Medical perspectives (Medicni perspektivi)

15-20

Authors: Кhaniukov O., Kozlov S., Yehudina Y., Sapozhnychenko L., Kozlova Yu., Somilo O.

Introduction and purpose of the study: high require­ments for graduates of higher medical establishments facilitate the search, implementation and improvement of modern teaching methods in order to optimize the development of clinical thinking in medical students. In the the course of the work, a big volume of information was used, which was worked out using such methods as historical and literary synthesis, structural and logical analysis, abstract thinking and personal experience taking into account the principles of systemic approach and analysis. To improve the quality of medical students' training it is necessary to use the innovative teaching methods. Presence of the personal clinical archive, with allow to use archival material in the training process (for example, to use case-method), in the analysis of a clinical case and the use of data in the scientific work. The article presents an example of a clinical problem and emphasizes the importance of the case-method in teaching students in higher educational institutions. Formation of clinical thinking takes place over the course of direct work with the patient, with an independent attempt to resolve a specific clinical situation in real conditions. Case method allows to reveal and form the necessary personal qualities and abilities of medical students, necessary for the further work. Modern methods and means of information technology must be purposefully implemented into clinical practice and educational process for the development of professional skills, formation of clinical thinking, ac­cumulation of clinical experience.

31-34

Authors: Semyonova L.S., Klimenko I.N.

This article shows the importance of studying history of medicine and importance of language training as an essential component of broadening of universal cultural and medical outlook of prospective doctors, upbringing of high moral ethical qualities inherent to a contemporary doctor. The authors of the article propose measure on improving teaching of these disciplines.

40-45

Authors: Poslavska О.V.

Merkel cell carcinoma (MCC) is a rare malignant primary skin neoplasia with epithelial and neuroectodermal differentiation. The problem of MCC, which determines the relevance of its research, is often a high frequency of local recurrence, regional lymph node metastasis and further hematogenous and/or distant lymphogenous dissemination. Materials and methods. A retrospective analysis of the biopsy material of 6 patients with isolated MCC metastasis aged from 29 to 82 years (average 63.11 ± 16.24; median 62.5) was carried out. For the control group, 9 cases of postoperative material of primary skin tumors with MCC of patients aged from 27 to 76 years (average 52.17 ± 12.72; median 53.5) were selected to determine the differential diagnostic criteria. The results of the study. Carcinomas without primary localization may be interpreted as MCC if they demonstrate phenotype Cytokeratin, Pan AE1/AE3 (paranuclearly +) / CK20 (paranuclearly +) / Vimentin (-) / CD45 (-) / S100 (-) / Chromogranin A (+) / Synaptophysin (+), with morphometric parameters of the area and perimeter, which is 2 times the size of ordinary lymphocytes, (all p>0.05). Findings. Metastatic CMC without primary localization, in comparison with locally spreading, often exhibit low-differentiated small-cell and transitional forms, which require additional immunohistochemical study to exclude carcinomas of other origin.

50-61

Authors: Idashkina N.G.

Objective – to evaluate the etiological significance of local and general factors in the occurrence of delayed union of bone tissue in patients with mandibular fractures. a personalized questionnaire was developed and filled by 74 patients with fragments mobility that persisted 1 month after reposition and fixation of the mandibular fractures for determination the role of local and general factors in the occurrence of delayed union. Thus, local and general factors that most closely correlate with the development of this complication were identified. The obtained data were compared with the results of a retrospective analysis of case histories of patients with mandibular fractures over a five-year period. The presence of a general somatic pathology, head injury and polytrauma, as well as such aggravating factors as alcohol and drug abuse should be considered as the general risk factors for the development of the delayed union of mandibular fractures. Among local factors, inflammation in the area of mandibular fractures takes the first place, the development of which is provoked by untimely treatment of patients, comminuted fractures, traumatic surgical interventions, etc. Among patients with delayed union of mandibular fractures, 86.5% received antibiotics for more than ten days. The risk group should also include patients with mandibular fractures of a young age (from 18 to 25 years) and those over 45 years. The problem areas for consolidation are mental section (31.1%) and the angle of the jaw (25.7%).

66-72

Authors: Rubtsov R.V.

