Medicni perspektivi, 2019;24(2)
2019 Vol. XXIV N 2
Key words: patent researches, scientific and technical development, object of economic activity, databases, medical and biological sciences, research institution, universities
Abstract. Methodological approaches to patent research in the field of biomedical sciences. Pyatchanyna T., Ogorodnyk A., Melnik-Melnikov P. Patent research in the field of biomedical sciences (BMS) allows to give an objective assessment of the novelty and technical and economic level of the developed object of economic activity, to identify the most promising objects of economic activity, to identify competitive trends in the analyzed industry, to use the best achievements of world science, in the course of scientific research (SR), timely protect own technological and technological solutions with patents in Ukraine and abroad. The purpose of the article is to optimize methodological approaches to conducting patent research in the field of biomedical sciences on the basis of analysis of patent and scientific and technical databases. The fulfillment of the patent researches requires the use of compulsory methodological approaches, which are developed on the basis of DSTU 3575-97 "Patent Research: Key Provisions and Procedure". At each stage of the implementation of the SR, the algorithm for the patent researches, which must be followed in order to ensure the perspective of the development of object of economic activity, its legal protection, and competitiveness has been developed. The methodical approaches to conducting the patent researches in the field of BMS are determined on the basis of analysis of patent and scientific and technical databases, which allow to reveal competitive directions in the field of BMS, identify the most promising ones, give an objective assessment of novelty and technical and economic efficiency of SR; to use the most outstanding achievements of the world science during SR; timely protect own technical and technological decisions by patents in Ukraine and abroad.
Key words: inguinal lymph nodes, cervical cancer, p16INK, ImageJ
Abstract. The diagnostic value of the p16ink marker for verification of tumors of unknown primary site in women with isolated lesion of inguinal lymph nodes. Poslavska О.V., Shponka I.S., Babiy H.S. Carcinomas with an unknown primary site are a heterogeneous group of metastatic tumors, numbering from 3% to 5% of all malignant carcinoma phenotypes. An isolated lesion of the inguinal lymph nodes is relevantly associated with primary localization of tumors in the pelvis, anal canal, lower abdomen, lower limbs, and more towards in the reproductive system (vulva, vagina and cervix for women, penis for men). But in the absence of clinical signs of cancer after careful research, the histological biopsy of the lymph node with additional immunohistochemical staining with organ-specific markers becomes the diagnostic method of choice. A retrospective analysis of the histological, morphometric and immunohistological characteristics of the biopsy material of 59 patients with isolated lesions of the inguinal lymph nodes (35 women and 24 men) aged from 20 to 87 years (mean 59.26±15.86; median 62 years) was conducted. The distribution of variants of an isolated lesion of the inguinal lymph nodes in women showed 14 of 35 (40.00%) metastatic tumors (the other 21 are lymphoproliferative conditions that require phenotyping, but not finding the primary localization). Of 14 metastatic lesions in women, 6 cases demonstrated a p16ink (+) phenotype. For comparison, of 24 cases in men, only 6 (25.00%) were of metastatic origin, of which p16ink (+/-) was partially 1 metastasis of melanoma (16.67%). After a thorough immunohistochemical study with a panel of organo-specific markers among isolated metastatic lesions of the inguinal lymph nodes of tumors in women, half of the revealed localized sites (7 out of 14) were in reproductive organs, namely: 4 p16ink (+) to squamous cervical cancers, 2 p16ink (+) to serous ovarian adenocarcinoma, 1 p16ink (-) to leiomyosarcoma of the uterus. Other localizations did not have a clear location, as they related to metastases of carcinoma from Merkel cells and melanomas, as a result of frequent reduction of the primary tumor lesion in the skin.
