ZAPOROZHYE MEDICAL JOURNAL

3-6

Authors: N. V. Avramenko, I. B. Gridina, O. A. Nikiforov, E. A. Lomeyko

Abstract Introduction Overweight is a serious medical, social and economic problem of the modern society. Today it is established that the level of sexual activity in women is not dependent on the body mass index. Unfortunately, about 40% of patients with overweight stop to receive modern combined oral contraceptives in the first two months of the side effects occurrence. Today it is very important to improve the modern combined oral contraceptives intake by women with overweight. Research objective To compare tolerance to the modern combined oral contraceptives with thioctic acid in women with excessive body weight. Materials and methods 64 patients were divided into two groups. Patients of the 1 group (32 observations) were recommended to use thioctic acid in a dose of 600 mg daily for the first month of reception of a modern combined oral contraceptive containing etinilestradiol and desogestrel. Women of the control group (32 observations) used combined oral contraceptives containing levonorgestrel and desogestrel, but not used drugs with thioctic acid. The results of the research In the course of the observation spotting were noted in 40% of women in both groups. The nausea was observed in 20% of patients of the second group and only in 7% of the patients in the first group. Decreased libido, and mood were observed only in 5% of patients of the first group and in 15% of patients of the second group. Weight gain within2 kgdue to fluid retention was observed in 30% of patients of the second group and only in 10% of the patients of the first group. After the end of the observation 90% of women of the first group and 75% of women of the second group continued to take combined oral contraceptive. Conclusions Use of thioctic acid in a daily dose 600 mg for the first month of intake of the combined oral contraceptive can significantly reduce the frequency of such unpleasant side effects as nausea, decreased libido, and mood, increased body mass index. Keywords overweight; contraception; thioctic acid References Метаболический сердечно-сосудистый синдром / [В.А. Алмазов, Я.В. Благосклонная, Е.В. Шляхто, Е.И. Красильникова]. – СПб.: ГМУ, 1999. – 203 с. Дедов И.И. Патогенетические аспекты ожирения / И.И. Дедов, Г.А. Мельниченко, Т.И. Романцова // Ожирение и метаболизм. – 2004. – № 1. – С. 3–9. Критерии приемлемости использования методов контрацепции / Всемирная организация здравоохранения, 2004. Прилепская В.Н. Гинекологическая эндокринология / В.Н. Прилепская, Е.В. Цаллагова. – М., 2004. – С. 283–320. Лептин и липидный спектр крови у женщин с разными типами ожирения / А.В. Светлаков, М.В. Яманова, О.С. Филиппов, Н.А. Малахова // Пробл. репродук. – 2001. – №6. – С. 33–35. Фармацевтична опіка при використанні засобів контрацепції: навчальний посібник / [Ю.П. Вдовиченко, Г.М. Войтенко, І.М. Білай та ін..]. – К.: Книга плюс, 2010. – 176 с. Huang K.C. Plasma leptin is associated with insulin resistance independent of age, body mass index, fat mass, lipids, and pubertal development in nondiabetic adolescents / Huang KC, Lin RC, Kormas N et al. // International Journal of Obesity. – 2004. – Vol. 12. – P. 23–25. Roberts L. Obesity. About the size of it / Roberts L., Haycox A. // Health Serv J. – 1999. – Vol. 109 (5662). – Р. 28–29.

13-15

Authors: M. A. Gavrilenko

Abstract Background. Actuality of the problem is determined by the high prevalence of periodontal tissues inflammatory diseases in children with blood pathology (100%). Primary prevention of dental caries and periodontal diseases has the exceptional importance in the dentist’s work with children who have blood coagulability disorders. Prevention of dental diseases of the oral cavity in this category of patients has a number of features because there is risk of bleeding during both home oral hygiene and professional hygiene. Exogenous prevention (fluoride-containing gels, varnishes, solutions, sealants) also has its own peculiarities in these children. On the other hand, the impossibility of preventive measures implementation is the significant factor in the pathogenesis of gingivitis and subsequently periodontitis in children with disorders of blood coagulability. Aim. To examine the status of oral hygiene in children with blood coagulability disorders. To examine the severity of inflammatory and destructive changes in the periodontal tissues in children with disorders of blood coagulability. To investigate timing and frequency of oral hygiene implementation in children with disorders of blood coagulability. To reveal the interrelations between the intensity, prevalence of periodontal tissues disorders in children with blood coagulability pathology and the periods of tooth development, taking into account the influence of risk factors and frequency of oral hygiene. Materials and methods. 120 children between 2 and 18 years old with blood coagulability disorders (hemophilia A, B, thrombocytopenia, thrombocytopathy) were examined. Children were divided into following age groups: I – 2-5 years old (40 children), II – 6-10 years old (40 children), III – 11-18 years old (40 children), according to the periods of tooth development, with an equal number of children in groups according to diagnoses. Hygiene index value was determined according to Fedorov and Volodkina, PMA index (papillary-marginal-alveolar index) was determined by standard methods. Visual presence of inflammation clinical signs and periodontal tissue condition was determined in each group. During interviews with parents the timing and frequency of oral hygiene were studied on the proposed scheme. Results. During clinical examination of children with pathology of blood coagulability unsatisfactory level of oral hygiene was revealed. When evaluating PMA index in different age groups it should be noted that mild gingivitis is observed in all groups (5%). The most numerous group was one with gingivitis of moderate severity (71%) and severe course (24%). Diffuse catarrhal gingivitis dominates in the structure of inflammatory diseases of gums, gingival papillae and gingival margin. Analysis of the data of PMA index and visual examination shows that diffuse inflammation prevails in 99% of cases. It was found out that everyday teeth cleaning was carried out by 25% of children in group I and 40% of children in group III. Obviously, the obtained data indicate the untypical inflammatory process and the high prevalence of gingival and periodontal inflammation in the examined children. Conclusions. It was found out that low indicators of the oral hygiene level are registered in all groups of examined children; oral hygiene in these children was not carried out because of the risk and fear of bleeding. Prevalence of inflammatory diseases of periodontal tissues in examined children was 100%. Treatment of gingivitis or visit to the dentist due to gingival bleeding were not carried out. Search and use of adequate oral hygiene products for children with pathology of blood coagulability, development of hygiene programs and supporting activities taking into account the underlying disease were put on the agenda by this fact.

