Medicni perspektivi, 2020;25(2)
2020 Vol. XXV N 2
Key words: coronavirus pandemic, distance learning, academic communications, training logistics, training methodology
Abstract. Distance learning: opportunities and challenges in quarantine. Zavizion V.F., Bondarenko I.M., Avierin D.I., Hojouj M.I., Davlietova N.O., Cherednychenlo N.O., Prokhach A.V., Mashtaler V.E., Dmytrenko K.O., Lohvynenko V.V., Kyslytsyna V.S., Sukhoversha O.A., Khvorostenko Y.M., Elhajj M.H., Suzdalev P.L., Myroniuk T.F., Kichtenko I.N., Hrabovskyi Y.V., Smolina K.V., Baranov I.V. The urgent introduction of distance education into the learning process due to the COVID-19 pandemic has become a spontaneous experiment, requiring urgent decisions, effective mechanisms to implement into the educational process and analysis of ongoing educational process. The possibilities of modern digital technologies made it possible to quickly set up the information component of education and to controle student’s knowledge. A detailed analysis of the communication between the faculty members of the department among themselves and analysis of the features of teaching and self-education of students in the field of medical radiology and oncology based on answers and comments with using Google classroom, Socrative, Messenger Telegram, etc. was made. Issues of communicative interaction between faculty members and students, psychological aspects of distance communication, language of instruction, logistics of distance education and methodological problems are described in details. It has been suggested that distance education may be equally effective for theoretical subjects in full-time study form, but when studying clinical disciplines, the priority should be given to traditional methods of teaching, involving student's bedside training. Taking into account technical possibilities and high risk of development of extreme and emergency situations, it is suggested to introduce permanent readiness for distance education, to create all – Ukrainian distance imitation service of patients’ follow-up. The importance of using the state language in training as the basis for mastering the professional Ukrainian and English language as the basis for mastering international medical experience is indicated.
Key words: primary medical care, palliative and hospice care, training of medical students in the specialty of GPFM
Abstract. The format of training family doctors on palliative care in the Dnipropetrovsk region. Vysochina I.L., Valchuk S.I.,Vasilevskaya I.V. The first global palliative care resolution WHA 67.19 has been developed recently, in 2014, where the need to improve access to palliative care around the world is first declared. In the article, the authors analyzed the change trends and the state of the medical care delivery system for incurable patients in the world and Ukraine. As the civilization of the state and the humanity of society as a whole is assessed by the level of PHC provision in today's world, this problem has attracted the attention of central (Ukraine) and regional (Dnipro city) government bodies, which was reflected in the search for new medical and educational initiatives. The need of the time is the need to focus the attention of family doctors on the issue that palliative care is a qualification component of their daily work, which will help to remove incurable patients from the periphery of attention of their multicomponent work, and will also help to clearly build the interaction between the primary and secondary link, in particular, with hospice departments of specialized hospitals. In particular, the experience of implementing a joint project of a new format for training family doctors on palliative care issues, realized by the Department of Family Medicine of the SE “DMA” and the Municipal non-commercial enterprise "City Clinical Hospital No. 2” of Dnipro City Council is described. Innovative forms of conducting classes help to expand the boundaries of the possibilities of teaching problematic issues of palliative medicine, which account for only 0.6% of instructional time in the existing program of training family doctors of secondary specialization, and the multicomponent format for studying palliative care issues, implemented, inter alia, with support of Director of the Municipal non-commercial enterprise "City Clinical Hospital No. 2” of Dnipro City Council (visiting hospice and palliative departments delivering secondary level of medical care assistance, a structured regulatory unit for the provision of PHC in Ukraine, working out of patients’ routing issues, interactive teaching methods, etc.) leaves in the memory of physician-trainees not only the essential content, but also a deep emotional trace, which helps to increase the motivation of the physician trainees, improves coordination between primary and secondary palliative care and improves the quality of training.
Key words: pharmaceutical education, master of pharmacy, model of professional pharmaceutical education, quality of education
Abstract. The state and prospects of development of national higher pharmaseutical education. Reva T.D., Nizhenkovska I.V., Stuchynska N.V., Chkhalo O.M. The paper considers the materials of the Pharmacists Summit and International Pharmaceutical Congresses, in particular, the issue of achieving quality pharmaceutical education. It shows cause of the proper training process of pharmacy sector specialists in accordance with current state and requirements of the society and suggests a model of professional pharmaceutical education. According to the authors of the paper, the implementation of education quality in Ukraine calls for, first, professionally educated personnel in the pharmacy sector of healthcare; second, proper academic and university infrastructure for training future specialists within the system of higher pharmaceutical education; third, ensuring the high quality of higher pharmaceutical education on the basis of implementing the competence approach and taking into account international experience on pharmacy development. Increasing significance of the pharmacy branch in Ukraine is directly linked to the quality of training of pharmacy specialists, continuous improvement of the content of their education, implementation of new educational technologies, adapting higher pharmaceutical education to European standards. According to the authors, an important condition of ensuring effective professional training of future pharmacy specialists within the national system of higher pharmaceutical education is the following: firstly, considering public demand to the level of healthcare services, disease prevention; secondly, implementing the productive global experience on introducing customer service standards. The established prospects of the development of national higher pharmaceutical education include: 1) the adoption of ethical principles of training Masters of Pharmacy within the system of higher pharmaceutical education; 2) focus on European pharmacy standards which are based on high customer service standards; 3) improvement of the content of pharmacy specialist education taking into account the development of national pharmaceutical production; 4) ensuring the development of the clinical direction within the system of general pharmacist training.
