Voichenko Ya.S., Rodynskyi O.H. Clinical course of pro-oxidant processes in brain structures in rats under conditions of experimental hyperthyroxinemia in age-related dynamics
The search for a connection between changes in the indicators of the pro-oxidant system of brain structures and the thyroid gland as a target organ is an urgent issue. The goal is to investigate the features of the pro-oxidant system against the background of experimental hyperthyroxinemia and to evaluate the age-related changes of malondialdehyde and diene conjugates in brain structures. Among Wistar rats (n=50) intact animals ("control", Σ=20) and experimental animals (under simulated hyperthyroxinemia, Σ=30) were selected for observation. The principle of the model of experimental hyperthyroxinemia lies in the addition of levothyroxine in a dosage of 20 μg/day (manufactured by "Berlin-Chemie AG", Germany) in the form of tablets with subsequent grinding at 9 o'clock in the morning with food. On day 14, hyperthyroxinemia in the animals was found, while the thyroxine level in the peripheral blood was >10 μg/dL in the first 48 hours and further, being >25 μg/dL (the results were verified in the laboratory, confirmed by immunoenzymatic method with the participation of the "Humarlander" test system). After functional testing in rats, highly specific parameters (malondialdehyde, diene conjugates) in the cortex, trunk, and hippocampus were further recorded and evaluated. The humane treatment of animals is certified by the local protocol of the meeting of the commission of the Dnipro State Medical University No. 10 dated 21.06.2023, bioethical principles and rules are taken into account during the experimental research. In the presented work, the results of the biochemical method were used to discuss the importance of the pro-oxidant system at the stage of protection against manifestations of stress and anxiety. Functional dependence on the accumulation of intermediate and final products of lipid peroxidation in the structures of the brain during the study of the state of the pro-oxidant system was found; the age-related dynamics of the activity of malondialdehyde and diene conjugates from young to middle-aged rats under conditions of experimental hyperthyroxinemia was observed; age-related changes contribute to a certain depletion of the activity of pro-oxidant compounds in response to stress as a principle of nervous system protection.
Key words: pro-oxidant system, thyroid processes, hyperthyroxinemia, age-related changes, rats
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Hlavachek D.O., Kondratenko O.Ye. Determining the effect of drug "Warfarin sodium" on toxicity indicators in an acute experiment
The drug "Warfarin sodium" refers to anticoagulants of indirect action. It contains only one substance - warfarin sodium, the toxicological indicator of which have been studied in many countries. Therefore, the range of indicators for DL50 of warfarin sodium is very large. However, warfarin sodium has not yet been studied in Ukraine, its maximum permissible concentration in the air of the work area has not been established. Significant volumes of production and use of the drug “Warfarin sodium” on the territory of Ukraine necessitate the clarification of its main toxicological indicators and the establishment of the maximum allowable concentration in the air of the working area, which includes several stages. The first of them is the purpose of this work, namely: to establish DL50 upon intragastric administration of the drug "Warfarin sodium" to two species of animals in the conditions of an acute experiment. Experimental animals (60 non-linear white rats and 70 non-linear white mice) were divided into 9 groups. Six groups were injected with the drug "Warfarin sodium" in different doses: the first group (female rats) – 58 mg/kg per animal, the second (also female rats) – 29 mg/kg, the third (male rats) – 323 mg/kg, the fourth (also male rats) – 161.5 mg/kg, the fifth (mice of both sexes) – 374 mg/kg, the sixth (also mice of both sexes) – 187 mg/kg. Three control groups (the first – 6 male rats, the second – 6 female rats, the third – 14 mice) received distilled water. As a result, the mortality rates of experimental animals were obtained, on the basis of which, using the probit analysis method, the toxicity indicator of DL50 was determined: for female rats – 15.85 mg/kg, male rats – 398.11 mg/kg and mice –645.65 mg/kg. The established DL50 for male rats after intragastric administration of the drug "Warfarin sodium" may indicate an increase in their resistance to the drug, and this determines the expediency of periodic repeated acute experiments in order to verify the relevance of previously established DL50 of sodium warfarin. According to DL50 upon intragastric administration to female rats, which are the most sensitive species of animals to it, warfarin sodium belongs to highly hazardous substances.
Key words: warfarin sodium, anticoagulants, toxicological indicator, DL50, intragastric administration
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Ostrovska S.S., Dychko Ye.N., Shumna T.Ye., Titov G.I., Trushenko O.S., Gerasymchuk P.G., Burega I.Y. The role of oxidized non-coding RNAs of the epigenome in the development of human diseases (literature review)
The attention of scientists to the role of the epigenome in the development of human diseases is associated with the discovery of new non-coding RNA molecules of the epigenome that affect gene expression with changes in protein function and the development of diseases. The study analyzed current scientific data on the effect of oxidative stress induced by cadmium on the regulatory mechanisms of the epigenome, resulting in the development of pathological changes in the body. The results of the study showed that cadmium manifests its toxicity by oxidizing micro RNAs and long RNAs that regulate gene expression without changing DNA/histone complexes. It has been shown that epigenetic disorders under the influence of cadmium-induced oxidative stress can be transmitted to offspring without changing the genotype, and these aberrant changes in non-coding RNA expression patterns are associated with aging, cancer, neurodegenerative, cardiovascular diseases, etc. Circulating micro RNAs that are sensitive to oxidative stress are reported to be potential biomarkers of cardiovascular diseases, including myocardial infarction, hypertrophy, ischemia/reperfusion, and heart failure. Many studies are aimed at using microRNAs for therapeutic purposes. The complete expression profile of microRNAs in human atherosclerotic plaques was studied, and the mechanisms affecting their formation were identified. Specific microRNAs and reactive oxygen species were identified as potential biomarkers in human malignancies, which expands the possibilities of their use as therapeutic targets. Unlike micro RNAs, the expression of long RNAs has tissue and species specificity, making them important candidates for specific disease markers. The role of these RNAs in carcinogenesis is being actively studied. A large number of them are disrupted at various types of cancer and may play an important role in the onset, metastasis, and therapeutic response of cancer. Thus, oxidative stress induced by cadmium affects non-coding RNAs, which disrupts the regulatory mechanisms of the epigenome and affects the development of cardiovascular, oncological, pulmonary and other human diseases. The search for the impact of non-coding RNAs on the epigenome is constantly growing and has great scientific and practical prospects in medicine.
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Zinych O.V., Shuprovych A.A., Trofymenko O.M., Komisarenko K.P. The role of epigenetic modifications in the formation of heterogeneous phenotypes in diabetes mellitus (a literature review)
This review article provides a summary and update on the role of epigenetic mechanisms in predisposition and progression of diabetes, analyzes the data concerning the cause-and-effect relationship between epigenetic changes and the emergence of distinct metabolic phenotypes. Extensive genetic research has enabled the isolation of a group of genes associated with a high risk of developing diabetes. However, numerous data point to the key role of so-called epigenetic modifications in the interaction between genes and the environment, which arise during ontogenesis based on the existing genotype under the influence of external factors. These modifications do not affect the primary DNA sequence, but influence gene expression through chemical modification and alteration of the secondary structure of DNA molecules and chromatin. Epigenetic mechanisms can program pathological phenotypes in subsequent generations. The main molecular mechanisms of epigenetic modifications are DNA methylation, histone and miRNA modification. Changes in the expression of genes that ensure the synthesis of key enzymes and regulatory molecules lead to disruption in the main signaling metabolic pathways. Deregulation of genes responsible for inflammatory, atherosclerotic and other pathological processes, in particular, leads to endothelial dysfunction and development of diabetic complications, such as cardiovascular diseases, diabetic nephropathy, retinopathy, neuropathy. Hyperglycemia, oxidative stress, inflammatory factors are known as mediators in the pathogenesis of type 2 diabetes and its complications. Since epigenetic modifications are reversible, the methylation process can be influenced by exercise, dietary, lifestyle changes and pharmacological agents such as methyl group donors. For example, S-adenosylmethionine, through participation in methylation reactions, can modulate the folate cycle function and production of homocysteine, an endothelium-toxic substance. Thus, the study of molecular modifications in chromatin structure and the features of activation and inhibition of various signaling pathways is a pressing task, the resolution of which will enable a deeper understanding of the pathogenesis of diabetes and the development of approaches to correct metabolic disorders.