20-22

Authors: V. G. Kadzharyan, A. I. Melnik, P. P. Bidzilya, S. A. Solovyuk

1. Actuality According to WHO Thyroid dysfunction is one of the most prevalent in humans and is one of the risk factors of cardiovascular diseases. Hypothyroidism affects the mechanisms of potentiation of cardiovascular risk factors, suggesting the need to study the level of the blood lipids in all patients with thyroid dysfunction. 2. The purpose of this study. To define features of lipid metabolism, depending on the functional state of the thyroid gland. 3. Material and methods. The study included 95 patients, mean age was 49,8 ± 12,9 years. 74 of them were women (78%) and 21 - men (22%). In accordance with the purpose of the work 3 groups of subjects were formed. I-st group - 35 patients with hypothyroidism, mean age 52,5 ± 10,3 years, II-nd group - 37 patients with hyperthyroidism, the average age was 45,1 ± 13 years, III (control) group - 23 patients with euthyroid, mean age 53,9 ± 14,8 years. Levels of TSH, triiodothyronine, thyroxine, microsomal antibodies to thyroglobulin and thyroid peroxidase were evaluated for total and biochemical analysis. To determine the type of hyperlipoproteinemia Fredrickson, 1967 recommendations were used. 4. Results of the study Lipid profile parameters in the I-st group compared with the control were even higher. Cholesterol increased up to 6,9% (p <0,005), Tg - 8,6% (p <0,005), β -DP - 6,8% (p <0,5), in comparison with the II-nd: cholesterol - 56% (p <0,005), TG - 55% (p <0,005) and β-PL 44% (p <0.5). In group II rates were lower than in the III- cholesterol - 8% (p <0,005), Tg 8,3% (p <0,005) and β-PL 6,5% (p <0,5). Patients from the I-st group had the following distribution of hyperlipidemia (Fredrickson, 1967.): I type - 10 patients (29%); IIb type - 15 subjects (43%); IIa type - 9 subjects (26%); IV type - 1 patient (2%). The correlation dependence of TSH and cholesterol (r = +0,37, p <0,05), TG (r = +0,25, p <0,05), β-PL (r = +0,74, p <0.05), TG AT (r = +0,55, p <0,05), the level of bilirubin (r = +0,29, p <0,05), thymol (r = +0, 27, p <0,05), potassium (r = +0,26, p <0,05) and females (r = +0,20, p <0,05) was detected. 5. Findings 1. Hypothyroidism is accompanied by hypercholesterolemia, elevated triglycerides, elevated levels of low-density lipoproteins and the prevalence of type II hyperlipidemia. 2. Inhyperthyroidism is a reduction in cholesterol, triglycerides and low density lipoproteins. 3. The pathology of the thyroid gland causes the need for a differentiated approach to lipid-lowering therapy, taking into account the functional state of the body.