Key words: professional competences, students’ individual work, higher medical education
Abstract. The role of students’ individual work in the formation of professional competences of future doctors. Kuryta O.V., Karapetian K.H., Frolova Ye.O., Kushnir Yu.S. Modern requirements for training of high-skilled specialists require the implementation of international medical and educational standards in the educational and integrative process. Formation of cognitive activity, pursuance of professional development, the necessity to correspond to world standards medical students’ of gained knowledge. Medical students’ individual work is very important for medical students’ education because it helps to systematize and use knowledge that was gained in practical classes. The aim of the work – to analyze the forms of students’ individual work, used at in the Department of Internal Medicine 2 and Phthisiology, in order to improve the educational process and to form the future doctor’s medical judgment, their ability to self-improvement and self-education. The recommended hours attempted for students’ individual work is 90 out of the total of 240 hours assigned to the discipline in teaching the module “internal diseases” for the 5th year students at the Depertment of Internal Medicine 2 and Phthisiology. In studying the discipline of "internal diseases" in the 5th year one of the main tasks of medical student’s occupation training is mastering ability of assimilation on his own, of knowledge and refresh it, and then to use knowledge effectively in the future career. The difference of the individual work lies in the fact that students can study individually choosing the necessary kind of extracurricular activity according to their interests. In addition, the lack of strict grading by the teacher has more advantages compared to practical classes. The curriculum, the teacher’s tasks and methodological materials determine the content of the individual work. The article presents the three main directions of students’ individual work in teaching discipline of "internal diseases" for students of the 5th year as: students’ individual work in classroom learning, students’ individual work individual work under the teacher’s supervision. When discussing the results of individual work, students learn to think critically, communicate with each other, and make their own well-thought-out (educated) decision. Well-structured process of the individual work encourages medical students to its qualitative fulfillment and it is a significant motivation for further professional growth. Significant reserves to increase its efficiency inherent in the use of modern computer technology. Medical students’ individual work should be considered as one of the necessary stages of a modern doctor training. The latest information technologies and individual scientific projects adoption into the educational process leads to efficiency improvement and it forms new future doctor’s professional competences.
Key words: multiple sclerosis, brain tumor, demyelinating diseases, glioma, astrocytoma, glioblastoma, oligodendroglioma
Abstract. Coexistence of multiple sclerosis and brain tumors: a literature review. Sirko A.H., Dzyak L.A., Chekha E.V. Concurrent development of primary brain tumors and multiple sclerosis is quite rare. Only a few dozens of such comorbidity have been reported. Nevertheless, given the fact that such pathologies are characterized by similar clinical picture and neuroimaging findings, issues about diagnosis and differential diagnosis of such conditions often arise, which makes the problem relevant. A literature review was conducted using PubMed, by selecting articles on concurrent multiple sclerosis and brain tumors, particularly glial origin tumors, over the past 20 years (1989 to 2019). The search was performed in English, Russian, and Ukrainian using the following key words and terms: comorbidity, concomitance, multiple sclerosis, brain tumor, glioma, astrocytoma, glioblastoma. The analysis included all articles on etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, neuroimaging, and pathomorphological assessment. After identifying all the articles that met the inclusion criteria and removing duplicate data, 35 literature sources on concurrent primary brain tumors and multiple sclerosis were selected. The conclusion on whether concurrent primary brain tumors and multiple sclerosis develop randomly or have common pathophysiological mechanisms is still under discussion. Potential causes of pathogenesis of both diseases include viral infection, chronic inflammation, neoplastic transformation, and involvement of neurotropic growth factors. The likelihood that two processes, demyelinating and neoplastic, can develop in parallel will never be underestimated. In such cases, strong clinical suspicion arises due to atypical clinical picture characterized by aggressive and rapidly growing neurological symptoms such as aphasia, spastic hemiparesis, epileptic seizures, or signs of intracranial hypertension. In MRI diagnosis, pathological findings such as single lesion of more than 2 cm; mass effect, edema, signal amplification in the form of ring-shaped shadow are the reasons for a more thorough examination and applying additional diagnostic methods: CT, MR spectroscopy, PET, CSF tests to determine oligoclonal antibodies and other markers content, cerebral biopsy. According to the literature, cases of concurrent primary brain tumors and multiple sclerosis are rare though described. Atypical clinical signs, neuroimaging data, and cerebral biopsy which is currently considered as the only method for making accurate diagnosis are helpful in the diagnostic process.
Key words: reimbursement, medicines, “Affordable Medicines” Programme
Abstract. Adoption of the governmental affordable medicines programme by ukrainians. Shevchenko M.V., Yurochko T.P., Skrypnikova O.S. Ensuring that the local population has access to medicines is one of the functions of a modern democratic state and an important element of social policy. The question of the affordability of medicines to the public is extremely important. This is also due to the fact that, unlike in European countries, Ukraine did not have a system of medicines reimbursement. To date, the reimbursement Affordable Medicines Programme has been in effect since April 2017 and is applicable to patients with cardiovascular disease, bronchial asthma, and type II diabetes. In total, 258 medicines are included in the Programme, 64 of which can be obtained free of charge and the others with a small extra payment. The respondents' perceptions of the Programme were conducted through a secondary analysis based on the third wave of the «Health Index. Ukraine» which was held in 2018 by the International Renaissance Foundation, the School of Public Health of the National University of Kyiv Mohyla Academy, and the Kyiv International Institute of Sociology. This study aims to present the results of the research of the attitude of Ukrainians to the government Affordable Medicines Programme and their perception of its implementation. The total number of respondents to this survey totaled more than 10,000 household representatives. The results of the research indicate a positive assessment of the respondents who participated in the survey «Health Index. Ukraine» (76% in 2018), which is confirmed by other research of the Kyiv International Institute of Sociology (63% in 2019) and by international experts. The results of the survey do not allow us to draw any official conclusions about the impact of the Programme on the health of Ukrainians, but during the interview 60.6% of the respondents said that the Programme «helped improve health»; in addition, positive changes in health were indicated by the most financially vulnerable categories of the population. It is also noted that 80–82% of prescriptions were reimbursed to Programme participants..
Key words: soy and sunflower lecithins, cognitive function, tetrachloromethane
Abstract. Influence of lecithins on disorders of cognitive functions of animals caused by tetrachloromethane. Svirgun I.S., Mohammed Adab, Koshelev O.S., Drozdov O.L. In our time the study of the influence of soya and especially sunflower lecithin as one of the natural monopolies in Ukraine, on the state of cognitive functions is relevant. Specified neurotropic activity of lecithin is characterized by the obstacle to the development of behavioral manifestations of neurotoxic action of carbon tetrachloride, prevention of inhibition of mobility, research, unconditional reflex activity. In this article the determination of the effects of soy lecithin (L), and sunflower lecithin on a state of cognitive processes in rats showed that there is no significant differences between them. Changes in memory were judged by conventional passive-defensive reactions. Conditional reaction of passive avoidance (passive avoidance reaction) was produced on the basis of a single electric-skin support. We proposed modified method of assessing the presence of individually obtained memory trace and a group of genetically fixed form of memory. The establishment of this fact allows to make a comparative analysis of changes caused by the two lecithins in reproduction of individually obtainjed memory trace. Lecithin, derived from both plants in the conditions of intoxication by carbon tetrachloride prevents and improves reproduction of conditional reaction of passive avoidance. Soy lecithin and sunflower lecithin prevent the development of behavioral manifestations of neurotoxic action of carbon tetrachloride, preventing inhibition of mobility, research, unconditional reflex activity, cause expressive anti-amnesic effect contributing to the course of protective instinctive behavior in recognition of new circumstances as a safe. Both lecithins of plant origin exhibit the improving effect on the course of cognitive processes and their neuro-hormonal mechanisms in conditions of poisoning with carbon tetrachloride. Sunflower lecithin has more antidepressive, nootropic effect whereas soy lecithin has been demonstrated to have significant anti-amnestic effect.
