Medicni perspektivi, 2017;22(2 part 1).
2017 Vol. XXII N 2 part 1
UKRAINIAN SCIENTIFIC CONFERENCE
WITH INTERNATIONAL PARTICIPATION IN FAMILY MEDICINE «FROM SCIENCE TO PRACTICE»
Key words: post-graduate education, family doctors, distance learning
Abstract. On the joint work of the Dnipropetrovsk Regional Council and the SЕ «Dnipropetrovsk medical academy of Health Ministry of Ukraine» on distance education of family doctors. Kouyumchyan M.S., Yuryeva L.N., Dukelsky A.A., Maksimenko O.P. In the conditions of local government functioning, the solution of issues of education, health, culture, physical education and sports is one of authorities of the executive bodies of rural, village, city councils. The article highlights the experience of cooperation between the «Dnipropetrovsk medical academy of Health Ministry of Ukraine» and the Dnipropetrovsk Regional Council on creation and implementation of the Internet conferences on distance learning, consultations of family doctors of Dnipropetrovsk region on urgent issues of delivering medical care to the population.
Key words: essential hypertension, metabolic syndrome, comorbidity, systemic inflammation
Abstract. Comparative evaluation of some markers of systemic inflammation in essential hypertension patients with metabolic syndrome and in the context of comorbidity. Burmak Yu.G., Petrov Ye.Ye., Тreumova S.І. In patients with essential hypertension (EH) aged 44 - 57 years (33 men, 21 women) with metabolic syndrome (n=23) and comorbid peptic ulcer (n=31) there was conducted study of proinflammatory tumor necrosis factor α in the blood serum, end product of lipid peroxidation of malonic dialdehyde, total content of nitroxide metabolites and ristomycin-induced platelet aggregation. It is shown that in patients with comorbid pathology, there was a high proinflummutory activity of blood serum, significantly intensified process of lipid peroxidation, elevated content of tissue component of primary hemostasis and decreased total content of nitroxide metabolites, preserved during the period of clinical laboratory remission. The emphasis on the need to monitor such violations for correction of treatment and development of preventive measures was made.
Key words: aortic stiffness index, HIV, CD4+ T-lymphocytes, total cholesterol
Abstract. Aortic stiffness index as a marker of subclinical atherosclerosis in HIV-infected patients. Vasylenko V.A. 121 HIV-infected patients clinical manifestations of cardiovascular pathology were examined. The aim of the study was to establish the degree of aortic elasticity loss in such patients by means of aortic stiffness index (ASI) determination. It has been established that among patients who have not been prescribed antiretroviral therapy (ART), yet ASI rises to 1.18 ± 0.02 mm Hg/ml. The maximum values (1.29±0.01 mm Hg/ml) were registered in HIV-infected people receiving ART. Direct correlations between ASI and duration of HIV infection, the number of CD4+ T-lymphocytes, total cholesterol concentration were established.
Key words: constipation, functional disorders of the digestive system
Abstract. Мanagement оf patients with constipation at the ambulatory stage. Visochina І.L., Bashkirova N.S. Constipation syndrome is an important medical and social problem, which is associated with a decrease in the quality of human life. By Legislation of Ukraine, the management of patients with constipation (independent diagnosis, independent treatment and provision of preventive measures in constipation in patients of different ages) is the duty of the general practitioner-family medicine doctor. The article suggests algorithm of management of patients with constipation at the ambulatory stage.
Key words: Kawasaki disease, incomplete form, infants
Abstract. A case report of Kawasaki disease in a 7-month-old infant. Gayduk O.I., Ivanus' S.G., Cherginets V.I., Gayduk T.A., Bashkirova N.S. We presented a case of Kawasaki disease in a 7-month-old infant. Its features were the late diagnosis (day 18 of the disease), early age of the infant, atypical (incomplete) form of the disease. Though intravenous immunoglobulin was administered in late terms of the disease course against formed aneurysms of the coronary arteries, a decrease in their size and complete disappearance by the age of 9 months were observed in dynamics.