26-29

Authors: D. A. Lashkul

Abstract Chronic heart failure (CHF) is one of the most common complications of cardiovascular disease. According multicenter studies conducted during recent years, coronary heart disease was the leading cause of heart failure and has been on average 64% of patients with chronic heart failure. The tight functional relationship of cardiovascular and urinary system causes a lot of interest to the functional state of kidneys in various cardiovascular diseases. Most risk factors for cardiovascular disease are common risk factors of renal failure. Causes significant differences in the prevalence of chronic kidney disease (CKD) in patients with chronic heart failure, defined as coronary artery disease and hypertension remain unclear. Need clarification prevalence of CKD among patients with CHF in general and in specific groups of patients. The aim of the study was to examine the prevalence, correlation and statistical relationships of renal dysfunction with functional class, age and gender of patients with coronary heart disease and heart failure, were hospitalized. Materials and methods. Analyzed the medical cards 344 patients (286 men and 58 women) with ischemic chronic heart failure, mean age 59.2±9.4 years. The etiology of heart failure in 298 (86.6%) patients had a combination of coronary artery disease and essential hypertension in 46 (13.4%) - CHD. Chronic heart failure 1 functional class (FC) was diagnosed in 10 (2.9%) patients, 2 FC - in 106 (31%), 3 FC - 207 (60.5%) and 4 FC - 19 (5, 6%) patients. Diabetes was 62 (18%) patients. Myocardial infarction had a history of 245 (71.2%) patients. Glomerular filtration rate was calculated using the formula MDRD (Modification of Diet in Renal Disease). Descriptive statistics are presented as mean±standard deviation for continuous variables and as percentages for categorical variables. Depending on the distribution of the analyzed parameters used unpaired Student's t-test or U-Mann-Whitney test. Comparisons among all groups for baseline clinical variables were performed with the Pearson χ2 or Fisher exact test for categorical variables. Differences considered reliable for values of p<0,05. Results. The total number of patients with chronic renal dysfunction (GFR less than 90 ml/min/1.73 m2) - 269 (78.2%). Decreased GFR less than 60 ml/min/1.73 m2 detected in 43 (12.5%) patients with CHF. In 60% of patients up to 45 years, 74.5% from 45 to 59 years, 83.4% aged 60 to 75 years and in 91.7 % of patients aged over 75 years revealed chronic renal dysfunction. The prevalence of CKD among patients with heart failure also increased with the growth of CHF severity. For example, among patients with FC 1 (10%) was observed GFR <60 ml/min/1.73 m2. In the group with FC II: signs of CKD detected in 7.5% patients. In the presence of more severe heart failure (FC III) - found 13.5% patients with evidence of CKD, 60 to 90 ml/min/1.73 m2 in 69.7%. Heart failure is characterized by IV FC progressive decrease of renal function, as reflected by the presence of signs of CKD in 31.6% and a moderate decrease in GFR of 60 to 90 ml/min/1.73 m2 in 47.4% patients. Ischemic heart failure, associated with GFR less than 60 ml/min/1.73 m2 is more common in men (12.9% vs 10.3%, χ2=0.3, p=0.58). Correlation analysis showed sustained statistically significant association between eGFR and age (r=-0,34, p<0,001), FC CHF (r=-0,21, p<0,001). High prevalence of CKD among patients with heart failure and poor prognosis requires strengthening of medical institutions for early detection of renal dysfunction in patients with diseases of the cardiovascular system. Conclusion. Thus, ischemic heart failure characterized by reduced filtration capacity of the kidneys and is inversely related to age and functional class. Prevalence of renal dysfunction among patients with ischemic heart failure is 78.2% and it increases with the age of patients and functional class. The perspective is to further explore the prognostic significance of the detected change, the possibility of pharmacological correction in patients with ischemic chronic heart failure, depending on age, sex, functional class, left ventricular contractile ability.

34-36

Authors: O. V. Makarenko, O. V. Kryvoviaz, S. O. Kryvoviaz

Abstract Today, the definition “glaucoma” combines a number of eye pathologies that lead to irreversible blindness, and therefore is difficult disabling disease. Glaucoma occurs in people of working age, so this problem is not only medical, but also social, because it causes disability in substantial economic costs not only for individual patients, but also for the whole country – patients become unable to work. Gender features of glaucoma are also contradictory. In European literature the basic idea is that men are more likely to suffer from glaucoma than women. Such studies have not been conducted in the Podillya region of Ukraine, that makes impossible to design a reliable global data to estimate the prevalence of glaucoma in different age groups for persons living in Vinnitsa region. Therefore, the aim of the study was a retrospective analysis of medical records of patients in Eye Microsurgery Department of Vinnitsa Regional Clinical Hospital for the period 2008-2012 years for determining the gender and age characteristics. Materials and methods 1418 patients with primary open-angle glaucoma (841 men and 577 women) aged 14 to 92 years (mean age 67,12 ± 7,64), which were treated in the Eye Microsurgery Department, took part in the study. For the purpose of the study they were divided into two groups: I – male patients with glaucoma, II – female patients with glaucoma. Each group was divided into 7 subgroups according to the ontogenesis scheme: A – teens, B – youth, C – I adulthood age, D – II adulthood age, E – elderly age, F – senily age and G – centenarians. Thus was allocated 12 research groups. Results The structure of the incidence of glaucoma is 59.31% in men and 40.69% in women. Incidence of glaucoma is highest in the IE group and is 34.98%. The group IIE incidence is lower – 35.32%. In the group D the incidence of glaucoma among men and women was very different (13.89% and 2.89%, respectively). It should also be noted the high incidence of glaucoma in elderly patients: 9.31% – IF group and 1.92 % – IIF group. The results of the analysis suggest that the incidence of glaucoma among people of working age is lower compared to the non-working population. The proportion of male patients of working age is 25.20%, which is almost in 3 times higher than in women of the same age group (8.32%). Structuring by gender also showed that the second place have male patients with glaucoma in a subgroup D (II adulthood age), while for women it is seen more often in the older age (subgroup F). Conclusions 1. Analysis of the gender and age structure of patients with glaucoma in the Vinnitsa Regional Clinical Hospital in 2008-2012 year was performed. 2. The results allow to predict the future number of newly diagnosed patients with glaucoma among different age groups of both sexes in Vinnytsia region. 3. Comparison of newly diagnosed glaucoma patients with predicted values will help to assess and subsequently adjust of the work of ophthalmological service area. 4. The data obtained from the study allows to calculate funding, that should be involved in the budget of health care institutions and social insurance funds to pay for medical treatment of disabled persons due to glaucoma.

40-44

Authors: S. A. Myagkov, A. P. Myagkov, I. R. Rybak, A. S. Sementsov, S. Y. Nakonechniy, Hesso Aref

The aim of the study was to study the morphological and structural changes of the vertebral bodies in patients with different bone mineral density by MRI. Materials and methods. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance. Results. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). Conclusion It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance.