Key words: children, morbidity, disorders of psyche and behavior, Chernobyl disaster, environment
Abstract. Dynamics of incidence of mental and behavior disorders in children of Ukraine: a 25-years’ observation experience. Volosovets O.P., Bolbot Y.K., Volosovets A.O., Trachuk L.E., Kryvopustov S.P., Beketova G.V., Kuzmenko A.Ya. Disorders of the psyche and behavior among children is an urgent problem of modern pediatric science and medical practice. The high prevalence of this pathology may be a result of the unfavorable psychological state of society, aggressive effects of the unfiltered information and negative influence of the environment (including radiatioactive factors) on the mind and body of the child. We have studied a 25-years’ trends in morbidity of mental illneses and behavior disorders among children of Ukraine in order to determine the impact of environmental factors (in particular - radioactivity after Chernobyl disaster in 1986) on their development. We have performed an analysis of the incidence and prevalence of psychiatric and behavioral disorders (PBD) among children from different regions of Ukraine, including radioactive regions, contaminated after Chernobyl disaster. We used methods of statistical evaluation and epidemiological analysis of statistical data about the mental health of children of the country, aquired from the Ministry of Health of Ukraine. Over the past 25 years, we have observed trend of reducing the incidence of PBD among children of Ukraine to 3.77 cases per 1,000 children (p<0.01) with prevalence of this pathology among children from large industrial and agricultural regions of the country. We have connected this trend with significant toxic influence of environmental factors on the child's organism. The incidence of PBD in the last 25 years among children from the regions of the country contaminated by the Chernobyl accident in 1986 (especially in Chernihiv and Zhytomyr regions) has exceeded the national incidence rates of PBD and its incidence among children from regions without territories of radiological control. In early 1990s the incidence of mental and behavioral disorders was high among children affected by Chornobyl accident. But over the last 25 years the incidence of PBD has become lower and now its level is even lower than among children who permanently lived in areas contaminated by radiation after the Chernobyl accident and the national incidence rate of PBD among children. The results of our 25-years’ follow-up of PBD morbidity among Ukrainian children have shown that children with prolonged exposure to ecotoxic factors, including radiation, have higher levels of prevalence and incidence of mental and behavioral disorders compared with other children. All this testify that there is a need of a proper correction programs and special attention to this cohort of children.
Key words: nitric oxide, FeNO, air pollution, eosinophilic inflammation, children, asthma
Abstract. Measurement of nitric oxide in exhaled air in primary school children in Ružomberok. Czubaj-Kowal M., Friediger T., Hudáková Z., Sokołowski M., Walczak-Kapołka E., Aštaryová I., Lesňáková A. Nowadays, there are a number of respiratory illnesses that directly affect children. Exhaled nitric oxide measurement (FeNO) is one of the modern methods of investigation used for diagnosing and controlling allergic eosinophilic airway inflammation. It is a simple, painless and time-saving method for the patient. Because of its non-invasiveness and simplicity, it is a valuable diagnostic method, especially in younger children. Measurement of FeNO is a recognized biomarker and an accurate quantitative indicator in the detection, assessment and monitoring of airway inflammation, including asthma. However, only a few studies assess the relationship between FeNO and level of air pollution. The aim of our study is to determine the relationship between FeNO in third-grade students of primary schools and the level of air pollution in Ruzomberok. 146 children aged 8-10 years were included in the research. This is the first stage of a wider research project involving FeNO measurements in children at different times of the year. The goal of the research is to determine the concentration of FeNO in the studied group of children in the autumn when air pollution is lower than in second stage which is observed in winter. The study showed elevated values of FeNO>20 ppb in 11% of the tested children and correct values <20 ppb in 89% of them. Level of average air pollution in survey days for PM10 ranged from 23 to 40 μg/m3 and for NO2 – from 28 to 44 μg/m3. The study shows that the significant majority of children have normal levels of nitric oxide in the exhaled air when air pollution is low. Analysis of the second phase of FeNO measurements in winter, when air pollution was higher, will allow to compare the results and assess the correlation between the FeNO value and air pollution.
Key words: long non-coding RNA, ANRIL, gene polymorphism, kidney cancer
Abstract. Analysis of ANRIL gene polymorphism rs4977574 association with kidney cancer development in Ukrainian population. Volkogon A.D., Harbuzova V.Yu., Ataman A.V. ANRIL (Antisense Non-coding RNA in the INK4 Locus, also known as CDKN2B-AS1) – 3.8-kb long non-coding RNA transcribed from the antisense strand of INK4b-ARF-INK4a gene cluster. It is known that ANRIL overexpression is associated with development of oncological pathologies of different localization. In addition, there are a number of studies devoted to role of ANRIL genetic polymorphism in emergence and progression of tumors, including tumors of genitourinary system. The aim of the study was to check the possible association between ANRIL gene polymorphism rs4977574 and kidney cancer development in representatives of Ukrainian population. Whole venous blood of 101 patients with clear cell renal cell carcinoma (CCRCC) (42 women and 59 men) and 100 patients without oncology history (34 women and 66 men) was used in the study. DNA from blood white cells was extracted using GeneJET Whole Blood Genomic DNA Purification Mini Kit (Thermo Fisher Scientific, USA). Genotyping of rs4977574 ANRIL gene polymorphic locus was performed using real-time polymerase chain reaction (real-time PCR) method in the presence of TaqMan assay C_31720978_30. The mathematical data were processed using the SPSS software package (version 17.0). P values <0.05 were considered as statistically significant. It was found that difference in rs4977574-genotype distribution between patients with CCRCC and control persons was absent in general group (P=0.216). At the same time, the statistical analysis stratified by gender showed that both in female and male subjects rs4977574-genotypes frequency also did not differ significantly between comparison groups (P=0.526 and P=0.160, respectively). However, after adjusting for age, body mass index, and smoking habits statistically significant association between rs4977574 ANRIL gene polymorphism and risk of kidney cancer development was detected in male subjects under superdominant inheritance model (P=0.049). It was revealed that heterozygotes (AG-genotype) have 2.17-fold higher risk of CCRCC development (95% CI=1.005-4.695) compared to patients with AA- and GG-genotypes. In summary, this is the first report about ANRIL gene polymorphisms association with kidney cancer. Obtained results revealed that rs4977574 is related to kidney cancer risk only in Ukrainian men. Male individuals with AG-genotype have higher risk of CCRCC development compared to AA- and GG-genotypes carriers.
