Medicni perspektivi, 2019;24(3)
2019 Vol. XXIV N 3
Skulinets O.B. Features of communication of a doctor with special groups of patients and in conflict situations
Usenko L.V., Krishtafor A.A., Tiutiunnyk A.H., Petrashenok Ye.V., Oleniuk D.V., Machuzhak H.A.,
Skulinets O.B. Features of communication of a doctor with special groups of patients and in conflict situations
Authors and affiliations
Usenko L.V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Key words: communication in the medical process, psychological peculiarities of patients
Abstract. Features of communication of a doctor with special groups of patients and in conflict situations. Usenko L.V., Krishtafor A.A., Tiutiunnyk A.H., Petrashenok Ye.V., Oleniuk D.V.,
Machuzhak H.A., Skulinets O.B. The article describes an important component of the medical process which should be paid a special attention: the preparation of a young doctor – the communication between the physician and the patient and his relatives. Distinctive features of a modern patient: the tendency to control the state of his own health with simultaneous irresponsible attitude towards it; when revealing a disease, he/she is looking for the worst in himself/herself; the reduction of the moral character against the background of a decline in the morals of society, which affects the culture of the patient's behavior, makes him/her more aggressive; a modern patient is more lenient to himself/herself with an extremely demanding attitude to the doctor. Several interrelated functions of communication are distinguished: informational, interactive, perceptual, emotive (affective-commutative). The levels of communication are distinguished: social-role (ritual); business; intimate-personal. There are three types of communication: imperative; manipulative; dialogical (based on equal partnership). In the process of communication of the physician with patients, depending on the circumstances, two systems of communication can be used: verbal and nonverbal. In the relationship "patient-physician" R. Witch identifies 4 models: paternalistic, technocratic, collegian, and contractual. Each patient needs an individual approach, individual forms of communication and measures of physician’s psychotherapeutic influence, especially in the communication of the doctor with so-called “difficult” patients, as well as at the risk of conflict situations. Causes of conflict situations are: insufficient attention to the patient; characteriological features of a doctor and a patient; unreliable information about the state of health of the patient from the part of junior and middle medical personnel; lack of patient’s information consent for treatment; lack of coordination of the actions of different medical specialists; defects in the maintenance of medical records; professional incompetence.
Nosivets D.S. Biopharmaceutical analysis of the interaction of L-thyroxin, diclofenac sodium and chondroitin sulphate, as components of pharmacotherapy of osteoarthritis manifestations resulted from hypothyroidism
Key words: osteoarthritis, hypothyroidism, L-thyroxin, diclofenac sodium, chondroitin sulfate, biopharmaceutical interaction
Abstract. Biopharmaceutical analysis of the interaction of L-thyroxin, diclofenac sodium and chondroitin sulphate as components of pharmacotherapy of osteoarthritis manifestations resulted from hypothyroidism. Nosivets D.S. The article deals with the issue of the biopharmaceutical interaction of L-thyroxin, diclofenac sodium and chondroitin sulfate as components of pharmacotherapy of osteoarthritis manifestations with concomitant hypothyroidism. It is known that functional insufficiency of the thyroid gland has a negative effect on all types of metabolism and in particular on the condition of the bone and cartilage tissue, leading to the development of osteoarthritis. Existing pharmacotherapeutic approaches to the medical treatment of this pathology require the use of basic hormone replacement therapy for the correction of thyroid insufficiency, and NSAIDs as drugs for the symptomatic treatment of osteoarthritis. However, to date, questions of the biopharmaceutical interaction of L-thyroxin and diclofenac sodium are not covered, and the prevention of osteoarthritis against the background of hypothyroidism with the help of chondroitin sulfate and its interaction with the components of pharmacotherapy has not been sufficiently studied. Based on the conducted research, it was established that, proceeding from the theoretical analysis of the physicochemical and chemical properties of these drugs, predominantly reversible acid-base interactions are assumed. The probability of strong and irreversible physicochemical reactions is very low and the physical mixtures of these drugs are not subject to negative interactions which can lead to profound destructive changes on the part of the dosage forms. Since L-thyroxin, diclofenac sodium and chondroitin sulfate are absorbed mainly by simple diffusion, have different transport mechanisms through biological membranes, have different degrees of binding to plasma proteins and various enzyme systems involved in their metabolism and excretion, pharmacokinetic interactions between them are excluded. At the level of pharmacological interaction, the combined and unidirectional effects of the combination of active substances L-thyroxin, diclofenac sodium and chondroitin sulfate are expected, in particular, in degenerative-dystrophic disorders due to functional insufficiency of the thyroid gland, for restoration of the structure of cartilage tissue and for a complex etiotropic and symptomatic treatment of osteoarthritis and related states.