48-51

Authors: V. D. Syvolap, S. M. Kyselov

Introduction. Worldwide myocardial infarction (MI) is one of the main causes of morbidity and mortality. Thanks to advances in modern cardiology we achieved a significant reduction in mortality and the incidence of fatal complications of acute Q-wave MI. However, keeping in mind the pathogenetic features of myocardial defeat of the left ventricle (LV cavity dilation and thinning at the focus of myocardial infarction), which increase the risk of left ventricular aneurysm development and parietal thrombus formation, it is impossible to reduce significantly the risk of these serious complications development. Post-infarction left ventricular aneurysm, extremely unfavorable prognostic factor complicates the course of Q-wave myocardial infarction in 30% of cases. The likelihood of parietal clot development in the anterior apical localization of aneurysms is 32%. The reasons of parietal clot formation are varied and are not fully disclosed, that is responsible for the relevance of this study. Aim: to investigate the serum level of protein C, von Willebrand factor, the expression of vascular adhesion molecules sVCAM-1, platelet aggregation properties and to evaluate their relationship with the structural and functional performance of the heart in patients with acute Q-wave myocardial infarction with aneurysm and parietal thrombus of LV. Methods. 110 patients (67 men and 43 women), mean age - 63,2 ± 5,7 years, with a diagnosis of acute Q-wave myocardial infarction were involved into the study. The first group included 72 patients with postinfarction left ventricular aneurysm, the second - 38 patients with postinfarction aneurysm and parietal thrombus of LV. Serum levels of protein C, von Willebrand factor, the expression of vascular adhesion molecules sVCAM-1, platelet aggregation properties were studied and their relationship with the structural and functional performance of the heart were evaluated. Results. There were revealed high activity of the key elements of the blood coagulation system, responsible for the formation of parietal blood clots on the background of low levels of protein C, which leads to an imbalance of coagulation-anticoagulation-fibrinolysis towards coagulation and suppression of fibrinolysis, associated with thrombosis. Vascular adhesion molecule sVCAM-1 can be regarded not only as an indicator reflecting the state of the blood coagulation system, but also as a marker of immunoinflammatory reactions and endothelial dysfunction, as an increase in their expression due to the increased systemic secretion of proinflammatory cytokines. Activation of immunoinflammatory reactions confirmed by the increase in serum levels of immune system mediators such as fibrinogen and prothrombin. Higher levels of von Willebrand factor is a marker of immune inflammation on a background of endothelial dysfunction. Synergies increase of fibrinogen and von Willebrand factor indicates a high propensity to parietal thrombus formation. Conclusion. It was found that in patients with Q-wave myocardial infarction, complicated by formation of acute aneurysm and parietal thrombus of LV, postinfarction heart remodeling processes are characterized by dilation of the left heart chambers and eccentric left ventricular hypertrophy, a violation of local contractility by dyskinetic type, parietal thrombus formation, the development of diastolic dysfunction of type II and closely associated with high procoagulant and aggregation serum potential with decreased activity of natural anticoagulants on the background of immunoinflammatory reactions and activation of endothelial dysfunction.

55-59

Authors: V. G. Syusyuka

Introduction Neurocirculatory dystonia (NCD) takes one of the leading positions among different extragenital diseases in pregnant women, and it promotes complications of pregnancy, labor and postpartum period. NCD which is included into the diagnostic section “Somatoform vegetative dysfunction” – is polyetiologic functional disease of cardiovascular system based on disorders of neuroendocrine regulation with multiple and various clinical signs that become worse in stress influence. Object of the work – is to estimate influence of medical and psychological correction program on the psycho-emotional state and rate of gestation complications in pregnant women with somatoform dysfunction of vegetative nervous system (SDVNS). Materials and methods of investigations There 56 pregnant women with NCD and it is the evidence of somatoform dysfunction of vegetative nervous system within gestation period of 12-34 weeks were examined in the study. Presence of this extragenital pathology was clinically proved by therapeutist. I group included 29 pregnant women who participated in the complex program of medical and psychological correction and sanatorium rehabilitation. II group included 27 pregnant women having rehabilitation in accord with standards of sanatorium-resort therapy. Control group comprised 24 somatically healthy pregnant women. Level of trait and state anxiety were estimated under methods of Spielberg-Hanin. Estimation of type of attitude towards the disease and of other associated personal attitudes was carried out using Personality Questionnaire of the V.M. Bekhterev Institute (PQBI). Results and their discussion. High rate of combination of SDVNS with various somatic pathology both in group I and group II was found (86.2% and 85.2% correspondingly). By comparing the results before sanatorium health improvement it was defined that average and high levels of state anxiety were dominating in all groups (group І - 91.7%, group II – 85% and 87.5% – in control group). After complex program of medical and psychological correction and sanatorium rehabilitation the estimation of psychological status of the pregnant women of group I showed the reduced level of anxiety in 79% of women. During analysis of labor progress it was found that the distress rate in group I and control group were 3.5 % and 4.2 % correspondingly. In addition the attention was paid to the high rate of fetus distress and weak labor process of women in group II (14.8% each correspondently). These complications increase the rate of operative delivery in group II which was two times higher in comparison with group I. Conclusions It was showed rather high level of trait and state anxiety of the pregnant women with SDVNS than in somatically healthy women. Program of medical and psychological correction of psycho-emotional state and sanatorium rehabilitation of the pregnant women with SDVNS helps to reduce level of state anxiety and in such way it influences on the indicators of obstetrics, reducing the rate of abnormalities of labor process and fetus distress during labor.

