Medicni perspektivi, 2019;24(4)
2019 Vol. XXIV N 4
Key words: KROK, International Basic Medicine Examination, USMLE, modernization, medical educa
Abstract. Relevant approaches to modernization of academic and material and technical process support of academic process in the field of knowledge “Health care” in terms of adapting to international assessment criteria. Pertseva T.O., Shponka I.S., Tverdokhlib I.V., Pototskaya O.Yu. One of the important tasks in modernization of Ukrainian medical education is to bring it in line with international assessment criteria, which has become especially relevant after the introduction of the International Basic Medicine Examination in 2018. The aim of this work was to identify the most significant differences between international medical exams (for example, The United States Medical Licensing Examination, USMLE) and the national system of licensed exams KROK, and based on this, determine the direction of modernization of Ukrainian medical education for its adequate adaptation to new systems of assessment. The most significant differences between the two exams are: format (on computers / on paper); presence / absence of digital files with images and audio data in tasks; thematic focus of tests within one / several subjects; different list of items by which tasks are distributed; in the case of USMLE, there is a much higher motivation to pass the exam with the highest possible result. To adapt the medical education system to such features, it is necessary: to provide students with high-quality illustrated textbooks and meaningful digital data bases for each specialized subject; to actively use images (audio, video files) from these sources during the analysis of the material and all types of control (including test ones); to establish cooperation between the fundamental and clinical departments in the process of creating test tasks, as well as the exchange of digital materials for practical classes. Of particular importance is the synchronization of methodological approaches to conducting practical classes and assessment criteria not only in theoretical but also in clinical departments, which will make the learning process more transparent and understandable. Such a set of measures will help not only to adapt students to exams at the international level, but also will increase their interest and improve the effectiveness of the educational process. The employment of digital images, audio, video files will also contribute to the adequate preparation of students for new directions in medicine, such as telemedicine and telepathology.
Key words: Combined Learning, Learning Management System, Academic Participation, Nursing Students, Iran University of Medical Sciences
Abstract. Investigation of students' academic participation in combined learning based on learning management system. Daryadokht Masroor Roudsar, Hamid Haghani, Afsaneh Dehnad, Mojtaba Ghanbari Ghalesari, Maryam Ghasemi Shoub, Mostafa Akbarian Rokni. Aim and Purpose – Using new methods and proper and interactive experiences can help improve the quality and attractiveness of education. The present study aimed to investigating the relationship between academic participation of nursing students who use combination education based on learning management system (LMS) and studied their degree of academic participation. This is a descriptive cross-sectional study in which the researcher has studied student participation through a demographic information form and a questionnaire on academic engagement. The purpose of this research was to study the nursing and midwifery faculty of Iran University of Medical Sciences in which 229 undergraduate nursing students were selected from the total of 280 from the second to the sixth semester by the total number and according to entry criteria. Then, data were analyzed by SPSS software version 23 and significance level less than 0.05, descriptive statistics, independent t-test, one way ANOVA, and Scheffe post hoc test and Pearson correlation. Most of the research units were female (52.8%), in the range of 21-29 years old (53.3%), single (90%) and native of Tehran (53.7%). The vast majority had a moderate or lower familiarity with the LMS system (75.5%). The majority did not easily access the LMS system (56.3%). Only 2.2% of the units had high satisfaction and 40.2% had relative satisfaction and 57.6% had low satisfaction from LMS-based combination training. The mean and standard deviation of the educational participation score was 51.16±14.86 and their behavioral subscale scores 69.68±16.48 and the emotional subscale was 49.56±20.53 and the cognitive subscale was 38.25±20.55%. According to the results of the study, most of the research units had low satisfaction with LMS-based combination training, which could increase student satisfaction by using all the capabilities of the learning management system and the more interactive design of the combination training, as the majority of previous studies have shown high satisfaction with combined training. Among the subscales of educational participation that have a positive relationship with academic success and academic achievement, the highest mean score was for subscales of behavioral participation and the lowest for cognitive subscales and this study did not show any relationship between the satisfaction of LMS-based combination education and the student's academic engagement.
Key words: neobladder, pharmacological correction, experimental in vivo, new chemical compounds
Abstract. Possibilities of pharmacological correction of the artifical bladder contractile activity in experimental conditions in vivo. Savchuk R.V., Kostyev F.I., Shmatkova N.V. The aim of this work was to study the possibility of pharmacological correction of the neobladder contractile activity of mini-pigs under the influence of new chemical compounds, m-anticholinergic (solifenacin), selective beta-2 sympathomimetic (ginipral (hexoprenaline)) in vivo. Neobladder, formed from the distal section of ileum, pre-denervated along the anti-mesenteric margin, retains peristalsis, and given the sharp thickening of the muscle layer, capable to contractile reactions and tone support. New chemical compounds pyrrole-2-carbaldehyde 2- hydroxybenzoylhydrazone (PChBh) and isatin benzoylhydrazone (IBh) demonstrated spasmodic properties directed at smooth muscle in vivo. Compound PChBh (I) showed more pronounced relaxing properties compared to compound IBh (II), reducing basal pressure against KCl by 40.91%, contraction amplitude by 30.63%, contraction rate by 25.49%. Solifenacin, being an m-anticholinergic antagonist, most clearly demonstrated antispasmodic properties in vivo, reducing hypertonicity by 55.23%, amplitude – by 49.31%, frequency of contractions in 10 minutes – by 57.40%, duration of contractions – by 18.18%. Selective beta-2-sympathomimetic hexoprenaline, previously used to relieve hypertonicity of a pregnant uterus actively affects intestinal motility. Hexoprenaline inhibited bladder overactivity with KCl, decreasing basal pressure by 58.75%, the amplitude of the contractions – by 39.62%, frequency rate – by 57.49%, reductions in the duration – by 54.55%. Preparations from the group of m-anticholinergics and selective beta-2-sympathomimetics showed a pronounced antispasmodic effect in experiment in vivo and can be used to correct incontinence in patients after orthotopic bladder repair. The new chemical compounds pyrrole-2-carbaldehyde 2-hydroxybenzoylhydrazone (PChBh) and isatin benzoylhydrazone (IBh) demonstrated antispasmodic properties in the experiment in vitro, and confirmed an antispasmodic effect in the experiment in vivo, promising further research, determining safety and efficacy.
