Medicni perspektivi, 2018;23(1 part 2).
2018 Vol. XXIII N 1 part 2
Key words: pneumonia, severe community acquired pneumonia, predicting fibrosis after pneumonia
Abstract. The forecasting of development of lung fibrosis after suffering a severe community-acquired pneumonia. Avramenko I.V. The article presents data on the possibility of predicting the formation of fibrous changes in 6 and 12 months after the past pneumonia in patients with severe nosocomial pneumonia during the year of prospective observation. The possibility of using indices of systemic inflammation (SRB over 87 mg/L at the onset of the disease) and fibrosis (Transforming growth factor beta - TGF β over 19675 pg/ml) to assess the risk of long-term consequences of severe community acquired pneumonia has been proved.
Key words: consequences of ischemic stroke, general practice-family medicine, Morissky-Green scale, secondary prevention, adherence to treatment
Abstract. Adherence to treatment of patients with past ischemic stroke. Azarenko V.Je., Potabashniy V.A. Fesenko V.I., Knjazjeva O.V. The main task of the general practitioner is managing patients with the effects of ischemic stroke. The improvement of patients adherence to treatment in a significant way contributes to successful secondary prevention of ischemic stroke. Adherence to treatment can be determined through various questionnaires, including Morissky-Green. Currently, the adherence to a long-term drug therapy remains insufficient.
Key words: apnea obstructive sleep, heart failure, arterial pressure, blood pressure monitoring
Abstract. Blood presure variability in patients with obstructive sleep apnea syndrome and heart failure with preserved ejection fraction. Andreieva I.O., Myrnyi D.P., Surmilo M.M. The aim of the study was to investigate the features of daily blood pressure changes in patients with obstructive sleep apnea syndrome (OSAS) and heart failure with preserved ejection fraction based on the data of daily blood pressure monitoring. Materials and methods. 86 patients with OSAS and HFpEF (group 1), 74 patients with HFpEF without OSAS (2nd group) and 52 patients with OSAS and without HF (group 3) were examined. All participants of the study underwent cardio-respiratory monitoring, ABPM, echocardiography, NT-proBNP. Results. SABP and DABP in patients with HFpEF and OSAS were generally higher in the day and night than in comparison groups. "Non-dipper" dominated among the pathological daily profiles. As results of the multivariate regression analysis, it was found that the level of SABP at night was determined by IAH (β=0,386, p<0,05) and MeanSaO2 (β=0,339, p<0,05). The DABP level at night was determined by the IAH (β=0.412, p<0.05). Conclusions. Patients with OSAS and HFpEF have insufficient reduction in blood pressure at night and greater variability of blood pressure overnight. With the increase of OSAS severity more often daily profiles "non-dipper" and "night-peaker" are recorded, the variability of blood pressure increases. When performing a multivariate regression analysis, it was found that the level of SABP at night was determined by IAH (β=0,386, p<0,05) and MeanSaO2 (β=0,339, p<0,05); DABP level at night was determined by the IAH (β=0,412, p<0,05).
Key words: non-Hodgkin's lymphoma, febrile neutropenia, medical support of cancer patients, clinical observation
Abstract. Non-Hodgkin's lymphoma in the practice of the family doctor (clinical observation). Vasylevska I.V. There is presented a clinical observation on the problem of establishing an oncological diagnosis by a family doctor, the route to a doctor-oncologist for specific treatment with subsequent work in the brigade team and medical support during the course of chemotherapy for the prevention and timely elimination of side effects and complications.
Key words: constipation, treatment of the constipation
Abstract. Тreatment of patients with the constipation by a general practitioner - family doctor at the ambulatory stage. Visochina І.L., Bashkirova N.S., Efimova N.O. In the context of professional competence, the management of constipation syndrome (self-diagnosis, self-treatment and provision of preventive measures for constipation in patients of different ages) is a function of doctors of a general practice medicine - family medicine. The authors developed and proposed an algorithm of treatment and management of a patient with constipation syndrome at the ambulatory stage.