Key words: pregnancy, pre-eclampsia, obstetric and perinatal complications, gene polymorphism
Abstract. Gene polymorphism of blood coagulation factors and endothelial dysfunction in early and late preeclampsia. Loskutova T.O., Demchenko T.V., Kryachkova N.V. The aim of our study was to find out the influence of gene polymorphisms of coagulation factors, endothelial dysfunction and regulators of blood pressure in early (EPE) and late preeclampsia (LPE). The study of genetic polymorphisms of blood coagulation factors and fibrinolysis (1691 G/A factor V Leiden (FVL), 20210 G/A prothrombin, -675 5G/4G PAI-1, 455 G/A fibrinogen β), endothelial dysfunction (192 Q → R paraoxonase 1, 677 C/T MTHFR, arterial pressure regulator (235 M/T angiotensinogen II (AGT II)) using an PCR was performed. A prospective cohort study of 39 women with EPE, 93 with LPE and 44 pregnant women with a physiological pregnancy (C group) was conducted. The average gestational age at the time of delivery in EPE group was lower than in LPE and control group (p<0.001). In group with EPE new-borns had low weight-growth characteristics, low grade by the Apgar scale and foetal distress (38.5% vs. 9.7%, p<0.05). Caesarean section in EPE group was performed by 2.25 times more often than in control group and by 2,13 times than in LPE group (p<0,05). It was detected that the number of 1691 GA FVL heterozygote carriers in the group with EPE was significantly higher than in LPE group (p<0.05, OR=3.65, 95% CI 1.5-8.9) and control group (6.04, 1.7-21.6). The number of 20210 GG homozygotes and 20210 GA heterozygotes in prothrombin gene was probably lower in EPE group compared with the LPE and control group (0.03, 0.002-0.49, and 0.18, 0.06-0.53, respectively). It was established increase in frequency of 677 TT MTHFR genotype in EPE compared with control group (17.27; 0.9-317). Also, the carriers of 235T allele AGT II gene have an increased risk of EPE and PPE development (2.25, 1.2-4.2), (1.9, 1.1-3.3) respectively. The allele -455A of fibrinogen β gene increases the chances of developing EPE by 4.4 times (2.0-9.5), and LPE by 3.5 times (1.7-7.1). Risk factors that significantly increase the chances of developing early preeclampsia were identified: allele 1691 A of FV Leiden (5.96, 1.5-8.9), allele 20210 A of prothrombin (39.8, 2,3-679), 677T MTHFR (2.5, 1.18-5.3). In was detected that other researched polymorphisms between groups with PE were not significantly different and did not affect on time of preeclampsia development.
Key words: chronic lumbosacral radiculopathy, osteoporosis, musculoskeletal system, occupational pathology, micro- and macronutrients
Abstract. Essential elements role in pathogenesis of occupational chronic lumbosacral radiculopathy in coal miners. Basanets A.V., Andrusyshyna I.N., Lashko О.N. The problem of diagnosis in the early and preclinical stages of diseases is important in the prevention of occupational diseases and their complications, because this is the key to the timely initiation of treatment, the implementation of preventive measures. Chronic lumbosacral radiculopathy (CLSR) or low back pain (LBP) is one of the most common diseases in the structure of occupational pathology in Ukraine, which usually develops in those of working professions associated with physical activity, forced work posture, effect of high levels of general vibration, etc. The highest levels of occupational morbidity are recorded in the coal industry, which accounts for about 80% of occupational pathology in Ukraine. Above 1600 cases of CLRS are diagnosed annually in the country. A risk factor for the development of the CLSR is osteoporosis, which arises due to the impairment of quantitative and qualitative characteristics of bone tissue and is characterized by a decrease in its strength, an impairment of microarchitecture with a further increase in risk of fractures. One of the modern methods of assessing condition of bone tissue is determination of the content of macro- and trace elements (MaE and ME) in the biological environments of patients. Ca, Al, Mg, B, P are the most important in the formation and development of bone and connective tissue. To date, studies of bone tissue status in patients with CLSR of professional etiology have not been conducted (small in numbers). Goal – to determine the role of essential elements Ca, Al, Mg, B, P in serum and urine in the formation of occupational CLSR in miners. The research was conducted in 20 miners with CLRS (slaughterer, mining worker of a clearing face (MWCF), drifter) of coal mining industry of Donbass and Lviv-Volyn basins. The results were analyzed in two groups: І group consisted of patients with 10-15 years of work experience (n=10), II group with 16-32 years of work experience (n=10). The control group included 22 patients without pathology of the musculoskeletal system and connective tissue. The inductively coupled plasma atomic emission spectroscopy method (ICPAE) was used to determine the MaE and ME concentrations. The study revealed that the average serum aluminum (Al) concentration in miners with occupational CLSR (115.07 μmol/l) exceeded control group level (3.3 μmol/l) by almost 30 times (p<0.05). Serum boron (B) concentration in both age groups (25.90 μMol/l and 19.43 μMol/l, respectively) were lower than in the control (62.90 μMol/l), (p<0.05). The average serum calcium (Ca) concentration in patients with occupational CLSR (2.82 mmol/l) was 1.3 times higher than the same indicator in the control group (2.16 mmol/l), with a significant difference between the two age groups (p<0.05). It was revealed that the average level of phosphorus (P) in the urine of patients with occupational CLSR (19.0 mmol/l) significantly exceeded its content in patients of control group (11.96 mmol/l) (p<0.05). The concentration of Al in the urine of patients with CLSR in both age groups (1.26 μMol/l and 1.334 μMol/l, respectively) was higher that in control (0.85 μMol/l), (p<0.05). Reduction of Ca and Mg levels in the serum of miners in increasing work experience in harmful working conditions, exceeding average concentration of aluminum in patients' blood compared to the normative value and indicators of the control group patients was established.