Key words: osteoarthritis, hypothyroidism, pain threshold, comorbid pathology
Abstract. Indicators of pain sensitivity threshold in experimental osteoarthritis and hypothyroidism. Nosivets D.S. Diseases of the thyroid gland are an urgent problem of modern society due to a wide, constant spread of this pathology and with somatic, reproductive and mental disorders associated with these diseases. The negative effect of thyroid hormone dysfunction on the functional state of organs and systems is due to the key role of thyroid hormones in metabolic processes. It is known that metabolic disorders in diseases of the thyroid gland negatively affect the state of bone and cartilage tissue and cause the development of a number of pathological conditions among which osteoarthritis is absolutely important. However, to date, the issue of changing the pain sensitivity threshold against the background of osteoarthritis due to functional insufficiency of the thyroid gland, which is of key importance in studying the efficacy and safety of pharmacotherapy of these diseases, is not sufficiently covered. The author studied the changes in pain sensitivity threshold in rats when modeling osteoarthritis and hypothyroidism. In the work 80 rats were used, which were divided into two experimental groups - the control group (n=40) and the group of animals with experimental osteoarthritis and hypothyroidism (n=40). Experimental hypothyroidism was reproduced by enteral administration of a 0.02% solution of carbimazole, which was prepared at the rate of 5 mg per 250 ml of saline and given with a drinking ration of animals for 6 weeks. Experimental osteoarthritis was reproduced by a single intra-articular injection of 0.1 ml of monoiodoacetic acid solution into the knee joint, prepared at the rate of 3 mg of reagent per 50 μl of sterile saline. To assess the threshold of pain sensitivity in rats against the background of experimental models, the method of electrical stimulation of the rat tail was used in the standard method. The pain threshold was determined by the reaction of vocalization during electrocutaneous stimulation of the rat's tail root. Based on the data obtained, conclusions were drawn about the negative effect of the thyroid hormone deficiency on the formation of the pain response in experimental animals, which indicates a weakening of the response to nociceptive effects, is manifested by an increase in the pain threshold.
Key words: nitric oxide, FeNO, smog, particulate matter, children, airway inflammation, asthma
Abstract. Assessment of the concentration of nitric oxide in exhaled air (FeNO) in primary school children in Krakow and Ruzomberk in relation to air pollution in these cities. Czubaj-Kowal M., Friediger T., Połcik-Jastrząb M., Sokołowski M., Hudakova Z. The measurement of the exhaled nitric oxide (FeNO) is a recognized biomarker in the detection and monitoring of airway inflammatory infections, this including asthma. Due to its simplicity, and noninvasiveness, it is more and more widely used in diagnostics of children. Few studies indicate the relationship between FeNO and atmospheric air pollution. The goal of the following study was the measuring of FeNO for 8-9 year old children in Krakow and Ruzomberok and relating the results of these measurements to the level of air pollution in the PM10 and PM2,5 range. 250 children aged 8-9 (125 in Krakow and 125 in Ruzomberok) attending third grades of primary schools, have constituted the research group. The measurement has been taken in accordance with the applicable standards with the application of a MediSOFT Belgium analyzer with a disposable head with an antibacterial filter. The results of the measurements have been referred to the PM10 and PM2,5 concentration of particulate matter in the air. Within the group of 125 children participating in the study in Krakow, the FeNO levels were normal for 104 (83.2%) children and increased for 21 (16.8%) children. During the period of the study, the average PM10 concentration was 55,7 µg/m3 and PM2,5 was 37.0 µg/m3. As far as the group of 125 children examined in Ruzomberok, the FeNO levels were correct (5-20 ppb) for 114 (91,2%) children and increased (21-55) for 11 children (8.8%). During the period of the study, the average PM10 concentration was 24.1 µg/m3 and PM2,5 was 15.4 µg/m3. As one can see from the comparison, 1.9 times more increased FeNO levels have been recorded in Krakow than in Ruzomberok (18.6 vs 8.8%), and, within the range of the heavily increased values (>50 ppb), this difference was as much as 4 times greater (3.2% vs 0.8%). These results correlate with the PM10 and PM2,5 levels in Krakow, which are respectively 2.3 and 2.4 times higher than those in Ruzomberok.
