Medical perspectives (Medicni perspektivi)

4-11

Authors: Nefyodov A.A., Mamchur V.Io.

A comparative analysis of the impact of citicoline, α-lipoic acid, nicergoline, donepezil and colloidal solution of nano-silver (CSNS) on the processes of learning and consolidation of memorable track in the test of the conditional reaction of passive avoidance (CRPA) in conditions of experimental allergic encephalomyelitis (EAE) was conducted. Testing of passive defensive skill was performed on days 12 and 20 after the induction of EAE. To assess the impact of drugs on the inputted information processes the investigated substances were administered intragastrically (CSNS - intraperitoneally) once daily in the definite dose from the second to the day 10 after the induction of EAE (latent phase of the disease), and assessing processes of conditional skill preserving, further administration of drugs by the day 20 of the experiment (average duration of EAE) was used. A positive effect of citicoline, α-lipoic acid, nicergoline and donepezil on the input information processes and the ability to prevent accelerated extinction of acquired contingent skill in the conditions of experimental pathology was established. Drugs statistically significantly increased duration of the latent period of CRPA in comparison with a group of active control by 49%, 43%, 39% and 34%, respectively. Here with preparations were characterized by a high coefficient of antiamnesic activity, by the end of the experiment it was recorded at the level of 95% (citicoline), 81% (α-lipoic acid), 76% (nicergoline) and 53% (donepezil). It is shown that the ability to prevent development of cognitive impairment in conditions of experimental equivalent of multiple sclerosis decreases in the number of citicoline (500 mg/kg) > α-lipoic acid (50 mg/kg) ≈ nicergoline (10 mg/kg) > donepezil (10 mg/kg).

17-25

Authors: Bondarenko I.M., Zavizion V.F., Kyslytsyna V.S., Aseyev O.I., Dmytrenko K.O., Mashtaler V.S., Kaniyka H.S., Starushkevych H.F., Filat T.V., Khodzhuzh M.I.M.

Motivation of students is one of the most efficient means of improving process and results of training, and motives being impetus of academic process and qualitative mastering of learning material. Formation of academic motivation today is one of the main tasks of up to date education. Academic motivation depends on individual peculiarities of students, character of the closest referent group, level of development of students’ collective, etc. Aim of the research was 1) studying level of academic motivation of students of SE “Dnipropetrovsk medical academy of HM of Ukraine”; 2) revealing prevailing motives of educational activity of students of high medical establishment; 3) assessment of moral readiness of students to inevitable mistakes in future work; 4) studying dynamics of motivation sphere of future doctors in the course of the studies in high medical school; 5) comparison of motivation and intellectual indices of students of junior, pre-graduate and graduate courses; 6) recommendations for lecturers as for improvement of academic motivation of the students. By means of anonymous testing of 537 students of the first, fifth and sixth courses there were studied peculiarities of academic motivation and intellectual indices of the students. Academic motivation of students at large is sufficiently high. Professional and scientific-cognitive motives of educational activity are the most expressed ones. Communicative motives and those of creative self-realization are somewhat less, social motives and motives of prestige are much less. Rather low indices of failure avoidance testify to moral mood of students to inevitable mistakes in their future work. On the whole, a tendency to academic motivation decreasing in the course of studies was revealed. Expressiveness of academic motivation does not depend on intellectual indices of students.

30-36

Authors: Pertseva T.O., Rokutova M.K.

The purpose of the study - to assess the role of insulin resistance in the development of initial manifestations of renal disease in patients with abdominal obesity. Materials and methods – 61 patients (I group) young with obesity, I-III degree, without diabetes 1 or type 2 were examined. The structure of the control group included 12 patients who were considered to be relatively healthy (II group), 10 patients with newly diagnosed type 2 diabetes (III group) and 10 individuals with uncomplicated hypertension without abdominal obesity and diabetes. The effect of hyperinsulinemia and insulin resistance indices on renal function (glomerular filtration rate, urine protein, urine albumin, urine β2-microglobulin, and relations - urine albumin / creatinine urine, β2-microglobulin urine/urine creatine) was studied. Results and discussion. Main group of patients, group of patients with diabetes type 2 and uncomplicated hypertension is characterized by disturbances in the form of hyperinsulinemia and increased insulin resistance index. Statistical analysis showed significant relationships between indicators of fasting insulin, IR index and renal function in patients with abdominal obesity. Regression analysis confirmed the pattern between the level of insulin resistance and the main indicators of renal function (GFR, MAU, β2-microglobulinuria and increased ratio β2-microglobulin/urine creatinine). Conclusions. In patients with abdominal obesity disorders in the form of hyperinsulinemia and increased insulin resistance index of HOMA-IR>2,77 were revealed. Significant correlation connections between levels of fasting insulin, insulin resistance index and indicators of renal function were observed. In regression analysis predictive role of insulin resistance in the formation of renal dysfunction in patients with abdominal obesity was established. The necessity of studying the state of insulin resistance in patients with obesity-associated nephropathy for the selection of adequate pathogenetic therapy, prognosis of renal dysfunction and prevention of the development of related metabolic disorders.