Kuryata O., Semenov V. Cardiovascular and nephrological risk in patients with chronic kidney disease in ambulatory care
Authors and affiliationsKuryata O. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Key words: cardiovascular risk, chronic kidney disease, progression, arterial hypertension
Abstract: Cardiovascular and nephrological risk in patients with chronic kidney disease in ambulatory care. Kuryata O., Semenov V. Patients with chronic kidney disease (CKD) have higher than in general population all-cause and cardiovascular mortality. Arterial hypertension (HTN) is a powerful potentially modifiable risk factor that affects the majority of patients with chronic kidney disease and one of the main causes of end stage renal disease worldwide. Existing tools for assessment of risk of CKD progression do not take into account arterial hypertension. The aim – to investigate the association between cardiovascular and nephrological risk factors in patients with CKD in ambulatory practice. The study was carried out in the Center of Nephrology Care in Mechnikov Dnipropetrovsk Regional Hospital, Dnipro, Ukraine. 278 patients (114 males and 164 women, aged 41 [31;61] years) with CKD (stages 1-3) who were followed-up in ambulatory care, but required diagnosis or treatment revision were enrolled to the study. All patients were examined and followed-up according to local and European standards. Females slightly prevailed in our study, gender distribution varied insufficiently in groups by CKD progression risk. Elevation of risk of CKD progression was accompanied by rise of prevalence of diabetes mellitus, left ventricle hypertrophy, proteinuria and HTN. Risk of CKD progression correlated with age, systolic and diastolic blood pressure, erythrocyte sedimentation rate, total cholesterol, glomerular filtration rate, albumin excretion rate, duration of HTN and body mass index. Rise of cardiovascular risk was accompanied by rise of proportion of patients with high risk of CKD progression. Increase in risk of CKD progression is associated with rise of burden of cardiovascular risk factors. HTN and blood pressure values should be accounted for assessment of risk of CKD progression.
Kolesnyk T.V., Nadiuk A.V., Kosova H.A. Influence of age and body mass index on arterial stiffness and left ventricular hypertrophy in patients with arterial hypertension II stage
Authors and affiliationsKolesnyk T.V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Kosova H.A. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Key words: arterial pressure, arterial hypertension, arterial stiffness, vascular aging, pulse wave velocity, central aortic pressure, amplification pressure, body mass index
Abstract. Influence of age and body mass index on arterial stiffness and left ventricular hypertrophy in patients with arterial hypertension II stage. Kolesnyk T.V., Nadiuk A.V., Kosova H.A. Based on the cumulative data of scientific research reference values for the central blood pressure and its amplification were proposed in patients with different cardiovascular risk factors. Still, the possibility of its practical implementation in patients of different age groups has not been fully studied. There were examined 132 untreated patients (23 females and 109 males) with uncomplicated essential hypertension, which were divided into 3 groups depending on age (WHO, 2012): I group included 47 patients of the young age, II group - 50 middle-aged patients and III group – 35 elderly patients. Measurements of central systolic blood pressure (cSBP), SBP amplification (SBP Amp), pulse wave velocity (PWV) were carried out by Arteriograph Tensioclinic (Tensiomed, Hungary). Target-organ damage included LVH which was determined by echocardiographic left ventricular mass index (LVMI), adjusted for body surface (g/m2) or height (LVMI2,7), aortic PWV>10 m/s. It was established that the use of a personalized approach in the examination of patients with arterial hypertension makes it possible to increase the efficiency of diagnosis of hypertensive-mediated subclinical organ damage. So in order to identify impairment of the vascular wall in patients of a young age with hypertension, with overweight and obesity, the reference values of PWV and cSBP in accordance with the age norm should be taken into account. It was particularly in this cohort of patients that the greatest adverse effect of vascular stiffness and body mass index (BMI) on the formation of left ventricular hypertrophy was revealed, while in elderly people it is necessary to use the reference values of cSBP, depending on the degree of hypertension.