Key words: functional disorders of the gallbladder and Oddi's sphincter, miRNA-4714-3p expression level, choleretic therapy, ursodeoxycholic acid, children
Abstract. Influence of choleretic therapy on the microRNA-4714-3p expression level in children with functional disorders of the gallbladder and Оddi's sphincter. Abaturov A.E., Babуch V.L. The high prevalence and possibility of transformation of functional disorders into organic pathology determine the relevance of the study of the cluster of functional disorders of the gallbladder and Oddi's sphincter (FD GB and OS) in children. Studies on the properties of ursodeoxycholic acid (UDCA) to alter the activity of generation of some microRNAs in various diseases of the hepatobiliary system have become important in view of the evidential impact on this process. The alm: to determine the effect of choleretic therapy with UDCA drugs addition on the microRNA-4714-3p expression level in functional disorders of the gallbladder and Oddi's sphincter in children. 70 children with FD GB and OS aged 4 to 14 years were examined. Main group included 50 children. They received standard therapy with UDCA combination. The comparison group included 20 patients receiving standard therapy without UDCA. A molecular genetic study was conducted to determine the microRNA-4714-3p expression level in serum before and after treatment by real-time polymerase chain reaction with reverse transcription according to TaqMan Gene Expression Assays. The correlation was established between the main anamnestic data, causative factors of development, clinical and paraclinical parameters of the FD GB and OS and the microRNA-4714-3p expression level in blood serum of children before therapy. The positive relationship of the microRNA-4714-3p expression profile with decrease in gallbladder contractility was determined (r=+0.36; p<0.05). It has been determined that in children with FD GB and OS after the combined therapy with UDCA, the mean value of the microRNA-4714-3p expression level in serum is significantly lower than before therapy (1.93±0.58 SU and 5.56±1.50 SU, respectively). A positive correlation was found between the microRNA-4714-3p expression level and the alkaline phosphatase activity level in the blood of children with FD GB and OS after therapy with UDCA addition (r=+0.33; p<0.05). There was no correlation between the microRNA-4714-3p expression level and the anamnestic, clinical-paraclinical parameters in children with FD GB and OS after treatment without UDCA. The effect of UDCA on the treatment of functional disorders of the gallbladder and Oddi's sphincter in children results in a decrease in the microRNA-4714-3p expression profile and is accompanied by the emergence of a direct correlation between low level of a microRNA-4714-3p expression and reduced alkaline phosphatase activity in serum.
Key words: diabetes mellitus, neuropathic pain, grape seed extraction, hot plate, streptozocin (STZ)
Abstract. Investigating effects of grape seed extract on neuropathic pain in the streptozotocin-induced diabetic mice. Yurt A., Köksal B., Gürbüz P., Yıldız A., Vardı N., Alçin E. Diabetes mellitus is a complicated and serious health problem involving peripheral neuropathy. This situation causes to loss of senses, tingle and pain. Diabetic peripheral neuropathy (DPN) affects 236 million people around the World. Hence there is a need to investigate alternative ways of cure focusing on DPN. Flavonoids have potential on pain due to their permeability characteristic in the capillary microcirculation system and in lowering blood pressure. Flavonoids are common in grape seed. The main flavonoids of grape seed involve proanthocyanidins which might be an effective agent in cure of pain in DPN. The purpose of this study is to investigate effects of grape seed extract on neuropathic pain in the Streptozotocin-induced diabetic mice. In the study, 50 eight-week old BALB-C strain mice in five different groups (Control, Diabetic Control, Control+25 mg/kg, Diabetes+25 mg/kg and Diabetes+50 mg/kg) were used. To induce diabetes in thirty of these animals, single dose Streptozotocin (180 mg/kg) was administered intraperitoneally. After diabetes was observed, grape seed extract (25 mg/kg and 50 mg/kg body weight) was administered by oral gavage in three groups (Control+25 mg/kg, Diabetes+25 mg/kg and Diabetes+50 mg/kg) during six weeks. At the end of the second and sixth weeks, pain threshold measurements in hot plate test were performed in line with a predetermined thermal pain model. Also the tissues of the sciatic nerve and abdominal aorta from the animals were histologically investigated. As a result hot plate measurements, pain threshold values of the animals in Diabetes+50mg/kg group significantly differed from the measurements of the animals in control group in the first measurements and from the animals in Diabetes+25 mg/kg group in the second measurements (p<0.05). However pain threshold values of the animals in Diabetes+25 mg/kg group differed significantly from the values of the animals in control+25 mg/kg group and control group. It means pain threshold values of the animals in Diabetes+50 mg/kg and Diabetes+25 mg/kg groups were significantly lower than the values of the animals in the other groups. The results of histological investigations showed that degenerations of myelin sheet and axons in diabetic control group were decreased significantly in Diabetes+50 mg/kg and Diabetes+25 mg/kg groups. Moreover degenerations of aorta tissues of animals in diabetic group were not seen in the animals of Diabetes+50 mg/kg except for tunica adventitia inflammation. It can be said that grape seed extract decreased threshold of neuropathic pain in the Streptozotocin-induced diabetic mice and prevented degenerations of myelin sheet and axons, and aorta tissues.