64-68

Authors: I. M. Fushtey, O. V. Soloviov, E. V. Sid’

The most common cardiac arrhythmia leading to disability is atrial fibrillation, it is associated with an increased risk of stroke and increased mortality. Currently, a large interest have studies of autonomic tone in patients with atrial fibrillation and clarify the pathogenetic mechanism of paroxysms by analysis of heart rate variability. Heart rate variability - is the variability of the duration of RR intervals of consecutive cycles of heart rate at regular intervals. The first studies of heart rate variability have been carried out in the late '50s under the guidance of RM Baevskiy, and were associated with pilot training for space flight. The main objective was to evaluate the functional state of healthy subjects. Nervous regulation of heart rate is pretty and the parasympathetic division of the ANS, has a complex hierarchical structure and consists of extracardiac and intracardiac systems. The parasympathetic and sympathetic nervous systems are in a particular interaction in the regulation of heart rate. There is a so-called vegetative homeostasis. The aim of the study was to assess heart rate variability in patients with persistent atrial fibrillation, changes in heart rate variability on the background of the therapy. We examined 124 people between the ages of 40 and 65. The first group included patients with primary with coronary heart disease combined with hypertension stage I-II with persistent atrial fibrillation, only 62 people. The second group consisted of 31 patients with ischemic heart disease and persistent atrial fibrillation without hypertension. The third group consisted of 31 practically healthy people. The study of HRV was performed at rest, by writing the 5-minute RR intervals. Conclusions: A role in the emergence and persistence of AF paroxysms play neuro effects on the heart. The analysis of HRV allows you to make a more precise choice of drug and find it more optimal dose. Given the lack of uniform standards of HRV in patients with coronary artery disease should be analyzed the dynamics of these parameters during treatment compared with baseline data. In the presence of the effect of β-blocker treatment in patients with persistent AF, the increase in HRV parameters should be considered as a beneficial effect of β-blockers in the SNC. The achievement of clinical effect in patients with persistent AF receiving amiodarone accompanied by an increase of HRV as SDNN and TP. Elimination of the HRV as SDNN and TP is a predictor of loss of effect, as in the treatment of β-blockers and amiodarone and require timely correction of antiarrhythmic therapy. Conclusions. 1. Acute hepatitis B in patients with chronic alcohol use in hepatotoxic doses is characterized by longer (p<0,05) prodrome, cholestatic (7,7%) and hemorrhagic manifestations (5,8%), higher levels of hyperbilirubinemia (p<0,05), and during convalescence maintaining higher (p<0,05), alanine aminotransferase activity compared with group II patients. 2. Acute period of acute hepatitis B regardless of whether chronic alcohol use in hepatotoxic doses is characterized by the development of autonomic imbalance towards vagotonia. 3. Period of convalescence in patients with acute hepatitis B with chronic alcohol use in hepatotoxic doses is accompanied by more severe autonomic dysfunction in 33,6% (p<0,05).

74-79

Authors: V. G. Kadzharyan, N. I. Kapshytar

Diabetes mellitus (DM) is a major medical and social problem almost in all countries of the world. Currently, there are more and more various pharmacological agents that make management of the glycaemia in patients with type 2 diabetes extremely difficult. Therefore, when the physician is faced with the choice of glucose-lowering therapy, he should be clearly aware of all the options in contemporary treatment. 11 groups of hypoglycemic agents are used for the treatment of type 2 diabetes The biguanides. According to modern concepts, biguanides inhibit the oxidation of glucose by stimulating anaerobic glycolysis. Both in the consensus of ADA / EASD, and in the IDF recommendations metformin may be the drug of the choice for hypoglycemic therapy of diabetes type 2. Sulfonylurea derivatives: glibenclamide, glimepiride, gliquidone, Glipizide. They belong to a group of secretagogues, as their action is based on the ability to stimulate the secretion of insulin by ß-cells of the pancreas. Prandial glucose regulators. Meglitinides (repaglinide and nateglinide) stimulate insulin secretion by ß-cells. Due to the rapid normalization of stimulated insulin level after taking the drugs the risk of hypoglycaemia between meals is minimized. Insulin sensitayzers. Thiazolidinediones (rosiglitazone, pioglitazone) reduce insulin resistance of peripheral tissues by binding to receptors, activating peroxisome proliferation (PPARg) in the nuclear membrane. Alpha-glucosidase inhibitors (acarbose, miglitol, voglibose) competitively inhibits intestinal enzymes (α-glucosidase). It consequently slows carbohydrate absorption from foods and supply of glucose into the blood. Incretin mimetics. Analogues of glucagon-like peptide 1 (GLP-1) stimulate the biosynthesis and secretion of insulin, regulate food consumption, support ß-cells in a healthy state, suppress glucagon secretion, depending on the glucose levels, affect the rate of gastric emptying, stimulat proliferation of ß-cells. They include the following drugs: exenatide, exenatide-LAR, liraglutide, liksizenatid, albiglyutid, dulaglyutid. GLP-1 is splited by dipeptidyl peptidase type 4 (DPP-4), which formed the basis for the creation of inhibitors of the enzyme DPP-4 and thus the maintaince of GLP-1 effect. There are the following inhibitors of DPP-4: sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin. Inhibitors of sodium-glucose cotransporter 2 (SGLT2). Their mechanism of action is reduced to the suppression of glucose reabsorption in the kidney, followed by reduction of hyperglycemia. Representatives of the group are dapagliflozin and kanagliflozin. The other three groups of drugs: amylin mimetics (pramlintide), bile acid sequestrants (cholestyramine and colestipol) and dopamine-2 agonists (bromocriptine) are used only in addition to the treatment of diabetes. Conclusions. The choice of drug therapy is a difficult and complex task. The heterogeneity of patients with type 2 diabetes suggests, that for effective treatment of this chronic progressive disease may not be an optimal use of only one class of glucose-lowering drugs. When physicians select treatment strategy against type 2 diabetes, he should rely on the national and international clinical guidelines and research results, as well as on his own clinical experience, and be sure to take into account the individual characteristics of the patient.