Key words: syncope, sick sinus syndrome, adolescent
Abstract. A case report of cardiogenic syncope in the adolescent. Gayduk O.I., Ivanus' S.G., Gayduk T.A., Shvirid I.I., Kramarenko L.N., Baralej T.V. The article presents authors’ observation of a clinical case of the girl aged 15 years old with cardiogenic syncope due to sick sinus syndrome, which progressed from normocardia sinus rhythm to pauses of the cardiac rhythm lasting 10.2-second during 3 years’ period.
Key words: arterial hypertension, tumor necrosis factor-α, risk factors, adolescents
Abstract. Immunological factors of cardiovascular risk (TNF-α) depending on various hemodynamic forms of arterial hypertension in adolescents. Gayduk T.A., Shostakovich-Koretska L.R., Gayduk O.I. 119 children aged 12-17 years with the stable and labile forms of arterial hypertension (AH) and prehypertension hospitalized to cardiopulmonary department due to ambulatory single-measured blood pressure (BP) elevation were observed. The level of TNF-α in adolescents with different forms of AH and prehypertension as well as the correlation of this marker with other cardiovascular risk factors was determined. There was a significant increase in the mean value (9.50±0.54 pg/ml) and frequency (45.6%) of increase of TNF-α level in the group of children with AH compared with the group of children with normotension (6.43±0,64 pg/ml and 12.5% respectively). There is shown a tendency to increase of TNF-α levels, depending on the degree of stabilization of AH with the highest level of proinflammatory cytokines of TNF-α in the group of children with stable systolic BP. The positive correlation of TNF-α with the daily BP monitoring indicators, especially with the level of diastolic BP and its variability at night was revealed.
Key words: iron deficiency, iron deficiency anemia, anemia of chronic diseases, chronic heart failure, iron supplements, erythropoietin
Abstract. The problem of anemia treatment in patients with chronic heart failure. Ivanov V.P., Kolesnуk M.O., Kolesnуk O.M., Ivanovа Ye.I. This article presents the literature review devoted to studying the problem of iron-deficient states in the event of chronic heart failure. The epidemiological indicators, various published data on the impact of anemia on the prognosis of chronic heart failure which show a particular urgency of this problem have been presented. All existing approaches to the treatment of iron deficiency anemia and anemia of chronic diseases in this category of patients have been described. The results of studies on the use of classical oral ferrocorrection, as well as the use of modern approaches – intravenous ferrotherapy, isolated and combined use of recombinant human erythropoietin have been demonstrated. The advantages and disadvantages of each of the methods of anemia correction in patients with chronic heart failure have been discussed. The possible reasons for failures in anemia treatment and the absence of a pronounced impact on the clinical manifestations of chronic heart failure with the use of standard approaches to treatment have been discussed as well.
Key words: hypertension, gout, quality of life, urat-lowering therapy
Abstract. The role of assessment of quality of life and health with the index of vital activity in patients with arterial hypertension combined with gout in the family doctor practice. Lazarenko O.M., Kuzmina A.P. The number of studies that assess the quality of life of patients with various comorbid diseases is increasing annually. Arterial hypertension and gout is no exception. There are difficulties in managing this category of patients at the primary stage in accordance with current recommendations. The purpose of the study was to analyze the effectiveness of use of questionnaires for assessing the quality of life (SF-36) and health (HAQ) with disability index (DI) in patients with arterial hypertension combined with gout in everyday clinical practice by the family doctor; to assess the correctness of maintaining this category of patients in accordance with current recommendations (EULAR, 2016). A sociological survey of general practitioners (n=30) was carried out by a specially developed questionnaire consisting of three sections. It was found that not all doctors prescribe an adequate dose of colchicine for exacerbation of gouty arthritis, and more than half of the doctors do not use preventive colchicine for 3-6 months after the attack. Most doctors do not use the assessment quality of life (SF-36) and Health Assessment Questionare (HAQ) with a disability index (DI) at admission, but most believe that the results of these questionnaires contain important information on the patient's condition and the prospects for their using at the outpatient stage.
Key words: newborn, early term birth, central nervous system
Abstract. Neurological features of newborns associated with late preterm and early term birth. Mavropulo T.K. Infants delivered at 37 and 38 weeks’ gestation are at increased risk for morbidity as compared to infants delivered at 39-40 weeks. Our objectives were to study the frequency of transient neurologic dysfunction in the first months in newborns and infants, depending on the gestational age. We found a higher incidence of risk factors of pregnancy, more frequent need in oxytherapy after birth, and differences of hemo lyquordynamics at the age of 2-3 months.
