducting practical classes and assessment criteria not only in theoretical but also in clinical departments, which will make the learning process more transparent and understandable. Such a set of measures will help not only to adapt students to exams at the international level, but also will increase their interest and improve the effectiveness of the educational process. The employment of digital images, audio, video files will also contribute to the adequate preparation of students for new directions in medicine, such as telemedicine and telepathology.

19-24

Authors: Savchuk R.V., Kostyev F.I., Shmatkova N.V.

The aim of this work was to study the possibility of pharmacological correction of the neobladder contractile activity of mini-pigs under the influence of new chemical compounds, m-anticholinergic (solifenacin), selective beta-2 sympathomimetic (ginipral (hexoprenaline)) in vivo. Neobladder, formed from the distal section of ileum, pre-denervated along the anti-mesenteric margin, retains peristalsis, and given the sharp thickening of the muscle layer, capable to contractile reactions and tone support. New chemical compounds pyrrole-2-carbaldehyde 2- hydroxybenzoylhydrazone (PChBh) and isatin benzoylhydrazone (IBh) demonstrated spasmodic properties directed at smooth muscle in vivo. Compound PChBh (I) showed more pronounced relaxing properties compared to compound IBh (II), reducing basal pressure against KCl by 40.91%, contraction amplitude by 30.63%, contraction rate by 25.49%. Solifenacin, being an m-anticholinergic antagonist, most clearly demonstrated antispasmodic properties in vivo, reducing hypertonicity by 55.23%, amplitude – by 49.31%, frequency of contractions in 10 minutes – by 57.40%, duration of contractions – by 18.18%. Selective beta-2-sympathomimetic hexoprenaline, previously used to relieve hypertonicity of a pregnant uterus actively affects intestinal motility. Hexoprenaline inhibited bladder overactivity with KCl, decreasing basal pressure by 58.75%, the amplitude of the contractions – by 39.62%, frequency rate – by 57.49%, reductions in the duration – by 54.55%. Preparations from the group of m-anticholinergics and selective beta-2-sympathomimetics showed a pronounced antispasmodic effect in experiment in vivo and can be used to correct incontinence in patients after orthotopic bladder repair. The new chemical compounds pyrrole-2-carbaldehyde 2-hydroxybenzoylhydrazone (PChBh) and isatin benzoylhydrazone (IBh) demonstrated antispasmodic properties in the experiment in vitro, and confirmed an antispasmodic effect in the experiment in vivo, promising further research, determining safety and efficacy.

30-35

Authors: Feshchenko Y.I., Gavrisyuk V.K., Dziublyk I.V., Dziublyk O.Ya., Gumeniuk G.L., Gumeniuk M.I., Kapitan G.B., Yachnik V.A.

To determine the prevalence and spectrum of viral pathogens in patients with infectious exacerbation (IE) of chronic obstructive pulmonary disease (COPD), 106 patients were examined, who underwent a virological examination using fast immunochromatographic tests (IC-tests), as well as real-time multiplex polymerase chain reaction (PCR) with the simultaneous identification of 12 respiratory viruses. Respiratory viruses, as the etiological factor of IE COPD were identified in (65.9 ± 4.7)% of patients. Among viral pathogens adenovirus and rhinovirus - in (24.5±6.1)% of cases each and parainfluenza virus - in (18.4±4.6)% were of greatest etiological significance for the entire observation period. The influenza A and B virus was detected much less frequently - in (8.2±3.9)% and in (4.1±2.8)% of cases, respectively; respiratory syncytial virus and bocavirus – in (6.1±3.4)% and metapneumovirus – in (8.2±3.9)% of cases. The last two types of viruses were detected in Ukraine for the first time. The spectrum of viral pathogens of IE COPD depended on the seasonal circulation of a particular type of virus, the epidemiological situation in the region, and the characteristics of the examined population. The use of modern virological diagnostic technologies testifies to the leading role of respiratory viruses in the etiology of IE COPD аnd also allows the etiological diagnosis to be established in a short period of time – from 10-15 minutes when using fast IC-tests and up to 6-8 hours – when using real-time multiplex PCR, which contributes to the timely administration of adequate etiotropic treatment.

43-50

Authors: Abaturov A.E., Babуch V.L.

The high prevalence and possibility of transformation of functional disorders into organic pathology determine the relevance of the study of the cluster of functional disorders of the gallbladder and Oddi's sphincter (FD GB and OS) in children. Studies on the properties of ursodeoxycholic acid (UDCA) to alter the activity of generation of some microRNAs in various diseases of the hepatobiliary system have become important in view of the evidential impact on this process. The alm: to determine the effect of choleretic therapy with UDCA drugs addition on the microRNA-4714-3p expression level in functional disorders of the gallbladder and Oddi's sphincter in children. 70 children with FD GB and OS aged 4 to 14 years were examined. Main group included 50 children. They received standard therapy with UDCA combination. The comparison group included 20 patients receiving standard therapy without UDCA. A molecular genetic study was conducted to determine the microRNA-4714-3p expression level in serum before and after treatment by real-time polymerase chain reaction with reverse transcription according to TaqMan Gene Expression Assays. The correlation was established between the main anamnestic data, causative factors of development, clinical and paraclinical parameters of the FD GB and OS and the microRNA-4714-3p expression level in blood serum of children before therapy. The positive relationship of the microRNA-4714-3p expression profile with decrease in gallbladder contractility was determined (r=+0.36; p<0.05). It has been determined that in children with FD GB and OS after the combined therapy with UDCA, the mean value of the microRNA-4714-3p expression level in serum is significantly lower than before therapy (1.93±0.58 SU and 5.56±1.50 SU, respectively). A positive correlation was found between the microRNA-4714-3p expression level and the alkaline phosphatase activity level in the blood of children with FD GB and OS after therapy with UDCA addition (r=+0.33; p<0.05). There was no correlation between the microRNA-4714-3p expression level and the anamnestic, clinical-paraclinical parameters in children with FD GB and OS after treatment without UDCA. The effect of UDCA on the treatment of functional disorders of the gallbladder and Oddi's sphincter in children results in a decrease in the microRNA-4714-3p expression profile and is accompanied by the emergence of a direct correlation between low level of a microRNA-4714-3p expression and reduced alkaline phosphatase activity in serum.

59-68

Authors: Burtniak T.Z., Potabasniy V.A., Fesenko V.I.