42-47

Authors: Khomazyuk T.A., Krotova V.Yu., Sova O.V., Yagolnik V.M.

There was analyzed the extent and structure of cognitive disorders in outpatient conditions by the data of examination of 118 hypertension patients stage II with arterial hypertension of 1-2 degrees, which were under the supervision of General Practitioners. Neuropsychological examination was carried out by MMSE (Mini-Mental State Examination) and FAB (Frontal Assessment Battery) scales, verbal memory was studied by the method of Luria, concentration and speed of sensorimotor reactions - by techniques of Schulte and Rybakov. It was found that 28.8% of patients had cognitive disorders, mainly of neurodynamic nature, in particular, the ability of concentration and speed of psychomotor reactions was reduced. The presence of verbal memory disorders of varying severity associated with hypertension was revealed. Analysis of medical records testifies to the absence of attention to this issue in rehabilitation programs of hypertensive patients at the primary stage of care. The importance of timely diagnosis of cognitive disorders as a marker of early disorders of cerebral circulation and the functional state of the brain, the target organ in hypertension of 1-2 degrees was demonstrated.

54-62

Authors: Berezin A.E., Sheychenko T.V., Berezina T.A., Vishnevaya N.V., Kovalenko N.V., Kulik Z.I., Мoiseenko I.А.

The review is de¬voted to the most important aspects of primary mixed dyslipidemia treatment in patients at high risk with concomitant metabolic comorbidities. Evidences for novel modern approaches regarding primary prevention of cardiovascular events among dyslipidemic patients are considered. The potential role of lipid-lowering treatment with statins and their role in reducing the cardiovascular risk are discussed. Information about modern methods of minimization of residual cardiovascular risk using a combined lipid-lowering strategies and new representatives of the statins are provided. It has been discussed various strategies of statin administering to patients with dyslipidemia of different age with exiting comorbidities, such as diabetes mellitus, obesity, metabolic syndrome. Objective findings and treatment approaches obtained from the patient with obesity, metabolic syndrome, and asymptomatic atherosclerosis are provided. The role of pitavastatin in primary prevention program of cardiovascular events is discussed

70-78

Authors: Korpusenko I.V.

Objective. Improve the effectiveness of surgical treatment in patients with bilateral destructive pulmonary tuberculosis by mini-invasive resection and collapse therapy. Materials and Methods: Retrospective analysis of 222 patients’ cards with bilateral destructive pulmonary tuberculosis who were treated in the period from 1995 to 2014 in the thoracic department of Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology". Patients were divided into 2 groups: basic (111 patients who underwent mini-invasive surgery) and control (111 patients, who underwent standard surgical approach). The distribution of patients in investigated groups was representative by the majority of parameters. Results and discussion. The average duration of simultaneous bilateral VATS lung resections was 1,90 ± 0,12 hour, standard thoracotomies - 2,13 ± 0,19 per hour, estimated blood loss was 234±5,20ml and 433±3,70ml respectively. The average postoperative time in-patient was 52,40±2,63 days in basic and 80,10±3,58 days in the control group. Number of postoperative complications after lung resection with VATS was significantly lower (1.6 times), as compared with standard surgical approach. Volume of blood loss less than 400 ml was 93,40±3,20% in basic and 72,60±4,80% in the control group, the amount of intraoperative complications reduced by 2.2 times. Complete clinical response (decontamination and closing of cavities) have been achieved in patients of the basic group by 1.6 times more often. Conclusions: For patients with bilateral pulmonary tuberculosis to perform mini-invasive surgical approach is the best option. Mini-invasive interventions with VATS due to its good abilities to visualize tissues and anatomical structures may significantly decrease the amount of intraoperative blood and plasma loss in the first postoperative day. It leads to the stabilization of tuberculosis process in the contralateral lung, responsible for overall positive clinical effect in patients with advanced pulmonary tuberculosis. For patients with bilateral destructive pulmonary tuberculosis, who can’t undergo resection, performing a mini-invasive therapeutic thoracoplasty is the optimal approach.

84-87

Authors: Makedonsky I.O.