Key words: type 2 diabetes, epigenetic modifications, gene expression, DNA methylation
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Dytiatkovska Ye.M., Nedohybchenko N.O. Optimization of the treatment of patients with severe chronic urticaria
Severe chronic urticaria (SCU) is a common disease that burdens the lives of millions of people, reduces their quality of life, and imposes a significant economic burden not only on the health care system, but also directly on the patient. To date, a single approach regarding the optimal dosing of omalizumab in this cohort of patients has not been determined. The purpose of the work: based on the assessment of the quality of life of patients with SCU and dynamic clinical and laboratory observation, to study the effectiveness and prove the feasibility of using the minimum dose of 150 mg for omalizumab according to the scheme every 21 days intramuscularly three times, which will allow to optimize the treatment tactics of these patients and reduce the economic burden of the cost of their treatment. In a prospective single-center study lasting 33 weeks, 104 patients with a diagnosis of SCU were included. All patients underwent a general clinical examination, quality of life indicators using the SKINDEX-29 questionnaire were studied; blood tryptase level once before the start of treatment using ImmunoCAP was determined, the level of total IgE in blood serum using an immunochemical method with electrochemiluminescence detection before and after the end of treatment was determined. The patients were divided into two groups: Group 1 (54 people) had a relapse of urticaria within 3 to 6 months after completing a course of second-generation histamine H1-receptor blockers and received a course of omalizumab at a dose of 150 mg intramuscularly every three weeks three times. Group 2 (50 people) had a relapse of urticaria no earlier than 6 months after the previous course of second-generation histamine H1-receptor blockers and received desloratadine, 5 mg during the first four weeks and 20 mg during the next four weeks. Indicators of urticaria activity (UAS7) and quality of life (SKINDEX-29) in patients were determined before the start of treatment and at each of the visits (on the 10th, 31st and 52nd days of therapy when treated with omalizumab and five and nine weeks after initiation of desloratadine therapy), and UAS7 was assessed six months after the end of treatment. Methods of descriptive and analytical statistics were used to process the obtained data. According to our data, patients with SCU are mostly people of working age, more than half of whom have a history of the disease for five years or more, in 70% of cases of a valid study, they are characterized by an increased content of total IgE and have a low level of indicators according to the questionnaire SKINDEX-29 at the level of physical symptoms, emotional sphere and functioning. We found that in patients of observation Groups 1 and 2, after the treatment, the level of total IgE in blood serum decreased statistically significantly. In patients of Group 1, the appointment of omalizumab in the minimum dose made it possible to ensure the control of urticaria symptoms already after the first injection in 15% of cases, and after the third injection there was a stable remission with the absence of urticaria symptoms during six months of follow-up in 92.3% of patients, against the existing 24% of subjects of Group 2, who after therapy according to UAS7 had very severe and severe symptoms. After the completion of treatment in patients of Group 2, nine weeks after the initiation of desloratadine therapy according to the SKINDEX-29 questionnaire, 44% of cases and 46% of very severe negative effects of urticaria on the emotional sphere and functioning remained, respectively; and in 46% of cases there was a low quality of life according to the generalized assessment of the impact of the disease at the level of "severe". At the same time, among the patients of Group 1, after completion of omalizumab therapy on the 52nd day of observation, no case of severe or very severe negative impact of urticaria on the quality of life was registered in any of the domains. Thus, the effectiveness and justified expediency of prescribing omalizumab treatment of 150 mg with an interval of 21 days three times in patients with SCU, who have a recurrence of chronic dermatosis within 3 to 6 months after the second-generation histamine H1-receptor blocker therapy has been confirmed.
Key words: urticaria, chronic forms of dermatosis, quality of life, rash, itching, immunoglobulin E, monoclonal antibodies, antihistamines, serum tryptase
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Usychenko К.М. The using of genetic markers as a possibility of predicting the rate of progress of liver fibrosis in patients with chronic hepatitis B.
According to recent WHO estimates, chronic HBV infection is one of the leading causes of death and disability in patients with infectious diseases. From 780 thousand to 1 million deaths are annually recorded in the world as a result of cirrhosis of the liver and hepatocellular carcinoma. Pathogenetic features of the course and outcomes of chronic hepatitis B are determined by the immunological, genetic factors of the host, as well as the molecular biological structure of the virus. The aim of the work was to study the interaction of polymorphic loci of the cytokine genes SMAD 7 (rs4939827), TNFα (rs1800620), IL-10 (rs1800896), IL-4 (rs2243250) and the degree of structural changes in the liver based on the non-invasive Fibrotest technique in patients with chronic hepatitis B as part of a search for possible predictors of predisposition to the rapid progression of liver fibrosis. The study included 82 patients with chronic hepatitis B. Assessment of morphological changes (stage of fibrosis) was carried out by the method of non-invasive diagnosis of FibroScan, which is an alternative to puncture biopsy of the liver. It has been suggested that homozygous alleles СС IL-4 (rs2243250), GG TNFα (rs1800620), СС SMAD family member 7 (rs4939827) have a protective effect on the course of chronic hepatitis B, as these variants of allelic polymorphism of cytokine genes were found mainly in patients with CHB with a degree of fibrosis F0-F1. The heterozygous genotypes СТ IL-4 (rs2243250) and GA TNFα (rs1800620), the mutant homozygous ТТ SMAD family member 7 (rs4939827) have a profibrotic effect on the course of chronic hepatitis B, as they are found mainly in patients with chronic hepatitis B with degree of fibrosis F3. The established relationship between the liver fibrosis stage according to the METAVIR scale and the polymorphism of the cytokine genes SMAD 7 (rs4939827), TNFα (rs1800620) and IL-4 (rs2243250) made it possible to create a prognostic scale for assessing the individual risk of rapid progression of liver fibrosis. The proposed scale, due to a comprehensive assessment of the polymorphism of cytokine gene alleles and the stage of liver fibrosis using the METAVIR scale, makes it possible to carry out an individual assessment of the risk of progression of chronic hepatitis and, possibly, draw up a personalized treatment plan for the patient. Coding of the studied polymorphisms and subsequent counting can be automated, which does not require significant financial investments. The possibilities of the prognostic scale are proven on the example of a group of patients who received the antifibrotic agent bicyclol in comparison with the control group.
Key words: chronic hepatitis B, liver fibrosis, prognosis, allelic polymorphism of cytokine genes SMAD 7 (rs4939827), TNFα (rs1800620), IL-10 (rs1800896), IL-4 (rs2243250), antifibrotic therapy, bicyclol
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Usychenko К.М. The using of genetic markers as a possibility of predicting the rate of progress of liver fibrosis in patients with chronic hepatitis B. Medicni perspektivi. 2023;28(3):45-54. DOI: https://doi.org/10.26641/2307-0404.2023.3.288931
Orlova Yu.A., Hromova A.M., Ketova O.M., Liakhovska T.Yu., Martynenko V.B., Krutikova E.I. Aseptic inflammation as the essential link in the pathogenesis of endometrioid disease
The paper was aimed at determination of the quantitative activity of iNOS and Arg1, as well as M1 and M2 phenotype macrophages in women with endometrioid disease to establish their role in the pathogenesis of endometriosis. A prospective study was performed in gynecological units of the medical facilities of Poltava city. 140 women of reproductive age who made up the main group (110 women with endometrioid disease) and the control group (30 women without endometrioid disease) voluntarily participated in the study. All women underwent planned surgical treatment for existing gynecological pathology. Before surgical treatment, women were examined in accordance with the current Orders of the Ministry of Health of Ukraine. The spectrophotometric method was used to determine the enzymatic markers of macrophages (in the endometrium and peritoneal fluid) polarized into M1(iNOS) and M2 (Arg1) phenotypes. The type of macrophages was determined individually in each patient according to the ratios: in iNOS>Arg1, the M1 macrophage type prevailed; in Arg1>iNOS, the M2 macrophage type prevailed. When examining endometrial samplings in women from the main group, the iNOS indicator was by 1.4 times higher compared to women from the control group. The obtained results at the stage of entry into the abdominal cavity showed that mostly women from the main group suffered from the pelvic adhesion, especially stage 3 and stage 4. Among the obtained results, the increased quantitative activity in the peritoneal fluid of both iNOS and Arg1 in women of the main group was significant compared to the control group. When comparing the stages of endometrioid disease to the rates of quantitative activity of macrophage enzyme markers (in peritoneal fluid), it was found that the increase in the stage of the disease (from stage 3 to stage 4) caused an increase in the quantitative activity of Arg1 by 1.9 times and a decrease in the quantitative activity of iNOS by 2.9 times. Therefore, the planning of surgical intervention for women with endometrioid disease should consider a significant percentage of the pelvic adhesive disease, especially at the severe stages. Initiation of the chronic aseptic inflammatory process in endometrioid disease is caused by an increased quantitative activity of iNOS in the endometrium. In the pathogenesis of endometrioid disease, the presence of M2 phenotype macrophages in the peritoneal fluid is important, while the switching of macrophage phenotypes from a pro-inflammatory subpopulation to an anti-inflammatory one is crucial.