The aim of the study was to establish the relationship between tolerance to exercise, oxygen saturation, and structural and functional cardiac status in patients with hypertension in combination with COPD. This study included 120 patients with primary arterial hypertension of stage I-II, grade 1, 2, and 3 in combination with COPD of grades 2 and 3 and clinical groups A, B, C, D, consisting group 1; group 2 – 30 patients with primary hypertension, and group 3 – 30 patients with COPD; group 4 – 30 practically healthy people representative by age and sex. Research methods included general clinical examination (collection of complaints, anamnestic data) and instrumental research methods: electrocardiography (ECG), echocardiography, measurement of ambulatory blood pressure (BP) profile (ABPM), spirometry, pulsoxymetry (SpO2), 6-minutes walking test (6MWT). On examination of 120 patients with stage I-II, grade 1 hypertension was established in 19 (15.8%), grade 2 was in 83 (69.2%) and grade 3 was in 18 (15%) patients, respectively. COPD in clinical group A was diagnosed in 10 (8.3%), B – in 51 (42.5%), C – in 18 (15%) and D - in 41 (34.2%) patients, respectively. The most common was AH stage 2 with COPD in clinical group B – 35 (29.2%) cases and D – 31 (25.8%) cases. The 24-hour average systolic BP (SBP) in patients of the main group was 165 [144;178] mmHg, and the diastolic BP (DBP) was 103 [94;111] mmHg. The daytime average SBP was 160 [140;180] mmHg, and the DBP was 105 [93;117] mmHg accordingly. The night-time average SBP was 165 [155;175] mmHg, DBP – 100 [95;105] mmHg, heart rate (HR) – 83 [76;88] minutes, respiration rate (RR) – 21 [19;24] minutes. Decreases in index of chronotropic reserve (ICR) and the index of inotropic reserve (IIR) and load index indicate an increase in myocardial oxygen demand during exercise. There was an inverse correlation of IIR with SBP at rest (r= –0.42; p˂0.05) and a direct correlation with age (r=0.28; p˂0.05), which is significantly different from the control group. A direct correlation was found between the double product (DP) before and after exercise (r=0.43; p˂0.05), which indicated an increase in consumption of oxygen by the myocardium. We found a direct correlation between left atrium (LA) and the ratio of expiratory volume per 1 sec (FEV1) to the forced lung capacity (FEV) – FEV1/FVC (r=0.32; p˂0.05), which indicates the effect of the severity of bronchial obstruction on the level of left ventricular (LV) overload in patients with hypertension combined with COPD. The inverse correlation between thickness of the posterior wall of the LV (RVWT) and FEV1/FVC (r= -0.32; p˂0.05) indicates the contribution of disorders of bronchial patency and intrathoracic pressure with the level of BP to the development of concentric remodeling and LV hypertrophy. The inverse correlation between SV and COPD Assessment Test (CAT) (r= -0.32; p˂0.05) indicates an additional effect of COPD clinical severity on central hemodynamics in patients with hypertension. This relationship between the ventilatory and hemodynamic parameters is confirmed by the inverse correlation of HR and FVC (r= –0.33; p˂0.05)), left ventricular internal dimension (LVEDD) of LV and CAT (r= –0.24; p˂0.05)), stroke volume (SV) and Modified British Medical Research Questionnaire (mMRC) (r= –0.42; p.00.05), CAT and pack years (r=0.33; p˂0.05), inverse correlation between CAT and mMRC and FEV1, FVC and FEV1/FVC (r= -0.40;p˂0.05 and r= -0.45; p˂0.05), respectively. Linear regression analysis showed that changes in SV LV, LVEDD and SpO2 were dependent predictors of patient’s worsening state according to CAT (p˂0.05). The direct correlation was established between the desaturation (ΔSpO2) and ΔDP (r=0.48) and the inverse of ΔSBP (r= -0.29), 6MWT (r= -0.45), ICR (r= -0.34) and IIR (r= -0.29), which indicates a pronounced effect of hypoxemia on hemo­dynamics in patients with hypertension in combination with COPD. Comprehensive determination of cardiorespiratory reserve by 6-minute walk test, pulse oximetry and ambulatory blood pressure monitoring in patients with hypertension in combination with COPD makes it possible to establish disadaptation of the body to physical activity due to hypoxemia, decrease in the index of chrono- and inotropic reserves, which is an indication for administering appro­priate therapy. In patients with hypertension combined with COPD, the degree of desaturation, stroke volume, end-diastolic parameters of the left ventricle, maximal size and volume of the left atrium, as well as remodeling of the left heart sections in the concentric direction can be considered as independent predictors of prognosis. The 6-minute walk test with desaturation can be used as an additional method of personalizing rehabilitation measures in patients with hypertension in combination with COPD.

74-83

Authors: Dzyak L.А., Rosytska О.А.

Aim to evaluate the comorbidity profile in patients with chronic cerebral ischemia on the background of multifocal atherosclerosis. The study included 137 patients aged 40 to 84 years with chronic cerebral ischemia (CСI) on the background of multifocal atherosclerosis, which were divided into three clinical groups depending on the localization of vascular lesions by stenosing atherosclerosis. The co-morbidity profile and severity were evaluated using the Charlson’s index in modification of R.A. Deyo (1992). In CCI patients, regardless of the combination of vascular basins affected by atherosclerosis, a severe degree of comorbidity prevailed - the Charlson’s comorbidity index (IC) was predominantly > 5 points (84.7% of cases). In the analysis of IC in age categories, depending on the combination of atherosclerotic lesions of the vascular basins, it was found that comorbidity of severe degree (IC> 5) was predominantly represented by patients of the older age group (60-74 years), and comorbidity of moderate severity (IC≤5) – patients of middle age group (45-59 years). A median difference of 3 points in assessing the mean value of age-matched comorbidity index showed that age, as a non-modifiable risk factor, in 1/3 cases determines the comorbidity index, which depends on the number of vascular basins affected by atherosclerosis. In 2/3 of the cases it is a modified comorbid pathology. Assessment of IC in clinical groups, taking into account the nature of the disease course (p <0.05), showed a correlation between the number of atherosclerosis affected by vascular basins, the severity of the clinical course of CCI and the severity of comorbidity. The severity of comorbidity, as measured by the Charlson’s index modified by R.A. Deyo, depends on age and determines the nature of the atherosclerotic lesion, as well as the severity of the clinical course of CCI. Assessing the profile and severity of comorbidity makes it possible to influence the nature of the development and course of brain ischemia, which is caused by systemic atherosclerotic lesions of the vascular system.

89-93

Authors: Dytyatkovska E.M., Bendetska Yu.V., Rodkina I.A., Nedogibchenko N.А.

The article presents summarized materials on etiology, pathogenesis, classification, clinical manifestations and treatment of chronic urticuria, The management of patients with this pathology at Dniprovsky Allergological Center was analyzed. For assessment of quality of life SKINDEX-29 questionnaire was used. The questionnaire includes three sections: symptoms, emotions and functions. Physical symptoms include six points: tenderness, heartburn or tingling, itching unpleasant sensations when cotacting with water, skin irritation, sensitivity. The emotional sphere is characterized by such ten points as: concern about the condition of the skin; deppression; feeling of shame; concern that scars can remain after skin disease; feelings about worsening of the skin; anxious mood; embarrassment, feeling of humiliation; skin irritation; rejection of oneself. “Features” section has twelve items: sleep quality; work and hobbies; social activity; sex life; solitude; fatigue; unwillingness to leave home; limiting intimacy with others; complexity in carrying out daily activities; difficulty in expressing feelings; obstruction to create relationships with others; limiting close communication with relatives. Gastrointestinal system was also examined: fibrogastroduodenoscopy with determination of Helicobacter Pylori, ultrasound diagnosis of abdominal organs, the intensity of clinical symptoms was determined on a UAS7 scale. Fifteen patients (including eight women and seven men) were successfully treated with omalizumab. The mean age was 39.1 ± 3.6 years. The average duration of the disease in patients was 5.1 ± 0.9 years. The intensity of symptoms was determined before treatment after the first and second injection of Omalizumab. After the first injection, there was a positive trend. The clinical effect occurred in seventy-two hours. Statistical processing of the study results was performed using Statistica v.6.1® software. (StatSoft, USA). The inclusion of omalizumab is an effective treatment for chronic urticaria in the absence of an effect from antihistamines.

101-111

Authors: Hnenna O.M.