Key words: urgent surgery, infusion therapy, liberal regime, warter balance, warter compartment of body
Abstract. Perioperative water balance in patients with acute abdominal pathology in a liberal regime of infusion therapy. Kravets O.V. In order to evaluate the effectiveness of the liberal regime of infusion therapy, we examined 50 patients with acute abdominal pathology considering the state of the water sectors of the body. We established that liberal regime of infusion causes hypervolemia and hyperhydration of peripheral tissues during the first 6 hours of the perioperative period, it retains a moderate deficit of hypovolemia and dehydratation from 1 to 14 day of observation and forms an increase in interstanial volume, causing its maximum edema from the 3d to 7th day of observation. These changes are combined with positive daily and cumulative water balances, which is reflected in a critical increase in the percentage of excess fluid from the 5th day of postoperative period.
Key words: hypoxia, ischemia, encephalopathy, dexmedetomidine, neonates, mechanical ventilation
Abstract. Using of dexmedetomidine in term neonates with hypoxic-ischemic encephalopathy. Surkov D. The negative impacts of standard pharmacologic sedative agents suggest that alternative agents should be investigated. Dexmedetomidine could be the new option for sedation in newborns with hypoxic-ischemic encephalopathy requiring mechanical ventilation. The aim – to compare cerebral blood flow indexes and results of treatment for hypoxic-ischemic encephalopathy between groups of full-term infants who received dexmedetomidine (study group) and other sedatives (control group) during therapeutic hypothermia period. Data of 205 term infants with hypoxic-ischemic encephalopathy by Sarnat scale stage II-III were collected during ≤72 hours of life. Infants of the study group (n=46) received dexmedetomidine during mechanical ventilation for pharmacological sedation. Control group infants (n=159) received morphine, sodium oxybutiras, and diazepam in standard recommended doses. A comparative analysis of the effect of dexmedetomidine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. A significant difference between groups in days of trachea extubation (p=0.022) was found; the chance for babies to be extubated before the 7th day of treatment was significantly higher in the dexmedetomidine group 68% versus 33% in the control group (p=0.018) with HR 0.48 (95% CI 0.27-0.86, p=0.011). Also, the NIRS index rScO2 differed significantly between the studied and control groups on the 1st day of treatment (65% versus 79%, p=0.012) and on the 2nd day of treatment (74% versus 81%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group – (58 [51-65] mm Hg versus 53 [46-60] mm Hg, p<0.001), with a lower dose of dobutamine (EV -1.87, 95% CI from -3.25 to -0.48, p=0.009). In the dexmedetomidine group, the rate of seizures was significantly lower on the 1st day of observation (4.3% versus 48.3%, p <0.001); the incidence of unfavorable outcome such as cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared to the control group (2.2% versus 15.1%, p=0.018). The determined peculiarities give grounds to use dexmedetomidine in the daily practice of the neonatal intensive care, but additional data needs to be collected before any further conclusions can be drawn.
Key words: рatent ductus arteriosus, restrictive infusion therapy, cox inhibitors, premature newborns
Abstract. Management of patent ductus arteriosus in premature infants. Obolonskyi A., Snisar V., Surkov D., Obolonska O., Kapustina O., Dereza K. Closure of hemodynamically significant patent ductus arterios (HSPDA) is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0 g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4 ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6 ml/kg/day, and on day 5 – to 89.7±6.8 ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1 mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in rectal form. In all groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle.
