Medicni perspektivi, 2019;24(1)
2019 Vol. XXIV N 1
Key words: sociological research, non-infectious diseases, students, risk factors
Abstract. The awareness and consciousness of young students about the threat of risk factors of development of non-infectious diseases – modern status of the problem. Serdyuk A.M., Gulich M.P., Petrenko O.D., Lyubarskaya L.S., Koblyanskaya A.V. The purpose of this study was to analyze students’ awareness and consciousness about the threat to health of risk factors for the development of chronic non-infectious diseases, to determine whether they have the skills of a healthy lifestyle and to develop and scientifically substantiate the Algorithm for introducing health-saving educational technologies in the educational process of higher educational institutions of Ukraine. A sociological survey was conducted among students of higher educational institutions of Ukraine regarding the levels of awareness and consciousness about certain factors in the development of non-infectious diseases. 430 students of the Kiev National University of Trade and Economics and 216 students of Sumy State Pedagogical University were interviewed. A specially designed questionnaire was used. A high level of awareness of students about the main factors in the development of non-infectious diseases – poor nutrition, low physical activity, smoking and alcohol abuse has been established. At the same time, students are not sufficiently conscious about the risk of developing diseases and are unsufficiently motivated to a healthy lifestyle. It is shown a significant difference in indicators of healthy lifestyle among students of institutions of various profile. The Algorithm for the introduction of a health-saving educational technologies into the educational process of higher educational institutions, which is a scientifically substantiated system containing the main tasks, principles and measures aimed at raising the level of awareness and consciousness of young students about the health threat of risk factors for the development of chronic non- infectious diseases has been developed. The data obtained are the basis for the improvement of measures for the prevention of non-infectious diseases among students in Ukraine.
Key words: case method, clinical thinking, higher educational institutions
Abstract. Formation and improvement of clinical thinking in medical students. Кhaniukov O., Kozlov S., Yehudina Y., Sapozhnychenko L., Kozlova Yu., Somilo O. Introduction and purpose of the study: high requirements for graduates of higher medical establishments facilitate the search, implementation and improvement of modern teaching methods in order to optimize the development of clinical thinking in medical students. In the the course of the work, a big volume of information was used, which was worked out using such methods as historical and literary synthesis, structural and logical analysis, abstract thinking and personal experience taking into account the principles of systemic approach and analysis. To improve the quality of medical students' training it is necessary to use the innovative teaching methods. Presence of the personal clinical archive, with allow to use archival material in the training process (for example, to use case-method), in the analysis of a clinical case and the use of data in the scientific work. The article presents an example of a clinical problem and emphasizes the importance of the case-method in teaching students in higher educational institutions. Formation of clinical thinking takes place over the course of direct work with the patient, with an independent attempt to resolve a specific clinical situation in real conditions. Case method allows to reveal and form the necessary personal qualities and abilities of medical students, necessary for the further work. Modern methods and means of information technology must be purposefully implemented into clinical practice and educational process for the development of professional skills, formation of clinical thinking, accumulation of clinical experience.
Key words: external genital endometriosis, mechanisms of endometriosis development, epigenetic, microRNA, long non-coding RNA
Abstract. Modern view on the etiology, pathogenesis and possibilities of diagnostics of external genital endometriosis. Medvedev M.V., Pokrovenko D.A. Endometriosis is a condition that determines the presence of functionally active glands and endometrial stroma outside the uterus, causing a chronic inflammation in these tissues. The prevalence of endometriosis varies between 5-10% for all women, 20-25% for gynecological patients and reaches 45-50% for women with infertility. The true frequency of endometriosis is not definitely known, and its growth over the past decades is associated with both the increasing frequency of the disease and the improvement of its diagnosis. Endometriosis occurs irrespective of ethnicity and race, socioeconomic conditions, at any age. Diagnosis of external genital endometriosis includes patients’ complaints, clinical examination, ultrasound examination, sometimes magnetic resonance imaging. Much has been done to understand the mechanisms of endometriosis, but still the "gold standard" of diagnosis is invasive methods, especially laparoscopy. An early diagnosis will allow to timely develop treatment tactic aimed at treating endometriosis and preventing its further spread and recurrence. The search for possible biomarkers for the diagnosis of endometriosis continues. Among non-invasive methods, the most promising for future study and research is the microRNA and long non-coding RNA. Molecular genetic methods in achieving good sensitivity and specificity results will be able to improve the results of infertility treatment associated with endometriosis through earlier treatment including surgery. In addition, various research groups have high expectations regarding the role of microRNA and long non-coding RNA chains in evaluating the effectiveness of drug therapy. The purpose of this review was to collect and analyze data from the world’s literature, search for new non-invasive markers for diagnosing this disease at the preclinical stages, as well as predicting the response to hormone therapy.
