Medical perspectives (Medicni perspektivi)

11-17

Authors: Babkina T.M., Smyrnova G.S., Polishchuk O.V., Hladka L.Yu.

Quantitative assessment of cavities and heart function is the most common task of echocardiography (EchoCG). It is difficult to overestimate the importance of standardizing EchoCG measurements, because their results influence clinical decisions. In January 2015, the American Society of Echocardiography and the European Association of Cardiovascular Imaging, published an update Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults. Since then, the results of new research using obtained prospective data, on the basis of which in February 2020 the British Society of Echocardiography (BSE) released a new guide. The authors of the recommendations set the goal of creating a simple, practical reference document and guide for everyday use that encourage the holistic interpretation of measurements (no single number should define normality or pathology). Based on these data, we considered the rational component of the updated recommendations, focused on important conceptual changes in the assessment of heart structure and function, provided new terminology for left ventricular function and left atrial size, and a new approach in assessing aortic root, right heart and left atrium. The BSE recommends obtain left ventricular dimensions from the parasternal long-axis window preferentially using 2D imaging. Aortic dimensions should be obtained using the “inner-edge to inner-edge” technique in end-diastole. The BSE suggests that for those Echocg labs that currently use the “leading-edge to leading-edge” technique, it is reasonable to continue doing so for continuity and consistency.

30-39

Authors: Kostyshyn N.M., Gzhegotskyi M.R., Yarova O.A., Kostyshyn L.P., Kulyk Yu.O.

This study aimed to investigate the influence of high-frequency whole body vibration (WBV) on metabolic and structural responses of rats' bone tissue under the sedentary lifestyle and obesity. Obesity combined with a sedentary lifestyle can present the potential negative health effects. However, whole body vibration can be used as a means of non-pharmacological correction of bone mineral density. For characterization of bone nanocomposites organisation and prevention of mineral density loss, X-ray diffraction method was used. Markers of bone remodeling in the rats' blood: leptin, osteocalcin, tartarate resistant acid phosphatase 5b, alkaline phosphatase. Using a high-calorie diet and low-mobility model, we proved that bone mineral mass had been decreasing since 8th week. It should be noted that the decrease in the relative amount of crystalline phase (hydroxyapatite) continued throughout the experiment, up to 24 weeks (p<0.05). These structural changes were accompanied by changes in quantitative indicators of the bone remodeling markers. Rats had lower bone mineral density compared to the animals that were on the normal diet and were additionaly affected by WBV. We observed the increase of the crystalline phase volume fraction from 84% to 93% (p<0.05) in group with additional whole body vibration and the decrease of the mineral component in rats with limited mobility and high-calorie diet. Therefore, WBV could improve structural conditions of bone and prevent fat accumulation and obesity-associated biochemical markers in obese rats. This can be an effective method to improve the structural and functional state of the bones while preventing the loss of bone mineral density.

46-53

Authors: Pototskaya O.Yu., Shevchenko K.M., Averkina L.I., Kobeza P.A.

Оbjective control of the level of knowledge in medical universities is the basis for guaranteeing the quality of education. There are a lot of examples of universal systems designed to evaluate medical students in different countries, including USMLE, IFOM and others; particularly in Ukraine Krok 1 licensed exam is conducted since 2005. Results of Krok 1 are also used for ranking medical universities at the national level. The purpose of our work was to conduct a comparative analysis of the results of the licensing exam Krok 1, in particular, a histology subtest, among students of specialties 221 “Dentistry” and 222 “Medicine” and different languages of education (Ukrainian, Russian, English) in Dnipropetrovsk medical academy. We have revealed that all the analyzed contingents of students (DMA as well as Ukrainian) in the majority of observation periods from 2014 to 2019 had lower average results on histology compared to average Krok 1 results. This could be explained by low quota of histological tests for students of specialty 222 “Medicine” which is 4-6%, and absence of the threshold level for doing each particular subject. These conditions do not motivate students of the third course to recollect a complicated discipline that ended more than a year ago. Another problem is in the content of anchor questions in Krok 1 booklets: the number of such questions are distributed unevenly among booklets of different years and different languages of study. As a result, students with different languages of study are put in unequal conditions. In addition, the variation in the number of anchor tests from year to year, the lack of a declared quota of such tests disorients students and makes it difficult to develop algorithms for preparing for Krok 1.