Key words: insulin resistance, statins, obesity, coronary artery disease
Abstract. Metabolic profile of patients with coronary artery disease and comorbid obesity. Maksymets T., Faynyk A., Sklyarov E. Cardiovascular diseases (CVD) are the leading cause of death worldwide. Most CVD can be prevented by modification of such risk factors as tobacco use, obesity and unhealthy diet, physical inactivity and harmful use of alcohol. Patients with CVD or who are at high cardiovascular risk due to the presence of risk factors such as dyslipidemia, hypertension, diabetes mellitus type 2, need early detection and management of these states. The article describes differences between metabolic profile of patients with obesity and coronary artery disease. The study included 58 patients. They were divided into 3 groups: 1st - patients with BMI <30 and CAD, 2nd - patients with BMI>30 and CAD, and 3rd - patients with BMI>30. 1st and 2nd group of patients were treated with atorvastatin in the dose of 40 mg for 2 years, 3rd - untreated. The results indicate that significant difference was faund in the lipid profile between groups of patients treated with atorvastatin in the dose of 40 mg . Transaminases and uric acid levels were different but within the reference range. The difference was found in serum glucose, insulin and HOMA-IR between participants of the 2-nd and other groups. We observed significant insulin resistance in the group of patients with coronary heart disease, obesity, treated with atorvastatin. So, administration of atorvastatin to the patients with IHD and obesity may negatively impact carbohydrate exchange and serve as a possible cause of diabetes melitus type 2 development.
Key words: pneumonia, elderly patients, statins, Ischaemic heart diseases, comorbidity, C-reactive protein
Abstract. The optimization of treatment of patients with community-acquired pneumonia with high cardiovascular risk (case from practice). Orlovskii V.F., Zharkova A.V., Udovichenko S.Ya. Pneumonia occupies a significant part in the structure of morbidity and mortality of the population of Ukraine and the whole world. The incidence of this disease is several times higher among elderly patients. At the same time the prognosis for patients of this category can be fairly unfavorable, being connected with a number of age features. This fact, in its turn, points out the necessity of more precise criteria and new methods of assessing changes in the condition of a patient with pneumonia, and it also became a valid criterion to use in determining the severity and prognosis of the disease course. In this article the specific example of the application of the algorithm, named “Integral geriatric evaluation adapted for emergency care”, in the treatment of an elderly patient with pneumonia was considered. The role of statins in the complex treatment of patients with inflammatory diseases and their link with the level of C-reactive protein as a risk indicator of the unfavourable course of the disease in the form of the thrombotic complications was specifieced. So, medical care for elderly patients with pneumonia should be comprehensive in terms of diagnosis (improving the fairness through the application of the new and more precise methodology of assessing the functional state of a human organism) and treatment. The high degree of comorbidity among patients of the category “frail elderly” with pneumonia requires the application of approaches, which enable to reduce the cardiovascular risks and otherones. Such approaches include the administering of statins at high doses, in light of its impact on the level of C-reactive protein as a predictor of the thrombotic complications.
Key words: dysphagia, aspiration, stroke, clinical cases
Abstract. Diagnosis of dysphagia in the practice of a family doctor (clinical cases). Rosytska О.A., Chernilovski A.V. Dysphagia is an important risk factor for such a serious life-threatening or health-patient complication as aspiration (aspiration pneumonia), dehydration, malnutrition. Prevention of dysphagia in the damage to the nervous system is not possible. However, with the proper evaluation and treatment of disorders that result from dysphagia, it is possible to prevent complications, to take into account this symptom when feeding the patient, carrying out rehabilitation measures and medical treatment. The article presents diagnostic algorithms for the actions of the general practitioner-family doctor in the detection of dysphagia and clinical cases of this syndrome of different etiology.