Key words: chronic obstructive pulmonary disease, hypertension, combined course
Abstract. Pecularities of the clinical course of chronic obstructive pulmonary disease in hypertensive patients. Arkhipkina O.L. Nowadays, the problem of comorbid chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) is considered from the point of view of the presence of common risk factors and pathogenetic mechanisms. The aim of the study was to investigate cardiorespiratory system function in patients with COPD and AH and to analyze the main cardiovascular risk factors. 284 patients with COPD were divided into 2 groups: the main group - 167 patients with COPD and concomitant hypertension, the comparison group - 117 patients with COPD and normal blood pressure values. An analysis of the clinical picture of COPD revealed that patients with AH more often had exacerbation of underlying disease, more expressed clinical manifestations of the disease, differed in phenotypic distribution of patients. All patients with COPD showed a tendency to increase in arterial pressure, blood glucose level and total cholesterol compared with the control group with enhanced tendency in hypertensive patients. In addition, in hypertensive group the patients had a higher body mass index and smoked intensively. According to EGC data, the majority of patients with COPD experienced tachycardia, arrhythmia and conduction disturbances, hypertrophy of ventricules, which occurred more often in hypertensive patients. Pulmonary function was characterized both by obstructive and restrictive changes that were more expressed in the comorbidity. Thus, in the presence of AH the clinical manifestations of COPD varied, demonstrating the contribution of vascular pathology to the respiratory disorders in those patients. The combined course of COPD with AH is characterized by a modification of clinical manifestations of the disease and COPD was associated with increased cardiovascular risk in patients examined.
Key words: septoplasty, perioperative period, anemia, systemic inflammatory response, hemostasis, blood loss, dexmedetomidine
Abstract. Features of changes in laboratory parameters of patients against the use of dexmedetomidine in septoplasty. Ayvardgi A.A. Currently, a lot of attention of scientists all over the world is paid to the perioperative management strategy, taking into account the volume of surgical intervention, the presence of comorbidities and their possible complications. This makes it possible to reduce mortality, decrease the number of adverse events in the intra- and postoperative period, effectively cope with pain, advance recovery and rehabilitation, and also increase patients’ satisfaction with the quality of medical care. We studied indices of 58 adult patients who underwent septoplasty. Patients were divided into 2 groups. In group “D”, dexmedetomidine was infused, which began 10 minutes before the induction of anesthesia at a dose of 0.7 μg/kg/h and ended 10 minutes before the end of the surgical intervention. The clinical blood test (hemoglobin level, erythrocytes, leukocytes, rods count), body temperature of patients, coagulogram (INR, fibrinogen level, Dyuk bleeding time) were studied. When comparing the indicators of clinical analysis in the postoperative period in the control group leukocytosis and stab left shift (p <0.001) was observed. For patients undergoing dexmedetomidine infusion, leukocyte and bacillus levels were normal. In both postoperative follow-up groups, low-grade fever was detected (p <0.001). In the control group, 12 hours after surgery, body temperature rose to febrile values. During the operative intervention, the “D” group was characterized by the better indices of blood coagulation. In the group "K" on the second day of the postoperative period, there was a slight increase in coagulation. The level of intraoperative blood loss in the “D” group was significantly lower than in the control group (p<0.001). In the “D” group in the postoperative period, the minimum decrease in hemoglobin was determined in contrast to the control group (p<0.001). The use of dexmedetomidine infusion leads to a decrease in the manifestations of a systemic inflammatory response in surgical interventions for the curvature of the nasal septum. The introduction of dexmedetomidine provides better blood coagulation during septoplasty. Infusion of dexmedetomidine causes a decrease in blood loss and consequently the maintenance of hemoglobin concentration at the proper level.
Key words: pregnancy, stress-associated hormones, hormones of the fetoplacental complex, pregnant women - displaced persons
Abstract. Features of hormonal function in pregnant women - displaced persons. Zhabchenko I.A., Korniets N.G., Tertychna-Telyuk S.V. Harmonious and stable psycho-emotional state of pregnant women is an important condition of successful pregnancy course, fetal development and physiological childbirth. People are facing various problems related to mental health that vary from psycho-emotional stress to the mental disorders. Important factors that determine the physiology of pregnancy are the psycho-emotional state of the pregnant and fetoplacental complex. Among the consequences of severe stress during pregnancy is dizziness, tachycardia, trembling of limbs, elevated arterial pressure, unmotivated increase in nervousness and anxiety, sleep disorder, depression that lead to worsening of general condition of a future mother. The purpose of the study was to determine changes in the production of placental hormones and stress-associated hormones in pregnant women - displaced persons. To carry out the study, a randomised dynamic prospective clinical-paraclinical examination of 96 pregnant women (the main group) - displaced persons and 39 pregnant women (control group), who lived permanently in the territory of Ukraine under control, with gestation period after 22 weeks was used. Concentration of stress-associated (cortisol and prolactin) and placental (estradiol, progesterone, placental lactogen) hormones in serum was determined by solid-phase immunoassay. Increased estradiol concentrations and relative reductions in progesterone and placental lactogen, displacement of estrogen-progesterone equilibrium toward relative hyperestrogeny, increase in the concentration of stress-associated hormones were observed. The revealed hormonal and metabolic disorders in pregnant women, internally displaced persons, are biochemical markers of placental dysfunction, which testifies to the expediency of a comprehensive preconceptional preparation with the involvement of a psychologist and inclusion of preventive measures in the form of long-term progesterone support during pregnancy in the program of antenatal observation of such women.