63-68

Authors: Gura O.I., Ragrina Z.M.

The article explores the benefits of using computer technology in the educational process and emphasizes their ability to increase the motivation of foreign medical students to study. Using the latest technologies in the educational process is a demand of time. Intensifying the interest to the discipline and improving the quality and level of knowledge of students is the purpose of such using. The necessity and importance of on-line education at the current stage of society development is substantiated. Using effective techniques and methods of online learning, creating a variety of online courses, engaging students in an independent creative process – this is the optimal way to update the internal reserves of the educational process. The role of students' independent work in the educational process is determined. It is moticed that the independent work of students requires the same organization and methodological support as the traditional class work. The peculiarities of the content of independent work of foreign medical students are revealed and their communicative needs are determined. In accordance with the subjects of the educational programs for specialists in the field of knowledge 22 "Health care", specialty 222 "Medicine" and according to the communication needs, EDX on-line platform was selected and created for creating and implementing online special courses for independent work of foreign students at different stages of study. The structure of individual online special courses is analyzed, the purpose, tasks and results of each of them are highlighted. The subject, distribution of classes, structure, linguistic, speech and communication material of the on-line special course "Introduction to the specialty: scientific speech" are characterized. The specificity, orientation, purpose and specifics of the task of the on-line special course "Professional communication: doctor – patient" are revealed. The conclusions about the necessity and appropriateness of the application of the specified online special courses in the process of preparation of foreign students in medical institutions of higher education.

78-84

Authors: Shponka I.S., Pesotskaya L.A., Korolenko H.S., Hutnik I.O., Murashevych B.V., Nikonenko V.A.

Chronic myelomonocytic leukosis (CMML) is rarely diagnosed and amounts to 1 per 100 thousand of adults per year, more often in men over 60 years. The clinical case of the rare, prolonged course of myelodysplastic chronic myelomonocytic leukosis (MD-CMML) in a middle-aged woman with rapid transformation into acute monocytic leukemia (AMoL-M5в) with the atypical fulminant course is presented. A retrospective analysis of the course of the disease drew attention to the severe vasculitis suffered by the patient 19 years ago, which could be regarded as the debut of CML in the presence of characteristic pathological changes in the hemogram. Non-pronounced clinical manifestations in the form of moderate cervical lymphadenopathy, skin lesions in the form of transient erythema, spotty eruptions over the next 10 years, fit into the clinical picture of MD-CMML. A detailed picture of the disease was observed after viral infection, bronchitis, antibiotic therapy. Absence of significant blastemia and severe inhibition of normal hematopoiesis with expressed extramedular manifestations of the disease in the patient were not typical for the course of AMoL-M5b in this case. The progression of skin lesions was noteworthy, which gave reason for unfavorable prognosis. For several weeks, the spread of erythematous elements was observed throughout the body with itching, not controlled by antihistamines and corticosteroid drugs; the appearance of maculopapular rashes, merging in places; small-point hemorrhages like vasculitis over the entire surface of the skin. Notable was the development of severe hemorrhagic syndrome without severe thrombocytopenia, significant changes in the coagulogram, as a manifestation of early severe coagulopathy.

90-98

Authors: Kononets O.M., Tkachenko O.V., Kamenetska O.O.

The nervous system, in particular the autonomic one, is well known to constantly regulate the internal functioning of the body, adapting it to changeable external and internal environmental parameters. In particular, there is a close multiple-vector correlation between the nervous system and the kidneys. The aim of this study was to specify the mechanisms, clinical and paraclinical characteristics of the concomitant lesions of the nervous system and the kidneys in patients with acute stroke. This paper presents the case report of 215 patients, aged 70 ± 8.44, who suffered from ischemic stroke. Among them, we examined 144 women and 71 men. The patients underwent a comprehensive examination, including a detailed clinical and neurological check-up (evaluating the patients’ condition severity with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel index on admission and on the 21st day of the disease), laboratory analysis (electrolyte balance, nitrogen metabolism (on admission and on the 21st day of the disease) and instrumental examination (CT scan of the brain, the follow-up brain magnetic resonance imaging). The statistical methods were used to analyze the data. In the 1st day of the disease, all the surveyed patients with right hemispheric carotid stroke and the overwhelming majority of the patients with left hemispheric carotid stroke and ischemic stroke in the vertebrobasilar system had cerebral renal syndrome, represented by renal concentration-filtration dysfunction, accompanied by the reduced glomerular filtration rate. A reliable relationship was found between the renal concentration and filtration function and the right hemispheric ischemic focus in patients with ischemic stroke, the characteristics are to be specified.