84-86

Authors: O. P. Balitska

Cohort research based on 180 patients with hypertension treated in cardiological department was carried out in Vinnitsa regional hospital in 2011–2012. Pharmacoeconomic analysis of prevalent schemes of essential hypertension medication was done.

91-94

Authors: A. S. Gotsulya, O. O. Mikolasyuk, O. I. Panasenko, Ye. G. Knysh

Introduction. In last decades considerable interest to the search of biologically active compounds in series of azole derivatives is indicated. This is mainly connected with the successful use of several drugs with heterocyclic system in the structure. Analysis of the pharmacological properties of heterocyclic nitrogen–containing compounds of the known groups let us to suggest, that the triazole substituent is an important pharmacophore fragment, responsible for the availability of diverse physiological activity. In addition, it causes a little toxicity. Considerable attention belongs to synthesis and research of the biological activity of 1,2,4-triazoles derivatives. The great importance also has research of the influence of heterocyclic fragments of different nature in combination in one molecule on the activity of the synthesized compounds. Like different synthons in the structure of 1,2,4-triazoles in various kinds of biological activity of the reaction products with an aim of new and highly efficient low-toxicity compounds reception. The aim of work was to study synthesis and properties of substances among salts of 2-(5-((theophylline-7'-yl)methyle)-4-phenyle-4Н-1,2,4-triazole-3-ylthio)acetate acid. Materials and methods of the research. In the process as a starting material for reception of new series of compounds theophylline has been chosen. It is important to note, that by the diversity and strength of pharmacological effects, which appears, this structure takes its rightful place among heterocyclic compounds. Through the series of the successive stages 4-phenyle-5-(1',3'-dimethylxantine-7'-yl)methyle-1,2,4-triazole-3-thiol was obtained from the theophylline. Research of the physico-chemical properties of the received compounds conducted according to methods, described in the State Pharmacopoeia of Ukraine. open capillary method, elemental analysis (Elementar Vario L cube (CHNS)). 1H NMR spectra of compounds were recorded with a spectrometer “Mercury 400” (solvent - DMSO-d6 or DMSO-d6 + CCl4, the internal standard - tetramethylsilane). Chromatography-mass spectral researches were performed on the instrument Agilent 1100 Series LC/MSD System, method of ionization - chemical ionization at the atmospheric pressure (APCI). Propyl ester of the theophylline-7-acetic acid. To the 0,055 mol of sodium hydrogencarbonate in 150 ml of DMF adds 0,05 mole of the theophylline and heated with stirring 5 - 10 minutes. To the reaction compound adds 0,055 mole of the monochloracetate acid propyl ester and boil with constant stirring 5 - 6 hours. After cooling to the reaction mixture with stirring, adds an equal volume of water. The precipitate dissolves, then falles again. Ester precipitate is filtered, washed with water, then with a small amount of methanol and dried. White crystalline solid, insoluble in water, soluble in organic solvents (alcohols, dioxane, DMF, DMSO). For the analysis is purified from 1-propanol. Yield 82%. Hydrazide of the theophylline -7-acetic acid. To the heated 0,03 mole solution of the propyl ester theophylline -7- acetic acid in 200 ml of ethanol adds 0.3 mole of hydrazine hydrate. Reactionary compound leave at room temperature for 12 hours. Hydrazide precipitate is filtered, washed with water, acetone and dried. Output 79%. White, amorphous substance, insoluble in water, acetone, soluble in alcohols, dioxane, soluble in DMF, DMSO. Crystallized from a mixture DMF-water (1:1). Tm. = 210-211 ºC. 2-(2-(theophylline-7'-yl)acetyl)-N-phenylhydrazinecarbothioamide. 0,05 mol of phenylisothiocyanate, 130 ml of dioxane and 90 ml of water heated up to boiling for 1 hour, cooled, add 100 ml of water, the precipitate is filtered, washed with water, 2-propanol and crystallized from a mixture water- dioxane, dimethylformamide. Output - 71 %. Tm . = 262-265 ºC. 7-((5-mercapto-4-phenyl-4H-1,2,4-triazoles-3-yl)methyl)theophylline. 