Key words: permanent atrial fibrillation, chronic heart failure with mid-range ejection fraction, clinical course, prognosis
Abstract. Clinical course and risk prediction of permanent atrial fibrillation development in patients with chronic heart failure and mid-range ejection fraction of the left ventricle. Khaniukov O.O., Yalovenko M.I., Kalashnykova O.S., Kravchenko O.I. The purpose of the study was to establish clinical features of permanent atrial fibrillation (AF) in patients with heart failure mid-range ejection fraction (HFmrEF) and to develop a mathematical model for predicting arrhythmia development. The study included 42 patients with IHD, arterial hypertension (AH), permanent AF and HFmrEF (1 group), mean age – 68.0±1.2 years (21 men and 21 women) and 36 patients with CAD / АH and HFmrEF without AF, mean age- 67.5±0.7 years (22 men and 14 women). The results of the study show, that patients with permanent AF and HFmrEF are characterized by the higher diastolic arterial pressure, higher values of the LDLP, iESV LV, index of end-systolic volume of LV septal thickness and lower EF of the LV in comparison with patients without AF. Patients with permanent AF and HFmrEF also have increased plasma levels of hsCRP, IL-1β, IL-6 and IL-10 in comparison with patients without AF. A mathematical model with scoring system of hsCRP, IL-1β, LV mass index, HDLP, LDLP was developed to assess the risk of AF development in patients with HFmrEF with accuracy of 85.9%, sensitivity of 85.7% and specificity of 86.1%.
Key words: combined atherosclerotic lesions of cerebral and coronary arteries, carotid endarterectomy
Abstract. Results of treatment of patients with combined atherosclerotic lesions of the cerebral and coronary arteries who underwent carotid endarterectomy at different terms before aortic-coronary bypass surgery. Grigoruk S.P., Zorin M.O., Dudukina S.O. The quality of life of patients after surgical interventions in those of with combined atherosclerotic lesions of the cerebral and coronary arteries remains a topical issue of modern medicine. The purpose of the study: to analyze the results of treatment of patients with combined atherosclerotic lesions of the cerebral and coronary arteries in the temporal aspect, who underwent carotid endarterectomy as the first stage of treatment. The results of treatment of 112 patients were analyzed. All patients underwent simultaneous cerebral and coronary angiography. After the operation, if new neurological symptoms appeared or a cardiological pathology progressed, the angiographic study was performed again, and the results of this study were used to decide on further tactics. Treatment results were evaluated 30 days, 5 and 10 years after ACBS. With the revealed indications for ACBS, hemodynamically significant stenoses of the operated carotid artery were found in 10.7% of patients. Stenoses of other cerebral vessels that required surgical correction (opposite ICA, VA) in 7.1%. These patients had cerebral artery stenting before ACBS. In 9.8% of patients, indications were found for stenting of cerebral and coronary arteries, which were performed in one session. In 5.4%, only coronary artery stenting was performed. In the remaining 75 patients without indicated surgical correction of cerebral arteries ACBS was performed. So, in 3-5 years after CEE, ACBS was performed in 35 patients, later than in 5 years – in 40 patients. In the postoperative period, ACBS TIA was registered only in 4%, ischemic stroke – in 5.3%. The total lethality rate is 4%. The 10-year survival rate after myocardial revascularization was 46% [CI 95% 58%; 34%]. the most intensive decrease in survival function was registered during the first 5 years of follow-up (5-year survival rate 60% [71%; 48%]. Carotid endarterectomy is an effective method of treating atherosclerotic stenosis of the ICA and a method of preventing neurological complications in patients with combined atherosclerotic lesions of the cerebral and coronary arteries with the progression of cardiac pathology.
Key words: dry eye syndrome, substitution therapy medications, ethiopathogenic treatment
Abstract. Substantiation of the ethiopathogenic choice of substitution therapy medications for the dry eye syndrome. Kryvoviaz O.V., Tomashevska Yu.O., Makarenko O.V., Kudria V.V. The purpose of the study is to substantiate the personalized selection of substitution therapy medications with the consideration of the pathogenesis of dry eye syndrome development in each patient. In order to achieve the set goal, we conducted a content-analysis of the information from nomenclature on active ingredient as well as on the mechanisms of action of substitution therapy medications provided in the prescribing information and labeling of the medications. After that, we performed a pathogenetic ranging of substitution therapy medications depending on the way they influence a certain aspect of disorder of the tear film renewal process in dry eye syndrome. The information received in the course of the conducted research makes it possible for an ophthalmologist – basing on information on the disorder in the quantitative and qualitative correlation between the tear film layers received with the help of modern diagnostic tools to prescribe targeted dry eye syndrome treatment taking into account the necessary point of application of the substitution therapy medications, considering their composition and action mechanism of the active ingredients which they contain.
Key words: vocal fold paralysis, central nervous system, bioelectrical brain activity
Abstract. Electroencephalography quantitative indicators of patients with bilateral vocal fold paralysis. Shydlovska T.A., Zemliak T.B. Treatment of patients with bilateral vocal fold paralyses remains a complicated task. Study of central mechanisms of realization of larynx functions in case of stenosis is of interest. By electroencephalography method (EEG) patients with bilateral vocal fold paralysis were examined: 55 patients without surgical treatment (group I), and 51 patients who had unilateral chordoarytenoidotomy (group II). All the patients showed changes in percentage content of the α - and β-rhythms and Δ- and θ-rhythms ("slow" waves). The group II patients demonstrated more pronounced rhythms, as compared with the control group. During the background recording, in group I the increase in the percentage content of the Δ-rhythms in frontal and parietal directions up to 28.2±2.3 and 29.2±2.4%, was seen, the group II patients showed the increase in Δ-activity up to 32.2±2.8 and 35.4±2.9% in frontal, temporal and parietal directions accordingly. Besides, the group II patients proved to have an increasing of β-rhythms activity in all the directions, as compared to the control group, as well as an increasing of θ-rhythms in temporal and parietal directions. Herewith, the increase of θ-rhythms in temporal directions up to 21.4±2.2%, was much higher as compared to group I data 16.5±1.3%. Besides, all the patients showed decrease in α-rhythms amplitude. So, the redistribution of electroencephalography rhythms in the way of α-range fluctuation decrease and increase of slow wave activity (θ- и Δ- waves), as well as α-rhythms amplitude decrease in patients having vocal fold motor disorders testify to the prevailing influence of subcortical structures on the bioelectrical brain activity and facts of nervous processes depletion in brain, including chronic hypoxia of patients suffering from larynx stenosis of paralytic origin.