105-114

Authors: Burlaka O.V., Vahnier V.O.

The aim of the study is to define awareness level and use of different contraception methods by servicewomen in the current armed conflict in the East of Ukraine. Between October 2018 and September 2019, 507 military women serving in the Joint Forces Operation Zone in eastern Ukraine and 100 civilian women from the frontline region participated in the questionnaire-based survey. The survey was focused on the knowledge and use of different methods of contraception and STI preventing by military women in conditions of armed conflict in Donbas. Servicewomen reported using of different methods of contraception in 48.3±4.3% of the cases, which is 1.5 times less than civilian women (RR=1.5; 95% CI: 1.2 – 1.7, p=0.001). Among those who reported using contraception, hormonal methods were chosen by 8.2±3.4% of active duty military women, which is two times less than by civilians (RR=2.1, 95% CI: 1.1-4.1, p=0.03). The low use of effective methods of contraception by active-duty servicewomen according to results survey is one of the reasons for the disruption of female reproductive health during military deployment. The primary reserve of preserving women's health in the current war environment,besides access to modern contraceptives and counseling, is improving the education of military medics in the gender-specific issues of reproductive health and contraception.

122-128

Authors: Dorofeeva G.S.

Reduction of cognitive functions in the postoperative period is gaining importance in the context of the insurance medicine introduction. Operational stress and anaesthetization are factors which increase the risk of deepening and developing postoperative cognitive dysfunction. The function of short-term memory, attention function, and the speed of psychomotor cognitive reactions are the most vulnerable to the action of general anesthetics. The influence of various methods of anesthesia on cognitive functions in ophthalmic surgery patients after end-to-end keratoplasty has been studied in this research work. Dexmedetomidine was used (the selective agonist of α-adrenoreceptors) as one of the components of multimodal anaesthetization. The sedative effect of this drug is explained by inhibition of neural activity in the blue spot of the brain stem. Dexmedetomidine is known to be used for sedation of patients. It allowed possibility to reduce the amount of fentanyl which was necessary for intra-and post-operative anaesthetization. Our research was conducted on the basis of ME "DRCOH". 78 patients at the age of 18 to 60 years were examined after end-to-end keratoplasty. Non-inclusion criteria: presence of concomitant pathology, neurological diseases, use of psychotropic substances and alcohol 6 months before the study. The study was conducted using neuropsychological testing: the Mini Mental State Examination (MMSE),the Frontal Assessment Battery (FAB), and Luria’s test. Testing was performed before the operation, in 6, 24 hours, 7 and 21 days. Patients were randomized into two groups. The first group – group k (n1=45) included patients who were provided with anaesthetic management according to the following scheme:premedication — ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously, sibazone 10 mg, fentanyl 0.1 mg intramuscularly 40 minutes before intervention. Induction of propofol – 2-2.5 mg/kg fractionally to achieve clinical symptoms of anaesthetization, fentanyl – 0.005% 0.1 mg tracheal intubation after relaxation on the background of atracuriumbenzylate – 0.3-0.6 mg/kg. Maintaining of anaesthetization: oxygen-sevoflurane mixture FiO250-55%, sevoflurane 1,4-1,8 vol.% on exhalation (1-1. 5 WT.) with the flow of no more than 1 l/min. BIS indicators were kept at the level of 30-40, during the surgery, the bolus injection of 0.1 mg of fentanyl was used in the event of hemodynamic reactions. Anaesthetic support was performed using the infusion of dexmedetomidin for 40 minutes, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously in the second group d (n2=33). Induction, relaxation and maintenance of anaesthetization were performed as in the previous group. Intra-operative monitoring of patients in both groups included: non-invasive measurement of blood pressure (BP), heart rate (HR), pulse oximetry, determination of blood gases (oxygen, carbon dioxide and inhaled anesthetic on inhalation and exhalation). Control of the depth of anaesthetization was performed on the basis of BIS and ANI - monitoring. The use of dexmedetomidinu as the component of a multi-modal method of anaesthetizational al lowed obtaining less pronounced POCD, due to the reduction in the number of used drugs. Further use of the combination of highly selective agonists of α2-adrenoreceptors with regional anaesthetization in ophthalmic surgery is the promising method.