Key words: endometriosis, inducible NO-synthase, arginase 1, M1 phenotype macrophages, M2 phenotype macrophages
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Orlova Yu.A., Hromova A.M., Ketova O.M., Liakhovska T.Yu., Martynenko V.B., Krutikova E.I. Aseptic inflammation as the essential link in the pathogenesis of endometrioid disease. Medicni perspektivi. 2023;28(3):55-61. DOI: https://doi.org/10.26641/2307-0404.2023.3.288961
Droniak M.M., Shevchuk I.M., Snizhko S.S., Sadovyi I.Ya., Fedorkiv N.B., Kuzenko R.T. The values of indices of non-specific resistance and cytokine regulation for early diagnosis of secondary peritonitis
The aim of the work is to study the changes in indices of non-specific resistance and cytokine regulation, relevant for the early diagnosis of secondary peritonitis. During the period 2016-2022, in the Surgery Department of the Communal Non-Profit Enterprise “Regional Clinical Hospital, Ivano-Frankivsk Regional Council” there were treated 192 patients with postoperative peritonitis. Of them, in 69 (35.9%) patients the changes in indices of non-specific resistance and cytokine regulation were studied. These studies were performed in the laboratory of the Department of Biological and Medical Chemistry of the Ivano-Frankivsk National Medical University. The content of CD3+-lymphocytes in the blood of patients with secondary peritonitis on admission to the hospital was 35.49±3.39%, which is 1.8-fold less than in the comparison group (p<0.002), with their subsequent drop up to 31.00±2.88% (p<0.002) during the third day of the disease. When determining CD4+-lymphocytes during the first day of observation, their indices were 21.49±3.11%, by 56% less than in the comparison group (p<0.002). During the third day of the disease, we observed a slight increase in this index – up to 23.90±3.26% (p<0.01). The study of the level of CD8+-lymphocytes showed that, on admission to the hospital, their level in blood serum was 13.92±1.05%, which is 1.6-fold lower than in patients of the comparison group (p<0.002). Their decrease was observed further, and during the third day this index was 8.08±2.28% (p<0.002). The content of CD11a+-cells on hospitalization was 11.32±0.54%, which is more than 6-fold less than in the comparison group (p<0.002). The content of CD162+-cells in the blood on hospitalization was 21.49±3.11%, which is 3.1-fold less than in the comparison group (p<0.002). The content of CD16+-cells in the blood on hospitalization was 10.83±0.87% (p<0.002). A significant increase in the content of IL in the blood serum at the initial stage of secondary peritonitis with subsequent pathological changes are contributing factors in the disorder of the body’s immune response. The content of IL-6 on admission was 759.72±28.06%, which is almost 3.4-fold higher than the indices in the comparison group (p<0.002). After surgery, this index gradually decreased and during the seventh day was 438.63±19.84% (p<0.002). The results obtained on such indices of non-specific resistance and cytokine regulation as CD3+, CD4+, CD8+, CD11a, CD162, CD95, CD16, HLA-DR+, IL-2, IL-4, IL-6 showed their significant differences between the subgroups studied (p<0.002), indicating their high sensitivity for diagnosing and predicting the development of secondary peritonitis.
Key words: secondary peritonitis, non-specific resistance, cytokine regulation
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The values of indices of non-specific resistance and cytokine regulation for early diagnosis of secondary peritonitis. Droniak M.M., Shevchuk I.M., Snizhko S.S., Sadovyi I.Ya., Fedorkiv N.B., Kuzenko R.T. Medicni perspektivi. 2023;28(3):61-67. DOI: https://doi.org/10.26641/2307-0404.2023.3.288963
Boginskis V., Zadoroznijs S., Cernavska I., Beikmane D., Sauka J. Artificial intelligence effectivity in fracture detection
The scientific study aimed to explore the practical implementation of artificial intelligence (AI) technologies in radiology and traumatology for fracture detection, as well as evaluate their overall effectiveness in modern medicine. In recent years, AI has gained significant traction in the healthcare industry, enabling the analysis of patients' clinical data and facilitating disease diagnosis, monitoring, risk assessment, and surgical intervention possibilities. The relevance of the scientific work is in the gradual expansion of practical applications of artificial intelligence technologies in medicine, particularly in radiology for diagnosing fractures. The study aimed to investigate the practical effectiveness of AI technology in fracture detection on example of Hospital of Traumatology and Orthopaedics in Riga, Latvia. The methodological approach combined system analysis of AI system implementation in modern medical institutions for creating X-ray images with a clinical study of fracture diagnosis experience at the Hospital of Orthopedics and Traumatology in Riga, Latvia. Fractures were detected by radiologists, attending physicians, and the AI program, with comparisons made between them. Results were analyzed to assess the program's efficacy. The results of the study demonstrated the high effectiveness of AI technologies in fracture detection. The application of these systems in clinical practice led to a significant reduction in diagnostic errors (by 2-3 times) and an increase in diagnostic accuracy (from 78.1% to 85.2%). Moreover, AI systems proved to be capable of detecting fractures that were not initially identified during routine examinations by paramedics and medical practitioners. This emphasized the practicality of expanding the use of these systems in clinical practice. The practical significance of the obtained results is in their potential use in the development of software systems based on AI, aimed at enhancing fracture diagnosis in medical institutions. These findings provided valuable insights for further advancements in AI-based technologies for fracture detection.
Key words: traumatology, radiology, clinical studies, fluoroscopy, orthopaedics diagnostics
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Kashtalian M.A., Kvasnevskyi Ie.A. Kvasnevskyi O.A. The first experience of using the "Senhance" robotic surgical system during cholecystectomy
The aim of our study was to evaluate the differences in intraoperative and postoperative outcomes of cholecystectomy using the Senhance robotic platform and laparoscopic cholecystectomy. A retrospective analysis of medical cases history of patients who underwent cholecystectomy from December 2021 to February 2022 was conducted. The treatment outcomes of patients with chronic calculous cholecystitis who underwent robotic cholecystectomy (RC) were compared with those who underwent laparoscopic cholecystectomy (LC). Robotic cholecystectomy was performed using the Senhance robotic platform. The RC and LC groups were matched for age, sex, body mass index and compared for the duration of the operation and hospital stay. For normally distributed data, the mean and standard deviation, determined using the Shapiro-Wilk test (p-value>0.05), were applied. Median and interquartile range (IQR) were also used. Difference between cohorts - 95% confidence interval (95% Confidence Interval) were estimated for normally distributed data. Data analysis was performed using standard summary statistics on the Jamovi 2.2.5 platform. Data were processed using application program packages. All surgical procedures were performed by two surgeons from Odesa National Medical University. Robotic cholecystectomy was performed on 18 patients and laparoscopic cholecystectomy was performed on 20 patients. There were no statistically significant differences between the groups in terms of length of hospital stay, blood loss or complications. There were no bile duct injuries, intraoperative complications, or conversions in either group. The only statistically significant difference was the total time under anesthesia (p>0.05), which was longer in the robotic cholecystectomy group. Cholecystectomy using the Senhance robotic platform was found to be safe, with an average operative time of 35.2±5.0 minutes, while the duration of laparoscopic cholecystectomy was 32.2±3.3 minutes. The study results showed that robotic cholecystectomy using the Senhance system is safe and effective. The use of robotic systems can improve precision and control during surgery, reduce blood loss and complications.