Key words: arginine, citrulline, ornithine decarboxylase, arginase, acute myeloid leukemia, obesity
Abstract. Chemotherapy effect on arginine / citrulline cycle indicators in patients with acute myeloid leukemia and concomitant obesity. Maslova G.S., Skrypnyk I.M. The aim of study was to investigate the changes in the arginine / citrulline cycle in patients with acute myeloid leukemia (AML) with concomitant obesity in dynamics of chemotherapy (CT). The study included 20 patients with newly diagnosed AML who had a body mass index (BMI) above 25. The average BMI was 29.35±0.93 kg/m2. Patients have undergone a course of remission induction CT "7+3" or "5+2". All patients were examined twice: before CT and on the 28th day. Complete blood test was assessed. Arginine and citrulline content, arginase and ornithine decarboxylase (ODC) activity were measured in the blood serum. The study results showed a 3-fold decrease in arginine content in the blood serum of patients with AML, as well as a 3.9-fold increase in arginase activity, 1.9-fold – ODC, 7.6-fold higher citrulline concentration compared with control (p<0.05). After CT, against the background of complete blood count normalization in AML patients with concomitant obesity, a 1.3-fold decrease in arginine concentration was noted, while the arginase activity increased by 2.2 times, ODC activity – by 1.8 times and citrulline content – by 2.4 times (р<0.05). After CT a high direct correlation between BMI and arginine concentration in AML patients with concomitant obesity (r=+0.63; p<0.05), as well as between the activity of ODC and arginine content (r=+0,55; p<0.05) was revealed. Thus, in AML patients with obesity prior to CT the disorders in the arginine / citrulline cycle were present, which are caused by oncohematological disease. Excess weight and obesity affect serum arginine levels, which may contribute to chemotherapy resistance.
Key words: chronic kidney disease, continuous ambulatory peritoneal dialysis, рro-inflammatory cytokines, comorbidity, mortality
Abstract. Activation of chronic inflammation and comorbidity in end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis. Shifris I.M., Dudar I.O., Driyanska V.E., Shymova А.U. The aim of the work was to determine the blood serum pro-inflammatory cytokine profile and to study their relationship with comorbidity and mortality in end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Ninety three ESRD patients treated with CAPD during 2012-2019 were included in the cohort prospective open study. The study was conducted in two stages. At the first stage, the determination of TNF-α and IL-6 levels was conducted and study of comorbidity, its quantitative assessment, baseline clinical and laboratory parameters was made. A modified polymorbidity index (MPI) which determined the quantitative assessment of comorbidity was calculated as the number of diseases per one patient excluding ESRD and its reasons. At the second stage, considering the baseline values of the studied cytokines, a prospective study of the dynamics of the prevalence of comorbid pathology, the value of MPI and mortality rate was carried out. The average duration of prospective follow-up was 26.4±6.8 months. Serum cytokines levels were determined by ELISA. Statistical analysis was performed by using "MedCalc", version 19.1.7. (Ostend, Belgium). Serum levels of TNF-α and IL-6 were significantly higher in PD-patients with 5 or more comorbid diseases. Levels of TNF-α>13.0 pg/ml have a negative effect on the dynamics of prevalence of heart failure (HF) and coronary heart disease (CHD), number of comorbid conditions in CAPD-patients. The proportion of the dead with a level of TNF-α>13.0 pg/ml was by three times higher, and deaths from cardiovascular events are almost by 10 times higher than patients who had a level of TNF-α≤13.0 pg/ml. Serum levels of IL-6>23.4 pg/ml are associated with a significant increase in number of comorbid conditions, prevalence of bacterial infections and overall and infectious mortality. Independent predictors of comorbidity and overall mortality in patients with ESRD who are treated with CAPD are serum levels of TNF-α, IL-6 and albumin. Serum levels of TNF-α and albumin are predictors of fatal cardiovascular events, and serum levels of IL-6 are predictors of fatal infectious events.
Key words: abscess of spleen, diagnosis, mini-invasive treatment, surgical treatment
Abstract. Features of diagnosis and treatment of spleen abscesses. Kutovyi O.B., Klishyn O.A., Kosulnikov S.O., Kravchenko K.V., Tarnopolskiy S.O., Lohvynenko M.V. The purpose of the study is to clarify the causes, features of clinical manifestations, to evaluate the results of diagnosis and surgical treatment of patients with sepleen abscesses. The article presents data on the results of diagnosis and treatment of 19 patients with spleen abscesses who were treated at the Surgery Department of the Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, from 2006 to 2018. A comparative analysis of the etiological factors of spleen abscesses among a selected group of patients was carried out. It was established that among the causes of spleen abscesses according to our data were: bacterial endocarditis, purulent diseases of the pancreas, trauma, simple cysts, portal vein thrombosis. When analyzing the results of inoculation of the contents of abscesses, it was determined that E.Coli (26.3%), St. Epidermalis (21.1%), Ac.Baumani (10.5%) and P. Aeruginosa 21.1%) occur the most often. For the diagnosis of spleen abscesses, general clinical, biochemical, and hardware methods of investigation (computed tomography, ultrasound examination of the abdominal organs) were used. The treatment of spleen abscesses was complex and included conservative therapy and surgical methods. As a surgical treatment minimally invasive, laparoscopic, as well as open techniques were used. The main surgical method was percutaneous drainage with ultrasound monitoring (42.1%). Relapse of abscess with this treatment option in the remote period was detected in 1 (5.6%) patient. In 5 (26.3%) cases patients with spleen abscesses underwent laparotomy and splenectomy. Laparoscopy was performed in 2 (10.5%) patients with spleen abscesses, operations were completed by opening, debridement and drainage of the abscess cavity and abdominal cavity. Fatal cases were not observed in the treatment of spleen abscesses. The combination of conservative therapy (using etiotropic antibacterial therapy) and surgical treatment (a combination of minimally invasive and laparoscopic techniques) allowed to achieve good treatment results. The number of complications was 15.8%..