The retrospective analysis of case histories of 35 infants (19 boys, 16 girls), treated in the department of reconstructive surgery of Dnipropetrovsk center of mother and child health in the period 2008-2013 was done. All the patients underwent one-stage treatment of anorectal malformations in neonatal period. Surgery was performed in the first 48 hours of life. Body weight of infants ranged from 2,8 to 4,4 kg (average weight 3,2 kg). Among related conditions there were observed vesico-ureteral reflux (VUR) – in 11 (31,4%), VATER association - in 6 (17.1%), malformations of the spine – in 18 (51,4%), of the heart – in 2 (5,7% ). During cystoscopy fistula in the urinary system was revealed in 16 boys. Surgical treatment was carried out by the posterior sagittal anorectoplasty (PSARP) by A.Pena. 2 patients additionally underwent laparotomy. Among 16 patients with fistula in the urinary system, prostatic urethra fistula was revealed in 14, bladder neck fistula – in 2. Children were discharged from the hospital 2 weeks after surgery. All the children re¬ceived anti¬biotics due to the presence of VUR. After 1 month after surgery VCUG was performed. Long-term results were studied for a period of 10 to 24 months. All patients had VUR without evidence of hydronephrosis. In the period of 3-6 months after surgery 2 patients presented anal stenosis due to violation of dilatation. The evaluation results in the late period (10-24 months after surgery) noted the presence of normal stool 2-3 times a day, 3 children had periodic con¬stipations treated by diet. Available merits of the described method: only one operation and general anesthesia is per¬for¬med, no risk of prolonged contamination by pathogenic flora of the urinary system through the fistula, potential risk of complications of laparotomy and colostomy decreases, fistula visualization in cystoscopy allows to avoid the X-ray.

94-99

Authors: Besedin A.M.

Lately vacuum therapy of wounds in patients with diabetic foot syndrome is an integral part of complex treatment. Due to the popularization of this technique and unique cellular, extracellular and total effects of its use in many surgical wards in Ukraine, the technique of vacuum therapy has been successfully used in the treatment of patients with purulent complications of diabetic foot syndrome. Unsolved technical issues of vacuum therapy of wounds are: delayed outflow of wound discharge, blockage of sponge pores, microflora contamination on foam rubber and "drying of wounds." Improved technique proposed by the author consist of instillation of antiseptic into vacuum bandage, which prevents microflora contamination in the foam sponge, and creates moist environment in the wound leading to wound dialysis. This advanced technique allows to prevent deterioration of the physical properties of synthetic sponges, to create a moist environment in the wound and prepare it for closure.

109-117

Authors: Bilous S.V., Vavrinevych E.P., Omelchuk S.T.

Hygienic evaluation of labour conditions during Orvego pesticide application on grapes and onion was carried out and content of ametoctradin and dimethomorp in the working zone air, atmospheric air, and the soil was studied. The findings allow to substantiate ametoctradin hygienic standards in the working zone air, atmospheric air, and the soil and to elaborate regulations of Orvego pesticide safe application in agriculture. Estimation of complex risk of ametoctradin and dimethomorp effects via different routes of exposure during airblast and boom spraying treatment showed that the values of the risks were within the ranges of allowable (1). Values of combined risk during simultaneous effect of the both active ingredients do not exceed allowable level (1) either.

124-130

Authors: Kovalchuk L.I., Mokiyenko A.V., Nasibullin B.A., Solodova L.B., Guscha S.G., Oleshko O.Ya., Bakholdina O.I.

In the work results of a complex estimation of functional changes in an organism of healthy rats which consumed water of the lake of Kagul as drinking water are given. Conformity of water of the lake of Kagul to requirements of operating standard documents except for nitrogen ammonia, nitrogen nitrit and the general organic carbon is established. 3 kinds of cyanobacteriaе, in particular high levels of Aphanocapsa pulverea, which causes water "flowering" are revealed. It is shown that the use of water of the lake of Kagul as drinking, causes strengthening of activity of central nervous system in healthy rats; some increase of possibilities of organism sensitisation development and specific phagocytosis, certain displays of disbalance of hummoral component of the immune response and expansion of autoimmune processes in the organism. In the view of absence of hyginicaly significant concentration of anthropogenous pollutants, the idea that the revealed biological effects are a consequence of cyanotoxins action produced by revealed cyanobacteriaе is presented. Necessity of expansion and continuation of researches on cyanobacteriaе in the context of their revealing in water, their identifications, influences of these xenobiotics on condition of warm-blooded animals and the human is proved.

137-144

Authors: Oleynyk A.Ye.

The most important periods of history of hip joint replacement are considered in this work. Endoprosthesing is the replacement of pathologically changed joint with artificial one which is called the endoprosthesis. Special attention is paid to the creation and development of ideas, approach and principles of endoprosthesing as well as to materials and structures of implants. The period from the first attempt of joint replacement to the development of scientific foundation and creation of industry of modern endoprosthesing is overviewed. Together with the world practice the author also considered the history of endoprostesing in USSR and CIS countries. The approach to the solution of endoprosthesing problem in Ukraine is proposed. The essential scientific and practical achievements in the field of development of the native joint replacement are noted. Some modifications of hip endoprostheses and also of shoulder, ankle, first metatarsophalangeal joint and head of the radius are developed and manufactured. The work as for the improvement of the design of implants and elaboration of endoprostheses of other localizations is being performed. These investigations are performed in different directions and include the tasks of biomechanics of the locomotor system, development of new kinds of constructions, elaboration of new coatings and experimental investigation of the characteristics of implants.