Lviv Clinical Bulletin

14-17

Authors: Shevaga V., Payenok A., Zadorozhnyj A., Zadorozhna B.

Introduction. Today, doctors in general practice observe the steady growth of chronic diseases of the internal organs, which lead to violations of the normal functioning of the central nervous system with the gradual emergence of encephalopathy. Metabolic encephalopathies include brain damage due to homeostasis disorders in organs in the case of chronic kidney disease. However, the appearance of renal encephalopathy provokes not only toxic and metabolic disorders, but also arterial hypertension, which is a companion of chronic kidney disease. Aim. To study the psycho-emotional changes in patients with renal encephalopathy by the standardized multivariate personality examination (SMPE). Materials and methods. 20 patients with renal encephalopathy were examined, among them 8 men (40.0%) and 12 women (60.0%) aged from 24 to 43 years (serum age 38.73 ± 0.76). According to ICD-10, chronic kidney disease stage I was in 5 (25.0%) of the examined patients with renal encephalopathy, stage II – in 8 (40.0%), III – in 4 (20.0%), and IV – in 3 (15.0%). The control group was made of 22 practically healthy persons of the corresponding age. For a quantitative and qualitative assessment of changes of the psycho-emotional sphere of patients with renal encephalopathy, the SMPE method, being the Minnesota Multiphasic Personality Inventory (MMPI) and adapted by L. N. Sobchik to our conditions, was used. Results. A floating profile of Minnesota Multiphasic Personality Inventory was found in the examined patients in which most scales were above the upper limit of standard. The studied profile signifies the state of general stress which involves different mechanisms and compensatory functions of psychic activity which are under the tension. These are directed for the discrimination of dysadaptation. Although with this profile mental tension increases, this prognostic profile is promising in terms of normalization, as in this case a psychogenic borderline conditions caused by chronic somatic diseases are observed. In particular, the increased level of anxiety, uncertainty in oneself, the concentration of negative experiences, the presence of affective perversity of manifestations of inhibition and psychoasthenic response to external stimuli within the limits of neurotic disorders in the surveyed testify the high level of scores on the scale 6 and 7 in comparison with the control group (p <0.05). The presence of health problems in the patients with nephrotic encephalopathy and the absence of significant co-participation and help from others causes their autisation, the separation from reality (scale 8) (p <0.05 comparatively with a control group). Conclusions. Patients with renal encephalopathy often have anxiety-asthenic syndrome, and therefore such patients need the social support, which will facilitate their return to normal, active daily life.

31-35

Authors: Nyankovskyy S., Iatsula M., Senkevich O., Pasichnuk I., Kulik I.

Introduction. The health of the nation is determined primarily by the health of children. The results of numerous studies show that the source of the differences in adult health should be sought in their childhood. Children’s health is an integral indicator of the general well-being of society, as well as a subtle indicator of all social and environmental problems. Recently, the situation with the health of children has come close to the critical one: the general level of morbidity and the prevalence of diseases of organs and systems is increasing. Aim. To evaluate the medical and social features of the health status of schoolchildren in Lviv and Lviv region, to determine their dependence on age and place of residence. Materials and methods. The analysis of the results of the surveys made in 2002 (about 20,000 schoolchildren in Lviv) and in 2012 (about 32 000 children of Lviv and 16 000 children of four districts of Lviv region) were considered. The main risk factors of the formation of functional disorders, syndrome of school maladaptation, neurotic reactions, age prevalence of major complaints were discussed. Results. The study of the state of children’s health, taking into account their individual age characteristics at all stages of their development, with the simultaneous determination of the influence on the children’s organism of the various factors of micro- and macrosocium plays an important role in the optimization and complex principles of the organization of scientific research of such an important direction of pediatrics as preserving the health of the child. It is impossible to create an effective system of preventive, organizational and other technologies aimed at improving and preserving the health of children without taking into account the complexity of the main risk and protection factors. Analyzing the results of questionnaires, we can conclude that in recent decades, the state of health of schoolchildren in the Lviv region has no tendency to improve. Among the factors that lead to a decrease of the level of child health, the most important role belongs to the school workload, due to the stressful action of which there is a maladaptive syndrome with neurotic reactions of varying degrees of severity. A screening survey of schoolchildren, conducted on a large sample, enables us to identify the main medical and social features of schoolchildren’s life, to assess the age-old prevalence of major complaints and threatening symptoms, the main trends in their habits, to distinguish risk groups for further in-depth review and survey. Comprehensive assessment of the health of children, the introduction of new health-improving technologies, the unification of efforts of health workers, pedagogues and parents will help to prevent the growth of functional disorders and organ lesions in schoolchildren, their chronization, reduce the symptoms of school maladaptation, and increase their health. Conclusions. Among the factors that assist the decline of child’s health level the educational loading plays an important role. Its stress making effect results in fast development of the disadaptation syndrome with the neurotic reactions of different degree of expressiveness. The complex estimation of the children’s health state and introduction of new health promotion technologies give an opportunity to prevent the increase of functional disorders and organic pathologies in schoolchildren.