The coexistence of psychopathological symptoms with HIV / AIDS is associated with aggravation of their condition due to the likelihood of deviant behavior. The aim of the study – assessment of the likelihood of deviant behavior in HIV-positive patients with non-psychotic psychiatric disorders. A comprehensive clinical and psychodiagnostic examination of 114 HIV-infected patients with non-psychotic psychiatric disorders was conducted including clinical-diagnostic interviews, pathopsychological and experimental-psychological methods of investigation, including the method of Ch.D. Spielberger in modification of Yu.L. Hanin (STAI - State-Trait Anxiety Inventory) for assessing anxiety level, Beck Depression Inventory (BDI-II) for assessing depression, SCL-90-R (Symptom Checklist 90-Revised) for assessing psychiatric symptoms. Statistical processing of the results was performed using descriptive and analytical methods implemented in the software STATISTICA 6.1 (StatSoftInc., Serial No. AGAR909E415822FA). Frequency and severity of depression and anxiety in HIV-infected persons is significant and by 3.4-4 times exceeds the corresponding in­dicators of a healthy Ukrainian population. Anxiety, depression, and other psychopathological symptoms according to SCL90-R scales (except for the obsessive-compulsive scale) are more pronounced in HIV-infected patients with destructive behavior than in patients without it. The chances of developing deviant behavior in HIV-infected persons with non-psychotic psychiatric disorders are increased at GSI>1 by 20.0 times (95% CI 5.63 - 71.07), in the presence of depressive symptoms – by 6.76 times (95% CI 2.16 – 21.18) and at a high level of personal anxiety – by 4.61 times (95% CI 2.05 - 10.40). Psychopathological symptoms of people with HIV status are characterized by high rates of depression and anxiety, somatization, paranoid ideas, interpersonal sensitivity. In patients with signs of deviant behavior, the severity of these disorders and the severity index of psychopathological symptoms was significantly higher (p<0.001) compared with patients who do not have such characteristics. According to the logistic prognostic model, the chance of developing deviant behavior significantly increases with an increase in the index of overall severity of psychopathological symptomatology, with an increase in the level of depression, and a level of personal anxiety. Considering this, when providing medical assistance to HIV-infected people, their needs for psycho-correction should be taken into account in order to prevent deviant behavior.

121-133

Authors: Krasnoselskyi M.V., Hladkykh F.V., Kulinich H.V., Sevastianova V.S.

According to the National Cancer Registry of Ukraine, cervical cancer ranks second among cancer morbidity, in women of reproductive age and the first place (14.1% of all cases) in the mortality from malignant neoplasms in women aged 18-29, and in aggregate almost 1.7 thousand women die from this pathology in Ukraine annually. Radiation therapy plays a leading role in the treatment of this pathology. In turn, an increase in the survival rate after the course of combined treatment leads to an increase in the absolute number of patients with adverse effects of treatment, in particular, late radiation toxicity (LRT). A retrospective analysis of 254 case histories of patients with malignant cervical neoplasms (127 patients with late radiation toxicity and 127 patients without late radiation toxicity) was conducted. Depending on the nature of the genesis of the late radiation toxicity, it has been found that inflammatory changes occurr in 95.3% of patients (atrophic cystitis, radiation recticite, radial enterocolitis, radiation retropsychoiditis, etc.); in 32,3% – late radiation toxicity of fibrotic genesis (intrapulmonary radiation, ureter stenosis, fibrosis of the skin and subcutaneous tissue of the irradiation fields, etc.); in 25.2% – degenerative late radiation toxicity (radial ulcers, fistulas, etc.) and 30.7% – hematologic late radiation toxicity. The comparative analysis of clinical and laboratory parameters of patients before and after radiotherapy with regard to cervical cancer has shown that prognostic factors of late radiation toxicity such as increase in hematocrit and fibrinogen indices deserve attention. It has also been established that the presence of laboratory signs of a cytolytic syndrome (increased levels of aspartate aminotransferase, urea and total protein) in patients with cervical cancer prior to radiation therapy can be a prerequisite for the formation of late radiation toxicity. In addition, it has been shown that the presence of concomitant aggravating diseases of the endocrine system, blood system, musculoskeletal system, nervous system and digestive system is statistically significantly (p<0,05) increases the risk of LRT in patients with cervical cancer by 20,2; 7.0; 2.3; 1.8 and 1.6 times respectively.

145-153

Authors: Khotimska Yu., Kovach I., Buniatian Kh., Kravchenko L., Varzhapetian S.

The purpose of the study was to determine the effect of tricalcium silicate cement on the protective process of pulp in the treatment of reversible pulpitis. There was carried out an experiment on 3-month-old male rabbits to study morphofunctional changes in the pulp tissue with modeling of reversible pulpitis followed by vital amputation with coating of the pulp with tricalcium silicate (8 animals, study group) and mineral trioxide aggregate (MTA) (8 animals, comparison group). In 2 and 6 weeks dental tissues were fixed by 10% formalin solution and after decalcification and done routine procedures, histological sections were made, stained with hematoxylin and eosin. After the application of tricalcium silicate cement in 2 weeks, the odontoblast density changed to 3.92±1.03×103/mm2 from 8.3±1.02×103/mm2 of cell density in the intact group. The number of neutrophils also plays a big role in the regeneration of inflamed pulp. Thus, in 2 weeks the number of neutrophils made up 6.39±2.61x102 per 1 mm2, which is 3 times less than after mineral trioxide aggregate usage – 19.49±2.85x102 per 1 mm2. It was established that the processes of rheological disorders with impaired lymph circulation are replaced by the restoration of the cellular component. In such a way the proposed vital amputation was examined for reversible pulpitis and it revealed similar clinical and pathological effectiveness with a positive regenerative process with formation of a sufficient number of odontoblasts (7.98±1.51×103/mm2) for the subsequent formation of a hard tissue bridge, which consists of collagen fibers in the form of a frame. The main goal of vital amputation procedure is regeneration (proliferation) of the pulp with a short-term signs of alteration and exudation, which is provided by the choice of material for the pulp covering. Thus, after the vital amputation of the pulp, followed by the use of tricalcium silicate cement 6 weeks after, the number of neutrophils was 1.39±0.72x102 per 1 mm2, which is 5 times less than after using mineral trioxide aggregate.

160-176

Authors: Hryhorenko L.V., Baibakov V.M.

Purpose of the research performed by the cohort method is to study the levels of public health among children and adults living in the rural industrial area of the Zaporizhzhia region. In order to estimate primary and overall disease incidence by the separate nosological forms in children and adult population: (C00-C97), (E10-E14), (I10-I15), (I20-I25), (J95- J99), (K20-K31) retrospective research was carried out according to the ICD-10. Scientific substantiation of the research in the rural district was based on the following categories: choosing category of the adult population and children aged 0-14 years to 15-17 years, social-hygienic parameters, types of water supply systems. Investigation of the incidence was carried out according to the report of Information Health Department Centre for the period of 2008-2016 years. The main factors which influence the formation of public health are demographic indicators of different age groups, as well as indicators of dispensary supervision (the composition of health groups, the proportion of frequently ill children) on the territory of experimental observation area. In our research we tried to study these two groups of medical and social factors to understand the conditions under which health of the rural population in this industrially developed region of Ukraine is being formed. The percent of organized groups of frequently ill childrenl in the Kamensko-Dniprovskyi rural district during 2008-2016 observation period increased from 53.3% in 2008 to 68.2% in 2016, which also testifies to a negative tendency to increase in the rate of children falling ill more than 4 times during 1 year, and the low resistance of the body to acute viral infections.