Key words: history of medicine, language training, humanism, medical students
Abstract. The importance of studying history of medicine and language training for the development of professional competencies of medical students. Semyonova L.S., Klimenko I.N. This article shows the importance of studying history of medicine and importance of language training as an essential component of broadening of universal cultural and medical outlook of prospective doctors, upbringing of high moral ethical qualities inherent to a contemporary doctor. The authors of the article propose measure on improving teaching of these disciplines.
Key words: gastrointestinal bleeding, pathology of the cardiovascular system, Forrest
Abstract. Clinical and statistical aspects of gastrointestinal bleeding course in patients with cardiovascular system pathology. Trofimov N.V., Kryshen V.P., Barannik S.I., Chukhryenko A.V., Chabanenko G.N., Gayterov A.N. We have collected, processed and analyzed the results of treatment of 329 patients with gastrointestinal bleedings in which the course of the underlying disease is aggravated by the pathology of the cardiovascular system, in Communal institution "Dnipro Clinical Emergency Care Association" of Dnipro City Council» in the period for 2017. First, the frequency of background diseases was determined, chronic pathology being 93.4%. Ischemic heart disease (IHD): cardiosclerosis of various origins (post-infarction, diffuse, atherosclerotic), hypertonic disease (HD) - HD-I, HD-II, HD-III are the most common, while acute disorders of cerebral circulation, the state after coronary artery bypass surgery, renal artery bypass, arrhythmias, acute myocardial infarction made up 16 (5%), 1 (0.3%), 3 (1%), 1 (0.3%), respectively. Secondly, the quality of endoscopic hemostasis in case of ulcerative bleeding from the stomach, duodenum, gastroenteroanastomosis, was assessed by Forrest classification, connecting the results with the accompanying pathology of the cardiovascular system. We found that active bleeding F I was determined in 24 people (7.3%), of which F Ia – in 14 (4.3%), F Ib – in 10 (3%). Unstable hemostasis with a high risk of recurrent F II bleeding, was observed in 251 patients, which makes up 76.2%, and F III – in 54 (16.5%). The degree of blood loss was directly influenced by drug – anticoagulants, antiplatelet agents, hypotensive drugs, as well as their combinations, aimed at correcting the rheological properties of blood. Depending on the degree of blood loss, the quality of hemostasis, the general condition of the patient, the treatment tactics for this cohort of patients was determined. 313 patients received conservative treatment, which made up 95.1%. 16 patients were operated. Postoperative mortality is 12,5%. The overall mortality of the above cohort is 10%.
Key words: Merkel cell carcinoma, cancer without primary localization, CK20, ImageJ
Abstract. Metastases of Merkel cell carcinoma in terms of diagnosing carcinomas with unknown primary localization. Poslavska О.V. Merkel cell carcinoma (MCC) is a rare malignant primary skin neoplasia with epithelial and neuroectodermal differentiation. The problem of MCC, which determines the relevance of its research, is often a high frequency of local recurrence, regional lymph node metastasis and further hematogenous and/or distant lymphogenous dissemination. Materials and methods. A retrospective analysis of the biopsy material of 6 patients with isolated MCC metastasis aged from 29 to 82 years (average 63.11 ± 16.24; median 62.5) was carried out. For the control group, 9 cases of postoperative material of primary skin tumors with MCC of patients aged from 27 to 76 years (average 52.17 ± 12.72; median 53.5) were selected to determine the differential diagnostic criteria. The results of the study. Carcinomas without primary localization may be interpreted as MCC if they demonstrate phenotype Cytokeratin, Pan AE1/AE3 (paranuclearly +) / CK20 (paranuclearly +) / Vimentin (-) / CD45 (-) / S100 (-) / Chromogranin A (+) / Synaptophysin (+), with morphometric parameters of the area and perimeter, which is 2 times the size of ordinary lymphocytes, (all p>0.05). Findings. Metastatic CMC without primary localization, in comparison with locally spreading, often exhibit low-differentiated small-cell and transitional forms, which require additional immunohistochemical study to exclude carcinomas of other origin.