Key words: arterial hypertension, chronic obstructive pulmonary desease, ambulatory blood pressure monitoring, pulsoxymetry, 6-minutes walking test
Abstract. Arterial hypertension with comorbid chronic obstructive pulmonary disease: relationship between tolerance to physical exercise and structural and functional state of the heart. Burtniak T.Z., Potabasniy V.A., Fesenko V.I. The aim of the study was to establish the relationship between tolerance to exercise, oxygen saturation, and structural and functional cardiac status in patients with hypertension in combination with COPD. This study included 120 patients with primary arterial hypertension of stage I-II, grade 1, 2, and 3 in combination with COPD of grades 2 and 3 and clinical groups A, B, C, D, consisting group 1; group 2 – 30 patients with primary hypertension, and group 3 – 30 patients with COPD; group 4 – 30 practically healthy people representative by age and sex. Research methods included general clinical examination (collection of complaints, anamnestic data) and instrumental research methods: electrocardiography (ECG), echocardiography, measurement of ambulatory blood pressure (BP) profile (ABPM), spirometry, pulsoxymetry (SpO2), 6-minutes walking test (6MWT). On examination of 120 patients with stage I-II, grade 1 hypertension was established in 19 (15.8%), grade 2 was in 83 (69.2%) and grade 3 was in 18 (15%) patients, respectively. COPD in clinical group A was diagnosed in 10 (8.3%), B – in 51 (42.5%), C – in 18 (15%) and D - in 41 (34.2%) patients, respectively. The most common was AH stage 2 with COPD in clinical group B – 35 (29.2%) cases and D – 31 (25.8%) cases. The 24-hour average systolic BP (SBP) in patients of the main group was 165 [144;178] mmHg, and the diastolic BP (DBP) was 103 [94;111] mmHg. The daytime average SBP was 160 [140;180] mmHg, and the DBP was 105 [93;117] mmHg accordingly. The night-time average SBP was 165 [155;175] mmHg, DBP – 100 [95;105] mmHg, heart rate (HR) – 83 [76;88] minutes, respiration rate (RR) – 21 [19;24] minutes. Decreases in index of chronotropic reserve (ICR) and the index of inotropic reserve (IIR) and load index indicate an increase in myocardial oxygen demand during exercise. There was an inverse correlation of IIR with SBP at rest (r= –0.42; p˂0.05) and a direct correlation with age (r=0.28; p˂0.05), which is significantly different from the control group. A direct correlation was found between the double product (DP) before and after exercise (r=0.43; p˂0.05), which indicated an increase in consumption of oxygen by the myocardium. We found a direct correlation between left atrium (LA) and the ratio of expiratory volume per 1 sec (FEV1) to the forced lung capacity (FEV) – FEV1/FVC (r=0.32; p˂0.05), which indicates the effect of the severity of bronchial obstruction on the level of left ventricular (LV) overload in patients with hypertension combined with COPD. The inverse correlation between thickness of the posterior wall of the LV (RVWT) and FEV1/FVC (r= -0.32; p˂0.05) indicates the contribution of disorders of bronchial patency and intrathoracic pressure with the level of BP to the development of concentric remodeling and LV hypertrophy. The inverse correlation between SV and COPD Assessment Test (CAT) (r= -0.32; p˂0.05) indicates an additional effect of COPD clinical severity on central hemodynamics in patients with hypertension. This relationship between the ventilatory and hemodynamic parameters is confirmed by the inverse correlation of HR and FVC (r= –0.33; p˂0.05)), left ventricular internal dimension (LVEDD) of LV and CAT (r= –0.24; p˂0.05)), stroke volume (SV) and Modified British Medical Research Questionnaire (mMRC) (r= –0.42; p.00.05), CAT and pack years (r=0.33; p˂0.05), inverse correlation between CAT and mMRC and FEV1, FVC and FEV1/FVC (r= -0.40;p˂0.05 and r= -0.45; p˂0.05), respectively. Linear regression analysis showed that changes in SV LV, LVEDD and SpO2 were dependent predictors of patient’s worsening state according to CAT (p˂0.05). The direct correlation was established between the desaturation (ΔSpO2) and ΔDP (r=0.48) and the inverse of ΔSBP (r= -0.29), 6MWT (r= -0.45), ICR (r= -0.34) and IIR (r= -0.29), which indicates a pronounced effect of hypoxemia on hemodynamics in patients with hypertension in combination with COPD. Comprehensive determination of cardiorespiratory reserve by 6-minute walk test, pulse oximetry and ambulatory blood pressure monitoring in patients with hypertension in combination with COPD makes it possible to establish disadaptation of the body to physical activity due to hypoxemia, decrease in the index of chrono- and inotropic reserves, which is an indication for administering appropriate therapy. In patients with hypertension combined with COPD, the degree of desaturation, stroke volume, end-diastolic parameters of the left ventricle, maximal size and volume of the left atrium, as well as remodeling of the left heart sections in the concentric direction can be considered as independent predictors of prognosis. The 6-minute walk test with desaturation can be used as an additional method of personalizing rehabilitation measures in patients with hypertension in combination with COPD.
Key words: group A β-hemolytic streptococcus, tonsillopharyngitis, children, antibacterial therapy
Abstract. Effect of antibacterial therapy on the clinical course of streptococcal tonsillopharyngitis in children. Haiduk T., Cherhinets A., Shostakovych-Koretska L. The aim of this study was to determine the effect of antibiotic therapy (AT) on the clinical course of streptococcal tonsillopharyngitis (STP) in children, depending on the timing of its administration, since the data on the need to start AT in the first days of the disease to achieve the effect are controversial. A retrospective analysis of inpatient medical records at “The Communal Dnipro City Clinical Hospital N 21 named after Professor Ye.G. Popkova” DRC” in the period from January 2012 to December 2018 was conducted. The inclusion criteria for the study were: 1) the diagnosis - tonsillopharyngitis; 2) the age of the patient: 3 to 18 yrs; 3) the exclusion of an alternative diagnosis (diphtheria, infectious mononucleosis, scarlet fever); 4) no complications; 5) positive results of the culture study on β-hemolytic streptococcus group A (GAS) (Streptococcus pyogenes) of the oropharyngeal swab. The study included 109 medical cards of children with STP. Depending on the timing of the onset of rational AT, all patients were divided into 5 groups. The first one consisted of 27 children who received AT from the 1st day of the disease, 2nd - 48 children (AT from the 2nd day), 3rd - 17 children (AT from the 3rd day) and the fourth - 7 children (AT from the 4th day), 5th - 10 children (AT from the 5th day). Clinical symptoms were evaluated by examining the patient with the main objective and subjective symptoms of STP. It was a retrospective open comparative study. All patients received the full recommended course of STP AT. The study showed no significant differences in the reduction of clinical symptoms of STP, regardless of the timing of antibiotic therapy (1-5 days from the onset of the disease) in almost half of patients with STP, which confirms the inadequacy of antibacterial therapy in children with tonsillopharyngitis. We believe that antibiotic therapy should only be used to prevent late complications in cases of children with tonsillopharyngitis only with a confirmed GAS etiology, and we propose the widespread use of the McIsaac Score, the Streptococcus Expression Test (RST) and the culture study of the oropharyngeal swab to confirm the etiology of GAS in children with tonsillopharyngitis to reduce the frequency of antibiotics overusing.