Key words: inflammatory bowel disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome, differential diagnosis, fecal calprotectin
Abstract. New aspects of non-invasive diagnosis of intestinal pathology. Fedorova N.S. A comparative assessment of fecal calprotectin (FC) levels was performed in 160 patients with chronic inflammatory bowel disease (CIBD) (Crohn's disease (CD), ulcerative colitis (UC)) and irritable bowel syndrome (IBS). The results of FC in patients with CIBD and IBS were compared with the values of FC of 31 healthy patients (control group). The mean FC level in patients with CIBD was 65.75 μg/g compared to the control group (13.72 μg/g) (p<0.05). In the group of patients with IBS, the FC level was 16.18 μg/g (p≥0.05). Significant correlation was found between the levels of FC with CIBD and FC with IBS (p<0.05). The obtained results confirmed the high diagnostic value of the method of determining fecal calprotectin in the differential diagnosis of functional and inflammatory bowel diseases.
Key words: flu, complications, multi-organ failure syndrome, sepsis
Abstract. A clinical case of a complicated course of influenza A/H3N2 strain in the epidemiological season 2017-2018. Chernilovsky A.V., Boltyansky S.V., Peshkova V.A. The article presents information on the course of influenza of H3N2 strain in a man aged 48 years, with complications in the late post-infectious period. A number of risk factors that led to this outcome of the disease are disclosed.
Key words: family doctor, professional training, children
Abstract. Problems of professional training of doctors of general practice – family medicine in the system of postgraduate education. Mokiya-Serbina S.A., Litvinova T.V., Zabolotnyaya N.I., Tsyktor S.V. The article reveals the problems of professional training of family doctors arising in the implementation of measures on preserving and promoting health, preventing diseases in children and adolescents. At present, the doctors of the first level are not able to organize and realize the entire complex of medical and social assistance in the ambulatory clinic at the proper level. The improvement of postgraduate training of family doctors in the field of outpatient pediatric care has been suggested. At the same time, the development of curricula for thematic improvement should be based on studying educational needs of the healthcare system in the region and the ongoing reform processes.
Key words: clinical thinking, «clip-on» thinking, «long-term» thinking, students, interns, doctors
Abstract. Clinical and «Clip on» thinking at different training stages according to «General practice – family medicine» specialty. Yekhalov V.V., Gayduk O.I., Kuz'mina A.P., Gayduk T.A. There was carried out an anonymous questioning– a survey of 6th-year students who received an internship assignment in the specialty «General Practice – Family Medicine», interns and students doing courses in the same specialty in order to diagnose the presence of «clip-on» thinking. M.B. Litvinova test method which is characterized by criterial and categorical validity and corresponds to reliability criterion was used. «Clip on» thinking was diagnosed in 36.5% of the surveyed students on training a budgetary basis and 37.8% of students studying on a contract basis, plus 38.5% of them were at risk. At the stage of postgraduate education (internship training), the percentage of «screen people» (with «clip» type of thinking) was significantly lower, but at the same time the share of the risk group on formation of a «clip» type of thinking was increased. The predominant increase in «people of the book» («long» thinking) among physicians with a certain length of service mainly is due to their age characteristics. Modern medical postgraduate education requires the formation of a qualitatively new approach to the educational process, based on the formation and development of clinical thinking, taking into account psychological characteristics of the modern youth and older colleagues. This phenomenon requires detailed social, andragogical and medical research, the creation of new educational technologies based on «live» communication.
Key words: professional competence and success of doctors, acmeological technologies, continuous higher medical education, professional improvement of doctors
Abstract. Acmeologic approach to formation of professional success in family doctors at different stages of full-time continuous training. Muryzina O.Yu. The article analyzes the peculiarities of the process of full-time training of family doctors for the competence in providing emergency care. The modern problem of reducing the level of adaptation to professional activity, associated with decrease in the ability to work and person's reserves in overcomeing crisis situations and the objective difficulties of the medical process itself is considered. The acmeological techniques, methods and technologies applied during the practical training in resuscitation are presented. The effectiveness of the method of guided discussion, analysis of concrete situations, game simulation technologies, that enable to move from cognitive motivation to professional, to improve interpersonal relations, to rise professional preparedness for actions in crisis situations and emergency care through the achievement of real indicators of practical skills and abilities is studied and generalized.