Key words: snhance surgical system, cholecystectomy, minimally invasive surgery, robotic surgery
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- McKechnie T, Khamar J, Daniel R, Lee Y, Park L, Doumouras AG, et al. The Senhance Surgical System in Colorectal Surgery: A Systematic Review. J Robot Surg. 2023 Apr;17(2):325-34. doi: https://doi.org/10.1007/s11701-022-01455-0
- Aggarwal R, Winter Beatty J, Kinross J, von Roon A, Darzi A, Purkayastha S. Initial Experience With a New Robotic Surgical System for Cholecystectomy. Surg Innov.2020 Apr;27(2):136-42. doi: https://doi.org/10.1177/1553350619890736
- Samalavicius NE, Kaminskas T, Zidonis Z, Janusonis V, Deduchovas O, Eismontas V, et al. Robotic cholecystectomy using Senhance robotic platform versus laparoscopic conventional cholecystectomy: a propensity score analysis. Acta Chir Belg. 2022 Jun;122(3):160-3. doi: https://doi.org/10.1080/00015458.2021.1881332
- Stephan D, Sälzer H, Willeke F. First Experiences with the New Senhance® Telerobotic System in Visceral Surgery. Visc 2018 Feb;34(1):31-6. doi: https://doi.org/10.1159/000486111
- Spinelli A, David G, Gidaro S, et al. First experience in colorectal surgery with a new robotic platform with haptic feedback. Colorectal Dis. 2018;20:228-35. doi: https://doi.org/10.1111/codi.13882
- Willuth E, Hardon SF, Lang F, et al. Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study. Surg Endosc.2022 Feb;36(2):1064-79. doi: https://doi.org/10.1007/s00464-021-08373-6
- Milone M, Vertaldi S, Bracale U, D'Ambra M, Cassese G, Manigrasso M, et al. Robotic cholecystectomy for acute cholecystitis: Three case reports. GD.Medicine (Baltimore). 2019 Jul;98(30):e16010. doi: https://doi.org/10.1097/MD.0000000000016010
- Melling N, Barr J, Schmitz R, Polonski A, Miro J, Ghadban T, et al. Robotic cholecystectomy: first experience with the new Senhance robotic system. J Robot Surg.2019 Jun;13(3):495-500. doi: https://doi.org/10.1007/s11701-018-0877-3
- Peacock JL, Peacock PL. Oxford Hadbook of Medical Statistics. 2nd ed. Oxford University Press, UK; 2020. 640 p. doi: https://doi.org/10.1093/med/9780198743583.001.0001
Berezyuk O.R., Filts O.O. Association of the feeling of anxiety and the phenomenon of inferiority.
The phenomenon of inferiority as a key concept of Adler's theory of psychology can contribute to the appearance of social anxiety. Since both anxiety and feeling of inferiority have an impact on mental and somatic health, the aim of the study was to investigate the association of the phenomenon of inferiority with the feeling of anxiety. During October-November 2021 in the course of the study, a questionnaire survey of 612 students of higher education institutions of Lviv was conducted. Two questionnaires were used for the survey: the Comparative Feeling of Inferiority Index and Beck's Anxiety Inventory. The analysis of the findings was performed using the methods of descriptive (median, 25% and 75% quartiles, percentages with 95% confidence intervals) and analytical statistics (Kruskal-Wallis test, Dunn's post-hoc paired test, Pearson's test). The research established that the feeling of anxiety is characteristic of 54.95% [45.67-64.07] of the respondents with the Index of Superiority, 48.84% [34.17-63.61] of the respondents with the Index of Inferiority and 43.91% [39.60-48.28] of respondents with the absence of the phenomenon of altered self-esteem (Norma). Median scores on Beck's Anxiety Inventory were significantly higher in individuals with the index of superiority – 8.5 [5; 16.3] points. A comparison of the presence of anxiety by gender showed that anxiety symptoms are significantly more common in women than in men: 57.85% [51.82-63.77] vs 37.04% [32.07-42.15] respectively, p<0.001. Anxiety is most often characteristic of women with the index of superiority – 76.67% [60.16-89.79]) of women in this group. The value of the findings is determined by the fact that in Ukraine this is the first scientific study regarding the research of the association of the phenomenon of inferiority and anxiety in adult population with using proven and valid questionnaires that are actively used by scientists around the world.
Key words: phenomenon of inferiority, feeling of anxiety, index of inferiority, index of superiority, absence of the phenomenon of altered self-esteem
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Ogorenko V.V., Nikolenko A.Ye., Shusterman T.Y., Kokashynskyi V.O. The integrative model of resiliency in higher education seekers in war conditions
The article presents the results of the study of “The Integrative Model of Resiliency” in higher education seekers in war conditions. 174 higher education seekers were examined, among them: 144 students of the 4th-6th year of the medical faculty and the faculty of medicine and pharmacy of the Dnipro State Medical University, majoring in 222 “Medicine” (main group) and 30 students of the 4th-5th year of the Ukrainian State University of Science and Technology (comparison group). The aim of the study was to determine the modalities of resiliency in higher education seekers in the war condition. A psychodiagnostic method with the integrative model of resiliency “BASIC Ph” was used in the research. The distribution of modalities, their degree of expression (scoring), gender features of the distribution of modalities and their correlations were studied. In the vast majority of higher education seekers, one modality of resiliency dominated (94% in the main group, 100% in the comparison group), which was cognitive modality (64% in the main group, 67% in the comparison group) as the most mature, adaptive and constructive way of overcoming the crisis, especially during the war. In 6% of the investigated ones in the main group, the dominance of two modalities was found, among which the cognitive strategy was once again the leading one (89%). Some gender features of the use of stress coping strategies were revealed. Thus, a statistically significant difference was observed between the indicators of the modalities “Belief”, “Emotions” and “Social support” among males and females of the main group and “Emotions” and “Imagination” in the comparison group (p<0.05). Analyzing the gender characteristics of the correlations of resiliency modalities, a more multifaceted model was found in medical students of male gender. The obtained data contribute to a deeper understanding of own personal strengths and the involvement of less developed ones by higher education seekers, aimed at strengthening and enriching their resources to overcome resiliency of war crisis. Thus, the results of the study should be taken into account when developing psychoeducational and psychocorrective measures and conducting psychological support for of higher education seekers in the conditions of war and post-war time.
Key words: resiliency, resources, seekers higher education, coping strategies, modalities, Basic Ph, war
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- Yuryeva LM, Sharun AI. Аdjustment disorder among students, who has suffered psychoemotional stress: systematic review of diagnostics, treatment and preventive care. Medicni 2021;4:47-51. doi: ttps://doi.org/10.26641/2307-0404.2021.4.248082
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Ogorenko V.V., Nikolenko A.Ye., Shusterman T.Y., Kokashynskyi V.O. The integrative model of resiliency in higher education seekers in war conditions. Medicni perspektivi. 2023;28(3):94-109. DOI: https://doi.org/10.26641/2307-0404.2023.3.289204
Gubin M.V., Olkhovskyi V.O., Garyuk G.I., Gubin V.M. Forensic-medical determination of the severity of closed injuries of the hyoid-laryngeal complex according to the data of a specialized clinic
Victims with closed blunt trauma of the hyoid-laryngeal complex often become the object of forensic examination. The purpose of the work was the forensic determination of the severity of injuries of the hyoid-laryngeal complex based on the materials of a specialized otolaryngological clinic in order to establish ways to improve the effectiveness of forensic diagnostics. 62 medical inpatient and outpatient cards of patients with injuries of the hyoid-laryngeal complex, who were treated in the Kharkiv clinical otolaryngological hospital No. 30 during 2011-2021, were processed. The mechanism of occurrence of injuries of the hyoid-laryngeal complex was as follows: in 51 (82.3% of cases there were blows to the neck with blunt hard objects (blows with fists and other objects), in 11 (17.7%) cases – squeezing of the neck with hands or blunt hard objects. The severity of injuries of the hyoid-laryngeal complex was determined from a forensic-medical point of view based on the observations of patients in a specialized hospital. Injuries of the hyoid-laryngeal complex in 3 (4.8%) patients with the occurrence of life-threatening phenomena, namely acute respiratory failure, were assessed as serious ones. Injuries in 8 (12.9%) patients were assessed as injuries of medium severity, mainly in cases of laryngeal cartilage fractures due to the lack of danger to life. Injuries in 38 (61.3%) patients were assessed as slight physical injuries that caused a short-term health disorder, mainly in cases of damage to the soft tissues of the larynx (hematoma, hemorrhage, swelling). Injuries in 13 (20.9%) patients in cases of acute post-traumatic laryngitis without pronounced morphological changes were assessed as slight ones. It was determined that additional diagnostic criteria for determining the severity of injuries of the hyoid-laryngeal complex, which have to be considered are: the dynamics and terms of restoration of post-traumatic morphological-clinical, and functional changes, the occurrence of life-threatening phenomena. The conducted scientific work made it possible to determine the ways of further improvement of diagnostics in the forensic-medical determination of the severity of the investigated injuries.