Khalimonchyk V., Klygunenko O. Influence of components of anesthesia on dynamics of stress markers in gynecological laparoscopic surgery
Authors and affiliationsKhalimonchyk V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Klygunenko O. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Key words: cortisol, glycemia, ketamine, dexketoprofen, postoperative pain
Abstract. Influence of components of anesthesia on dynamics of stress markers in gynecological laparoscopic surgery. Khalimonchyk V., Klygunenko O. Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immulogic, and metabolic alterations. Objective: to evaluate the effect of combined intraoperative use of ketamine in low subnarcotic doses and dexketoprofen on intensity of the pain syndrome and dynamics of the stress response in gynecological laparoscopic surgery. A total of 45 patients scheduled for laparoscopic gynecological surgery under total intravenous anesthesia (TIA) were examined randomly and divided into 2 groups. Demographic characteristics, anthropometric data, functional status, duration of surgery and anesthesia were similar in all groups. Group 1 (n=25) patients received total intravenous anesthesia (TIVA) with propofol and fentanyl. Group 2 (n=20) patients received TIVA with additional administration of subanesthetic doses of ketamine and a single administration of 50 mg of dexketoprofen 30 minutes before the end of the surgery. Cortisol and blood glucose levels were evaluated before induction into anesthesia, after the main stage of operation, 2 and 24 hours after surgery. The intensity of postoperative pain was evaluated by VAS in 2 and 24 hours after surgery. The intensity of postoperative pain, concentration of serum cortisol 2 hours after surgery were significantly lower (p <0.05) in patients of group 2, compared to control (p<0,05). Differences of blood glucose levels between groups at the stages of the study were not identified. Combined intraoperative use of subanesthetic doses of ketamine and dexketoprofen at the end of the surgery provides a stress-protective effect. This is confirmed by the rapid normalization of serum cortisol levels and stable blood glucose levels after surgery and is manifested by a low level of postoperative pain syndrome.