136-142

Authors: Ilchenko S.I., Fialkovska A.O., Cherhinets V.I., Skriabina K. V.

In modern pediatric practice, inhalated hypertonic saline (IHS) is often used for therapeutic and diagnostic purposes. However, the potential development of serious side effects in children is not predicted. The aim of the study was to determine the efficacy and tolerability of IHS of various concentrations in children with cystic fibrosis (CF). The study involved 34 children with CF aged 6 to 18 years (middle age is 13.0±4.4 years). The comparison group consisted of 27 children (middle age is 7.8±2.3 years) without chronic respiratory diseases. The study included three consecutive inhalations. Sterile 0.9% NaCl solution was used for the first inhalation, 3 % NaCl solution – for the second one and 7% NaCl solution – for the third inhalation. For children under 7 years of age, a patented method of obtaining sputum without forced coughing was used. Spirometry was performed before and after each inhalation, and clinical changes were analyzed. It was noted that after inhalation of IHS, the cough in patients became more productive, moist rales were more often heard over the entire surface of the lungs. The activity of induced sputum secretion after inhalation of 3% and 7% NaCl solution did not differ significantly. However, after inhalation of 7% NaCl solution, side effects, such as sore throat, shortness of breath, spastic cough, auscultatory symptoms of bronchospasm were recorded significantly more often compared with lower concentrations of the solution. The decrease in FEV1 was observed in 5.8% of patients after inhalation of 3% NaCl solution and in 11.8% of patients after inhalation of 7% NaCl solution, which was significantly associated with the clinical symptoms of bronchospasm. Inhalation of IHS has an effective mucolytic effect in patients with CF, however, it is necessary to determine the individual sensitivity of the patient to predict a positive therapeutic effect.

150-155

Authors: Bolbot Yu.K., Bordiі T.A., Vilenskyi Ya.V.

Allergic diseases of the respiratory system seriously affect the psychological, physical and social aspects of the live of sick children, morally and financially exhausting members of their families as well. It is known that exacerbations of allergic diseases of the respiratory tract occur due to interaction with numerous triggers, one of which is a respiratory viral infection. At the same time, it is widely known that patients with allergic respiratory diseases are more prone to to acute respiratory infections. One of the reasons for this tendency often is an insufficient activity of non-specific factors of local immunity of the respiratory system – endogenous amphiphilic antimicrobial peptides, in particular the most studied their representatives - the family of defensins and human cathelicidin. Current research proves that these antimicrobial peptides are characterized by broad antiviral, antimicrobial and immunomodulatory activity. The aim of this study was to study the concentrations of local immune factors - human HbD-2 and LL-37 - in the secretion of the mucous membranes of the upper respiratory tract in children with asthma and allergic rhinitis and to clarify their role in protection against respiratory viral infections in this contingent of patients. We performed laboratory and clinical examinations of 76 children aged 7 to 18 years, of whom 24 were diagnosed with allergic rhinitis, 28 children - bronchial asthma, and 24 - bronchial asthma and allergic rhinitis. The control group consisted of 20 healthy children of the appropriate sex and age. In addition to general clinical methods, patterns of respiratory morbidity were analyzed and concentrations of antimicrobial peptides were determined: by ELISA human cathelicidin (LL-37), β-defensin 2 (HbD-2) in the secretion of the upper respiratory tract, statistical analysis was performed. It was found that children with allergic diseases of the respiratory tract are characterized by a higher frequency of acute respiratory infections with more frequent involvement of the lower respiratory tract, which led to an increase in the duration of the disease compared to their healthy peers. In children with allergic rhinitis and bronchial asthma, there was revealed a significant decrease in the concentrations of antimicrobial peptides in the secretion of the upper respiratory tract compared with the control group.

