Medical perspectives (Medicni perspektivi)

9-12

Authors: Novytska-Usenko L.V.

Memory roads

19-23

Authors: Kravets O.V.

In order to evaluate the effectiveness of the liberal regime of infusion therapy, we examined 50 patients with acute abdominal pathology considering the state of the water sectors of the body. We established that liberal regime of infusion causes hypervolemia and hyperhydration of peripheral tissues during the first 6 hours of the perioperative period, it retains a moderate deficit of hypovolemia and dehydratation from 1 to 14 day of observation and forms an increase in interstanial volume, causing its maximum edema from the 3d to 7th day of observation. These changes are combined with positive daily and cumulative water balances, which is reflected in a critical increase in the percentage of excess fluid from the 5th day of postoperative period.

33-40

Authors: Obolonskyi A., Snisar V., Surkov D., Obolonska O., Kapustina O., Dereza K.

Closure of hemodynamically significant patent ductus arterios (HSPDA) is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0 g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4 ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6 ml/kg/day, and on day 5 – to 89.7±6.8 ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1 mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in rectal form. In all groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle.

46-51

Authors: Ayvardgi A.A.

Currently, a lot of attention of scientists all over the world is paid to the perioperative management strategy, taking into account the volume of surgical intervention, the presence of comorbidities and their possible complications. This makes it possible to reduce mortality, decrease the number of adverse events in the intra- and postoperative period, effectively cope with pain, advance recovery and rehabilitation, and also increase patients’ satisfaction with the quality of medical care. We studied indices of 58 adult patients who underwent septoplasty. Patients were divided into 2 groups. In group “D”, dexmedetomidine was infused, which began 10 minutes before the induction of anesthesia at a dose of 0.7 μg/kg/h and ended 10 minutes before the end of the surgical intervention. The clinical blood test (hemoglobin level, erythrocytes, leukocytes, rods count), body temperature of patients, coagulogram (INR, fibrinogen level, Dyuk bleeding time) were studied. When comparing the indicators of clinical analysis in the postoperative period in the control group leukocytosis and stab left shift (p <0.001) was observed. For patients undergoing dexmedetomidine infusion, leukocyte and bacillus levels were normal. In both postoperative follow-up groups, low-grade fever was detected (p <0.001). In the control group, 12 hours after surgery, body temperature rose to febrile values. During the operative intervention, the “D” group was characterized by the better indices of blood coagulation. In the group "K" on the second day of the postoperative period, there was a slight increase in coagulation. The level of intraoperative blood loss in the “D” group was significantly lower than in the control group (p<0.001). In the “D” group in the postoperative period, the minimum decrease in hemoglobin was determined in contrast to the control group (p<0.001). The use of dexmedetomidine infusion leads to a decrease in the manifestations of a systemic inflammatory response in surgical interventions for the curvature of the nasal septum. The introduction of dexmedetomidine provides better blood coagulation during septoplasty. Infusion of dexmedetomidine causes a decrease in blood loss and consequently the maintenance of hemoglobin concentration at the proper level.

59-65

Authors: Chun Liu, Pohorielov O.V.

The study of the effectiveness and safety of intermittent fasting (IF) at 185 patients aged from 25 to 75 years (mean age – 48,6 years) with arterial hypertension (AH) and headache was carried out. AH was seen as the most likely factor of cerebral discirculation and associated cephalgia. Patients volunteered to maintain a short-term dietary restriction with terms of 16 or 24 hours once in 7 days over a period of 4 weeks. During this period, 43 patients stopped participation in the study, of which 31 - at 24-hour IF and 12 - at 16-hour IF. The assessment of the influence on cephalgia was considered positive when the score of visual analog scale (VAS) was decreased by 2 or more points and / or there was a significant decrease in the duration and frequency of cephalgia attacks. In a rhythmic diet with a 16-hour food intake missing, a positive result was registered at 35% (37,25% of young patients, 40,48% – of average and 28,57% of the elderly) without a significant difference between ages. The effectiveness of a 24-hour type of IF was higher and made up about 75% in all age groups. Negative side effects of IF that would require its termination due to objective reasons (threatening changes in blood pressure, syncope states and others) were not recorded, the most common complaints were the feeling of hunger (from 50 to 76% with a difference in age), psychological tension, uncertain anxiety (on average about 32%). The authors consider that such a psychological feature - namely, the impossibility and unwillingness to endure short-term fasting was a main factor of refusal to continue the treatment regimen, and within certain limits prevents the wider use of IF method in the treatment of cephalgia. In general, the efficacy of a 24-hour IF compared with a 16-hour type was significantly higher, without severe side effects.

73-82

Authors: Yeltsova L.B., Omelchuk S.T., Petrosian A.A.

Availability of various healthy food products in the student’s diet and conscious student’s choice represents the best way of prevention of the alimentary and alimentary-associated diseases, preservation and promotion of health. The aim of the study: hygienic assessment of frequency of consuming food products of animal origin by medical students in order to prevent alimentary diseases by means of correction of diet. The authors studied medical students’ diet using map questionnaire with the subsequent data assessment. The study includes the data of 858 respondents, students of the 2nd, 4th and 6th years of study of medical faculties of O.O. Bogomolets National Medical University. Random sampling was used. The age of the respondents ranges between 18 and 25 years, 570 females and 288 males. Frequency of consumption was estimated according to the following categories: consuming of food products of animal origin once a day or even more often, consuming them almost every day, consuming them once a week, consuming them several times a week, consuming them once or several times a month, consuming them rarely or never. The study assessed frequency of consumption of such product groups as: meat and meat products, fish and seafood, milk and dairy products, eggs and fatty products. The authors have established that one third of the respondents, regardless of their gender and year of study, consume meat and meat products once a day or almost every day. From 20% (the 2nd year of study) to 28% (the 6th year of study) of male respondents and from 13% (the 2nd year of study) to 21% (the 6th year of study) of female respondents consume fish and seafood once a week or several times a week. Less than 30% of both male and female respondents, without regard to the year of study, consume milk and dairy products once a day or even more often. About 20% of male respondents and from 10% (the 2nd year of study) to 25% (the 6th year of study) of female respondents consume eggs daily. 16-18% of male respondents and 6-10% of female respondents consume fatty products (butter, lard) daily or almost every day. The obtained results make it possible to conclude that more than 2/3 of the medical students’ diets according to the frequency of consuming food products of animal origin do not correspond to the National recommendations on nutrition precisely by the frequency of their consumption [12, 13]. This may lead to polynutrient deficiency and development of alimentary diseases, which proves the necessity of correction of medical students’ diet.