Kravets O.V. Assessment of fluid balance in different regimens of infusion therapy of high surgical risk patients with acute abdominal pathology
Key words: goal-directed regimen, restrictive regimen, infusion therapy, water balance, acute abdominal pathology, high surgical risk
Abstract. Assessment of fluid balance in different regimens of infusion therapy of high surgical risk patients with acute abdominal pathology. Kravets O.V. Fluid disorders always accompany acute pathology of abdominal organs. To conduct comparative analysis of efficiency of the goal-directed and restrictive regimens of infusion therapy of replenishment of volume depletion in high surgical risk patients with acute abdominal pathology 80 patients, operated by urgent laparotomy were studied. Patients were divided into two groups. In the first group (n=40) a goal-directed infusion therapy was conducted, in the second (n=40) – restrictive. Rheographic method was used to investigate the performance of water sectors of the organism, daily and cumulative water balances were defined, the percentage of excessive fluid was determined and estimated. In patients of the first group an increase in plasma volume by 11% (p<0.05), exceeding of the volume of interstitium by 14% (p<0.05) and the volume of extracellular fluid by 7% (p<0.05) on the 1st and 2nd day were noted. From the 3 to 7th day a reduction in extracellular fluid to 91.5% (p<0.05) of the norm was noted. Recovery of all the studied parameters was detected on the 10th postoperative day, when the percent of excessive fluid reached 9.6%. In patients of the second group there was restoration of plasma volume to normal in reduced by 10% (p<0.05) – 12% (p<0.05) from the norm of the interstitium volume, respectively to the 1st and 2nd day after surgery. From the 3d day there was a significant restoration to normal of all the studied parameters, which coincided with the “zero” values of the daily water balance and sufe limits of the percent of excess fluid, which reached 6.1% on the 10th day of treatment. Thus, the goal-directed infusion therapy allows to perform the correction of volume depletion in high surgical risk patients with acute abdominal pathology by increasing intravascular volume to excessive and increase of interstitium volume on 1st and 2nd day, development of a mild volume depletion from the 3d to 5th day, maintainance of the percentage of excessive fluids within safe borders. Restrictive mode of infusion therapy normalizes fluid balance of water sectors due to restoration of plasma volume in 6 hours of treatment and maintains it within the limits of the norm during all the postoperative period, preventis the development of interstitial oedema, ensures the "zero" daily water balance and limits the postoperative growth of the percentage of excess fluid.
Filippova A.Yu. Possibilities of correction of lipid-phospholipid disorders in patients with non-alcoholic steatohepatitis against obesity and pathology of the biliary tract
Key words: nonalcoholic steatohepatitis, obesity, lipids, phospholipids, ursodeoxycholic acid, arginine glutamate
Abstract. Possibilities of correction of lipid-phospholipid disorders in patients with non-alcoholic steatohepatitis against obesity and pathology of the biliary tract. Filippova A.Yu. High priority in the pathogenesis and treatment of non-alcoholic steatohepatitis (NASH) is given to disorders of lipid-phospholipid fractions, which are directly related to the functioning of hepatocytes. The aim of the study was to evaluate the effect of various complex treatment regimens on lipid-phospholipid fractions in patients with NASH in combination with obesity (OB) and pathology of the biliary tract (BT) according to a 6-month follow-up. 52 patients with NASH in combination with OB and BT pathology were examined. The control group consisted of 20 practically healthy individuals. The effect of complex treatment (preventive and therapeutic measures) on the indicators of lipid-phospholipid fractions in patients with NASH in combination with obesity and pathology of the biliary tract was studied. Changes in the indicators of serum lipid-phospholipid fractions were detected before treatment in all observation groups, which were accompanied by decrease in phospholipids (PL), phosphatidylcholine and sphingomyelin content and a significant increase in PL lysoforms – lysophosphatidylcholine and phosphatidylethanolamine, triglycerides, cholesterol esters (from p<0.05 to p<0.001). Combination therapy with the inclusion in the standard treatment of ursodeoxycholic acid and arginine glutamate in the comorbid course of NASH can be considered as a promising direction in the treatment of this category of patients, this allows to improve indicators of lipid-phospholipid fractions and stabilize the hepatocytes’ membrane (from p<0.05 to p<0.001).