Key words: chronic brain ischemia, risk factors, comorbidity, Charlson’s comorbidity index modified
Abstract. Comorbidity profile in chronic brain ischemia on the background of multifocal atherosclerosis. Dzyak L.А., Rosytska О.А. Aim to evaluate the comorbidity profile in patients with chronic cerebral ischemia on the background of multifocal atherosclerosis. The study included 137 patients aged 40 to 84 years with chronic cerebral ischemia (CСI) on the background of multifocal atherosclerosis, which were divided into three clinical groups depending on the localization of vascular lesions by stenosing atherosclerosis. The co-morbidity profile and severity were evaluated using the Charlson’s index in modification of R.A. Deyo (1992). In CCI patients, regardless of the combination of vascular basins affected by atherosclerosis, a severe degree of comorbidity prevailed - the Charlson’s comorbidity index (IC) was predominantly > 5 points (84.7% of cases). In the analysis of IC in age categories, depending on the combination of atherosclerotic lesions of the vascular basins, it was found that comorbidity of severe degree (IC> 5) was predominantly represented by patients of the older age group (60-74 years), and comorbidity of moderate severity (IC≤5) – patients of middle age group (45-59 years). A median difference of 3 points in assessing the mean value of age-matched comorbidity index showed that age, as a non-modifiable risk factor, in 1/3 cases determines the comorbidity index, which depends on the number of vascular basins affected by atherosclerosis. In 2/3 of the cases it is a modified comorbid pathology. Assessment of IC in clinical groups, taking into account the nature of the disease course (p <0.05), showed a correlation between the number of atherosclerosis affected by vascular basins, the severity of the clinical course of CCI and the severity of comorbidity. The severity of comorbidity, as measured by the Charlson’s index modified by R.A. Deyo, depends on age and determines the nature of the atherosclerotic lesion, as well as the severity of the clinical course of CCI. Assessing the profile and severity of comorbidity makes it possible to influence the nature of the development and course of brain ischemia, which is caused by systemic atherosclerotic lesions of the vascular system.
Key words: anxiety, teenage girls, communication technologies, sensory-color perception
Abstract. Features of the emotional portrait of teen-age girls in the context of their color-sensory attitude to modern communication technologies and state of anxiety. Vysochyna I., Avramenko I., Kramarchuk V., Yashkina T. This work is a continuation of previous studies on the relationship of high anxiety and the use of modern electronic communication tools. The purpose of this study was to determine the characteristics of the emotional portrait of adolescent girls in the – context of their color-sensory attitude to modern communication technologies and state of anxiety. The study involved 136 girls aged 17 years (at the time of the survey). All respondents were evaluated according to standardized valid psychological methods (WAM - well-being, activity and mood), color relationship test (TCR), the method of "Multidimensional assessment of child anxiety" (MACAQ), the personal Taylor anxiety manifestation scale in the modification of Norakidze) and contained an author's questionnaire regarding the time spent in a sitting position; time spent in front of the screen of a mobile phone, tablet, laptop, PC; problems in relationships with parents. The study was conducted in accordance with the bioethical principles and provisions of the Helsinki Declaration and Good Clinical Practice (GCP). In the course of the work, it was proved that the time spent near the screens of electronic devices (phone, tablet, laptop, PC) for more than 6 hours a day is a significant factor, which is a predictive of emotional disorders in adolescent girls due to disruption of compensation mechanisms and the formation of a high level of personal anxiety, the appearance of achromatic sensory-color associations in interpersonal interactions, exacerbation of family conflicts with parents, which together indicates maladaptation and requires disruption work corrective programs.