182-190

Authors: Kolesnik N.S., Marchenko N.A., Stadnik A.I., Ielisieiev V.V., Stepanova T.A.

In the practical activities of a modern doctor, significant difficulties are noted in the diagnostics and proper management of patients with hereditary diseases due to the limited coverage of the population by genetic researches. For a long time, the patients with a variety of complaints are observed by doctors of various specialties, and the therapy often has little effect due to a lack of understanding of the true causes of pathological changes. The situation is complicated by case of a combined course of a hereditarily caused disease and some other disease of an infectious, non-infectious or tumor nature. The aim of the research was to study the characteristics of clinical manifestations, course of tuberculosis with resistance to anti-TB drugs in a patient with a rare hereditary disease from the group of phacomotoses - Bourneville-Pringle disease or tuberous sclerosis. This disease has a wide range of clinical manifestations, accompanied with the development of benign neoplasms in various organs and systems, damages to the skin, brain, organs of vision, lungs, kidneys, heart, as well as the musculoskeletal and endocrine system. It leads to development of various infectious and non-infectious pathologies in these organs. The article covers a 4-year period of observation of a young patient with late diagnosed tuberous sclerosis, suffering from pulmonary tuberculosis and tuberculosis of urinary system, includes the initial diagnosis of a specific disease, the course, the dynamics against received treatment and the development of relapse with the formation of resistance to anti-TB drugs. The difficulties in the management of tuberculosis in this patient were in the detection of numerous neoplasms and changes in the internal organs, in particular in the kidneys and lungs, which characterized tuberous sclerosis, on the one hand this contributed to untimely diagnosis of tuberculosis, and on the other hand – worsening the course and the progression of a specific process, as well as an unfavourable prognosis for recovery.

4-9

Authors: Usenko L.V., Krishtafor A.A., Tiutiunnyk A.H., Petrashenok Ye.V., Oleniuk D.V., Machuzhak H.A., Skulinets O.B.

The article describes an important component of the medical process which should be paid a special attention: the preparation of a young doctor – the communication between the physician and the patient and his relatives. Distinctive features of a modern patient: the tendency to control the state of his own health with simultaneous irresponsible attitude towards it; when revealing a disease, he/she is looking for the worst in himself/herself; the reduction of the moral character against the background of a decline in the morals of society, which affects the culture of the patient's behavior, makes him/her more aggressive; a modern patient is more lenient to himself/herself with an extremely demanding attitude to the doctor. Several interrelated functions of communication are distinguished: informational, interactive, perceptual, emotive (affective-commutative). The levels of communication are distinguished: social-role (ritual); business; intimate-personal. There are three types of communication: imperative; manipulative; dialogical (based on equal partnership). In the process of communication of the physician with patients, depending on the circumstances, two systems of communication can be used: verbal and nonverbal. In the relationship "patient-physician" R. Witch identifies 4 models: paternalistic, technocratic, collegian, and contractual. Each patient needs an individual approach, individual forms of communication and measures of physician’s psychotherapeutic influence, especially in the communication of the doctor with so-called “difficult” patients, as well as at the risk of conflict situations. Causes of conflict situations are: insufficient attention to the patient; characteriological features of a doctor and a patient; unreliable information about the state of health of the patient from the part of junior and middle medical personnel; lack of patient’s information consent for treatment; lack of coordination of the actions of different medical specialists; defects in the maintenance of medical records; professional incompetence.

15-21

Authors: Kuryata O., Semenov V.

Patients with chronic kidney disease (CKD) have higher than in general population all-cause and cardiovascular mortality. Arterial hypertension (HTN) is a powerful potentially modifiable risk factor that affects the majority of patients with chronic kidney disease and one of the main causes of end stage renal disease worldwide. Existing tools for assessment of risk of CKD progression do not take into account arterial hypertension. The aim – to investigate the association between cardiovascular and nephrological risk factors in patients with CKD in ambulatory practice. The study was carried out in the Center of Nephrology Care in Mechnikov Dnipropetrovsk Regional Hospital, Dnipro, Ukraine. 278 patients (114 males and 164 women, aged 41 [31;61] years) with CKD (stages 1-3) who were followed-up in ambulatory care, but required diagnosis or treatment revision were enrolled to the study. All patients were examined and followed-up according to local and European standards. Females slightly prevailed in our study, gender distribution varied insufficiently in groups by CKD progression risk. Elevation of risk of CKD progression was accompanied by rise of prevalence of diabetes mellitus, left ventricle hypertrophy, proteinuria and HTN. Risk of CKD progression correlated with age, systolic and diastolic blood pressure, erythrocyte sedimentation rate, total cholesterol, glomerular filtration rate, albumin excretion rate, duration of HTN and body mass index. Rise of cardiovascular risk was accompanied by rise of proportion of patients with high risk of CKD progression. Increase in risk of CKD progression is associated with rise of burden of cardiovascular risk factors. HTN and blood pressure values should be accounted for assessment of risk of CKD progression.

33-39

Authors: Khalimonchyk V., Klygunenko O.

Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immulogic, and metabolic alterations. Objective: to evaluate the effect of combined intraoperative use of ketamine in low subnarcotic doses and dexketoprofen on intensity of the pain syndrome and dynamics of the stress response in gynecological laparoscopic surgery. A total of 45 patients scheduled for laparoscopic gynecological surgery under total intravenous anesthesia (TIA) were examined randomly and divided into 2 groups. Demographic characteristics, anthropometric data, functional status, duration of surgery and anesthesia were similar in all groups. Group 1 (n=25) patients received total intravenous anesthesia (TIVA) with propofol and fentanyl. Group 2 (n=20) patients received TIVA with additional administration of subanesthetic doses of ketamine and a single administration of 50 mg of dexketoprofen 30 minutes before the end of the surgery. Cortisol and blood glucose levels were evaluated before induction into anesthesia, after the main stage of operation, 2 and 24 hours after surgery. The intensity of postoperative pain was evaluated by VAS in 2 and 24 hours after surgery. The intensity of postoperative pain, concentration of serum cortisol 2 hours after surgery were significantly lower (p <0.05) in patients of group 2, compared to control (p<0,05). Differences of blood glucose levels between groups at the stages of the study were not identified. Combined intraoperative use of subanesthetic doses of ketamine and dexketoprofen at the end of the surgery provides a stress-protective effect. This is confirmed by the rapid normalization of serum cortisol levels and stable blood glucose levels after surgery and is manifested by a low level of postoperative pain syndrome.

45-52

Authors: Filippova A.Yu.

High priority in the pathogenesis and treatment of non-alcoholic steatohepatitis (NASH) is given to disorders of lipid-phospholipid fractions, which are directly related to the functioning of hepatocytes. The aim of the study was to evaluate the effect of various complex treatment regimens on lipid-phospholipid fractions in patients with NASH in combination with obesity (OB) and pathology of the biliary tract (BT) according to a 6-month follow-up. 52 patients with NASH in combination with OB and BT pathology were examined. The control group consisted of 20 practically healthy individuals. The effect of complex treatment (preventive and therapeutic measures) on the indicators of lipid-phospholipid fractions in patients with NASH in combination with obesity and pathology of the biliary tract was studied. Changes in the indicators of serum lipid-phospholipid fractions were detected before treatment in all observation groups, which were accompanied by decrease in phospholipids (PL), phosphatidylcholine and sphingomyelin content and a significant increase in PL lysoforms – lysophosphatidylcholine and phosphatidylethanolamine, triglycerides, cholesterol esters (from p<0.05 to p<0.001). Combination therapy with the inclusion in the standard treatment of ursodeoxycholic acid and arginine glutamate in the comorbid course of NASH can be considered as a promising direction in the treatment of this category of patients, this allows to improve indicators of lipid-phospholipid fractions and stabilize the hepatocytes’ membrane (from p<0.05 to p<0.001).