0,01 mol of compound 2 -(2-(theophylline)acetyl)-N-phenylhydrazyncarbothio-amide, 0,01 mol of sodium hydroxide and 50 ml of water heated up to boiling during 2 hours, cooled and added to the filtrate 2 ml of concentrated hydrochloric acid. Output - 84%. Tm. > 270 º C. 2-((5-((theophylline-7'-yl)methyle)-4-phenyle-4Н-1,2,4-triazole-3-il)thio)acetate acid. In a round, heat-resistant flack heated 0,01 mol of 7-((5-mercapto-4-phenyl-4H-1 ,2,4-triazoles-3-yl) methyl)theophylline, 0,02 mol NaOH and 0,01 mol monochloracetate acid. Heated up to boiling for 1 h. Cooled. Neutralized by acetic acid. Output - 71%. Tm. = 227-230 º C. Salts of 2-(5-((theophylline-7'-il)methyle)-4-phenyle-4Н-1,2,4-triazole-3-il-tiо)acetate acid. A compound: 0.01 mole of acetic acid, 35 ml of ethanol and 0.01 mol of corresponding base (monoethanolammonium, dyethylammonium, dyetanolammonium, monoetanolammonium, threebutylammonium, morpholine, piperidine, piperazine) heated for 1 hour in a water bath, the solvent is evaporated. Getting white crystalline substances soluble in water, soluble in diethyl ether and chloroform. For analysis compounds recrystallized from ethanol. Potassium, sodium salts of 2-(5-((theophylline-7'-il)methyle)-4-phenyle -4Н-1,2,4-triazole -3-iltio)acetate acid. A compound - 0.01 mole of acetic acid and 0.01 mole of potassium or sodium hydroxide in 30 ml of water evaporated in a water bath. The dry residuum crystallized from ethanol. Getting white crystalline substances, difficulty soluble in organic solvents. For analysis compounds recrystallized from water. Magnesium , calcium, zinc , copper (II) and iron (II ) salts of 2-(5-((teophylline-7'-yl)methyle)-4-phenyle-4Н-1,2,4-triazole-3-iltio)acetate acid. A compound of 0.02 mole acetic acid, 25 ml of water and accordingly 0.01 mol of magnesium oxide , calcium carbonate , zinc sulfate, copper ( II) sulfate or iron ( II) chloride is heated till the dissolution of precipitate , filtered , the filtrate evaporated. Received white, light blue , brown crystals with sharp melting points, little soluble in water, hardly soluble in organic solvents. For the analysis, compounds recrystallized from water. Ammonium salt of 2-(5-((teophylline-7'-yl)methyle)-4-phenyle-4Н-1,2,4-triazole-3-iltio)acetate acid. A solution of 0.01 mole acetic acid in 30 ml of 25% ammonia solution evaporated. Received a white crystalline solid, easily soluble in water, difficult soluble in ethanol. For the analysis compound recrystallized from the compound - dioxane: water (3:1). Results and their discussion. As starting material we used 7 - ((5-mercapto-4-phenyl-4H-1 ,2,4-triazoles-3-yl) methyl) theophylline, received from 2 - (2 - (theophylline) acetyl)-N phenylhydrazyncarbotioamide, which was obtained from the previously described hydrazide theophylline-7-acetic acid as a result of interaction with phenylizotiocyanate. By interaction of the resulting thiol with monochloracetate acid in an aqueous solution of double lye number received the corresponding carboxylic acid. Research has shown, that the reaction proceeds quantitatively In the 1Н NMR - spectra of the resulting acid was observed number of signals. In a strong part of magnetic field available the protons of -СН2-groups, which resonate as singlets at 3.90 m.p and 5.75 m.p The signals of СН3 groups protons also appears as intense singlet in the 3.30 - 3.36 m.p region. Proton of the methyne group is characterized by a signal at 8.36 m.p. Signals of the phenyl radical protons in 1Н NMR- spectra form two one - proton doublets (at 7.70 m.p. and at 7.48 m.p. ) and three one – proton triplets (at 6.83 - 7.17 m.p. ) . Broadening proton signal of aromatic COOH groups fixed at 12.0 m.p. IR- spectra of the received acid characterized by deformation and valence fluctuations of synthesized compounds basic fragments: plane deformation of C-H fluctuations in 1225 - 950 cm-1 area ( weak intensity band 1175-1125 сm-1 , 1110-1070 сm-1, 1070-1000 1 сm-1), out – plane deformation of C-H fluctuations in the 1000-650 сm-1 area ( strong intensity band 770 - 730 сm-1, , 710 - 690 сm-1 ). Available bands of the carboxyl group valence fluctuations - 1760 сm-1. C = N in a 1660-1480 сm-1 cycle . Theophylline fragment: 3060 - 3010(νс-н), 1000 - 960 сm-1 (C- H deformation fluctuations), 875 - 775 сm-1 (C- H deformation fluctuations) , 1580 - 1520 сm-1 ( ring fluctation) . Also, available bands of NH- groups fluctuations within 1650 - 1620 сm-1 (νas) and 1345 - 1310 сm-1 (νs). Conclusions Installed the optimal conditions of salts reception