Bashkirova N.S., Vуsochina I.L. Sensitivity of bronchial receptors under the effect of tobacco smoke in the conditions of various activity of the thyroid gland in children
Authors and affiliationsBashkirova N.S. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Vуsochina I.L. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Key words: tobacco smoke, children, thyroid, bronchial hypersensitivity
Abstract. Sensitivity of bronchial receptors under the effect of tobacco smoke in the conditions of various activity of the thyroid gland in children. Bashkirova N.S., Vуsochina I.L. The role of the initial hormonal profile disorders of the system “pituitary – thyroid” in the emergence of a bronchospasm in response to exogenic stimuli has not been finally determined. The aim of our research was to investigate the character and degree of the relationship between bronchial hypersensitivity in children exposed to smoking and the functional activity of the thyroid gland. The research involved 74 patients aged 10 to 17 years. Sixteen children were not exposed to tobacco smoke, 50 children were passive smokers, and 8 of the children surveyed smoked actively. To investigate the level of bronchial sensitivity, a bronchial provocation test with a non-specific stimulus – bronchoconstrictor acetylcholine was carried out. We assayed the functional state of the thyroid gland by the level of free triiodothyronine (FT3), free thyroxin 4 (FT4) and thyroid stimulating hormone (TSH), identified by Enzyme-linked Immunosorbent Assay (ELISA) (Alkor Bio, Russia). Indicators of hormones of a thyroid gland in most of the examined children did not differ from standard values for healthy children. Analysis of the results of the inhaled bronchial provocation test with acetylcholin showed that the state of non-specific bronchial hypersensitivity was observed in 2 active smokers and in none of the passive smokers and non-smokers (χ2=15,4>χ201=9,21 або р<0,01). According to our data, in children with hypothyroidism, under the effect of tobacco smoke, changes in the functional state of sensitive bronchial receptors do not occur. Among 2 children who had an increased activity of the thyroid gland (hyperthyroidism), one child from the group of smokers had an increased bronchial sensitivity by the results of the acetylcholine test (p>0.05). According to our data, changes in the functional status of sensitive bronchial receptors (cholinergic receptors) resulting from exposure to tobacco smoke in children exposed to tobacco smoke, active or passive, do not depend on the functional state of the thyroid gland (Рχ2>0,05).
Sirko A.G., Dzyak L.A., Pylypenko G.S., Yovenko I.O., Skrypnik A.A. Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds
Authors and affiliationsSirko A.G. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
ME «Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov», Dnipro, Ukraine
Dzyak L.A. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Pylypenko G.S. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
ME «Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov», Dnipro, Ukraine
Yovenko I.O. ME «Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov», Dnipro, Ukraine
Skrypnik A.A. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Key words: purulent-septic complications, intracranial complications, craniocerebral wounds, combat-related gunshot wounds, prognostic factors, antibacterial therapy, mortality, outcomes
Abstract. Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds. Sirko A.G., Dzyak L.A., Pylypenko G.S., Yovenko I.O. , Skrypnik A.A. Purpose – to analyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of examination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001).
Dytiatkovsky V.O., Abaturov O.E., Naumenko N.V., Pinayeva N.L., Alifirenko O.O. Associations of genotype variants of single nucleotide polymorphism of gene Orosomucoid-1-like-protein 3 and atopic diseases in children
Authors and affiliationsDytiatkovsky V.O. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Abaturov O.E. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Naumenko N.V. MI "Dnipro clinical association of emergency medicine" Allergy Centre, Dnipro, Ukraine
Pinayeva N.L. MI "Dnipro clinical association of emergency medicine" Allergy Centre, Dnipro, Ukraine
Alifirenko O.O. MI "Dnipro clinical association of emergency medicine" Allergy Centre, Dnipro, Ukraine
Key words: atopic diseases, children, genotype, associations, orsomucoid-1-like protein 3
Abstract. Associations of genotype variants of single nucleotide polymorphism of gene orosomucoid-1-like-protein 3 and atopic diseases at children. Dytiatkovsky V.O., Abaturov O.E., Naumenko N.V., Pinayeva N.L., Alifirenko O.O. The paper presents data of the firstly conducted in Ukraine own study of associations of the single nucleotide polymorphism (SNP) rs7216389 of orsomucoid-1-like protein 3 gene (ORMDL3) variants’ with atopic diseases in children. Aim: to detect clinical significance of the SNP rs7216389 ORMDL3 in genesis of atopic diseases in children. We examined 153 children aged 3 to 18 years. The main group consisted of 119 children with clinical manifestations of atopic diseases with elevated total serum immunoglobulin E, confirmed by immunofluorescence assay method. The comparison group consisted of 34 children with a non-aggravated individual or family allergic anamnesis in whom there was detected the absence of any clinical syndromes and symptoms of atopic diseases and, mostly, physiological parameters of the serum total immunoglobulin E by immunofluorescence assay method. All the children were genotyped by ORMDL3 gene using polymerase chain reaction in real time with a restricted fragment length polymorphism. The genotype T/T within SNP rs7216389 of ORMDL3 gene significantly prevails among the children with atopic diseases and is associated with an increased incidence risk of seasonal allergic rhinoconjunctivitis (SARC) by 4.11 times (95% CI 1.55; 16.61), perennial allergic rhinitis (PAR) by 5.07 times (95% CI 1.22; 13.90) times and bronchial asthma (BA) by 10.31 times (95% CI 2.50; 42.62). Children with genotype T/T in locus rs7216389 of the ORMDL3 gene are the increased risk group for developing the atopic diseases. Children with genotype C/C in locus rs7216389 of the ORMDL3 gene are the decreased risk group for the development of atopic dermatitis.