58-66

Authors: Sirko A.G., Dzyak L.A., Pylypenko G.S., Yovenko I.O. , Skrypnik A.A.

Purpose – to ana­lyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of exa­mination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001).

74-79

Authors: Ilchenko S.I., Fialkovska A.А.

Chronic bronchitis (СB) remains one of the most pressing problems of pediatric pulmonology. This is due to the high prevalence of this disease and the possible transformation into chronic obstructive pulmonary disease (COPD) in adults. Today, there is a large number of exogenous and endogenous risk factors for developing CB in children and adolescents. However, the effect of smoking on the development, clinical course of СB and the molecular genetic basis of its formation is insufficiently studied in adolescence. The purpose of the study is to investigate the clinical features of the course and genetic risk factors for the development of CB in adolescent smokers. A comprehensive survey of 107 adolescents was performed. All patients were divided into three groups. The group 1 included 40 adolescent smokers with СВ, the group 2 – 30 adolescents with СВ who never smoked, the control group included 37 conditionally healthy adolescent smokers. The study included the collection of anamnesis, an objective examination of adolescents, and a molecular genetic investigations. For statistical processing of the results obtained, the program “Statistica 6.1” was used. The results of the study showed that smoking leads to the development of СВ in adolescence and affects its course, increasing the frequency and duration of exacerbations. An association of the 2G/2G genotype of the MMP-1 (rs1799750) gene with the risk of developing СВ in adolescent smokers was detected. At the same time, it was found that the presence of the TT genotype of the CYP1A1 (T3801C) gene can be considered as a possible factor of resistance to the development of CB in adolescent smokers. The data obtained in the course of the research will help develop measures of primary prevention and individual approaches to the rehabilitation of adolescents with СВ, which will prevent the development of COPD in the future.

87-96

Authors: Nikolenko O.O., Shulga O.D., Kozliuk V.V., Zheshko O.M., Yurko O.A., Dubinets M.I.

Exact causes of contradictions in the understanding of relapsing course as characteristic phenomenon of multiple sclerosis (MS) and primarily relapsing-remitting type are still considered to be “sub rosa”. We tried to determine connection and correlation between seasonal dynamic factors, chronometric parameters of disease progression (age, disease duration) and frequency of relapses and the role of gender differences as well. A four-year prospective study included complete registration of all cases of MS exacerbations in resident patients with a relapsing-remmiting course of the disease according to McDonald criteria in Volyn region of Ukraine in 2010. Each patient had neurological score based on EDSS scale to ensure compliance with inclusion criteria. 128 patients (44 males and 84 females) with a remitting-recurring course of the disease were involved in this study. Statistical analysis was performed using SPSS 18, MedCalc and Microsoft Excel software using standard descriptive statistics, correlation and regression analysis. In total, 197 cases of MS relapses were registered. Episodes of relapses prevailed in winter-spring period. Multiple regression model including suggested climate factors showed multiple correlation coefficient – 0.55 (p<0.01). The prevalence of MS was higher in females, while general incidence of recurrences was similar to males. However, relapse rate in different age groups differs: the rate of recurrence increases in women aged after 50 years (mean annualized relapse rate (ARR)=0.66), while it slowly decreases in men with aging. The duration of the disease did not have significant effect on the course of MS in women, whereas weak negative relationship (0.24, p<0.001) between the duration of the disease and the frequency of MS in men was showed. Correspondingly, the average negative correlation (-0.37, p<0.001) was detected between the age of disease onset and the incidence of MS recurrence in males, while this connection was not observed in females. We established that the recurrence of MS is a result of multifactorial influence of external and internal factors. Individual seasonal climate variability did not have sufficient force of influence. Therefore, combined effect of corresponding climate changes played a significant role. Furthermore, it is quite probable that interactions of MS with external factors influencing the human body can be mutually integrated.

101-105

Authors: Raznatovska O.M., Fedorec A.V., Shalmina M.O., Grekova T.A.

Objective – to update the literature data with the clinical features of pregnancy in multidrug-resistant tuberculosis (MRD-TB) and type 1 diabetes mellitus (T1DM) comorbidities based on an example from own clinical experience. A clinical case of pregnancy course in MRD-TB and T1DM comorbidities was described based on our own clinical experience. We report the clinical case of newly diagnosed MRD-TB in a 38-year-old woman suffering from T1DM. Her general condition was unstable from satisfactory to moderately severe despite an adequate treatment of MRD-TB and T1DM with manifestations of intoxication syndrome and nephropathy. Adenomyosis with periodic bloody vaginal discharge was diagnosed. There was no clinical-radiological dynamics and sputum culture conversion. After an intensive phase of antimycobacterial therapy within 3 months, the patient got pregnant. Based on the medical indications (MRD-TB, absence of sputum culture conversion and clinical-radiological dynamics, moderate severity of T1DM, nephropathy) and adenomyosis with bloody vaginal discharge, the patient was requested to induce the pregnancy termination, and she consented. On month 7 of antimycobacterial therapy, an extensive drug-resistance of Mycobacterium tuberculosis to antimycobacterial agents and negative dynamics by follow-up chest X-ray were diagnosed. The feature of pregnancy course in MRD-TB and T1DM comorbidities was an unfavorable coexistence of both these diseases simultaneously resulting in an induced abortion. In this case, doctors to working with patients suffering from both MRD-TB and T1DM are recommended to advise patients the use of contraception in order to prevent pregnancy during treatment of active MRD-TB.

113-122

Authors: Lekhan V.M., Kriachkova L.V.

In the modern world, the use of the global burden of diseases and the quantitative assessment of the factors leading to the loss of a healthy life provides fundamental evidence for the development of an adequate public health policy. The purpose of the study is to substantiate the system of measures on improvement of the health of the population of Ukraine on the basis of an in-depth analysis of the global burden of diseases and injuries and associated risks. The study used materials from the Institute of Health Metrics and Evaluation of the University of Washington, Human Development Network of the World Bank and the «Disease Burden Unit» of the World Health Organization, collected during 1990-2017 years. The bibliosemantic, historical, epidemiological, conceptual modeling methods and benchmarking were used in the course of study. The loss rate of age-standardized disability-adjusted life year (DALY) in Ukraine in the period between 1990-2017 practically unchanged and in 2017 it was 34 975.04 DALYs per 100 000, which is almost a quarter more than in the countries of Eastern Europe and twice as much as in the countries of Western Europe. In the structure of Global diseases burden in Ukraine, 3/4 falls on non-communicable diseases, about 15 % depend on external causes and less than 1/10 – on infectious and other diseases and conditions. Shares of the disease burden associated with specific risk factors and diseases related to the relevant factor were identified. The evidence-based system of measures is aimed at achieving goals to reduce the global burden of disease and the risk factors affecting it, being based on an inter-sectoral approach and combines population and individual risk strategies. The subjects of the system are parliament, central and local governments / communities, private campaigns, the media, public health structures and primary health care.