Key words: acute pancreatitis, minimally invasive interventions, stage approach
Abstract. Stage approach in surgical treatment of acute pancreatitis. Kolosovych I.V., Bezrodnyi B.H., Hanol I.V., Cherepenko I.V. The article deals with the problem of diagnosis and treatment of acute pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity with a high risk of complications, the mortality rate of which reaches 5.5%, and in acute pancreatitis it varies within 40-70%. The purpose of this work is to improve the results of surgical treatment of patients with acute pancreatitis. The results of treatment of 112 patients with acute pancreatitis, who were hospitalized in the procedure of ambulance in the Department of Surgery No. 2 of the Bogomolets National Medical University in 2009-2019 period are analyzed. Severe disease course was observed in 83 (74.1%) patients, moderate – in 29 (25.9%) patients. In the early phase of the disease, endoscopic operations were performed in 44 (39.3%) patients, and laparotomy was performed in 12 (10.7%) patients with advanced purulent peritonitis. In the late phase 15 (13.4%) patients underwent laparotomy, necrsequestrectomy, abdominization of the pancreas, drainage of the abdominal cavity and retroperitoneal space, 36 (32.1%) patients were treated with ultrasound-guided puncture treatments. In the case of progression of the disease and ineffective drainage under ultrasound control, 5 (4.5%) patients were treated with retroperitoneoscopically assisted necrsequestrectomy, combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy was performed in 3 (2.7%) patients, and in 2 (1.8%) patients – open laparotomy, abdominization, necrsequestrectomy, drainage of the abdominal cavity and retroperitoneal space. The surgical intervention in the late phase of the disease was 21±4.2 days from the onset of the disease. A stage approach in the treatment of acute pancreatitis was applied to 80 (71.4%) patients in the main group. The comparison group consisted of 32 (28.6%) patients who underwent laparotomy and laparoscopic interventions in the early and late periods of the disease without prior use of endoscopic interventions or drainage operations under ultrasound control. In the main group the length of stay in the hospital was 21,3±4,2 days, in the comparison group – 48.2±5.3 days respectively. In 42 (95.5%) patients who underwent endoscopic surgery, a positive clinical effect, rapid regression of symptoms of acute pancreatitis was achieved. In two (4.5%) patients who underwent endoscopic interventions, the disease progressed with the development of an abscess of the omental pouch, they underwent puncture drainage under ultrasound control. When using puncture drainage operations under ultrasound control in 26 (72.2%) patients, a positive result was achieved, the abscess cavity decreased by 63±6.2% within 7 days. In 10 (27.8%) patients due to the progression of the disease, the following stage of treatment was performed: retroperitoneoscopically assisted necrsequestrectomy (5 (13.9%) patients), combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy (3 (8.3%) patients), and open laparotomy, abdominization, necrosequestrectomy, drainage of the abdominal cavity and retroperitoneal space (2 (5.6%) patients). Complications in the main group developed in two (2.5%) patients, the mortality rate was 2.5% (two patients). In the comparison group, complications developed in 8 (25%) patients, the mortality rate was 18.8% (6 patients). The use of minimally invasive endoscopic interventions, draining surgeries under ultrasound control followed by combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy or open laparotomy reduces the length of hospital stay of patients from 48.2±5.3 days (comparison group) to 21.3±4.2 days (main group) (p<0.0001, t=28.346) and the number of complications by 22.5% (p=0.0002, χ2=14.104, CI 9.2333-39.7022). The use of a stage approach in the surgical treatment of acute pancreatitis reduces mortality by 16.3% (p=0.0026, χ2 =9.058, CI 4.6571-32.9639).
Key words: retention, pericoronaritis, third molars, inflammatory complications
Abstract. Effectiveness of morphogenetic protein rhBMP-2 use in atypical third mandibular molars extraction. Gudaryan O.O., Іdashkіna N.G., Nekhanevich Zh.M. Objective – improving the effectiveness of treatment of patients with retention and dystopia of the third molars of the lower jaw in their horizontal or inverse position by developing an integrated approach using photodynamic therapy and drugs that enhance osteogenesis (platelet autoplasma enriched with i-PRF fibrin and recombinant morphogenetic protein (rhBMP-2). 82 patients with difficult eruption of third molars of the lower jaw aged 19 to 37 were included in research: 40 (48.8%) men and 42 (51.2%) women. The standard approach to performing operations of atypical removal of retined third molars causes a significant number of complications (large bone defects, inflammatory contracture, post-traumatic neuritis, etc.). Treatment process was provided in two stages. During the first (preoperative) stage sanitation was done to eliminate or stabilize an acute infection which is inflammatory process in the area of impacted third molar. The second stage provides abscessed tooth extraction, wound sanitation, formed defect filling with osseo-inductive medications under the collagen membrane and complete closure. The developed surgical method for treating retention and dystopia of the lower third molars using biomaterial based on demineralized bone matrix (BCP) saturated with recombinant morphogenetic protein of bone rhBMP-2 can reduce the occurrence of postoperative inflammatory complications by 35.4%, and also reduce the time for their elimination as well.
Key words: bone tissue, osteopenia, pollution of the environment
Abstract. Clinical and hygienic assessment of bone mineral density in population of ecologically contrasting territories. Loskutov O.E., Biletska E.M., Kalinicheva V.V., Onul N.M., Sinegubov D.A. Disorder of the relationship between biotic and abiotic elements against the background of anthropogenic stress on the human body affects the course of bone remodeling. It is bone tissue in the human body that has the greatest cumulative properties with respect to many xenobiotics, lead in particular. The accumulation of lead in the bone leads to the replacement of calcium ions by ions of the abiotic element and causes further changes in the bone structure: inhibition of growth processes, decreased density, the development of osteopenia and osteoporosis. In the article, a comparative hygienic analysis of bone mineral density levels (according to T-score) in industrial (n=68) and control (n=70) areas was conducted. The T-score, calculated at the LI-LIV level obtained by the method of dual-energy X-ray absorptiometry was used and was evaluated according to the recommendations of the WHO. The formation of a homogeneous sample of persons for the study was conducted according to the place of residence, age, sex, absence of diseases and regular intake of drugs leading to a decrease in bone mass. Summarizing the results, it should be noted that the population of Dniprо city has a more negative and significant decrease in the bone mineral density (according to the T-score) compared to the same values of the control areas – 2.15-4.6 times and Ukraine's – 1.39-4.21 times. According to WHO recommendations, T-score indices for residents of industrial territory indicate to the presence of osteopenia, while among residents of the control area, the norm for this indicator is noted. Consequently, there is an effect of man-made including lead, pollution of the environment on the level of bone mineral density in the industrial city this contributes to the development of osteoporotic changes in the population.