Ilchenko S.I., Fialkovska A.А. Clinical features and molecular genetic risk factors for the development of chronic bronchitis in adolescent smokers
Key words: chronic bronchitis, smoking, adolescents
Abstract. Clinical features and molecular genetic risk factors for the development of chronic bronchitis in adolescent smokers. Ilchenko S.I., Fialkovska A.А. Chronic bronchitis (СB) remains one of the most pressing problems of pediatric pulmonology. This is due to the high prevalence of this disease and the possible transformation into chronic obstructive pulmonary disease (COPD) in adults. Today, there is a large number of exogenous and endogenous risk factors for developing CB in children and adolescents. However, the effect of smoking on the development, clinical course of СB and the molecular genetic basis of its formation is insufficiently studied in adolescence. The purpose of the study is to investigate the clinical features of the course and genetic risk factors for the development of CB in adolescent smokers. A comprehensive survey of 107 adolescents was performed. All patients were divided into three groups. The group 1 included 40 adolescent smokers with СВ, the group 2 – 30 adolescents with СВ who never smoked, the control group included 37 conditionally healthy adolescent smokers. The study included the collection of anamnesis, an objective examination of adolescents, and a molecular genetic investigations. For statistical processing of the results obtained, the program “Statistica 6.1” was used. The results of the study showed that smoking leads to the development of СВ in adolescence and affects its course, increasing the frequency and duration of exacerbations. An association of the 2G/2G genotype of the MMP-1 (rs1799750) gene with the risk of developing СВ in adolescent smokers was detected. At the same time, it was found that the presence of the TT genotype of the CYP1A1 (T3801C) gene can be considered as a possible factor of resistance to the development of CB in adolescent smokers. The data obtained in the course of the research will help develop measures of primary prevention and individual approaches to the rehabilitation of adolescents with СВ, which will prevent the development of COPD in the future.