Key words: forensic-medical examination, trauma of the hyoid-laryngeal complex, diagnostic criteria, degree of severity of physical injuries
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Gubin M.V., Olkhovskyi V.O., Garyuk G.I., Gubin V.M. Forensic-medical determination of the severity of closed injuries of the hyoid-laryngeal complex according to the data of a specialized clinic. Medicni perspektivi. 2023;28(3):110-116. DOI: https://doi.org/10.26641/2307-0404.2023.3.289205
Trybulski R., Biolik G., Kuczmik W., Ivasyk N., Tyravska O. Application of deep oscillation therapy in the treatment of peripheral arterial diseases
Intermittent claudication is a common symptom of peripheral arterial disease, affecting up to 50% of patients over the age of 50, which is characterized by pain, discomfort, and cramping in the leg muscles during physical activity. Intermittent claudication is a common symptom of lower extremity arterial disease (LEAD), which significantly impacts patients’ quality of life and drives healthcare costs. Current treatments for intermittent claudication are often inadequate, leading to a need for more effective treatments. Developing new treatments is critical to improve outcomes for patients and address the public health implications of LEAD. This study’s aim was to present the impact of comprehensive physiotherapy, conducted independently, with the supervision of a physiotherapist, for 14 weeks, on a patient with intermittent claudication caused by peripheral arterial disease. The therapy included bicycle training in a form of physical therapy at home, combined with deep oscillation therapy. Deep oscillation therapy involved the use of an electrostatic field with a frequency of 5 to 250 Hz. The field was applied following the lymphatic drainage methodology. In the discussed case, a statistically significant and favourable increase in the measured variables was observed, such as the increase of bone-brachial index from 0.65 to 0.8, the increase of tissue perfusion, measured by laser Doppler flowmetry, from 12.3% to 61%, depending on the measurement site, and the increase in pain-free walking distance by 451%. TcPO2 measurement in the affected leg increased from 31 to 48 mmHg. The use of physical therapy at home combined with deep oscillation showed improvements in pain-free walking distance, Ankle Brachial Index, and other measures in patients with peripheral arterial disease. Deep oscillation therapy demonstrated potential analgesic effects but also raised concerns about possible nerve damage. The study indicated that physical therapy at home might serve as an alternative to supervised exercise therapy, but it had limitations like a small sample size and lack of direct comparisons.
Key words: physical medicine, microcirculation, intermittent claudication, physical training, vascular disease
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Trybulski R., Biolik G., Kuczmik W., Ivasyk N., Tyravska O. Application of deep oscillation therapy in the treatment of peripheral arterial diseases. Medicni perspektivi. 2023;28(3):116-127. DOI: https://doi.org/10.26641/2307-0404.2023.3.289207
Proshchenko N.S., Sorochenko H.V., Ostapko O.I., Plyska O.M., Trokhimets Yu.V. Complicated caries of permanent teeth in children: status of the problem and modern solution ways
The issue of improving dental care protocols for children with multiple (decompensated) and complicated caries of permanent teeth, their full rehabilitation is particularly relevant, especially in periods of social cataclysms (the COVID-19 pandemic, martial law, etc.). The purpose of this study was an assessment of the dental caries experience, analysis of modern approaches to diagnosis, treatment, prevention and rehabilitation of complicated caries of permanent teeth among children in Kyiv. The material of the study was data from medical histories of 236 children aged 7-18 years. During the analysis of the obtained data, the dental caries experience, % of cases of toothache complaints and part of the need for replacement or correction of restorations after the treatment of complicated caries were calculated. The prevalence of caries of permanent teeth among 7-18-year-old children (n=236) in the period 2020-2023 was 42-95%, the dental caries experience – 1.73-6.4, the frequency of diagnosis of complicated caries – 4.8-37,1%, the prevalence of toothache – 31%, the part of the need for replacement of restorations after treatment of complicated caries – 62%. The obtained indicators confirm the absence of a downward trend compared to similar data for more than 15 years of observation. Diagnosis, treatment and full rehabilitation of complicated caries of permanent teeth in children is complex, multi-stage and requires the practical experience and patience of a dentist and the usage of the most modern materials and technologies. To date, there are no clear scientifically based protocols for the restoration of permanent teeth, in particular with incomplete root formation, after endodontic treatment. The usage of modern technologies of orthopedic dentistry and materials science (3D scanner, 3D printer, T-scan, polymers) will allow to significantly improve the quality of comprehensive treatment and rehabilitation of children with complications of caries of permanent teeth.
Key words: permanent teeth, caries, children, hard tooth tissues, tooth restoration, endodontic treatment, digital dentistry
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Proshchenko N.S., Sorochenko H.V., Ostapko O.I., Plyska O.M., Trokhimets Yu.V. Complicated caries of permanent teeth in children: status of the problem and modern solution ways. Medicni perspektivi. 2023;28(3):128-136. DOI: https://doi.org/10.26641/2307-0404.2023.3.289211
Prodanchuk M.H., Basanets A.V., Kravchuk O.P., Hashynova K.Y., Hvozdetskyy V.A. Analysis of the dynamics of occupational morbidity and its consequences in Ukraine in comparison with other countries of the world
In general, 5-7% of global deaths are related to occupational diseases and industrial injuries. The social expenses related to occupational diseases reach 2-14% of the gross national product (GNP) in different countries. The aim of the investigation is to analyze the indicators and dynamics of occupational morbidity, related incapacity for work and disability in Ukraine in comparison with other countries of the world. The analysis of reporting materials of the State Labor Service of Ukraine, reports of the World Health Organization, and the International Labor Organization was carried out. According to the State Statistics Committee of Ukraine, the number of people working in the main sectors of the economy in conditions that do not meet sanitary and hygienic standards and requirements is 836,600 people, or 28.4% of the registered number of full-time employees. The results obtained in the study indicate the discrepancy of statistical data on occupational morbidity and its consequences with the real situation: the level of occupational morbidity in Ukraine is 17 times lower than the European average, despite the fact that the working conditions in most of them do not meet hygienic standards. The most common occupational diseases in Ukraine are diseases caused by dust exposure: pneumoconiosis, chronic bronchitis, COPD, which make up 39% of the occupational morbidity structure. The global indicator of Disability Adjusted Life Year (DALYs) from the occupational exposure factors in the world (5.1%) is 3 times higher than the similar one in Ukraine (1.53%). The rate of Years lived with disability (YLDs) caused by occupatipnal factors in Ukraine is 0.38 per 100,000 population, and is significantly lower than the similar rate in most European countries and the USA as well. Obvious distortion of statistical indicators on occupational morbidity and related consequences leads to inconsistency in determining priority areas of health care activity. Due to the process of reintegration of Ukraine into the European Union, the requirements for sanitary and hygienic working conditions, medical and sanitary services for workers, the system of recognition, registration and prevention of occupational diseases should definitely be adapted to international requirements and recommendations as well.
Key words: occupational diseases, incapacity, handicap
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Gulich M.P., Petrenko O.D. Healthy nutrition as a disease prevention factor: WHO Policy and National Experience (to mark the 75th anniversary of WHO in Ukraine)
In the context of the constant increase in the burden of chronic non-communicable diseases, the World Health Organization's (WHO) activities are aimed at developing policies and strategies in the field of non-communicable disease (NCD) prevention, which have been continuously evolving. The work is dedicated to examining the sequential policy of the WHO outlined in documents regarding the link between nutrition and the development of non-communicable diseases. The objective of this study is to identify the main stages of WHO's policy on healthy nutrition as a key prerequisite for preventing the development of non-communicable diseases and outline the corresponding measures in Ukraine. Materials and methods: informational, bibliographic, normative-legal. The study utilized systematic-structural, formal-logical, bibliographic, and non-formalized (traditional) analysis methods. An analysis of WHO's policy on healthy nutrition as a factor in preventing the development of chronic non-communicable diseases has been conducted. The key stages of policy development and decision-making at the global level over the past three decades have been identified. It has been determined that the evolution of the role of nutrition within WHO's policy has progressed from urging governments to develop national food policies and create national action plans in the 1990s to global strategies and actions that have taken place in the 21st century. The basic WHO documents regarding the link between nutrition and the development of chronic diseases have been examined, as well as the expansion of understanding the content and necessity of healthy nutrition. The implementation of WHO's policy in Ukraine has been highlighted: the "National Action Plan on Non-communicable Diseases to Achieve the Sustainable Development Goals by 2030" (2018) has been developed and implemented, serving as a roadmap for the development of a series of guiding documents. The most important of these documents pertain to the organization and standards of healthy nutrition for children. However, the formation of a national regulatory and legal framework regarding healthy nutrition has not yet been completed. It has been determined that Ukraine needs to improve its policy on limiting the use of saturated fats, industrially produced trans fatty acids, and marketing unhealthy food and non-alcoholic beverages targeted at children. There is a need for extensive informational and educational activities to promote WHO's recommendations on healthy nutrition.