Key words: arterial hypertension, left ventricular hypertrophy, risk factors, children
Abstract. Relationship between left ventricular myocardial mass index and risk factors in adolescents with arterial hypertension. Gayduk T.A., Shostakovich-Koretska L.R., Gayduk O.I., Ivanus' S.G., Baralej T.V., Kramarenko L.N., Ustimenko M.A. 118 children aged 12-17 years with stable and labile forms of arterial hypertension (AH) and prehypertension hospitalized to pediatric cardiopulmonary department due to elevation of blood pressure (BP) onetime-measured at ambulatory stage were observed. A high frequency of left ventricular hypertrophy (LVH) in children and adolescents with hypertension (33.9%) is established. Analyzing univariant models, it was shown that the risk of LVH formation in children with hypertension was associated (P <0.05-0.001) with indicators characterizing the presence of abdominal excess of body weight or obesity (BMI, RT, ratio of actual weight to body weight at birth), lipids and carbohydrates (blood insulin level, IR HOMA), hereditary load in cardiovascular diseases, as well as with indicators of ABPM, which characterize AH. Indices of TG and LDL / HDL ratio are of prognostic value among the factors that characterize lipid metabolism. Together with BMI, they increase the maximum probability of LVH formation (with the worst values of the indices) from p=0.75 to 0.952 and the forecast accuracy from 78% to 80.5%.
Key words: destructive tuberculosis, chronic bronchitis, clinical and instrumental methods of examination
Abstract. Clinical and instrumental algorithm of tuberculosis diagnosis against with chronic bronchitis. Il'nyts'kyy I.H., Bilozir L.I., Kostyk O.P., Tymchak E.V., Starichek H.V., Kashkadamova S.M., Tymchak A.I., Havrylyak-Stadovych Z.V., Fedchyna O.Ya., Zhylovs'ka O.V., Shvayenko N.P., Stadovych O.I. Aim of the study was developing the criteria of clinical-instrumental and laboratory diagnostic algorithm for pulmonary tuberculosis against chronic bronchitis. In modern conditions clinical course of pulmonary tuberculosis is often manifested by the development of specific process on a background of chronic bronchitis, characterized by the presence of common manifestations of both diseases, complicating the timely diagnosis of tuberculosis, and therefore the problem of relation of these two diseases requires in-depth study. The study involved 300 patients with destructive pulmonary tuberculosis aged 15-67 years: in 93 (31,0 %) tuberculosis was combined with chronic bronchitis, in 207 (69,0%) - only pulmonary tuberculosis. Clinical, laboratory and instrumental methods were used in the survey. In 31,0% of patients a big proportion of chronic bronchitis was established before the specific inflammation. Acute onset with the presence of productive cough was observed in 26 (27,9%) of patients, elevated erythrocyte sedimentation rate - in 49 (52,6%) and leukocytosis - in 29 (32,0%), more often it was expressed in patients with mixed-pathology. These patients experienced a longer period of healing of destructive process. Antimycobacterial therapy revealed high therapeutic effect in patients with tuberculosis combined with chronic bronchitis: the cessation of bacterial excretion was observed in 85 (96,6%) and the healing of destructions - in 76 (81,7%) patients, which is slightly inferior to the results of treatment of patients with history of pulmonary tuberculosis only. The presence of two variants of endobronchitis: nonspecific diffuse inflammation of the bronchi, as a result of symptoms of chronic bronchitis, and so-called reactive "paraspetsific" endobronchitis as a result of toxic-allergic effect of tuberculosis was established.
Key words: gluten intolerance, children gluten-free diet
Abstract. Gluten intolerance without celiac disease - recommendations for dietotherapy in children. Kazytska N.M., Stepanenko T.І., Kharitonova O.N., Perekhrest І.M. The article describes the possibilities of dietary treatment of gluten intolerance without celiac disease. Gluten-containing foods and products containing hidden gluten are presented, stage rehabilitation and a variant of a gluten-free diet for young children are offered.
Key words: tuberculin sensitivity, allergen tuberculosis recombinant, risk groups, informative test
Abstract. Comparative evaluation of results of intraskin tests with standard tuberculin (Mantoux test) and Allergen Tuberculosis Recombinant (ATR-test) in children from risk groups for tuberculosis Kolisnyk N.S., Taran S.K., Fedosova S.S. The aim of our study was to investigate informative value of intradermal tuberculin tests with standard tuberculin and with allergen tuberculosis recombinant (ATR) in children with established and nonestablished contact with TB patients. The results of skin tests - Mantoux test and test with allergen tuberculosis recombinant (ATR) of 759 children who lived in the centers of tuberculosis infection (first group) and 1006 children from a healthy environment (second group) were analyzed. Analysis of results of Mantoux test in children of both groups revealed no significant differences in the frequency of positive reactions and intensity of tuberculin sensitivity: the most often reactions with mild to moderate sensitivity to tuberculin were recorded. However, the results of tests with ATR differed significantly between groups of observation: among contact children positive responses were recorded three times more often - in 422 (55.6%) than in children from a healthy environment - in 172 (17,1%), p<0,05. The degree of intensity of sensitivity to ATR in contact children was significantly higher than in children from a healthy environment; this is testified by average size of infiltration - (15,7±0,3) mm and (13,4±0,3) mm, respectively, p<0,05. When conducting CT scan of the chest in patients with positive and doubtful reactions to ATR, additionally changes in the lungs or intrathoracic lymph nodes were detected in 213 individuals (12.0%), while using standard radiation methods changes were registered only in 43 children (2,4%), p<0,05.