98-103

Authors: G. L. Panfi lova, O. V. Tsurikova

Introduction. Since 2002, the pharmaceutical care of the cancer patients in Ukraine is carried out centrally by public funds in the framework of the target program "Oncology." In a chronic shortage of funds in the national health care system, as well as taking into account the perspectives of the introduction of the social model of obligatory medical insurance (OMI), enhanced the importance of research on the development of rational mechanisms for the use of public funds, which are sent to drug purchases. Given the high mortality rate among cancer patients, especially in children in Ukraine, these works are of particular socio-economic importance. The aim of work. To study drug purchases that are made for cancer patients in Ukraine in order to identify the main problems and directions of rational scientific basis for the use of public funds in terms of lack of resources in health care, as well as from the perspectives of the introduction of the social model of OMI in Ukraine. Materials and methods. Objects of research: data from the National Cancer Registry, annual plans and registers of public drug procurement Ministry of Ukraine. The paper used data from national legislative and regulatory framework governing the organization of pharmaceutical support cancer patients, standard methods of statistical processing of the dynamics of the clinic-economic analysis. Results and discussion. During 2010-2013 marked increase in the amounts of permanent drug purchases for cancer patients, which is on the growth rate did not meet the dynamics of changes in the relevant during epidemiological indicators. The results integrated ABC/VEN-analysis found no drug purchasing products from the group N and with the status A/V, and the dominance of the number of agents with the status items C/V. The main volume of financial resources was directed to the purchase of drugs from the group E (84.8% - 92.4%) and the status of A/E (78,9% -79,8%), as well as drug belonging to the group L01X - Other antineoplastic agents, (64.8% - 72.4%). During 2010-2013 there is a significant proportion of the fluctuation of the value of the groups of drugs В (in the status В/V and В/E), V (in the status В/V and C/V), E (in the status В/E and C/E). This indicates a lack of evidence-based approaches to determining the need for the acquisition and purchase volumes for the budget. In addition, the statutes disproportionately relative to all groups of oncohematological patients, the distribution of funds for the procurement of drugs. Stable priority position on the amount of purchases (63.5% - 71.2%) took five drugs (bortezomib 3.5 mg, imatinib 400 mg, nilotinib 200 mg, rituximab 500 mg, fludarabine 50 mg), which in most cases, are used in the treatment of chronic forms of leukemia and lymphoma. Conclusions. The results of these studies provide an opportunity to argue about the need to develop and implement the state target program "Hematology." The most important condition for the effective implementation of this program in the functioning of the social model is the introduction of OMI of evidence-based model provide pharmaceutical oncohematological patients according to their actual needs in the various denominations of drugs, as well as the financial capacity of the national health system.

107-108

Authors: V. M. Klimenko, O. V. Zakharchuk, V. V. Vakulenko, A. S. Dosaieva

The discussion about the necessary shift from teaching to learning has been considerably boosted by the Bologna Process and related issues such as qualification frameworks, the European Credit Accumulation and Transfer System (ECTS) and the Diploma Supplement. Teaching and learning in higher education is a shared process, with responsibilities on both student and teacher to contribute to their success. Within this shared process, higher education must engage students in questioning their preconceived ideas and their models of how the world works, so that they can reach a higher level of understanding. Nobody would contest that we need high quality teaching and learning throughout our education and training systems. The aim of this work was to examine the effect of student scientific circle of Surgery on the formation of professional motivation of students. An important form of scientific-research work of students in Zaporizhia state medical university (ZSMU) is functioning of student’s scientific circle as branche of Scientific Student Association. In task group are also practical skills, which is primarily important for, the formation of a future doctor character qualities such as tenacity, ambition, determination. The feature of the circle is that students study discipline independently, using help of the department teachers, collaborate with students of other scientific circle and societies of ZSMU and other Ukraine medical high schools. The best teaching helps students to motivates them to learn. The results of monitoring in 2012-2013 showed that about 85% of students improved learning outcomes from such disciplines as operative surgery and topographic anatomy, propaedeutic Internal Medicine, General Surgery, Faculty surgery, Hospital surgery. Presented the possibilities of using various forms information technology to enhance learning, acquire new knowledge and information sharing. Every year students of surgery circle participate in student conferences with international participation, receive prizes. Teaching and learning are fundamental core missions of university, that involve students in governance, curricular design, development and review, quality assurance and review of the procedures. Academic staffs are employed not just to teach, but to teach on a high professional level. Thus, student scientific circle is an important means to improve the efficiency of education contributes to future surgeon.

113-115

Authors: O. V. Kraydashenko, О. O. Svintozelskyi, A. V. Sarzhevska, T. O. Samura, M. V. Shevchenko

The World Health Organization (WHO) has identified the current strategic direction of health care throughout the world as "Focus on the patient." Therefore, the pharmacist role in the healthcare system is changing - a pharmacist has a key role in public health. Pharmacist provides assistance to the patient and guarantees that assistance is designed correctly, effective among all the available options, is safe and right for this patient. Due to this the approaches to teaching students are changed significantly, it is necessary to create the clinical thinking in future pharmacists. The main objective in teaching pharmacotherapy and clinical pharmacy is training the pharmacist to have an adequate theoretical knowledge and practical skills to control the conduct of the most rational drug therapy in a concrete patient. Pharmacist must choose the appropriate therapy for a patient based on pharmacokinetics, pharmacodynamics, possible side effects and age, sex, presence of comorbidities of the patient. Practical sessions conducted directly in the clinic, include this organizational structure: The preparatory phase (organization and setting teaching purposes and motivations, control the output level of knowledge - tests, oral theoretical questions); The basic phase (formation of professional skills and knowledge to identify general principles of clinical pharmacy, work near a bed, definition of clinical syndromes, define treatment plan, analysis of the tests results, solving typical tasks and tests). The final phase – control of the the final level of knowledge and skills (solving atypical problems, writing prescriptions). We provided a special sense to the independent work of students on the preparation and wrote recommendation "The efficacy and safety protocol of medicines". Particular attention is paid to the following sections: medication and allergy history; pharmacotherapy; assessment of possible interactions of drugs; selecting assess the efficacy and safety of pharmacotherapy; daily logs of the dynamic control to the pharmacotherapy efficacy and safety. The important stage in the formation of clinical thinking in students is educational practice. During the practical training students should be familiar with the basics of deontology and the ethics of communication with pharmacies visitors; acquire skills of medicinal history collecting. Students are expected to acquire skills of choosing the optimal OTC medicine for a concrete patient and use to practice the algorithm of the distribution patients who need and do not need doctor consultation. Thus, an integrated approach to the teaching of pharmacotherapy, clinical pharmacy, practical training in clinical pharmacy, promotes the formation of clinical thinking in students.