Key words: healthy nutrition, prevention of chronic diseases, WHO policy, legislative and regulatory acts of Ukraine, healthy eating habits
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Gulich M.P., Petrenko O.D. Healthy nutrition as a disease prevention factor: WHO Policy and National Experience (to mark the 75th anniversary of WHO in Ukraine). Medicni perspektivi. 2023;28(3):152-162. DOI: https://doi.org/10.26641/2307-0404.2023.3.289218
Prokopov V.О., Lypovetska О.B., Kulish T.V. Hygienic assessment of dangerous chlorites in drinking water treated with chlorine dioxide and the risk of its consumption to the health of the population
Today, chlorine dioxide has begun to be more widely implemented in water treatment technologies on river running water systems of Ukraine. Chlorine dioxide is used in traditional water treatment technology for both primary and secondary water treatment on the Dnipro running water system in Kyiv. Objective – to analyze the results of the content of dangerous chlorites in tap drinking water of certain districts of the city of Kyiv, and calculate and assess non-carcinogenic risk of this drinking water for human health. It was shown that in the drinking water from the running water networks of Svyatoshynskyi, Shevchenkivskyi, Obolonskyi and Podilskyi districts of the city, into which it enters after treatment with chlorine dioxide from the Dnipro running water system, the levels of chlorites were the lowest in winter and spring. In summer, the concentrations of chlorites in the water from the studied networks were the highest and averaged from 0.32 to 0.45 mg/dm3. In autumn, chlorites in the water from these systems were at the level of 0.22-0.28 mg/dm3. In spring (May) and especially in summer, the levels of chlorites in drinking water, according to average data, exceeded the national hygienic standard (0.2 mg/dm3) by 1.5-2 times, but they were never higher than the chlorite standard (0.7 mg/dm3) recommended by WHO. Our analysis of sanitary-chemical and microbiological indicators in drinking water showed that the water is characterized by high quality and safety during the entire period of observation. The risk assessment of the development of non-carcinogenic effects for the oral route of intake of chlorites with drinking water from the specified water networks based on average annual data showed the value of the danger coefficient (HQ) at the level of 0.24-0.38, that is, it was lower than 1.0. The danger coefficient for chlorite content in drinking water was also determined at the level of 0.2 mg/dm3 and 0.7 mg/dm3. According to this indicator, the lifetime use of drinking water with a chlorite content of 0.2 mg/dm3 and even 0.7 mg/dm3 does not pose a threat to human health, since the danger coefficient is within 1.0, which is a permissible (acceptable) risk by degree of danger. Thus, the use of chlorine dioxide in traditional water treatment technology ensures high quality and safety of drinking water in terms of microbiological and sanitary-chemical indicators. There is a periodic (mainly in summer) excess of chlorite content in drinking water in relation to the national standard (0.2 mg/dm3), but its level was never higher than the standard recommended by WHO (0.7 mg/dm3). It has been shown that the existing levels of chlorites in drinking water and its use with such a toxic load do not pose a threat to human health.
Key words: drinking water, chlorine dioxide, chlorites, drinking water quality, non-carcinogenic risk
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Prokopov V.О., Lypovetska О.B., Kulish T.V. Hygienic assessment of dangerous chlorites in drinking water treated with chlorine dioxide and the risk of its consumption to the health of the population. Medicni perspektivi. 2023;28(3):162-169. DOI: https://doi.org/10.26641/2307-0404.2023.3.289220
Komilova N., Egamkulov Kh., Hamroyev M., Khalilova Kh., Zaynutdinova D. The impact of urban air pollution on human health
Atmospheric air can be polluted as a result of the ingress of various chemicals into it, which have a harmful effect on human health, causing an exacerbation of cardiovascular, airborne diseases, diseases of the gastrointestinal tract and the endocrine system, and exceeding the norms of dust content in the air leads to an increase in incidence of allergies and bronchial asthma. The relevance of the subject under study lies in the investigation of the sources of air pollution, as they lead to an increase in the degree of morbidity and mortality among the population. This, in turn, requires a radical change in the way people live, as well as the adoption of specific measures to ensure the reduction of air pollution. In this regard, the objective of this study was to perform a comprehensive analysis of the ecological and hygienic conditions of atmospheric air and evaluate its impact on human health due to pollution. The study incorporated empirical research methods such as empirical description and comparison to analyze emissions of pollutants, assess population morbidity rates, and conduct correlation and regression analyses. Official data from the State Committee of Uzbekistan on Statistics and scientific papers were utilized, alongside statistical analysis techniques and logical reasoning to investigate atmospheric air pollution and its impact on public health. The study analysed the indicators of emissions of pollutants into the atmosphere in the Republic of Uzbekistan as a whole and by regions. Furthermore, the paper provides a detailed analysis of the general morbidity of the population of the Republic of Uzbekistan and indicators of the incidence of cardiovascular diseases, based on which a correlation and regression analysis was performed. In addition, the morbidity rates of the population with diseases of the respiratory system and eye diseases throughout the Sirdaryo Region were analysed. The study revealed that Uzbekistan experiences high levels of environmental pollution, with a direct correlation found between atmospheric pollutants and the incidence of cardiovascular diseases, respiratory organ issues, and eye conditions. To protect the atmosphere, reducing pollutant emissions and implementing sustainable development principles, such as industrial modernization and the use of alternative energy sources, are necessary. The results highlight the importance of identifying pollutant types, their properties, and release conditions for effective pollution assessment. The practical significance of this study is to optimize the data of environmental monitoring of urban air pollution in the Republic of Uzbekistan, where in general there is a high level of pollutants in the atmosphere, which affects the health of the population.
Key words: urbanization, pathological condition, atmosphere, total mortality, industry
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Kodynets A.O., Doroshenko O.F., Volynets I.P., Dorozhko G.K., Petrenko V.O., Belitsky V.V. Supplementary protection of intellectual property rights for medicines
The article discusses the issue of extending the legal protection of intellectual property rights for medicines. The research aims to provide a comprehensive overview of the problems related to the implementation of Supplementary Protection Certificates (SPCs) in national legislation and possible solutions. The study also seeks to draw conclusions and make proposals for improving the regulatory framework for the SPCs of medicines. The work utilizes general scientific and specialized methods of scientific cognition, including dialectical, formal-logical, systemic-structural, comparative legal, as well as modeling, analysis, and synthesis methods, which collectively contributed to the organization, planning, and conduct of the research. The study is based on scientific publications from databases and search systems (PubMed, JAMA, Scopus, Springer, BMC, Oxford Academic), international and national regulatory acts, statistical studies by international organizations (Precedence Research), patents for inventions related to medicines, recommendations by national government bodies, as well as prescriptions and guidelines from international and national experts. Considering the analysis of statistical data on the development and implementation of medicines, it has been determined that original biological medicines are a major factor in the rising prices of treating conditions such as diabetes, oncological diseases, and others. Examples of patents for medicines owned by global pharmaceutical companies (Gilead, Bayer Intellectual Property Gmbh, etc.) that have ensured their commercial success and competitive advantages are examined. It has been established that patent protection provides the right holder with the opportunity to maintain a monopoly in the market, thereby compensating for the time spent on the development and research of original medicinal products. Legislative approaches to regulating relationships concerning the supplementary protection of inventions related to medicines in the form of SPCs in Ukraine and the EU are identified. The exclusivity periods for regulatory data protection for medicines in the EU are outlined. Based on the conducted research, it is concluded that the application of the SPC mechanism is a tool to achieve a balance between the protection of intellectual property rights and access to original medicines. Timely entry of generics and biosimilars to the market contributes to reducing market prices but negatively impacts the profitability of manufacturers of original medicines. Attention is drawn to problematic aspects of the legislative implementation of the SPC mechanism in Ukraine, which leads to incorrect interpretation and implementation of relevant provisions and necessitates updating. In light of the aforementioned, there is an urgent need in Ukraine to implement, update, and improve the legislative mechanism for regulating SPCs.