41-44

Authors: Markin L., Medvjedjeva O.

Introduction. Anomalies of the heart and major vessels of the fetus take the first place in the structure of mortality from the abnormalities developed in the early neonatal period, they occur with a frequency of 7 to 17 per 1000 newborns and cause about 40.0% of perinatal losses. Given the fact that preventative measures for the prevention of congenital heart diseases are not successful, their prenatal ultrasound diagnosis is relevant. There are cardiological abnormalities that are incompatible with life – in these cases, it is proposed to interrupt pregnancy. There are heart defects that can serve as markers for chromosomal abnormalities. Some variants of the congenital heart diseases can be adjusted by surgical intervention immediately after birth (such patients must be born in specialized centers). In addition, modern medicine is at such a stage of development that some structural anomalies of the heart can be eliminated even during the intrauterine period of the life of the fetus with the best pathway. Aim. To improve the diagnosis of fetal heart abnormalities during the routine screening ultrasound. Materials and methods. Recommendations for the improvement of the diagnosis of fetal heart anomalies by the routine screening ultrasound examination in the second trimester of pregnancy by the additional visualization of the major vessels with an assessment of the average diameter, the location of the heart axis, the ratio of the chambers of the heart and the size of the pulmonary artery, aorta and upper vena cava. Results. It is believed that the results of prenatal research is mainly influenced by the technical reasons (resolution of the device, pregnancy period, thickness of the anterior abdominal wall of the mother, position and size of the fetus). In our opinion, the prenatal detection of congenital heart defects strongly depends on the algorithm of conducting a fetal heart study in the screening regimen. All screening ultrasounds should be performed according to a single protocol, which is the main for the standardization of echographic research. In the case of suspicion of airborne disease in the fetus, the patient is referred for medico-genetic counseling with karyotyping and verifying the diagnosis. The main screening examination of the heart is based on a four-chamber cut. To obtain this image, the sensor should be installed perpendicularly to the fetal ridge at the level of atrioventricular valves. During the adequate withdrawal of this section, the right and left ventricles, right and left atrium, interventricular and interatrial septum, mitral valve and tricuspid valve openings are clearly visualized (the level of the tricuspid valve is normally slightly lower than mitral), an oval window can also be seen. Conclusions. During the additional visualization of the major vessels more than 90.0% of congenital heart defects can be diagnosed, indicating the need to optimize the protocol for the providing of the assistance of such patients, and the basic specific criteria for evaluating the anatomy of the heart and the fetal heart. So, the study of fetal heart is one of the most important stages of screening ultrasound in the second trimester of pregnancy.

49-51

Authors: Katerenchuk O.