Kalbus O.I., Shastun N.P., Makarov S.O., Bukreyeva Yu.V., Somilo O.V. The evaluation of approaches to the treatment of myasthenia gravis
Authors and affiliationsKalbus O.I. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Shastun N.P. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Makarov S.O. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Bukreyeva Yu.V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Somilo O.V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Key words: myasthenia gravis, type of treatment, symptomatic treatment, basic treatment, immunomodulatory treatment, survival, treatment efficacy
Abstract. The evaluation of approaches to the treatment of myasthenia gravis. Kalbus O.I., Shastun N.P., Makarov S.O., Bukreyeva Yu.V., Somilo O.V. Myasthenia gravis is a relatively rare autoimmune disease with an undetermined aetiology which affects neuromuscular junctions. Currently, the following approaches to the treatment of myasthenia gravis are mainly distinguished: symptomatic treatment with anticholinesterase inhibitors (AChEIs), immunomodulatory therapy (“basic” therapy) with glucocorticoids, cytostatics, monoclonal antibodies; surgical treatment — thymectomy; short-term treatment with plasmapheresis and intravenous administration of immunoglobulin. The efficiency of treatment approaches to myasthenia gravis in Ukraine remains insufficiently studied. The purpose of this work is to analyse the therapeutic approaches in patients with myasthenia gravis depending on the clinical form and severity of the disease. Between 2014 and 2017, 182 patients with myasthenia gravis have been examined, out of which 147 (80.8%) were the patients with the generalized form of the disease and 35 (19.2%) — with its ocular form. The clinical neurological examination included the collection of complaints, an anamnesis of disease and life as well as a neurological examination. In all the patients, the level of antibodies to acetylcholine receptors (AchR) and to muscle-specific tyrosine kinase (MuSK) has been measured, in terms of quantity as well, using the enzyme-linked immunosorbent assay (ELISA), and the presence of antibodies to titin and SOX1 has also been detected by means of indirect immunofluorescence. Of the total sample, less than a third (28.0%) of the patients examined received basic therapy; among them, there were no patients with the ocular form and only 34.7% — with the generalized form (p<0.001). Basic therapy is found more often among the patients with class II myasthenia gravis (51.9%), with a statistically significant (p<0.001) higher share of the patients receiving such a therapy than in classes III and IV (26.6% and 22.6% respectively). The structure of therapy in patients with classes III and IV has not shown any statistically significant difference (p=0.658), with symptomatic treatment being the predominant type of therapy. Undergoing basic therapy reduces the chances of a severe clinical course of myasthenia gravis (the QMG score of 17 and higher) — OR=0.52 (95.0% CI 0.14-0.90), p=0.032; fatal cases of the disease — OR=0.36 (95.0% CI 0.02-0.70), p=0.049. When basic therapy is used, the survival rate of the patients (Figure 2) is 42.0 years on average (95% CI 42.0-42.7) which is considerably higher (p=0.021) compared to that of the patients receiving symptomatic treatment only — 33.0 years (95% CI 30.9-36.7). Immunomodulatory therapy was prescribed for only 28% of the patients in the total sample, for none of the patients with the ocular form of myasthenia gravis, and for 34.7% of the patients with the generalized myasthenia gravis. The prescription of immunomodulatory therapy reduces relative risks of a severe clinical course of myasthenia gravis — OR=0.52 (95.0% CI 0.14-0.90), p=0.032. The prescription of immunomodulatory therapy decreases the probability of a fatal outcome of the disease — OR=0.36 (95.0% CI 0.02-0.70), p=0.049). With the use of immunomodulatory therapy, the patient survival rate rises considerably reaching an average of 42.0 years (95% CI 42.0-42.7), which is much higher compared to that in the group of the patients receiving symptomatic treatment only — 33.0 years (95% CI 30.9-36.7), p=0.021.