Key words: chronic urticaria, immunoglobulins E, omalizumab
Abstract. Current approaches to the treatment of frequently recurrent urticaria. Dytyatkovska E.M., Bendetska Yu.V., Rodkina I.A., Nedogibchenko N.А. The article presents summarized materials on etiology, pathogenesis, classification, clinical manifestations and treatment of chronic urticuria, The management of patients with this pathology at Dniprovsky Allergological Center was analyzed. For assessment of quality of life SKINDEX-29 questionnaire was used. The questionnaire includes three sections: symptoms, emotions and functions. Physical symptoms include six points: tenderness, heartburn or tingling, itching unpleasant sensations when cotacting with water, skin irritation, sensitivity. The emotional sphere is characterized by such ten points as: concern about the condition of the skin; deppression; feeling of shame; concern that scars can remain after skin disease; feelings about worsening of the skin; anxious mood; embarrassment, feeling of humiliation; skin irritation; rejection of oneself. “Features” section has twelve items: sleep quality; work and hobbies; social activity; sex life; solitude; fatigue; unwillingness to leave home; limiting intimacy with others; complexity in carrying out daily activities; difficulty in expressing feelings; obstruction to create relationships with others; limiting close communication with relatives. Gastrointestinal system was also examined: fibrogastroduodenoscopy with determination of Helicobacter Pylori, ultrasound diagnosis of abdominal organs, the intensity of clinical symptoms was determined on a UAS7 scale. Fifteen patients (including eight women and seven men) were successfully treated with omalizumab. The mean age was 39.1 ± 3.6 years. The average duration of the disease in patients was 5.1 ± 0.9 years. The intensity of symptoms was determined before treatment after the first and second injection of Omalizumab. After the first injection, there was a positive trend. The clinical effect occurred in seventy-two hours. Statistical processing of the study results was performed using Statistica v.6.1® software. (StatSoft, USA). The inclusion of omalizumab is an effective treatment for chronic urticaria in the absence of an effect from antihistamines.
Key words: HIV infected, non-psychotic mental disorders, deviant behavior, depression, anxiety, psychopathological symptoms
Abstract. Prognosis of the probability of the development of deviant behavior among HIV infected with non-psychotic mental disorders based on multiple logistic analysis. Hnenna O.M. The coexistence of psychopathological symptoms with HIV / AIDS is associated with aggravation of their condition due to the likelihood of deviant behavior. The aim of the study – assessment of the likelihood of deviant behavior in HIV-positive patients with non-psychotic psychiatric disorders. A comprehensive clinical and psychodiagnostic examination of 114 HIV-infected patients with non-psychotic psychiatric disorders was conducted including clinical-diagnostic interviews, pathopsychological and experimental-psychological methods of investigation, including the method of Ch.D. Spielberger in modification of Yu.L. Hanin (STAI - State-Trait Anxiety Inventory) for assessing anxiety level, Beck Depression Inventory (BDI-II) for assessing depression, SCL-90-R (Symptom Checklist 90-Revised) for assessing psychiatric symptoms. Statistical processing of the results was performed using descriptive and analytical methods implemented in the software STATISTICA 6.1 (StatSoftInc., Serial No. AGAR909E415822FA). Frequency and severity of depression and anxiety in HIV-infected persons is significant and by 3.4-4 times exceeds the corresponding indicators of a healthy Ukrainian population. Anxiety, depression, and other psychopathological symptoms according to SCL90-R scales (except for the obsessive-compulsive scale) are more pronounced in HIV-infected patients with destructive behavior than in patients without it. The chances of developing deviant behavior in HIV-infected persons with non-psychotic psychiatric disorders are increased at GSI>1 by 20.0 times (95% CI 5.63 - 71.07), in the presence of depressive symptoms – by 6.76 times (95% CI 2.16 – 21.18) and at a high level of personal anxiety – by 4.61 times (95% CI 2.05 - 10.40). Psychopathological symptoms of people with HIV status are characterized by high rates of depression and anxiety, somatization, paranoid ideas, interpersonal sensitivity. In patients with signs of deviant behavior, the severity of these disorders and the severity index of psychopathological symptoms was significantly higher (p<0.001) compared with patients who do not have such characteristics. According to the logistic prognostic model, the chance of developing deviant behavior significantly increases with an increase in the index of overall severity of psychopathological symptomatology, with an increase in the level of depression, and a level of personal anxiety. Considering this, when providing medical assistance to HIV-infected people, their needs for psycho-correction should be taken into account in order to prevent deviant behavior.
Key words: cervical cancer, radiation therapy, late radiological complications, radiation cystitis, radiation rectum
Abstract. Clinical-laboratory portrait of patients with cervical cancer with late radiation toxicity due to radiation therapy. Krasnoselskyi M.V., Hladkykh F.V., Kulinich H.V., Sevastianova V.S. According to the National Cancer Registry of Ukraine, cervical cancer ranks second among cancer morbidity, in women of reproductive age and the first place (14.1% of all cases) in the mortality from malignant neoplasms in women aged 18-29, and in aggregate almost 1.7 thousand women die from this pathology in Ukraine annually. Radiation therapy plays a leading role in the treatment of this pathology. In turn, an increase in the survival rate after the course of combined treatment leads to an increase in the absolute number of patients with adverse effects of treatment, in particular, late radiation toxicity (LRT). A retrospective analysis of 254 case histories of patients with malignant cervical neoplasms (127 patients with late radiation toxicity and 127 patients without late radiation toxicity) was conducted. Depending on the nature of the genesis of the late radiation toxicity, it has been found that inflammatory changes occurr in 95.3% of patients (atrophic cystitis, radiation recticite, radial enterocolitis, radiation retropsychoiditis, etc.); in 32,3% – late radiation toxicity of fibrotic genesis (intrapulmonary radiation, ureter stenosis, fibrosis of the skin and subcutaneous tissue of the irradiation fields, etc.); in 25.2% – degenerative late radiation toxicity (radial ulcers, fistulas, etc.) and 30.7% – hematologic late radiation toxicity. The comparative analysis of clinical and laboratory parameters of patients before and after radiotherapy with regard to cervical cancer has shown that prognostic factors of late radiation toxicity such as increase in hematocrit and fibrinogen indices deserve attention. It has also been established that the presence of laboratory signs of a cytolytic syndrome (increased levels of aspartate aminotransferase, urea and total protein) in patients with cervical cancer prior to radiation therapy can be a prerequisite for the formation of late radiation toxicity. In addition, it has been shown that the presence of concomitant aggravating diseases of the endocrine system, blood system, musculoskeletal system, nervous system and digestive system is statistically significantly (p<0,05) increases the risk of LRT in patients with cervical cancer by 20,2; 7.0; 2.3; 1.8 and 1.6 times respectively.