Key words: inguinal hernia, mesh imalant, TAPP, recurrence, glue fixation, postoperative pain
Abstract. Estimation of options of the mesh implant fixation in transabdominal preperitoneal alloplasty in patients with inguinal hernia. Feleshtinsky Ya.P., Kohanevich A.V. The frequency of chronic postoperative pain after TAPP surgery is maintained at 4.6-18.7%, and the incidence of inguinal hernia recurrence is 5.3% to 10%. Purpose – estimation of efficiency of different variants of fixation of a mesh implant in TAPP in patients with inguinal hernia. Various variants of fixation of a mesh implant with TAPP in 240 patients with inguinal hernia have been analyzed. Immediate results: pronounced postoperative pain was observed in 6 (7.5%) patients in group І, in 1 (1.25%) patients in group ІІ, in group III postoperative pain was absent. Long-term results: chronic post-operative pain was observed in 5 (7.57%) patients in group І, in 2 (3.12%) in group ІІ, in group ІІІ, chronic postoperative persistent pain was not observed. The recurrence of inguinal hernia was in 5 (7.57%) patients of group І, in 1 (1.56%) patient of group II and in 1 (1.53%) patient of group ІІІ. The results of the TAPP operation for the inguinal hernia with different types of fixation of the mesh showed that glue fixation has significant advantages among them.
Key words: mandibular fracture, delayed union, risk factors, prognosis
Abstract. Delayed union of mandible: analysis of general and local factors. Idashkina N.G. Objective – to evaluate the etiological significance of local and general factors in the occurrence of delayed union of bone tissue in patients with mandibular fractures. a personalized questionnaire was developed and filled by 74 patients with fragments mobility that persisted 1 month after reposition and fixation of the mandibular fractures for determination the role of local and general factors in the occurrence of delayed union. Thus, local and general factors that most closely correlate with the development of this complication were identified. The obtained data were compared with the results of a retrospective analysis of case histories of patients with mandibular fractures over a five-year period. The presence of a general somatic pathology, head injury and polytrauma, as well as such aggravating factors as alcohol and drug abuse should be considered as the general risk factors for the development of the delayed union of mandibular fractures. Among local factors, inflammation in the area of mandibular fractures takes the first place, the development of which is provoked by untimely treatment of patients, comminuted fractures, traumatic surgical interventions, etc. Among patients with delayed union of mandibular fractures, 86.5% received antibiotics for more than ten days. The risk group should also include patients with mandibular fractures of a young age (from 18 to 25 years) and those over 45 years. The problem areas for consolidation are mental section (31.1%) and the angle of the jaw (25.7%).
Key words: mandible, complete adentia, complete denture, base, repairing of denture, term of use
Abstract. Statistical analysis of repair of complete removable dentures on the upper jaw for a three-year period of use. Vasilenko R.E. The aim of the study is a analyze the use of full dentures on the upper jaw and the number of repeated visits of patients who received treatment at the dental offices in the Dnepr city. Materials and methods: during 2015–2017 years in dental office of the SE “DMA”, patients were examined, a statistical analysis was made, the number of manufactured of full dentures on the upper jaw and, accordingly, the number of repairs for each year and comparison statistics with the city dental clinics in the previous years was done. According to the results of the study, it was established then in three-year examination period the patients in three dental clinics of the city, the percentage of breakdowns and correction of full dentures on the upper jaw was near 50%. At dental office of SE “DMA”, according to the results 2015-2017 years a numbers of 48.4% was obtained .So that when we compared with the dental clinic from the previous study that is closest in scope of the work, it indicates the absence of statistically significant differences in the indicators of the first and second studies. This can be explained by the fact that despite the use of more modern materials and methods in the manufacture of complete dentures, the problem of improving the quality of full dentures manufacturing on the upper jaw and increasing the strength of the base has not been fully resolved.
Key words: pneumoconiosis, chronic obstructive pulmonary disease, radiography, thorax
Abstract. Value of roentgenologic examination in diagnostics of pneumoconiosis associated with chronic obstructive pulmonary disease in workers of the mining and metallurgical industry. Rubtsov R.V. The aim of the research is to study the peculiarities of changes in the chest on survey radiograph at pneumoconiosis associated with COPD in workers of mine and metallurgical industry. The data of clinical examination of 635 workers with lung pathology of occupational genesis are presented in the article. Group I consisted of 99 workers with pneumoconiosis associated with COPD, II group – of 21 workers with pneumoconiosis, and III group – of 515 workers with COPD of occupational etiology. A comparative analysis of radiographic changes in the chest X-ray has established that the most informative radiologic changes for pneumoconiosis associated with COPD are: linear reticular obscuration up to 1.5 mm in size, cord obscuration from 1.5 to 3.0 mm in size, and less significant changes in the form of nodules size up to 1.5 mm, from 1.5 to 3.0 mm, the thickening of pleura more than 10.0 mm wide. The most sensitive radiographic signs typical for PC associated with COPD are the indicated obscurations and nodules, their etiological share in diagnosis of this disease is 100%, determining the greatest absolute risk of development of this occupational pathology in this category of patients. The revealed X-ray diagnostic criteria allow to conduct timely diagnostics, define the tactics of treatment and prevention of PC associated with COPD in workers of mining and metallurgical industry.