The aim of the research is to study the peculiarities of changes in the chest on survey radiograph at pneumoconiosis associated with COPD in workers of mine and metallurgical industry. The data of clinical examination of 635 workers with lung pathology of occupational genesis are presented in the article. Group I consisted of 99 workers with pneumoconiosis associated with COPD, II group – of 21 workers with pneumoconiosis, and III group – of 515 workers with COPD of occupational etiology. A comparative analysis of radiographic changes in the chest X-ray has established that the most informative radiologic changes for pneumoconiosis associated with COPD are: linear reticular obscuration up to 1.5 mm in size, cord obscuration from 1.5 to 3.0 mm in size, and less significant changes in the form of nodules size up to 1.5 mm, from 1.5 to 3.0 mm, the thickening of pleura more than 10.0 mm wide. The most sensitive radiographic signs typical for PC associated with COPD are the indicated obscurations and nodules, their etiological share in diagnosis of this disease is 100%, determining the greatest absolute risk of development of this occupational pathology in this category of patients. The revealed X-ray diagnostic criteria allow to conduct timely diagnostics, define the tactics of treatment and prevention of PC associated with COPD in workers of mining and metallurgical industry.

80-86

Authors: Khomenko I.M., Zakladna N.V.

The relevance of the work is determined by the absence of documents on the problems of observation zones of nuclear power plants, including the organization and monitoring of environmental objects in Ukraine. The purpose of the study was to assess the state of radioactive contamination of the environmental objects of the observation zone of the Zaporizhzhia nuclear power plant. To accomplish the tasks, we analyzed the data of the laboratory control performed by the external radiation monitoring laboratory of the Zaporizhzhia nuclear power plant and the data of the State Institution «Zaporizhzhia Regional Laboratory Center of the Ministry of Health of Ukraine». The obtained results allow us to draw the conclusions that in the environmental objects (water of the Kakhovsky reservoir, atmospheric air, soil, drinking water) of the observation zone of the Zaporizhzhia nuclear power plant, the main dose-forming radionuclides were identified. It is established that their levels are not uniform, and the identified instability indicates the need for continuous laboratory monitoring of the content of cesium and strontium and the need to monitor the impact on health of the residents of the observation area. It is necessary to improve radiation monitoring through the development and implementation of new methodological documents and regulations on the organization of laboratory control, justification of its frequency and the required amount of laboratory research, which will allow to establish the true impact on public health in these areas.

94-100

Authors: Yeroshkina T.V., Derevyanko D.V.

The purpose of the study is to analyze the activity of the laboratory service of the Dnepropetrovsk region, to develop and substantiate the concept of optimizing its work. We have carried out in dynamics the analysis of the laboratory service of the Dnepropetrovsk region: its structure; staffing level of doctor-laboratory assistants, biologists and laboratory assistants; carrying out laboratory researches, their structure and quality, as well as the state of laboratory equipment and reagent base. The methods of research used: bibliosemantic – systematic and historical analysis of domestic and world literary sources on the organization of laboratory service; reports and legislative documents on the activities of the laboratory service of the region; systematic analysis – to identify the existing shortcomings and positive experience in the training system, the formation of an effective team of employees, quality of the provided laboratory services, ways to optimize the work of the clinical-diagnostic laboratories (CDL); medical statistics for the analysis and interpretation of research results, logical mode­ling – for the development of the concept. The article covers the state of the laboratory service of the region: changes of its structure due to restructuring of the treatment-prophylactic institutions (TPI), the reforming of primary medical-sanitary care; development of family medicine – the number of hospital decreased by 39,8% in 2017 as compared to 1995, the number of hospital – by 38% beds per 10 thousand population; At the same time, the number of outpatient cl­inics increased by 70,1% during this period, which is in line with the WHO recommendations for provision of out­patient care to 80% of patients. Coefficient of provision of population of the region with doctor-laboratory assistants per 10 thousand of population is 0,68; staffing level of doctor-laboratory assistants with of medical doctors by natural persons is 25,9% with tendencies to decrease. The staffing level of specialists with higher non-medical education is 63.6%. Clinical and diagnostic laboratories in most cases have a minimum of equipment that is often outdated, without means for automatization equipment. Problems of the laboratory service of the region consist in the presence of a large number of low-power CDLs, performing the minimum set of diagnostic tests, lack of programs of research in the framework of separate nosological forms of diseases at different stages of medical care provision, acute shortage of high-tech equipment; lack of a systematic approach; the high turnover of personnel due to unsatisfactory material and technical and economic condition of the service and low wages. The main ways of optimization of laboratory services are offered.