Introduction. According to the World Health Organization (WHO) Report currently more than 350 million people in the world suffer from clinically significant anxiety and depressive disorders and this number is expected to grow. Depression is the leading cause of disability worldwide. The special attention should be given to the category of patients with the cardiovascular diseases, because the existence of depression greatly deteriorates the disease course. It is well-known that depression and anxiety are the risk-factors for the development of cardiovascular diseases. Also depression is usually observed in patients in early post-myocardial infarction period, in patients with hypertension, especially with the heart failure syndrome. Aim. To analyze the literature sources and to propose own thoughts on the topic of the depression and cardiovascular diseases, their causes, consequence or comorbidity. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of research of actual scientific researches on the topic of the depression and cardiovascular diseases, their causes, consequence or comorbidity was made. Results and discussion. The combination of depression and cardiovascular diseases is a well-known clinical fact, supported by the results of many clinical studies. Since the 90’s more than 100 descriptive studies in this field assessing the relationship of depression with cardiovascular morbidity and mortality have been performed. Also more than 60 prospective studies were conducted to establish the connection between the presence of depression and coronary heart disease. It is important to note that the negative impact on the prognosis has not only the so-called major depression, but also its mild form. Women are 1.7 times more likely to experience a significant depression than men. The majority of clinical studies of depression in patients with heart failure do not provide a separate data for men and women. One study analyzed the prevalence of depression in patients with heart failure only in out-of-hospital settings. The symptoms of depression were observed in 64 % of the women and 44 % of the men. Interestingly, the hospitalization for treatment of acute heart failure usually exacerbates the symptoms of depression. Once the heart failure is under control, the depressive signs and symptoms may abate. There are different pathological mechanisms of depression in cardiovascular diseases. The first is the psychological aspect associated with the development of life-threatening condition. The feeling of fear of death, anxiety about the future course of the disease, restrictions of physical activity, necessity of the invasive procedures usually cause anxiety and\or depression in patients in the acute phase of the disease. For the early post-myocardial infarction patients’ depression substrate more often is due to the impossibility of returning to normal physically active life, reduced work capacity, social adjustment difficulties and the impact of myocardial infarction on sexual activity. At the same time, despite the psychological mechanisms of depression, the dysfunction of the heart muscle also attributes to the development of depression. Myocardial dysfunction is usually observed in cardiovascular diseases (coronary heart disease, arterial hypertension, cardiomyopathy, inflammatory heart diseases, valvular lesions). Also the myocardial dysfunction in the form of heart failure is the final link in the chain of cardiovascular continuum. Any damage to the heart muscle leads to the increasing of the filling pressure in the heart chambers and thereby stimulates the increased activity of neurohumoral systems: the rennin-aldosterone-angiotensin, sympathetic nervous system, vasopressin and natriuretic peptides systems. Activation of neurohumoral systems aims to support the adaptation processes and homeostasis in heart failure syndrome but often causes harm. In the settings of the heart failure syndrome we should also mention the endogenous cannabinoid system, which as a system of the immediate response to stress, after the period of overstimulation becomes depleted causing a paradoxical effects. At the same time, depressive disorders are often accompanied by the hyperactivity of the hypothalamic- pituitary-adrenal axis, followed by increased excretion of cortisol in the bloodstream. Increased cortisol in this situation has a protective effect by mobilizing the body’s reserves. Interestingly, the higher levels of blood coagulation are observed in patients with cardiovascular disease and depression in comparison with patients without depression. Conclusions. The depression in terms of cardiovascular diseases may act as a risk factor for their development, it can be a cause of the heart muscle dysfunction, as well as be caused by psychological problems in consequence of the disease.

57-60

Authors: Ilnyckyу G., Bilozir L., Bojko O., Chulovska U., Nevzhoda O.

Introduction. At the stage of the unceasing progress of science and technology, the quality of education, and hence the use of innovative technologies, makes it possible to improve it. In the educational sector of Ukraine, the Concept for the training of the physicians is being developed, elaborated in accordance with the requirements of the World Federation of Medical Education and the main provisions of the Bologna Process. The educational sector, like medical education in particular, has entered the path of radical reforms and entry into the European educational space, requires the bringing of all of itscomponents to the generally accepted international standards. One of the initiators of the implementation of reforms and innovations into the medical and educational sector of Ukraine is the Danylo Halytsky Lviv National Medical University, the oldest medical institution of the country’s education, founded in 1784. Aim. To highlight the teaching methodology of the discipline “tuberculosis” for the students of the English-speaking form of education using computer-information technologies. Materials and methods. The experience of the Department of Phthisiology and Pulmonology in conducting the educational process among the students of the English-speaking form of education is described. The achievements, problems and ways of their improvement in conditions of joining the European educational space are considered. Results. The work of the staff of the Department of Phthisiology and Pulmonology of the Danylo Halytsky Lviv National Medical University in a complex with modern equipment of educational rooms and lecture rooms, dynamic provision of pedagogical process is provided taking into account the latest information technologies, systematic updating and replenishment of materials, including bench and test tasks, as well as comprehensive publishing of the activities and not only improve the quality of the educational process, but also the growth of students’ interest in the subject “Tuberculosis” highlighting the problems of tuberculosis, which positively affects the prospects of the further professional orientation of future doctors. Conclusions. Achievements in the field of obtaining modern medical education in higher educational institutions of Ukraine will facilitate the attraction of new foreign citizens to study. High professionalism and spirituality, the achievements of the Ukrainian, in particular, Lviv medical school, can serve outside of our country. Ukraine, in keeping with the global educational trends, will have a worthy place in the modern information world.