Key words: oral piercing, tongue piercing, lip piercing, complications, questionnaire survey, dental students
Abstract. Oral piercing is a new challenge in the dentistry. Samoilenko A.V., Orishchenko V.Yu., Strelchenia T.N., Strelchenia O.V. The number of the young adults undergoing oral piercing is increasing worldwide. Oral piercing leads to numerous complications, and it is possible that the incidence of complications may increase as the prevalence of oral piercing rises in Ukraine. However, not everyone is aware of its potential risks, local and systemic complications shortly after, or long after the piercing procedure. Dentists should educate patients with oral piercing or those who plan to have this type of body art performed about potential side effects and possible oral, dental, and systemic complications. However, data related to these complications in Ukrainian literature are limited. The purpose of this study – to assess the potential complications of the oral piercing; and to analyze awareness about the actual health risks linked to the practice of oral piercing by dental students. This study includes 37 cases of oral piercing in 36 young women attending the department of therapeutic dentistry of Dnipropetrovsk medical academy with and without complaints. The average subjects age was 22,3 years. Patients were examined clinically and radiographically. 200 students of Dnipropetrovsk medical academy answered a questionnaire about oral piercing knowledge. Immediate complications of oral piercing included pain (58.3% of cases), oedema (47,2%) and bleeding (11.1%) as the most representative. Prolong time of piercing wearing is associated with a greater prevalence of complications. Dental fractures or fissures (35,1%), gingival recession (29,7%) and mucosal atrophy (21,6%) are the most representative. The accumulation of dental plaque and calculus on piercing elements (43,2%) was an additional risk of infection. The results of the survey showed a high level (85,4%) of awareness of dental students about local oral piercing risks. At the same time, dental students (50,6%) are not sufficiently aware of the risk of piercing on developing systemic complications. Approximately 60% of dental students do not have a negative attitude towards the new practice of oral piercing.
Key words: pulpitis, tricalcium silicate, mineral trioxide aggregate, histology, experiment
Abstract. Comparative analysis of the effect of tricalcium silicate cement and mineral trioxide aggregate on the cellular composition of the pulp after the vital amputation in experimental animals. Khotimska Yu., Kovach I., Buniatian Kh., Kravchenko L., Varzhapetian S. The purpose of the study was to determine the effect of tricalcium silicate cement on the protective process of pulp in the treatment of reversible pulpitis. There was carried out an experiment on 3-month-old male rabbits to study morphofunctional changes in the pulp tissue with modeling of reversible pulpitis followed by vital amputation with coating of the pulp with tricalcium silicate (8 animals, study group) and mineral trioxide aggregate (MTA) (8 animals, comparison group). In 2 and 6 weeks dental tissues were fixed by 10% formalin solution and after decalcification and done routine procedures, histological sections were made, stained with hematoxylin and eosin. After the application of tricalcium silicate cement in 2 weeks, the odontoblast density changed to 3.92±1.03×103/mm2 from 8.3±1.02×103/mm2 of cell density in the intact group. The number of neutrophils also plays a big role in the regeneration of inflamed pulp. Thus, in 2 weeks the number of neutrophils made up 6.39±2.61x102 per 1 mm2, which is 3 times less than after mineral trioxide aggregate usage – 19.49±2.85x102 per 1 mm2. It was established that the processes of rheological disorders with impaired lymph circulation are replaced by the restoration of the cellular component. In such a way the proposed vital amputation was examined for reversible pulpitis and it revealed similar clinical and pathological effectiveness with a positive regenerative process with formation of a sufficient number of odontoblasts (7.98±1.51×103/mm2) for the subsequent formation of a hard tissue bridge, which consists of collagen fibers in the form of a frame. The main goal of vital amputation procedure is regeneration (proliferation) of the pulp with a short-term signs of alteration and exudation, which is provided by the choice of material for the pulp covering. Thus, after the vital amputation of the pulp, followed by the use of tricalcium silicate cement 6 weeks after, the number of neutrophils was 1.39±0.72x102 per 1 mm2, which is 5 times less than after using mineral trioxide aggregate.
Key words: air, chemical pollution, risk to the health
Abstract. Features of atmospheric air pollution in a non-industrial city: risk for the population. Serdyuk A.M., Hushchuk I.V., Chernychenko I.O., Lytvychenko O.M. Purpose – to study the territorial features of atmospheric air pollution of the regional administrative center without specific industrial sources of pollution, to determine carcinogenic and non-carcinogenic risks for the population. The study was carried out in Rivne. The results of our own observations, the materials of the State Institution “Rivne Regional Laboratory Center of the Ministry of Health of Ukraine”, the materials of the Central Geophysical Observatory of the Ministry of Emergency Situations in Ukraine were analyzed. It was found that in the atmospheric air of Rivne, a regional center with a number of industrial facilities of communal property and a developed road network, the presence of chemical compounds of different classes is stably recorded, the concentrations of which in 20-40% of the samples exceed the MPC and reference concentrations. Territorial indicators of the content of harmful substances are in the following relationship: motorway ≥ industrial zone > park zone. Hygienic assessment of air quality by MPC criteria allows it to be classified as slightly hazardous. According to the criteria of carcinogenic and non-carcinogenic risks, air pollution in the city is not safe for the population and requires the adoption of preventive measures. It was shown that with exposure of detected air pollution there is a rather high probability of damage to the respiratory system of the body and the appearance of congenital malformations, as well as the development of cancer pathology. Hazard assessment of air pollution by carcinogenic and non-carcinogenic risks indicators is more informative and critically significant for determining its effect on public health.