163-168

Authors: Alamdari M.P., Ahmadi F., Abedini M.

Multiple sclerosis is a chronic and unpredictable disease and is a growing trend and, like other chronic diseases, affects one's quality of life and since sleep quality is one of the dimensions of quality of life, this study aimed to investigate the effect of applying continuous care model on sleep quality of patients with MS in 2013. This clinical trial study was performed on 80 patients with multiple sclerosis who were randomly assigned to experimental and control groups. Data collection tools included demographic information questionnaire, PSQI questionnaire and model implementation in four stages (familiarization, sensitization, control, evaluation). Model stages were performed individually and in groups for three weeks according to patients' educational needs (sleep, activity, medication and nutrition) and after two months follow up, control and evaluation were performed. Data were analyzed using Chi-square test, independent t-test and repeated measures ANOVA and spss16 software. Statistical analysis of variance (ANOVA) with repeated measures showed a significant difference between the mean of total score and the scores of sleep quality dimensions in three times between the two groups (p<0.05). It can be concluded that the implementation of continuous care model causes a significant difference in the sleep quality of patients with MS.

175-184

Authors: Ogorenko V.V., Kyrychenko A.G., Hnenna O.M.

The article studys the psychological characteristics in patients with brain tumors of different localization which allows to reduce the diagnostic period and, as a result, minimize the time of early detection and the consequences of the surgical treatment of this pathology, and to cause a positive effect on preventing the development of psychopathological disorders at the hospital stage. Analysis of the clinical manifestations of depressive disorders of the subclinical level revealed their polymorphism: depression was accompanied by various variants of asthenic (prevalence of dyssomnias, psychalgia, adynamia and anxiety component) and anxiety (prevalence of senestopathies, hypochondria, phobia) states. The revealed symptom complexes of psychopathological and pathopsychological characteristics of the patient's condition were the clinical justification for the choice of methods of psychotherapeutic correction. Adjuvant psycho­logical therapy, individual rational and family psychotherapy were used as the basic method of psycho­therapeutic influence. Pharmacological correction included: anxiolytics, antidepressants, atypical mild antipsychotics in low doses. The results of the SCL-90-R test demonstrate the effectiveness of the comprehensive treatment aimed at preventing and reducing the manifestations of psychopathological symptoms. Comparison of the mean values of the SCL-90-R test revealed significant differences in such indicators as somatization (p<0.05), depressiveness (p<0.01), anxiety (p<0.05); high statistical significance is noted in the “index of symptom severity” integral indicator (p<0.01). Obtained results of psychological and psychiatric research became the basis for the development of differential diagnostic criteria for the diagnosis and prevention of the development of mental disorders.

191-196

Authors: Odintsova I.V., Diudiun A.D.

The purpose of the work is to evaluate the efficacy and tolerance of extemporal dosage form with pyroctone olamine in the local treatment of patients with seborrheic dermatitis. Under our supervision there were 78 patients with seborrheic dermatitis aged 18 to 57 years. The average age of the patients was 29.5±2.1 years. Comprehensive treatment of patients with seborrheic dermatitis in both groups depended on the severity of clinical manifestations, the duration of the disease, and information on the effectiveness of previous therapy. For external treatment of the main group of patients with seborrheic dermatitis, an extemporaneously prepared gel with pyrocton olamine was used. Local treatment of patients in the comparison group consisted of the appointment of 1% cream of clotrimazole. An analysis of the results shows good therapeutic, microbiological effectiveness and good tolerance of extemporaneously prepared gel with pyrocton olamine in the complex treatment of patients with seborrheic dermatitis. The period for resolving the clinical manifestations of seborrheic dermatitis among patients in the main group was 2.5±0.1 days shorter compared with patients in the comparison group. The intensity of clinical manifestations in patients with seborrheic dermatitis of the main group decreased twice on the second day of complex treatment. In control patients with comparative seborrheic dermatitis, similar therapeutic efficacy was achieved on the fourth to fifth day. Long-term results of the study showed that the recurrence of the disease among patients of the main group was 5 (6.4%), and in patients of in the comparison group was 14 (17.9%). Clinical studies have shown good therapeutic efficacy and tolerance of the extemporal gel with pyroctone olamine in the complex treatment of patients with seborrheic dermatitis, which gives reason to recommend this dosage form for wider use in the practice of dermatovenerologists.