Key words: intermittent fasting, therapeutical fasting, interval feeding, arterial hypertension, headache, cephalalgia
Abstract. Clinical characteristics of cephalalgia at patients with arterial hypertension during intermittent fasting. Chun Liu, Pohorielov O.V. The study of the effectiveness and safety of intermittent fasting (IF) at 185 patients aged from 25 to 75 years (mean age – 48,6 years) with arterial hypertension (AH) and headache was carried out. AH was seen as the most likely factor of cerebral discirculation and associated cephalgia. Patients volunteered to maintain a short-term dietary restriction with terms of 16 or 24 hours once in 7 days over a period of 4 weeks. During this period, 43 patients stopped participation in the study, of which 31 - at 24-hour IF and 12 - at 16-hour IF. The assessment of the influence on cephalgia was considered positive when the score of visual analog scale (VAS) was decreased by 2 or more points and / or there was a significant decrease in the duration and frequency of cephalgia attacks. In a rhythmic diet with a 16-hour food intake missing, a positive result was registered at 35% (37,25% of young patients, 40,48% – of average and 28,57% of the elderly) without a significant difference between ages. The effectiveness of a 24-hour type of IF was higher and made up about 75% in all age groups. Negative side effects of IF that would require its termination due to objective reasons (threatening changes in blood pressure, syncope states and others) were not recorded, the most common complaints were the feeling of hunger (from 50 to 76% with a difference in age), psychological tension, uncertain anxiety (on average about 32%). The authors consider that such a psychological feature - namely, the impossibility and unwillingness to endure short-term fasting was a main factor of refusal to continue the treatment regimen, and within certain limits prevents the wider use of IF method in the treatment of cephalgia. In general, the efficacy of a 24-hour IF compared with a 16-hour type was significantly higher, without severe side effects.
Key words: arterial hypertension, cognitive disorders, cardiovascular risk
Abstract. Features of cognitive disorders in patients with arterial hypertension of low cardiovascular risk. Krotova V.Yu. By the WHO data, Ukraine is country number 1 in Europe and number 2 in the world according to the cardiovascular mortality rate. In the structure of the prevalence of cardiovascular diseases in Ukraine, the percentage of persons of working age with arterial hypertension is 36.7%. The improvement of the prognosis of patients with arterial hypertension depends not only on long-term effective control of blood pressure, but the diagnosis and initiation of therapy at the initial stage of the development of the disease, when the target organs have not yet undergone hypertensive damage is also an important condition. The article presents the results of neuropsychological examination of 509 outpatients with a controlled second stage arterial hypertension, with an integrated assessment of cognitive functions using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MCA) methods. It has been established that even in patients with controlled arterial hypertension stage II with a low cardiovascular risk, by SCORE scale cognitive disorders were revealed in 32,2%. The peculiarities of the development of cognitive disorders in arterial hypertension in connection with the history and course of the disease are analyzed. The majority of patients with hypertension have an increased level of anxiety, especially personality, and this is not due to the presence or absence of cognitive disorders. In patients with hypertension and cognitive disorders, on the basis of testing data by the SF-36 scale, there was a significant (p<0.001) decrease in quality of life on all scales as compared with healthy ones on average by 24.5-66.0 points.