4-9

Authors: Pyatchanyna T., Ogorodnyk A., Melnik-Melnikov P.

Patent research in the field of biomedical sciences (BMS) allows to give an objective assessment of the novelty and technical and economic level of the developed object of economic activity, to identify the most promising objects of economic activity, to identify competitive trends in the analyzed industry, to use the best achievements of world science, in the course of scientific research (SR), timely protect own technological and technological solutions with patents in Ukraine and abroad. The purpose of the article is to optimize methodological approaches to conducting patent research in the field of biomedical sciences on the basis of analysis of patent and scientific and technical databases. The fulfillment of the patent researches requires the use of compulsory methodological approaches, which are developed on the basis of DSTU 3575-97 "Patent Research: Key Provisions and Procedure". At each stage of the implementation of the SR, the algorithm for the patent researches, which must be followed in order to ensure the perspective of the development of object of economic activity, its legal protection, and competitiveness has been developed. The methodical approaches to conducting the patent researches in the field of BMS are determined on the basis of analysis of patent and scientific and technical databases, which allow to reveal competitive directions in the field of BMS, identify the most promising ones, give an objective assessment of novelty and technical and economic efficiency of SR; to use the most outstanding achievements of the world science during SR; timely protect own technical and technological decisions by patents in Ukraine and abroad.

13-19

Authors: Poslavska О.V., Shponka I.S., Babiy H.S.

Carcinomas with an unknown primary site are a heterogeneous group of metastatic tumors, numbering from 3% to 5% of all malignant carcinoma phenotypes. An isolated lesion of the inguinal lymph nodes is relevantly associated with primary localization of tumors in the pelvis, anal canal, lower abdomen, lower limbs, and more towards in the reproductive system (vulva, vagina and cervix for women, penis for men). But in the absence of clinical signs of cancer after careful research, the histological biopsy of the lymph node with additional immunohistochemical staining with organ-specific markers becomes the diagnostic method of choice. A retrospective analysis of the histological, morphometric and immunohistological characteristics of the biopsy material of 59 patients with isolated lesions of the inguinal lymph nodes (35 women and 24 men) aged from 20 to 87 years (mean 59.26±15.86; median 62 years) was conducted. The distribution of variants of an isolated lesion of the inguinal lymph nodes in women showed 14 of 35 (40.00%) metastatic tumors (the other 21 are lymphoproliferative conditions that require phenotyping, but not finding the primary localization). Of 14 metastatic lesions in women, 6 cases demonstrated a p16ink (+) phenotype. For comparison, of 24 cases in men, only 6 (25.00%) were of metastatic origin, of which p16ink (+/-) was partially 1 metastasis of melanoma (16.67%). After a thorough immunohistochemical study with a panel of organo-specific markers among isolated metastatic lesions of the inguinal lymph nodes of tumors in women, half of the revealed localized sites (7 out of 14) were in reproductive organs, namely: 4 p16ink (+) to squamous cervical cancers, 2 p16ink (+) to serous ovarian adenocarcinoma, 1 p16ink (-) to leiomyosarcoma of the uterus. Other localizations did not have a clear location, as they related to metastases of carcinoma from Merkel cells and melanomas, as a result of frequent reduction of the primary tumor lesion in the skin.

24-33

Authors: Surkov D.

The negative impacts of standard pharmacologic sedative agents suggest that alternative agents should be investigated. Dexmedetomidine could be the new option for sedation in newborns with hypoxic-ischemic encephalopathy requiring mechanical ventilation. The aim – to determine the impact of dexmedetomidine and other sedatives on the cerebral blood flow and outcomes of hypoxic-ischemic encephalopathy in term neonates. Data of 205 term infants with hypoxic-ischemic encephalopathy by Sarnat scale stage II-III were collected during ≤72 hours of life. The infants were divided using a simple open randomization by pharmacological sedative agents during mechanical ventilation into dexmedetomidine group (n=46) and the control group (n=159), which included morphine, sodium oxybutyrate, and diazepam in standard recommended doses. A comparative analysis of the effect of dexmedetomidine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. A significant difference between groups in days of trachea extubation (p=0.022) was found; the chance for babies to be extubated before the 7th day of treatment was significantly higher in the dexmedetomidine group 68% versus 33% in the control group (p=0.018) with HR 0.48 (95% CI 0.27-0.86, p=0.011). Also, the NIRS index rScO2 differed significantly between the studied and control groups on the 1st day of treatment (65% versus 79%, p=0.012) and on the 2nd day of treatment (74% versus 81%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group – (58 [51-65] mm Hg versus 53 [46-60] mm Hg, p<0.001), with a lower dose of dobutamine (EV -1.87, 95% CI from -3.25 to -0.48, p=0.009). In the dexmedetomidine group, the rate of seizures was significantly lower on the 1st day of obser­vation (4.3% versus 48.3%, p <0.001); the incidence of unfavorable outcome sueh as cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared to the control group (2.2% versus 15.1%, p=0.018). Dexme­detomidine is a safe sedative agent with a stable hemodynamic profile, without adverse influence on cerebral perfusion and possible neuroprotective effects in term infants with HIE, as addition to standard therapeutic hypothermia.

40-45

Authors: Arkhipkina O.L.

Nowadays, the problem of comorbid chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) is considered from the point of view of the presence of common risk factors and pathogenetic mechanisms. The aim of the study was to investigate cardiorespiratory system function in patients with COPD and AH and to analyze the main cardiovascular risk factors. 284 patients with COPD were divided into 2 groups: the main group - 167 patients with COPD and concomitant hypertension, the comparison group - 117 patients with COPD and normal blood pressure values. An analysis of the clinical picture of COPD revealed that patients with AH more often had exacerbation of underlying disease, more expressed clinical manifestations of the disease, differed in phenotypic distribution of patients. All patients with COPD showed a tendency to increase in arterial pressure, blood glucose level and total cholesterol compared with the control group with enhanced tendency in hypertensive patients. In addition, in hypertensive group the patients had a higher body mass index and smoked intensively. According to EGC data, the majority of patients with COPD experienced tachycardia, arrhythmia and conduction disturbances, hypertrophy of ventricules, which occurred more often in hypertensive patients. Pulmonary function was characterized both by obstructive and restrictive changes that were more expressed in the comorbidity. Thus, in the presence of AH the clinical manifestations of COPD varied, demonstrating the contribution of vascular pathology to the respiratory disorders in those patients. The combined course of COPD with AH is characterized by a modification of clinical manifestations of the disease and COPD was associated with increased cardiovascular risk in patients examined.

52-58

Authors: Zhabchenko I.A., Korniets N.G., Tertychna-Telyuk S.V.