Key words: cadmium, lead, acute, subacute and chronic experiments, maximum daily permissible dose, maximal non-effective dose
Abstract. The substantiation of the maximum daily permissible doses of lead and cadmium in everyday diet. Fedorenko V.I. The article is dedicated to the bright memory of Prof. Shtabsky B.M. (the 90th anniversary) and comprises a fragment of results of experimental investigations conducted under his supervision in 1984-1989 years. They are related to the methodological approaches to the conducting acute, subacute, and chronic experiments, as well as analysis of the results and verification of the maximum daily permissible dose (DPD) of lead and cadmium in the everyday diet. In the acute experiments it has been established that lead nitrate belongs to the group of the low-toxic compounds, Cadmium nitrate belongs to the mid-toxic compounds, while both are considered to be highly cumulative. The toxicity and the level of cumulation does not depend on the carrier – water, milk, vegetable oil. In subacute and chronic experiments the comparative toxicity of Ionic (comes with water and nourishment) and biocommunicated (liver and kidney homogenate, cottage cheese) forms of metals in the range of doses 1/10-1/100000 LD50 and additionally 1/500000 LD50 for cadmium has been studied. Toxicometrically significant distinctions under the action of the afore-mentioned forms have not been detected. The excretion of δ-aminolevulinic acid and coproporphyrin with urine, and concentration of SH-groups in the blood plasma and liver tissue and protein in urine under the effect of cadmium in the effect of lead appeared to be the most demonstrative. Both metals possess clear gonadotoxical effect, they cause genetic effects, which can be determined by cytogenetic method, and in the Ames test with presence of liver S-9 microsomal fraction. Maximal non-effective supra-background dose DE050 0,0015 mg/kg for lead, and 0,00005 mg/kg for cadmium have been established on the basis of analysis of “dose-effect” dependency in subacute and chronic experiments, having taken into consideration results obtained according to the method of loading by same metals. Taking into the account natural metallic background dose of with daily diet (0,0025 mg/kg for lead, 0,0005 mg/kg for cadmium of the body weight), the DPD of lead and cadmium in everyday diet is recommended at the level of 0,004 mg/kg and 0,00055 mg/kg of the weight of the body respectively.
Key words: nuclear power plants, observation area, environment, levels of pollution, radionuclides, radiation-hygienic monitoring
Abstract. Improving the system of radiation and hygienic monitoring of environmental objects in the areas of observation of Ukrainian nuclear power plants as a fundamental of radiation safety. Khomenko I.M., Zakladna N.V. The relevance of the work is determined by the absence of documents on the problems of observation zones of nuclear power plants, including the organization and monitoring of environmental objects in Ukraine. The purpose of the study was to assess the state of radioactive contamination of the environmental objects of the observation zone of the Zaporizhzhia nuclear power plant. To accomplish the tasks, we analyzed the data of the laboratory control performed by the external radiation monitoring laboratory of the Zaporizhzhia nuclear power plant and the data of the State Institution «Zaporizhzhia Regional Laboratory Center of the Ministry of Health of Ukraine». The obtained results allow us to draw the conclusions that in the environmental objects (water of the Kakhovsky reservoir, atmospheric air, soil, drinking water) of the observation zone of the Zaporizhzhia nuclear power plant, the main dose-forming radionuclides were identified. It is established that their levels are not uniform, and the identified instability indicates the need for continuous laboratory monitoring of the content of cesium and strontium and the need to monitor the impact on health of the residents of the observation area. It is necessary to improve radiation monitoring through the development and implementation of new methodological documents and regulations on the organization of laboratory control, justification of its frequency and the required amount of laboratory research, which will allow to establish the true impact on public health in these areas.