Key words: frequency of consumption, map questionnaire, food products of animal origin, diet, alimentary diseases, ways of correction, medical students
Abstract. Hygienic assessment of frequency of consuming food products of animal origin in the diet of medical students and rationale of ways of its correction. Yeltsova L.B., Omelchuk S.T., Petrosian A.A. Availability of various healthy food products in the student’s diet and conscious student’s choice represents the best way of prevention of the alimentary and alimentary-associated diseases, preservation and promotion of health. The aim of the study: hygienic assessment of frequency of consuming food products of animal origin by medical students in order to prevent alimentary diseases by means of correction of diet. The authors studied medical students’ diet using map questionnaire with the subsequent data assessment. The study includes the data of 858 respondents, students of the 2nd, 4th and 6th years of study of medical faculties of O.O. Bogomolets National Medical University. Random sampling was used. The age of the respondents ranges between 18 and 25 years, 570 females and 288 males. Frequency of consumption was estimated according to the following categories: consuming of food products of animal origin once a day or even more often, consuming them almost every day, consuming them once a week, consuming them several times a week, consuming them once or several times a month, consuming them rarely or never. The study assessed frequency of consumption of such product groups as: meat and meat products, fish and seafood, milk and dairy products, eggs and fatty products. The authors have established that one third of the respondents, regardless of their gender and year of study, consume meat and meat products once a day or almost every day. From 20% (the 2nd year of study) to 28% (the 6th year of study) of male respondents and from 13% (the 2nd year of study) to 21% (the 6th year of study) of female respondents consume fish and seafood once a week or several times a week. Less than 30% of both male and female respondents, without regard to the year of study, consume milk and dairy products once a day or even more often. About 20% of male respondents and from 10% (the 2nd year of study) to 25% (the 6th year of study) of female respondents consume eggs daily. 16-18% of male respondents and 6-10% of female respondents consume fatty products (butter, lard) daily or almost every day. The obtained results make it possible to conclude that more than 2/3 of the medical students’ diets according to the frequency of consuming food products of animal origin do not correspond to the National recommendations on nutrition precisely by the frequency of their consumption [12, 13]. This may lead to polynutrient deficiency and development of alimentary diseases, which proves the necessity of correction of medical students’ diet.
A CASE FROM PRACTICE
Key words: obsessive compulsive disorder, Gilles de la Tourette syndrome, behavioral disorders
Abstract. Obsessive compulsive disorder in an adult patient with Gilles de la Tourette syndrome and expressed behavioral disorders (clinical case). Yuryeva L., Shusterman T., Varshavskyi Ya., Malyshko V. The article describes the clinical case of obsessive-compulsive disorder in an adult patient with Gilles de la Tourette syndrome and severe behavioral disorders. The authors demonstrated the comorbidity of Gilles de la Tourette syndrome and obsessive-compulsive disorder. Obsessive thoughts and compulsive actions were diagnosed as the most frequent behavioral disorders in Tourette syndrome. It was indicated on gender as an additional sanctioning factor for the early onset of mental disorders. Obsessive-compulsive disorder in the patient was characterized by mixed obsessive thoughts and actions, had a protracted nature, with prolonged decompensations requiring treatment in a psychiatric hospital. Emotional instability, impulsivity, obsessions and compulsions affecting the social functioning of not only the patient himself, but also those around him, as well as pronounced behavioral disturbances led to social malajustment. When treating the patient, the doctors had to resort to a combination of typical neuroleptics with second-generation antipsychotics, mood stabilizers and antidepressants due to the poor response to pharmacotherapy. Comorbidity of mental disorders determined the complexity of therapeutic measures with the use of psychotherapeutic interventions, which made it possible to achieve an improvement in the mental state and avoid disability of the patient.
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