Key words: medicines, intellectual property, supplementary protection certificate, legal protection, patent
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Kodynets A.O., Doroshenko O.F., Volynets I.P., Dorozhko G.K., Petrenko V.O., Belitsky V.V. Supplementary protection of intellectual property rights for medicines. Medicni perspektivi. 2023;28(3):180-189. DOI: https://doi.org/10.26641/2307-0404.2023.3.289223
Kaduk D.Ye., Aleksandrova T.M., Talapova P.S., Agieieva I.B., Ved M.M., Trofymenko M.O., Kolesnyk M.R., Nesmiian T.S. Current state and prospects of implementation of data standardization in the health care system of Ukraine (literature review)
The orientation of the world medical community, and Ukraine in particular, towards the improvement of the quality of medical services includes the introduction of modern tools and methods for quality regulation in the healthcare system. The focus of research on the modernization of medical services, methods and forms of treatment and diagnosis, as well as focus on global experience in regulating the quality of services provided by relevant institutions, undoubtedly contributes to the transition of the Ukrainian healthcare system to a new level. One of the most powerful and modern ways to improve the medical health care system is to introduce the standardization of the format and content of medical data. Quality implementation of the standardization program is a leading factor in the improvement of the quality of medical services, such as: early detection of diseases and emergencies, setting new therapeutic goals, improving the quality of clinical trials, improving of assessment of the quality of medical services and work of the doctors and nursing staff, improving the efficiency of health care programs, improving the safety of use of medical devices, forecasting medical consequences, reducing administrative costs, integrating artificial intelligence into the healthcare system, etc.
Key words: data standardization, common data model (CDM), eHealth, Observational Medical Outcomes Partnership Common Data Model (OMOP CDM)
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Kaduk D.Ye., Aleksandrova T.M., Talapova P.S., Agieieva I.B., Ved M.M., Trofymenko M.O., Kolesnyk M.R., Nesmiian T.S. Current state and prospects of implementation of data standardization in the health care system of Ukraine (literature review). Medicni perspektivi. 2023;28(3):190-198. DOI: https://doi.org/10.26641/2307-0404.2023.3.289226
Yaroshenko R.A., Panasenko S.I., Chorna I.O., Khorosh M.V., Ligonenko O.V. Epidemiology of gastrointestinal bleedings compared in Ukraine and in the Poltava region
Acute gastrointestinal bleeding was and remains one of the severe emergency surgical diseases both in Ukraine and in other countries. The study of epidemiology, namely of the prevalence of gastrointestinal bleedings is relevant and will allow to intensify the diagnostic stage and create clearer algorithms for the treatment of this pathology. The aim of the work was to study the dynamics of emergency medical care for patients with gastrointestinal bleedings in Ukraine and the Poltava region. A statistical retrospective study of indicators of emergency medical care for patients with gastrointestinal bleedings in Ukraine and the Poltava region was conducted using data from official sources of the Center for Medical Statistics of the Ministry of Health of Ukraine. The wave-like nature of the increase in hospitalization of patients with gastrointestinal bleedings was observed in Ukraine and the Poltava region. The growth rates obtained as a result of the alignment of the dynamic series gave a clear trend towards the acceleration of the decline of this indicator: from -1.25 to -1.36 in Ukraine; and in the Poltava region before increasing the rate: from 4.85 to 3.62. During the entire studied period, the average level of hospitalization of patients with gastrointestinal bleeding after 24 hours was consistently higher in the Poltava region than in Ukraine (in Ukraine – 36.13% versus 43.16% in the Poltava region) (р<0.05). The rate of postoperative mortality in these patients in Ukraine increased (from 5.02% to 6.30%) (р<0.05)with gradual inhibition (the growth rate decreased). In the Poltava region, the level of the indicator exceeded the national level and the leveling of the dynamic series had a downward trend (from 12.4% to 10.38%) (р<0.05). Thus, the problem of gastrointestinal bleeding remains relevant at the present time, as it continues to remain one of the severe urgent surgical diseases, both in Ukraine as a whole and in its individual regions, in particular in the Poltava region. Peptic ulcer disease of the stomach and duodenum continues to remain the first nosology that causes gastrointestinal bleeding. Postoperative mortality remains high and ranges from 5% to 12%. The time of hospitalization from the onset of the disease to hospitalization is consistently higher in the Poltava region than in Ukraine (the average level in Ukraine is 36.13% versus 43.16% in Poltava region) (р<0.05).
Key words: acute gastrointestinal bleedings, emergency medical care, epidemiology, statistical study
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Yaroshenko R.A., Panasenko S.I., Chorna I.O., Khorosh M.V., Ligonenko O.V. Epidemiology of gastrointestinal bleedings compared in Ukraine and in the Poltava region. Medicni perspektivi. 2023;28(3):198-204. DOI: https://doi.org/10.26641/2307-0404.2023.3.289227
A CASE FROM PRACTICE
Myndziv K.V., Yarema N.I., Vereshchahina N.Ya., Bondarchuk V.I., Hevko U.P., Vayda O.V. Application of diagnostic methods in the verification of Lyme carditis (clinical case)
The aim of the reserch was to investigate the genotype of the pathogen in a patient with Lyme carditis and to analyze the course of the disease in the process of etiotropic treatment. The article describes a clinical case of infectious myocarditis associated with Lyme disease in a 49-year-old patient. The value of modern diagnostics technologies in diagnosis determination was described. The course of the disease and the results of treatment of the patient were analyzed. The severe rhythm and conduction disorders were revealed with the method of Holter monitoring: AV-block of the first degree, transient AV-block of the II degree (Mobitz 2) and III degree, polytopic extrasystoles. The morphological changes in the heart were diagnosed with ultrasonography and cardiac MRI in order to confirm the diagnosis and to monitor the patient's subsequent course. Total antibodies to antigens of the B. burgdorferi sensu lato complex in blood serum were determined by the ELISA method with test systems Euroimmun AG (Germany). At the second stage, the immunoblot method was applied using the EUROLINE Borrelia RN-AT test system. Due to timely diagnosis, including serological, prescribed etiotropic antibacterial treatment, the patient achieved a significant improvement in both clinical condition and positive serological and ECG dynamics with improved AV conduction. The most frequent ECG changes in Lyme carditis are conduction disorders with development of blockades of various stages. The application of the modern technologies in patients with myocarditis made it possible to determine the etiological factor of the disease with the establishment of genotypes, which caused Lyme carditis.
Key words: Lyme disease, myocarditis, AV-block, serological testing, Holter monitoring, ultrasonography, magnetic resonance imaging
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Myndziv K.V., Yarema N.I., Vereshchahina N.Ya., Bondarchuk V.I., Hevko U.P., Vayda O.V. Application of diagnostic methods in the verification of Lyme carditis (clinical case). Medicni perspektivi. 2023;28(3):205-212. DOI: https://doi.org/10.26641/2307-0404.2023.3.289228
Sanina N.A., Hondulenko N.O., Panina S.S., Shulha V.S. A clinical case of asymptomatic pancreatic hyperenzymemia on the background of taking a Glucagon-like peptide-1 analogue (GLP-1)
According to current statistics, the incidence of type 2 diabetes has increased significantly over the past few years. The number of drugs prescribed to correct carbohydrate metabolism is also increasing, and new groups of hypoglycemic drugs are appearing. This prompts a more detailed study and analysis of the possible side effects of the prescribed therapy. One of the modern groups of medications f or treating type 2 diabetes are analogues of glucagon-like peptide-1 receptor agonists, which, in addition to correcting carbohydrate metabolism, have a beneficial effect on the risk of developing cardiovascular events. Despite this, there is evidence that their use may be associated with the development of undesirable adverse effects from the pancreas, particularly acute pancreatitis, pancreatopathy, or asymptomatic hyperenzymemia. The aim of our work was the analysis of a clinical case of an asymptomatic increase in the level of pancreatic enzymes (Gullo's syndrome) in a patient with type 2 diabetes, who used a glucagon-like peptide-1 receptor analogue for treatment according to the usual scheme (dulaglutide 0.75 mg subcutaneously once a week during 2 years). As a result, the patient developed a side effect that could be related to taking this medicine. This did not lead to the withdrawal of the drug but required a more thorough examination of the patient and regular further screening for the timely detection of the development of possible organic pathology of the pancreas in the future. So, after analyzing this clinical case, it is possible to see the possibility of developing asymptomatic pancreatic hyperenzymopathy during the treatment of type 2 diabetes mellitus with glucagon-like peptide-1 receptor agonist analogues, which should be taken into account when determining the treatment tactics.