Key words: incidence and prevalence of diseases, public health, classification of diseases according to ICD-10, growth rates; average annual level of morbidity
Abstract. Analysis of indicators of public health in the Kamensko-Dneprovskyi rural region. Hryhorenko L.V., Baibakov V.M. Purpose of the research performed by the cohort method is to study the levels of public health among children and adults living in the rural industrial area of the Zaporizhzhia region. In order to estimate primary and overall disease incidence by the separate nosological forms in children and adult population: (C00-C97), (E10-E14), (I10-I15), (I20-I25), (J95- J99), (K20-K31) retrospective research was carried out according to the ICD-10. Scientific substantiation of the research in the rural district was based on the following categories: choosing category of the adult population and children aged 0-14 years to 15-17 years, social-hygienic parameters, types of water supply systems. Investigation of the incidence was carried out according to the report of Information Health Department Centre for the period of 2008-2016 years. The main factors which influence the formation of public health are demographic indicators of different age groups, as well as indicators of dispensary supervision (the composition of health groups, the proportion of frequently ill children) on the territory of experimental observation area. In our research we tried to study these two groups of medical and social factors to understand the conditions under which health of the rural population in this industrially developed region of Ukraine is being formed. The percent of organized groups of frequently ill childrenl in the Kamensko-Dniprovskyi rural district during 2008-2016 observation period increased from 53.3% in 2008 to 68.2% in 2016, which also testifies to a negative tendency to increase in the rate of children falling ill more than 4 times during 1 year, and the low resistance of the body to acute viral infections.
Key words: children's health, childhood medicine, postgraduate education of medical personnel, competency-based model
Abstract. Ways of optimizing medical services for children at educational institutions under the Health Care system reform in Ukraine. Khomenko I.M., Ivakhno O.P., Zakharova N.M. Aim – scientific substantiation of the ways to optimize preventive childhood medicine under the health care system reform in Ukraine. The medical, sanitary and epidemiological conditions of children’s stay were studied at 147 schools in five oblasts of Ukraine and the city of Kyiv. The following methods were used: system analysis, analytical, mathematical and statistical, bibliosemantic, modeling and expert assessments. The results of an expert assessment (224 specialists) on the optimization of medical services for schoolchildren were analyzed. The main risk factors for schoolchildren staying at educational institutions were identified: daily routine failure, non-compliance with the hygiene requirements for the premises where the educational process is carried out, as well as failure in food and water quality and safety. The levels of medical observation provision were analyzed. There were suggested two ways of maintaining the role of medical personnel in preserving and enhancing the health of schoolchildren: involving doctors of primary care centers of the Ministry of Health of Ukraine and creating an autonomous medical service in the institutions of the Ministry of Education and Science of Ukraine in accordance with the current licensing requirements. The issues of prevention and promotion of children's health, including schoolchildren, are one of the key aspects of the training of medical personnel at all stages. Such programs need to be modernized on the basis of a competency approach, taking into account the current needs of the health care system and the best international experience in resolving these issues.
A CASE FROM PRACTICE
Key words: chemoresistant tuberculosis, tuberous sclerosis, phacomatosis
Absract. Clinical case of chemoresistant tuberculosis in the patient with tuberous sclerosis: difficulties of diagnosis, features of the course and treatment. Kolesnik N.S., Marchenko N.A., Stadnik A.I., Ielisieiev V.V., Stepanova T.A. In the practical activities of a modern doctor, significant difficulties are noted in the diagnostics and proper management of patients with hereditary diseases due to the limited coverage of the population by genetic researches. For a long time, the patients with a variety of complaints are observed by doctors of various specialties, and the therapy often has little effect due to a lack of understanding of the true causes of pathological changes. The situation is complicated by case of a combined course of a hereditarily caused disease and some other disease of an infectious, non-infectious or tumor nature. The aim of the research was to study the characteristics of clinical manifestations, course of tuberculosis with resistance to anti-TB drugs in a patient with a rare hereditary disease from the group of phacomotoses - Bourneville-Pringle disease or tuberous sclerosis. This disease has a wide range of clinical manifestations, accompanied with the development of benign neoplasms in various organs and systems, damages to the skin, brain, organs of vision, lungs, kidneys, heart, as well as the musculoskeletal and endocrine system. It leads to development of various infectious and non-infectious pathologies in these organs. The article covers a 4-year period of observation of a young patient with late diagnosed tuberous sclerosis, suffering from pulmonary tuberculosis and tuberculosis of urinary system, includes the initial diagnosis of a specific disease, the course, the dynamics against received treatment and the development of relapse with the formation of resistance to anti-TB drugs. The difficulties in the management of tuberculosis in this patient were in the detection of numerous neoplasms and changes in the internal organs, in particular in the kidneys and lungs, which characterized tuberous sclerosis, on the one hand this contributed to untimely diagnosis of tuberculosis, and on the other hand – worsening the course and the progression of a specific process, as well as an unfavourable prognosis for recovery.