Harmonious and stable psycho-emotional state of pregnant women is an important condition of successful pregnancy course, fetal development and physiological childbirth. People are facing various problems related to mental health that vary from psycho-emotional stress to the mental disorders. Important factors that determine the physiology of pregnancy are the psycho-emotional state of the pregnant and fetoplacental complex. Among the consequences of severe stress during pregnancy is dizziness, tachycardia, trembling of limbs, elevated arterial pressure, unmotivated increase in nervousness and anxiety, sleep disorder, depression that lead to worsening of general condition of a future mother. The purpose of the study was to determine changes in the production of placental hormones and stress-associated hormones in pregnant women - displaced persons. To carry out the study, a randomised dynamic prospective clinical-paraclinical examination of 96 pregnant women (the main group) - displaced persons and 39 pregnant women (control group), who lived permanently in the territory of Ukraine under control, with gestation period after 22 weeks was used. Concentration of stress-associated (cortisol and prolactin) and placental (estradiol, progesterone, placental lactogen) hormones in serum was determined by solid-phase immunoassay. Increased estradiol concentrations and relative reductions in progesterone and placental lactogen, displacement of estrogen-progesterone equilibrium toward relative hyperestrogeny, increase in the concentration of stress-associated hormones were observed. The revealed hormonal and metabolic disorders in pregnant women, internally displaced persons, are biochemical markers of placental dysfunction, which testifies to the expediency of a comprehensive preconceptional preparation with the involvement of a psychologist and inclusion of preventive measures in the form of long-term progesterone support during pregnancy in the program of antenatal observation of such women.

65-72

Authors: Krotova V.Yu.

By the WHO data, Ukraine is country number 1 in Europe and number 2 in the world according to the cardiovascular mortality rate. In the structure of the prevalence of cardiovascular diseases in Ukraine, the percentage of persons of working age with arterial hypertension is 36.7%. The improvement of the prognosis of patients with arterial hypertension depends not only on long-term effective control of blood pressure, but the diagnosis and initiation of therapy at the initial stage of the development of the disease, when the target organs have not yet undergone hypertensive damage is also an important condition. The article presents the results of neuropsychological examination of 509 outpatients with a controlled second stage arterial hypertension, with an integrated assessment of cognitive functions using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MCA) methods. It has been established that even in patients with controlled arterial hypertension stage II with a low cardiovascular risk, by SCORE scale cognitive disorders were revealed in 32,2%. The peculiarities of the development of cognitive disorders in arterial hypertension in connection with the history and course of the disease are analyzed. The majority of patients with hypertension have an increased level of anxiety, especially personality, and this is not due to the presence or absence of cognitive disorders. In patients with hypertension and cognitive disorders, on the basis of testing data by the SF-36 scale, there was a significant (p<0.001) decrease in quality of life on all scales as compared with healthy ones on average by 24.5-66.0 points.

83-86

Authors: Yuryeva L., Shusterman T., Varshavskyi Ya., Malyshko V.

The article des­cribes the clinical case of obsessive-compulsive disorder in an adult patient with Gilles de la Tourette syndrome and severe behavioral disorders. The authors demonstrated the comorbidity of Gilles de la Tourette syndrome and obsessive-compulsive disorder. Obsessive thoughts and compulsive actions were diagnosed as the most frequent behavioral disorders in Tourette syndrome. It was indicated on gender as an additional sanctioning factor for the early onset of mental disorders. Obsessive-compulsive disorder in the patient was characterized by mixed obsessive thoughts and actions, had a protracted nature, with prolonged decompensations requiring treatment in a psychiatric hospital. Emotional instability, impulsivity, obsessions and compulsions affecting the social functioning of not only the patient himself, but also those around him, as well as pronounced behavioral disturbances led to social malajustment. When treating the patient, the doctors had to resort to a combination of typical neuroleptics with second-generation antipsychotics, mood stabilizers and antidepressants due to the poor response to pharmacotherapy. Comorbidity of mental disorders determined the complexity of therapeutic measures with the use of psychotherapeutic interventions, which made it possible to achieve an improvement in the mental state and avoid disability of the patient.

4-14

Authors: Serdyuk A.M., Gulich M.P., Petrenko O.D., Lyubarskaya L.S., Koblyanskaya A.V.

The purpose of this study was to analyze students’ awareness and con­sciousness about the threat to health of risk factors for the development of chronic non-infectious diseases, to determine whether they have the skills of a healthy lifestyle and to develop and scientifically substantiate the Algorithm for introducing health-saving educational technologies in the educational process of higher educational institutions of Ukraine. A sociological survey was conducted among students of higher educational institutions of Ukraine regarding the levels of awareness and consciousness about certain factors in the development of non-infectious diseases. 430 students of the Kiev National University of Trade and Economics and 216 students of Sumy State Pedagogical University were interviewed. A specially designed questionnaire was used. A high level of awareness of students about the main factors in the development of non-infectious diseases – poor nutrition, low physical activity, smoking and alcohol abuse has been established. At the same time, students are not sufficiently conscious about the risk of developing diseases and are unsufficiently motivated to a healthy lifestyle. It is shown a significant difference in indicators of healthy lifestyle among students of institutions of various profile. The Algorithm for the introduction of a health-saving educational technologies into the educational process of higher educational institutions, which is a scientifically substantiated system containing the main tasks, principles and measures aimed at raising the level of awareness and consciousness of young students about the health threat of risk factors for the development of chronic non- infectious diseases has been developed. The data obtained are the basis for the improvement of measures for the prevention of non-infectious diseases among students in Ukraine.

21-30

Authors: Medvedev M.V., Pokrovenko D.A.

Endometriosis is a condition that determines the presence of functionally active glands and endometrial stroma outside the uterus, causing a chronic inflammation in these tissues. The prevalence of endometriosis varies between 5-10% for all women, 20-25% for gynecological patients and reaches 45-50% for women with infertility. The true frequency of endometriosis is not definitely known, and its growth over the past decades is associated with both the increasing frequency of the disease and the improvement of its diagnosis. Endometriosis occurs irrespective of ethnicity and race, socioeconomic conditions, at any age. Diagnosis of external genital endometriosis includes patients’ complaints, clinical examination, ultrasound examination, sometimes magnetic resonance imaging. Much has been done to understand the mechanisms of endometriosis, but still the "gold standard" of diagnosis is invasive methods, especially laparoscopy. An early diagnosis will allow to timely develop treatment tactic aimed at treating endometriosis and preventing its further spread and recurrence. The search for possible biomarkers for the diagnosis of endometriosis continues. Among non-invasive methods, the most promising for future study and research is the microRNA and long non-coding RNA. Molecular genetic methods in achieving good sensitivity and specificity results will be able to improve the results of infertility treatment associated with endometriosis through earlier treatment including surgery. In addition, various research groups have high expectations regarding the role of microRNA and long non-coding RNA chains in evaluating the effectiveness of drug therapy. The purpose of this review was to collect and analyze data from the world’s literature, search for new non-invasive markers for diagnosing this disease at the preclinical stages, as well as predicting the response to hormone therapy.

35-39

Authors: Trofimov N.V., Kryshen V.P., Barannik S.I., Chukhryenko A.V., Chabanenko G.N., Gayterov A.N.