Key words: asymptomatic pancreatic hyperenzymemia, glucagon-like peptide-1, type 2 diabetes
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Sanina N.A., Hondulenko N.O., Panina S.S., Shulha V.S. A clinical case of asymptomatic pancreatic hyperenzymemia on the background of taking a Glucagon-like peptide-1 analogue (GLP-1). Medicni perspektivi. 2023;28(3):213-217. DOI: https://doi.org/10.26641/2307-0404.2023.3.289229
Zhdan V.M., Ivanytskyi I.V., Babanina M.Y., Ivanytska T.A., Kitura Y.M., Volchenko H.V., Tkachenko M.V., Kyrian O.A., Lebid V.H. Possibilities of ultrasonography in the diagnosis of pigmented villonodular synovitis. Clinical case
Pigmented villonodular synovitis is a rare proliferative disease of the synovial membrane, which most often affects the knee joints. Being a benign disease, at the same time, this pathology is often aggressive, and in some cases spreads to the soft tissues outside the joint. There are two forms of monoarticular damage: localized and diffuse. The diffuse form gives frequent relapses. To date, there are no standards for the management of this disease, just as there are no early markers for the detection of pigmented villonodular synovitis. This joint lesion has a long asymptomatic course, or it has symptoms of non-specific recurrent arthritis, so the patients can later be referred for magnetic resonance imaging, which is the only non-invasive method of diagnosing this pathology. At the same time, in modern conditions, most patients with recurrent synovitis will undergo an ultrasound examination of the joint according to the diagnostic standards. Ultrasonography made for abovementioned synovitis is insufficiently described in the medical literature. The aim of our study was to highlight the current data on the diagnosis and management of patients with pigmented villonodular synovitis and to describe our own clinical case. A feature of our clinical case was the detection of characteristic symptoms using ultrasonography. Irregular thickening of the synovial membrane with nodular formations and villous growths, with the length of villi up to 7 mm near the patella with single loci of blood flow, was revealed by ultrasound examination and power Doppler mapping. Shear wave elastometry of the synovial membrane was performed. It demonstrated a significant increase in the stiffness of the synovial membrane, which can be a pathognomonic symptom of this pathology. The diagnosis of villonodular synovitis was confirmed histologically after surgical treatment. Subsequently, the patient had a recurrence of the pigmented villonodular synovitis, which was also detected by ultrasound diagnostics. Thus, pigmented villonodular synovitis of the knee joint is a rather rare pathology that requires differential diagnosis with inflammatory joint diseases. The final diagnosis is based on histological examination. MRI and ultrasound diagnostics are non-invasive methods that can detect this pathology with high accuracy. The advantage of ultrasonography is its availability and non-invasiveness. The increase in stiffness of the synovial membrane along with its proliferation, which we found, can serve as an additional criterion of villonodular synovitis, and, according to the data available to us, has not been described in the literature so far.
Key words: villonodular synovitis, ultrasound diagnostics, synovial membrane, elastometry
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Zhdan V.M., Ivanytskyi I.V., Babanina M.Y., Ivanytska T.A., Kitura Y.M., Volchenko H.V., Tkachenko M.V., Kyrian O.A., Lebid V.H. Possibilities of ultrasonography in the diagnosis of pigmented villonodular synovitis. Clinical case. Medicni perspektivi. 2023;28(3):218-226. DOI: https://doi.org/10.26641/2307-0404.2023.3.289260
Popovych O.O., Moroz L.V., Chabanov F.A., Androsova O.S., Kulias S.M., Chichirelo-Konstantynovych K.D., Plotytsia L.P. Clinical case of meningoencephalitis of Epstein-Barr viral etiology in an immunocompetent patient
The article describes a rare clinical case of meningoencephalitis of Epstein-Barr viral (EBV) etiology in an immunocompetent patient. The purpose of the work was to acquaint practitioners with the problems of diagnosis and treatment of EBV-neuroinfection, features of the course and management of EBV-meningoencephalitis. The woman, 46 years old, was admitted to the intensive care unit with a diagnosis of mushroom poisoning. Based on clinical-laboratory-instrumental examinations the diagnosis of EBV-meningoencephalitis was made. EBV DNA was detected in the cerebrospinal fluid by polymerase chain reaction (PCR) and magnetic resonance imaging (MRI) of the brain showed focal changes in the left temporal-insular region with signs of leptomeningitis. Taking into account the specifics of this case, the authors of the article came to the following conclusions: EBV-meningoencephalitis can occur in people with normal immune status under conditions of psychological and physical stress; delayed diagnosis of meningoencephalitis at the onset of the disease in this case is associated with the prevalence of clinical manifestations of general brain syndrome, mistakenly regarded as symptoms of intoxication and dyspepsia due to food poisoning; meningoencephalitis of EBV-etiology is accompanied by signs of convulsive, atactic, cognitive and mental syndromes; temporal-insular localization of focal brain changes may be characteristic for EBV-meningoencephalitis; treatment with acyclovir and glucocorticoids may have benefits; complicated vascular anamnesis, bed rest and glucocorticoid therapy predict an increased risk of venous thrombosis, which in this patient was realized as acute sural phlebothrombosis; according to MRI the resolution of leptomeningitis and focal brain changes with gliosis formation occurred 3 months after manifestation of the disease; the risk of the following neurological pathologies due to specific localization of gliosis should be considered and requires medical control.
Key words: Epstein–Barr virus, encephalitis, meningoencephalitis, magnetic resonance imaging, acyclovir, glucocorticoids
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- Cohen JI. Optimal treatment for chronic active Epstein-Barr virus disease. Pediatr Transplant. 2009;13(4):393-6. doi: https://doi.org/10.1111/j.1399-3046.2008.01095.x
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Popovych O.O., Moroz L.V., Chabanov F.A., Androsova O.S., Kulias S.M., Chichirelo-Konstantynovych K.D., Plotytsia L.P. Clinical case of meningoencephalitis of Epstein-Barr viral etiology in an immunocompetent patient. Medicni perspektivi. 2023;28(3):226-233. DOI: https://doi.org/10.26641/2307-0404.2023.3.289264
Samoilenko A.V., Oryshchenko V.Yu., Strelchenia T.M. Oral lichen planus post COVID-19 vaccination: report of two cases
Manifestations of сoronavirus disease 2019, caused by SARS-CoV-2 virus, are diverse and can vary from asymptomatic infection to respiratory failure needing intensive care. Vaccines against SARS‐CoV‐2 focusing on the spike glycoprotein have shown promise in diminishing the spread of Covid‐19. Adverse effects, however, are associated with every vaccination. Currently, there are literature reports of some cases of lichen planus eruption following COVID-19 vaccine injection. Oral lichen planus is a relatively common immune-mediated dermatologic disorder that can occur isolated or associated with cutaneous lichen planus. Postvaccination lichen planus has previously been reported in the literature as a rare adverse event following various vaccinations, especially hepatitis A and B, influenza, and varicella. The majority of patients presented with classic cutaneous lichen planus, although some reports highlighted primarily mucosal involvement. Herein we describe two rare cases of erosive-ulcerous oral lichen planus among SARS-CoV-2 vaccine recipients. The first is a case of a 67-year-old male who developed mucocutaneous lichen planus 5 days after administration of the single-dose of Ad26.COV2.S COVID-19 vaccine. In the second case, a 56-year-old female presented with reactivation of oral lichen planus after receiving a first dose of Pfizer COVID-19 vaccination 2 days earlier. The mechanism of the association between vaccines and lichen planus is not known, it is attributed to cell-mediated autoimmunity. Although there is currently no evidence of a causal relationship between SARS-CoV-2 vaccination and lichen planus, these clinical observations suggest that the COVID-19 vaccine is a possible key initiating event leading to the development or recurrence of this disease.
Key words: COVID-19, oral lichen planus, SARS-CoV-2 vaccine, case report
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