Key words: essential hypertension, daily monitoring of arterial pressure, bisoprolol
Abstract. Influence of bisoprolol on parameters of daily monitoring of arterial pressure in patients with hypertonic disease. Koshlia V.I., Mouna Ben F,id, Skliarova N.P., Vrabie I.P. In 32 patients with essential hypertonia of which 17 with I degree and 15 with II degree of hypertonia the influence of bisoprolol on parameters of daily monitoring of arterial pressure has been studied. Bisoprolol was administered once in day in a dose of 5 mg. Course of treatment made up 18-21 days. Carried out researches have shown, that bisoprolol therapy led to a stable decrease in arterial pressure, this effect was growing during the course of treatment. Therewith a multifaceted corrective influence on parameters of a daily profile of arterial pressure was marked, owing to this the rate of daily rise of arterial pressure decreased.
Key words: hypertension, hyperuricemia, antihypertensive drugs
Abstract. Therapeutic strategy of the family doctor on the choice of therapy in patients with hypertension combined with hyperuricemia. Kuzmina G.P., Lazarenko O.M., Markova O.Y. Most patients with hypertension combined with hyperuricemia seek help from a family doctor who must understand the importance of prescribing adequate antihypertensive therapy, not only to control blood pressure, but also to control the level of uric acid. The aim of the study is to analyze the strategy of the family doctor for the choice of therapy in patients with hypertension in combination with hyperuricemia at the primary stage. A sociological survey of general practitioners of family medicine (n=30) was carried out according to a specially developed questionnaire. It was found that general practitioners administer appoint patients with hypertension in combination with hyperuricemia main groups of antihypertensive drugs of the first line, preferring drugs with proven hypouricemic effect. Among sartans valsartan and losartan are preferred, among ACE inhibitors – ramipril and enalapril, among calcium antagonists – amlodipine and lercanidipine, among diuretics – hydrochlorothiazide, which is usually prescribed in triple antihypertensive therapy. Most physicians (53.3%) prescribe xanthine oxidase inhibitors (allopurinol, febuksostat) for asymptomatic hyperuricemia in patients with hypertension.
Key words: premature babies, physical development, Fenton graphs
Abstract. Features of physical development of premature infants in the first year of life. Plekhanova T.N., Kharytonova O.N., Perekhrest I.M. The first year of life of preterm infants is the most important period in the development and implementation of compensatory possibilities. Physical impairment in post-neonatal period significantly correlates with long-term neurological and somatic consequences. We assessed physical development of infants with birth weight less than 2000 g before discharge from the hospital and at the age of one year of their chronological age. We have found that only in 30% of children with ELBW and in about 50% with low and very low birth weight physical development before discharge corresponds to the gestational age. By the end of the first year of life in 40-50% of children with birth weight less than 2000 g impairments of physical development are formed. Monitoring of physical development of premature infants using Fenton graphs allows to detect deviations and carry out correction.
Key words: arterial hypertension ,chronic obstructive pulmonary desease, primary health care level
Abstract. The problems of diagnosis and treatment of patients with arterial hypertension combined with COPD at the primary level of medical care according to retrospective analysis. Potabashniy V.A., Fesenko V.I., Burtniak T.Z. The purpose of this study was to determine the quality of primary care, as well as clinical and instrumental examination of patients with arterial hypertension (AH) combined with COPD by retrospective analysis of outpatient cards. As a result of the research, insufficient volume of examination and treatment was revealed, which is a sign of hypodiagnosis of AH combined with COPD. Groups of drugs used in the treatment of these patients the most frequent are also identified.
Key words: сognitive impairments, hypoglycemia, geriatric syndrome, diagnosis, clinical cases
Abstract. Analysis of clinical cases with syndrome of cognitive impairment in ambulatory medical practice. Rosytska О.А. The urgency of problem of diagnosis and differential diagnosis of cognitive impairment and dementia in outpatient practice is due to a large number of diseases occurring with the syndrome of cognitive impairments of varying degrees. The article presents clinical cases of patients of different age with reversible cognitive impairments.