Key words: shoe production, occupational factors, working conditions, noise, vibration
Abstract. Harmful occupational factors of shoe productions: noise and vibration. Lototska-Dudyk U.B. Shoe production is an important and promising industry of light industry in Ukraine. More than 15 thousand people work at almost 300 enterprises. Improvement of technologies and equipment, intensification of production processes on the background of their incomplete mechanization and automation cause production noise and vibration at the workplaces, in particular, in сutting, сlicking and closing workshops. Levels of manufacturing noise and production vibration in the workplaces of workers of the main occupations: cutters, clicking details, shoe markers, seamstresses, striking operatives, сementing operators, fitters and lasters, trimers and bottom scourers were analyzed. According to noise level, working conditions of cutters on the сutting machines Gerber, seamstresses, skivers, stitchers of upper, casters, fitters and lasters, сementing operators belong to the 2nd class (permissible). The working conditions of cutters on the сutting presses, shoe markers, fitters of upper on the heavy-class sewing machines, bottom scourers, trimers and striking operatives are classified as harmful ones (class 3.1), on separate workplaces of clicking details (press PVH-8) and bottom scourers – class 3.2 degree of danger. Equivalent correction levels of local and general vibration don’t exceed permissible levels. The presence of related unfavorable industrial factors necessitates the study of both combined and jointed action of noise and vibration with the subsequent assessment of the risks to the health of workers in the light industry.
Key words: activity of the laboratory service of the region, personnel potential, ways of describing the work
Abstract. Analysis of the states of the activity of the laboratory service of the industrial region of Ukraine and the ways of it optimization. Yeroshkina T.V., Derevyanko D.V. The purpose of the study is to analyze the activity of the laboratory service of the Dnepropetrovsk region, to develop and substantiate the concept of optimizing its work. We have carried out in dynamics the analysis of the laboratory service of the Dnepropetrovsk region: its structure; staffing level of doctor-laboratory assistants, biologists and laboratory assistants; carrying out laboratory researches, their structure and quality, as well as the state of laboratory equipment and reagent base. The methods of research used: bibliosemantic – systematic and historical analysis of domestic and world literary sources on the organization of laboratory service; reports and legislative documents on the activities of the laboratory service of the region; systematic analysis – to identify the existing shortcomings and positive experience in the training system, the formation of an effective team of employees, quality of the provided laboratory services, ways to optimize the work of the clinical-diagnostic laboratories (CDL); medical statistics for the analysis and interpretation of research results, logical modeling – for the development of the concept. The article covers the state of the laboratory service of the region: changes of its structure due to restructuring of the treatment-prophylactic institutions (TPI), the reforming of primary medical-sanitary care; development of family medicine – the number of hospital decreased by 39,8% in 2017 as compared to 1995, the number of hospital – by 38% beds per 10 thousand population; At the same time, the number of outpatient clinics increased by 70,1% during this period, which is in line with the WHO recommendations for provision of outpatient care to 80% of patients. Coefficient of provision of population of the region with doctor-laboratory assistants per 10 thousand of population is 0,68; staffing level of doctor-laboratory assistants with of medical doctors by natural persons is 25,9% with tendencies to decrease. The staffing level of specialists with higher non-medical education is 63.6%. Clinical and diagnostic laboratories in most cases have a minimum of equipment that is often outdated, without means for automatization equipment. Problems of the laboratory service of the region consist in the presence of a large number of low-power CDLs, performing the minimum set of diagnostic tests, lack of programs of research in the framework of separate nosological forms of diseases at different stages of medical care provision, acute shortage of high-tech equipment; lack of a systematic approach; the high turnover of personnel due to unsatisfactory material and technical and economic condition of the service and low wages. The main ways of optimization of laboratory services are offered.
PAGES OF HISTORY
Key words: history of pharmacology and clinical pharmacology, Dnipro scientific school of pharmacology, 100th anniversary of development
Abstract. Dnipro Pharmacology School: a 100 years’ journey (to the centenial of the department of pharmacology and clinical pharmacology of Dnipropetrovsk medical academy). Part I: 1918-1943. Mamchur V.I., Zhilyuk V.I., Kovalenko E.Yu. The article presents analysis of the main historical stages of the establishing and development of the scientific school of pharmacology of the SE "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine" for a 100-year lifetime period of the pharmacology department. Part I (1918-1943) is devoted to one of the most important and difficult periods – the first period of development of scientific school of pharmacologists: since the establishment of the Department of Pharmacology of Katerinoslavsky Medical Institute in 1918, its first difficult steps in the organization of the department and creation of its facilities and equipment base, of establishing training process on the basics of pharmacotherapy, up to the period of formation of important scientific discoveries in experimental and clinical pharmacology and active scientific development of the whole direction of pharmacological school in the 30-40ies of the XX-th century. It is shown that during the first 25 years of scientific and pedagogical work, the department turned into a powerful scientific school, which brought up outstanding scientists of the day to the medical science of our country, and formed a generation of young students and doctors with a new worldview, with understanding the importance and value of scientific knowledge of fundamental pharmacology, applied knowledge of rational pharmacotherapy and clinical pharmacology to improve the quality of patients’ care in practical medicine.