Key words: оrgan weight, thyroid gland, adrenal glands, liver, hyperthyroidism
Abstract. Weight of the thyroid, adrenal glands, and the liver of white rats in the conditions of hyperthyroidism: the possibility of applying indices changes as screening-markers for determining body status effected by organic and inorganic iodine. Ryabukha O.I. Despite the available information on the interaction between the thyroid gland activity and that of the adrenal glands, and the liver involvement in their hormones metabolism, the study of the connection existing between these organs in hyperthyroidism is still incomplete. Changes in the weight indices values of the thyroid and adrenal glands and the liver of 90 non-linear white male rats were studied. Animals received histologically verified minimally active (21 μg iodine per kg body weight), moderate (50 μg iodine per kg body weight), and significant (100 μg iodine per kg body weight) doses of organic and inorganic iodine during 30 days under the model hyperthyroidism conditions. It was found that consumption of organic and inorganic iodine at a minimal dose approximates the digital values of adrenal gland and those of the liver of the intact animals. Consumption of a moderate organic iodine dose is accompanied by a decrease in the previously achieved values of the thyroid weight index by 17.28%, and the increase in the liver weight index by 19.66%. When consuming a moderate amount of inorganic iodine, the largest change in the values achieved was the liver weight index which increased by 13.76%. Consumption of organic and inorganic iodine compounds in a significant dose is accompanied by further changing in the studied parameters. When consuming organic iodine the thyroid weight index grows by 10.44%, that of the adrenal glands – by 13.33%, the liver – by 34.52%. Сonsuming of inorganic iodine is accompanied by a rapid increase in the thyroid glands weight index by 21.25%, that of the liver – by 34.31%. The established indicates the existence of functional communication between the studied organs; the effect depends on the chemical nature and dose of iodine consumed. The existing functional dependence gives grounds to apply changes in the weight index of the thyroid gland, adrenal glands and the liver as screening-markers to determine the body’s condition in hyperthyroidism.
Key words: students, institutions of higher medical education, educational process, emotional burnout, formation processes
Abstract. Features of the processes of formation of indicators of emotional burnout of students in the dynamics of learning in modern institutions of higher medical education. Serheta I. V., Mostovaya O. P., Panchuk O. Yu., Stoyan N. V. The purpose of the work is to establish features of the processes of formation of indicators of emotional burnout of students in the dynamics of learning in modern institutions of higher medical education. Research was conducted on the basis of National Pirogov Memorial Medical University, 307 students of the 1st, 3d, and 6th courses were surveyed. To assess the level of development of the characteristics of emotional burnout Boyko’s personal questionnaire was used. It was established that a high level of severity of the leading manifestations of emotional burnout among students which determines their pronounced emotional instability and a tendency to develop various disorders in terms of the characteristics of psychophysiological adaptation and of the mental sphere was observed among young women, and, first of all, among third-year and first-year young women. Considering the structural distribution of the studied indicators, it should be noted that in all comparison groups the leading components of emotional burnout were either at the formation stage (young men, of the 1st and 3d courses, and young women of the 1st and 6th courses), or were already formed (young men of the 6th course, and young women of the 3rd course). During the analysis of the features of formation of the main phases of emotional burnout, it should be noted that the highest degree of their development during period of learning was inherent of the resistance phase, followed by indicators of individual manifestations of the exhaustion phase and, lastly, tension phase. In the structure of the characteristics of the phase of tension mostly pronounced both in young men and young women, it is necessary to consider indicators of anxiety, depression and experiences of traumatic circumstances, in the structure of the leading characteristics of the phase of resistance – indicators of inadequate selective emotional response and reduction of professionally-oriented educational duties, in the structure of the leading characteristics of the phase of exhaustion – indicators of the severity of psychosomatic and psychovegetative shifts, personal detachment and emotional deficit.
Key words: health, occupational health care, economic training profile, prevention, formation and preservation of health of specialists of the economic sphere
Abstract. Psychological bases of occupational health of specialists of economic sphere. Shevchenko О.А., Burlakova I.A., Sheviakov О.V., Agarkov O.A., Shramko I.A. A theoretical and methodological approach to the study of the process of professional health of specialists in the economic sphere was developed, which allowed to distinguish professionally important qualities of a specialist influencing his professional health, as well as to predict their transformation in changing social conditions. The peculiarities of the dynamics of the process of occupational health of specialists in the economic sphere (the stage of "primary formation" and undefined attitude to the profession; "personal-activity" stage - realization of social status at the level of the professional community; "professional-ethical" stage – values-based attitude to the profession) are revealed. Types of values-based attitude relation (neutral; pragmatic-realistic; values-based) to professional activity and peculiarities of their manifestations in specialists of economic sphere having different experience of such activity are determined. It is shown that the dynamics of professional becoming of specialists in the economic sphere is associated with the activation of changes in the internal and external environment of the subject of activity. The conceptual model of formation and preservation of professional health of specialists of the economic sphere is offered, implemented as a theoretical and methodological strategy of the systemic and holistic process in the direction of ensuring its effectiveness, presented in the form of an image of a healthy person, responsibly managing his own health and realizing himself in society, and an image of a specialist who independently sets the goals of formation and preservation of professional health, chooses the best ways and means and achievements. The developed model provides a qualitatively new level of personal, physical, professional and social readiness of the person for self-realization in the professional economic sphere of activity and successful integration into society.
PAGES OF HISTORY
Key words: medicine, trade union, society, physicians, protection
Abstract. Analysis of the statute and the first year of the activities of Lviv Society of Halician Physicians («Towаrzystwo lekarzów Galicyjskich»). Berest I.R., Berest R.Ya., Pasichnyk M.S., Savchuk H.M., Oliynyk M.A. Based on the principle of historicism, system analysis, structural functionalism, dialectics and synergetics, the paper analyzes the charter and activity the of the Lviv Society of Halician Physicians, the first trade union organization in the medical sphere. Contemporary codition as well as development of historiography of the issue including the history of the medical and trade union movement, the names of the Society founders is shown. The crucial problem among physicians of the second half of the nineteenth century which was in line with the problems of all population segments is proved. This organization played a prominent role in the development of medicine in Halychyna. The activity of the Society was regulated by the charter. Each member, when joining the Society, assumed the obligation to comply with all the provisions of the charter and had to care for its growth and the glory of the organization. Acting members had to be present at scientific meetings and provide observations on the status of the medical case. That is, to provide statistics on the diseases and patients they have been treated, as well as to share the experience gained in practice. The purpose of the organization and its activities were primarily socio-economic and cultural-educational ones. Under its control, the Society kept a record of the movement of patients in Lviv hospitals (kept statistics of all cured patients), analyzed new methods in the treatment of fever, various pathologies and other issues. The members of the Society promised to meet every first Saturday of the month to participate in scientific meetings. They discussed major events in the life of the organization, read correspondence and planned work for the next month. Once a year, in December, the Society of Galician physicions held an annual meeting, which provided a full annual financial report, discussed the issues of new members and those who left the organization, announced the names of new honorary and advisory members.