Key words: clinic ZPSM, dementia, cognitive impairment, diagnosis, algorithm of actions
Abstract. Dementia syndrome – approaches to diagnostics in the general medicine practice. Rosytska O.A. In the article algorithm of actions of a general practitioner - family physician in detecting cognitive impairment (dementia) in patients under the current Order of Ministry of Health Ukraine from 07.19.2016 N 736 is presented. To optimize the work of physician at the primary level, differences of diagnostic search at primary and secondary levels of care delivery were analyzed.
Key words: premature babies, bronchopulmonary dysplasia, factor analysis
Abstract. Regression factors of clinical manifestations of bronchopulmonary dysplasia in premature infants. Stepanenko T.І., Kazytska N.M., Latsins'ka S.A. In order to study regression factors of clinical manifestations of bronchopulmonary dysplasia (BPD) during the first year of life in 136 preterm infants with BPD, the multifactor analysis of biomedical risk factors, RDS course characteristics, duration and parameters of ventilation, use of medications, pulse oximetry, echocardiography, radiography was carried out. As a result of the study, it was shown that in addition to such factors as gestational age (r=0.74), duration of mechanical ventilation (r=-0.79), "severe" ventilation parameters (r=-0.73), nutritional factors (early onset, lack of food disruption), the presence of an open arterial duct (r=0.53), diseases of the nervous system (r=0.49) had а large effect on regression of сlinical manifestations of BPD. Brocholitic and inhaled steroid therapy had a moderate effect on regression of clinical manifestations of BPD. Thus, for favorable outcome of BPD, it is necessary to organize a dispensary observation with control over the course of comorbid diseases, rational nutrition of a premature baby in the first year of life, differentiated approach to drug therapy.
Key words: chronic glomerulonephritis, arterial hypertension syndrome, differentiated approach, treatment
Abstract. Differentiated approach to correction of high blood pressure in patients with chronic glomerulonephritis. Chernilovsky A.V., Yashkina T.O., But N.А., Turenko E.A., Chernilovskaya S.V. Actuality of chronic kidney disease (CKD) in ambulatory practice of a family doctor is determined by various factors, including development and progression of hypertension, which in its turn necessitates selection of adequate treatment of this condition. The aim of our study was to study choice of amount of drug therapy in control of high blood pressure in patients with chronic glomerulonephritis depending on the level of GFR decrease confirms the need in differentiated approach to correction of high blood pressure, depending on GFR level.
Key words: obesity, NAFLD, prediabetes, type 2 diabetes, cardiovascular risk
Abstract. Modern views on etiology and pathogenesis of nonalcoholic fatty liver disease (literature survey). Chopey I.V., Griadil T.I., Chubyrko K.I. Judging from literature data on pathogenesis of NAFLD, the disease itself may be considered as independent risk factor of CVD as it was proved a close link of the latter with insulin-resistance and further with diabetes type 2 and dislipidemia. The question on whether the patients with pre-diabetes and NAFLD are related to one or another cardio-vascular risk group remains unsolved.
Key words: obesity, prediabetes, type 2 diabetes, cardiovascular risk
Abstract. The study of cardiovascular risk in patients with obesity against prediabetes and type 2 diabetes. Chubirko K.I. In patients with 2 degree obesity and prediabetes there was established a very high cardiovascular risk (10,70±1,07%), this risk is reliably higher as compared with patients with prediabetes without obesity (4,85±1,12%). In patients with obesity against type 2 diabetes this risk was higher by 2,5 times (25,05±3,56%) as compared with patients with obesity and prediabetes. It was proved that usage of therapeutic scheme including balanced diet with daily requirements in proteins, fats and carbohydrates, 30-minutes’ sharp work daily, rosuvastin 10 mg/d, omega-3 PUFA 1000 mg/d and ursodeoxycholic acid 10 mg/kg/d in patients with obesity and prediabetes favors decrease of cardiovascular risk as in patients with obesity and type 2 diabetes with inclusion of sitaglyptine in the dose of 100 mg/d.