We have collected, processed and analyzed the results of treatment of 329 patients with gastrointestinal bleedings in which the course of the underlying disease is aggravated by the pathology of the cardiovascular system, in Communal institution "Dnipro Clinical Emergency Care Association" of Dnipro City Council» in the period for 2017. First, the frequency of background diseases was determined, chronic pathology being 93.4%. Ischemic heart disease (IHD): cardiosclerosis of various origins (post-infarction, diffuse, atherosclerotic), hypertonic disease (HD) - HD-I, HD-II, HD-III are the most common, while acute disorders of cerebral circulation, the state after coronary artery bypass surgery, renal artery bypass, arrhythmias, acute myocardial infarction made up 16 (5%), 1 (0.3%), 3 (1%), 1 (0.3%), respectively. Secondly, the quality of endoscopic hemostasis in case of ulcerative bleeding from the stomach, duodenum, gastroenteroanastomosis, was assessed by Forrest classification, connecting the results with the accompanying pathology of the cardiovascular system. We found that active bleeding F I was determined in 24 people (7.3%), of which F Ia – in 14 (4.3%), F Ib – in 10 (3%). Unstable hemostasis with a high risk of recurrent F II bleeding, was observed in 251 patients, which makes up 76.2%, and F III – in 54 (16.5%). The degree of blood loss was directly influenced by drug – anticoagulants, antiplatelet agents, hypotensive drugs, as well as their combinations, aimed at correcting the rheological properties of blood. Depending on the degree of blood loss, the quality of hemostasis, the general condition of the patient, the treatment tactics for this cohort of patients was determined. 313 patients received conservative treatment, which made up 95.1%. 16 patients were operated. Postoperative mortality is 12,5%. The overall mortality of the above cohort is 10%.

46-49

Authors: Feleshtinsky Ya.P., Kohanevich A.V.

The frequency of chronic postoperative pain after TAPP surgery is maintained at 4.6-18.7%, and the incidence of inguinal hernia recurrence is 5.3% to 10%. Purpose – estimation of efficiency of different variants of fixation of a mesh implant in TAPP in patients with inguinal hernia. Various variants of fixation of a mesh implant with TAPP in 240 patients with inguinal hernia have been analyzed. Immediate results: pronounced postoperative pain was observed in 6 (7.5%) patients in group І, in 1 (1.25%) patients in group ІІ, in group III postoperative pain was absent. Long-term results: chronic post-operative pain was observed in 5 (7.57%) patients in group І, in 2 (3.12%) in group ІІ, in group ІІІ, chronic postoperative persistent pain was not observed. The recurrence of inguinal hernia was in 5 (7.57%) patients of group І, in 1 (1.56%) patient of group II and in 1 (1.53%) patient of group ІІІ. The results of the TAPP operation for the inguinal hernia with different types of fixation of the mesh showed that glue fixation has significant advantages among them.

61-65

Authors: Vasilenko R.E.

The aim of the study is a analyze the use of full dentures on the upper jaw and the number of repeated visits of patients who received treatment at the dental offices in the Dnepr city. Materials and methods: during 2015–2017 years in dental office of the SE “DMA”, patients were examined, a statistical analysis was made, the number of manufactured of full dentures on the upper jaw and, accordingly, the number of repairs for each year and comparison statistics with the city dental clinics in the previous years was done. According to the results of the study, it was established then in three-year examination period the patients in three dental clinics of the city, the percentage of breakdowns and correction of full dentures on the upper jaw was near 50%. At dental office of SE “DMA”, according to the results 2015-2017 years a numbers of 48.4% was obtained .So that when we compared with the dental clinic from the previous study that is closest in scope of the work, it indicates the absence of statistically significant differences in the indicators of the first and second studies. This can be explained by the fact that despite the use of more modern materials and methods in the manufacture of complete dentures, the problem of improving the quality of full dentures manufacturing on the upper jaw and increasing the strength of the base has not been fully resolved.

73-80

Authors: Fedorenko V.I.

The article is dedicated to the bright memory of Prof. Shtabsky B.M. (the 90th anniversary) and comprises a fragment of results of experimental investigations conducted under his supervision in 1984-1989 years. They are related to the methodological approaches to the conducting acute, subacute, and chronic experiments, as well as analysis of the results and verification of the maximum daily permissible dose (DPD) of lead and cadmium in the everyday diet. In the acute experiments it has been established that lead nitrate belongs to the group of the low-toxic compounds, Cadmium nitrate belongs to the mid-toxic compounds, while both are considered to be highly cumulative. The toxicity and the level of cumulation does not depend on the carrier – water, milk, vegetable oil. In subacute and chronic experiments the comparative toxicity of Ionic (comes with water and nourishment) and biocommunicated (liver and kidney homogenate, cottage cheese) forms of metals in the range of doses 1/10-1/100000 LD50 and additionally 1/500000 LD50 for cadmium has been studied. Toxicometrically significant distinctions under the action of the afore-mentioned forms have not been detected. The excretion of δ-aminolevulinic acid and coproporphyrin with urine, and concentration of SH-groups in the blood plasma and liver tissue and protein in urine under the effect of cadmium in the effect of lead appeared to be the most demonstrative. Both metals possess clear gonadotoxical effect, they cause genetic effects, which can be determined by cytogenetic method, and in the Ames test with presence of liver S-9 microsomal fraction. Maximal non-effective supra-background dose DE050 0,0015 mg/kg for lead, and 0,00005 mg/kg for cadmium have been established on the basis of analysis of “dose-effect” dependency in subacute and chronic experiments, having taken into consideration results obtained according to the method of loading by same metals. Taking into the account natural metallic background dose of with daily diet (0,0025 mg/kg for lead, 0,0005 mg/kg for cadmium of the body weight), the DPD of lead and cadmium in everyday diet is recommended at the level of 0,004 mg/kg and 0,00055 mg/kg of the weight of the body respectively.

87-93

Authors: Lototska-Dudyk U.B.

Shoe production is an important and promising industry of light industry in Ukraine. More than 15 thousand people work at almost 300 enterprises. Improvement of technologies and equipment, intensification of production processes on the background of their incomplete mechanization and automation cause production noise and vibration at the workplaces, in particular, in сutting, сlicking and closing workshops. Levels of manufacturing noise and production vibration in the workplaces of workers of the main occupations: cutters, clicking details, shoe markers, seamstresses, striking operatives, сementing operators, fitters and lasters, trimers and bottom scourers were analyzed. According to noise level, working conditions of cutters on the сutting machines Gerber, seamstresses, skivers, stitchers of upper, casters, fitters and lasters, сementing operators belong to the 2nd class (permissible). The working conditions of cutters on the сutting presses, shoe markers, fitters of upper on the heavy-class sewing machines, bottom scourers, trimers and striking operatives are classified as harmful ones (class 3.1), on separate workplaces of clicking details (press PVH-8) and bottom scourers – class 3.2 degree of danger. Equivalent correction levels of local and general vibration don’t exceed permissible levels. The presence of related unfavorable industrial factors necessitates the study of both combined and jointed action of noise and vibration with the subsequent assessment of the risks to the health of workers in the light industry.

101-109

Authors: Mamchur V.I., Zhilyuk V.I., Kovalenko E.Yu.

The article presents analysis of the main historical stages of the establishing and development of the scientific school of pharmacology of the SE "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine" for a 100-year lifetime period of the pharmacology department. Part I (1918-1943) is devoted to one of the most important and difficult periods – the first period of development of scientific school of pharmacologists: since the establishment of the Department of Pharmacology of Katerinoslavsky Medical Institute in 1918, its first difficult steps in the orga­nization of the department and creation of its facilities and equipment base, of establishing training process on the ba­sics of pharmacotherapy, up to the period of formation of important scientific discoveries in experimental and clinical pharmacology and active scientific development of the whole direction of pharmacological school in the 30-40ies of the XX-th century. It is shown that during the first 25 years of scientific and pedagogical work, the department turned into a powerful scientific school, which brought up outstanding scientists of the day to the medical science of our country, and formed a generation of young students and doctors with a new worldview, with understanding the importance and value of scientific knowledge of fundamental pharmacology, applied knowledge of rational pharmacotherapy and clinical pharmacology to improve the quality of patients’ care in practical medicine.