201-209

Authors: Mikhaylusov R.N., Negoduyko V.V., Gubina-Vakuli G.I., Pavlov S.B., Pavlovа G.B., Veligotsky A.M., Khvysiuk O.M.

The article presents the results of experimental modeling of super­ficial fragment gunshot wounds of soft tissues, obtained in low-energy gunshot wounds. The pathomorphosis of gunshot wounds was studied, and the features and timing of their healing were compared depending on the temperature of the damaging fragments. The aim of the work was to study the effect of the temperature of the injuring shrapnel on the healing processes of the soft tissues of experimental animals with superficial low-energy fragment gunshot wounds. Using the random number method, laboratory animals (rabbits) were divided into 3 experimental groups (15 animals each). In each group, wounding was with fragments with different temperatures − 18°С, 50°С and 100°С. The control group consisted of 10 intact animals. On day 14th, 30th and 60th, 5 animals from each group were withdrawn from the experiment. Microscopic examination of soft tissues was performed using a PRIMO STAR light microscope (Carl Zeiss, Germany) at magnification by 56 and 400 times. When assessing the state of tissues in the area of wound damage, it was established that as the temperature of the injuring fragment increases, a slower filling of the defect formed by the necrotic detritus in the process of utilization of necrotic detritus is observed. The high temperature of the injuring fragment along with the mechanical rupture of tissues causes thermal coagulation necrosis. Dense coagulated necrotic masses covering the wound canal from the inside, not only increase the volume of necrotic masses, but also complicate the process of wound healing. At a temperature of wounding fragments 100°C, the formation of a necrotic crust on the surface of the wound occurred on average 3±1.2 days later than at temperatures of 18°C and 50°C, the least pronounced healing took place at the bottom of the wound and in the muscle tissue. Microscopically necrotic, not dystrophic changes were observed in myocytes. Thus, a comparative analysis of the pathomorphosis of soft tissues in a wound when injured from an air rifle MP-532 with different temperature of the fragments showed differences from both the alteration of the tissues and the regenerative potential.

217-225

Authors: Foros А.І., Kostenko Ye.Ya., Goncharuk-Khomyn M.Yu.

The number of drug addicts in the world is growing every year. The aim of the study was to assess the dental status of drug-addicted patients with parafunction of the dental-jaw apparatus. We used clinical, analytical, functional and histological research methods. 119 drug-addicted and 110 non-drug-dependent patients aged 18 to 54 were examined. In order to confirm the presence of parafunctions of the dental-jaw apparatus in patients, we conducted an occludogram study, as well as an assessment of the index of parafunctions of the masticatory muscles and the degree of their severity. The structure of tooth tissues was examined by histological method. Examination of drug-addicted patients revealed the presence of numerous carious cavities, secondary adentia, enamel erosion, pathological abrasion, signs of gingivitis and periodontitis, tooth chipping. The prevalence of parafunction of the dental-jaw apparatus, in particular bruxism, in drug-addicted patients is 1.56 times higher than this figure among non-drug addicts. The results of the occludogram and the index of parafunctions of the masticatory muscles differ significantly between the study groups. The mean value of the masticatory muscle parafunction index among drug-addicted patients is 2.06 times significantly higher than the value among non-drug-addicted men and 2.03 times higher among women. Histological examination of the tooth tissues of drug-addicted patients indicates a disorder of the mineralization of both enamel and dentin. Thinning of the peripheral zone of the pulp, which is normally represented by a layer of odontoblasts, which provide regeneration and nutrition of dentin, is more common in persons under 25 years of age. Drug use adversely affects the dental status of patients and the condition of the hard tissues of the tooth.