Key words: KROK-3, STEP 3, educational process, licensing, internship
Abstract. Features of realization of the project STEP-3 in the structure of the licensed examination KROK-3. Bolonska A.V., Sorokina O.Ju., Buryak T.O. Comparative analysis of two licensed testing KROK-3 and STEP-3 is a part of the reform of medical education in Ukraine. Significant changes in the assessment of knowledge and skills of interns set issues that require further consideration of educators. Study of STEP-3 system allows us to draw some conclusions. Firstly, features of test structuring not only according to the clinical experience of interns, but to their knowledge in medical law, statistics, ethics and deontology as well. Secondly, differences in creation of clinical tests and certain difficulties in converting international concepts into common ones in Ukraine. In general, the major differences are in short supply of international guidelines adopted in Ukraine and lack of material support in medical care delivery.
Key words: self-esteem, medical interns, harassment
Abstract. Self-assessment and reference evaluation of practical skills mastering by interns in the specialty "general practice - family medicine" as a way to improve teaching methods. Vysochina І.L., Кramarchuk V.V., Bashkirova N.S., Gayduk O.I. The paper presents the analysis of results of professional self-assessment of first year interns in the specialty "general practice - family medicine" in comparison with the reference assessment of their professional competencies by the teachers of the family medicine department. Specific problems in the method of mastering such skills as ECG interpretation, CPR, breast examination, ophthalmoscopy, otoscopy and neurological examination of the patient were identified, this allowed to develop recommendations for further training of interns by correspondence in the internship.
Key words: family medicine, general practice - family medicine, secondary specialization, formation of the doctor's consciousness, syndrome information format
Abstract. Building up new communications as a way to solve didactic problems in training physicians in specialty "general practice-family medicine" (secondary specialization). Vysochina I.L., Chukhrienko N.D., Vasilevskaya I.V., Gaiduk O.I. The article presents generalized data on methodological developments of the department of family medicine of FPE of «DMA of HM of Ukraine» over 20-years’ period of training of physicians of secondary specialization and building up new communications with physicians, who are doing courses with inclusion of collective decision-making (facilitation) in methodology of teaching process.
Key words: educational and practical center, self-education, postgraduation, speciality "General practice – family medicine"
Abstract. Organization of training of interns at the department of family medicine and therapy. Zhdan V.M., Babanina M.Ju., Kitura Je.M., Shylkina L.M., Ivanyc'kyj I.V., Volchenko G.V., Tkachenko M.V., Kyr’jan O.A. The article considers features of organization of training of interns at the department of family medicine and therapy: outpatient care, follow-up of patients in the hospital, participation in the preparation of clinical and clinical-anatomical conferences, abstract reviews, multimedia presentations; describes forms of distance learning, organization of scientific work of interns, study in the educational and practical center.
Key words: secondary specialization, general practice-family medicine, nerve diseases
Abstract. Actual problems of teaching nerve diseases on the cycle of secondary specialization "General Practice - Family Medicine". Kuz'mina G.P., Azarenko V.Je., Knjazjeva O.V., Vasylenko A.M. Preparation of a highly professional general practitioner-family doctor on the cycle of secondary specialization is one of the serious tasks facing the department. The use of modern, interactive methods can improve the quality of training of doctors, the level of practical skills mastering, the assimilation of theoretical material. Questioning doctors doing courses, we identified a number of problems in the process of training general practitioner-family doctors.
Key words: newborns, neurointensive care, education
Abstract. Focus on neonatology questions in Post-Graduate training programs. Mavropulo T.K., Plekhanova T.N. Modern possibilities in the care of seriously ill newborn babies, their improved survival correlates with a high risk of adverse neurological outcames.Traditional focus in the intensive care of such children on cardiorespiratory support cannot be sufficient. Nowdays formation of the system of neurointensive care is an urgent need, with key components as staff motivation and education. The purpose our study was to substantiate methodological approaches to training at the postgraduate level. Questioning of 57 neonatologists in two directions have been conducted: analysis of the system of neurointensive care components and necessity of staff education to improve theoretical knowledge. The obtained results testify to a high motivation to introduce the concept of neurointensive care in nursing newborn children in intensive care units. Multidisciplinary approach with formation of key competencies a should be practical step in the implementation of this concept at the stage of postgraduate training.
Key words: general practice-family medicine, secondary specialization, general practitioners-family physicians
Abstract. Optimization of training doctors, doing courses on cycles of secondary specialization in the specialty "general practice-family medicine" Potabashny V.A., Fesenko V.I., Markova E.Ya., Shvets S.V. Training of primary care physicians is essential one for postgraduate medical education. The training of general practitioner-family physicians during the courses of secondary specialization first of all involves the formation of a certain motivation, integral approach to the problems of the patient, mastering practical skills on providing emergency care and working in a team using modern information technologies.