Nikolenko O., Shulga O., Kozliuk V., Zheshko O., Yurko O., Dubinets M. Relapses in multiple sclerosis
Authors and affiliationsNikolenko O. Volyn Regional Clinical Hospital, Lutsk, Ukraine
Kozliuk V. Volyn Regional Clinical Hospital, Lutsk, Ukraine
Zheshko O. Volyn Regional Clinical Hospital, Lutsk, Ukraine
Yurko O. Volyn Regional Clinical Hospital, Lutsk, Ukraine
Dubinets M. Volyn Regional Clinical Hospital, Lutsk, Ukraine
Key words: relapse, exacerbartion, multiple sclerosis, gender, age, seasonal factors
Abstract. Relapses In multiple sclerosis. Nikolenko O.O., Shulga O.D., Kozliuk V.V., Zheshko O.M., Yurko O.A., Dubinets M.I. Exact causes of contradictions in the understanding of relapsing course as characteristic phenomenon of multiple sclerosis (MS) and primarily relapsing-remitting type are still considered to be “sub rosa”. We tried to determine connection and correlation between seasonal dynamic factors, chronometric parameters of disease progression (age, disease duration) and frequency of relapses and the role of gender differences as well. A four-year prospective study included complete registration of all cases of MS exacerbations in resident patients with a relapsing-remmiting course of the disease according to McDonald criteria in Volyn region of Ukraine in 2010. Each patient had neurological score based on EDSS scale to ensure compliance with inclusion criteria. 128 patients (44 males and 84 females) with a remitting-recurring course of the disease were involved in this study. Statistical analysis was performed using SPSS 18, MedCalc and Microsoft Excel software using standard descriptive statistics, correlation and regression analysis. In total, 197 cases of MS relapses were registered. Episodes of relapses prevailed in winter-spring period. Multiple regression model including suggested climate factors showed multiple correlation coefficient – 0.55 (p<0.01). The prevalence of MS was higher in females, while general incidence of recurrences was similar to males. However, relapse rate in different age groups differs: the rate of recurrence increases in women aged after 50 years (mean annualized relapse rate (ARR)=0.66), while it slowly decreases in men with aging. The duration of the disease did not have significant effect on the course of MS in women, whereas weak negative relationship (0.24, p<0.001) between the duration of the disease and the frequency of MS in men was showed. Correspondingly, the average negative correlation (-0.37, p<0.001) was detected between the age of disease onset and the incidence of MS recurrence in males, while this connection was not observed in females. We established that the recurrence of MS is a result of multifactorial influence of external and internal factors. Individual seasonal climate variability did not have sufficient force of influence. Therefore, combined effect of corresponding climate changes played a significant role. Furthermore, it is quite probable that interactions of MS with external factors influencing the human body can be mutually integrated.
Zakharov S.V., Zakharov V.K., Gorbuntsov V.V. The content of cytokines in the blood serum of patients with early latent syphilis in process of treatment
Authors and affiliationsZakharov S.V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Key words: syphilis latent early, cytokines, treatment, prognosis, serological resistance
Abstract. The content of cytokines in the blood serum of patients with early latent syphilis in process of treatment. Zakharov S.V., Zakharov V.K., Gorbuntsov V.V. Objective – to study the concentration of pro- and anti-inflammatory cytokines in patients with early latent syphilis before and after treatment. The study was conducted in 112 patients with early latent syphilis (52 men and 60 women) and 15 healthy persons of the control group – all aged 18-43. Serological tests were used: the classical complex of serological reactions (CSR), ELISA, the reaction of passive hemagglutination (RPGA), immunofluorescence reaction with absorption (RIF-abs) and RIF-200. Using ELISA, the levels of cytokines IL-2, IL-6, IL-10, TNFα, and INFγ were determined in serum (in patients with latent syphilis, before and after treatment). The analysis of the received data was carried out with application of the program package Statistics 6.0. To identify the relationships between the indices, Friedman's nonparametric variance analysis with the definition of χ2 was used. The concentration of IL-10 before treatment in patients with early latent syphilis was significantly increased by 3.7 (14.9±0.9 pg/ml compared to the control group 4.11±0.5 pg/ml). The dependence of the content of this cytokine on the period of infection was established. It was found that one year after treatment concentration of IL-10 remained 1.8 times higher. The concentration of IL-6 was increased by 6.5 times in patients with latent early syphilis and was also dependent on the period of the infection, and also even 1.5-2 years after treatment the IL-6 content remained elevated. It was also found that in patients with latent early syphilis the concentration of IL-2 was increased by 2.3 times and it did not normalize in 24.5% of patients even two years after treatment. In patients with latent early syphilis, the concentration of TNFα was increased by 3.6 times. After treatment, the concentration of TNFα decreased, but exceeded the control values by 1.55 times. Further analysis of the concentration of TNFα revealed that, with a disease period of up to one year, the concentration of this cytokine was normal during ten months after treatment, and in patients with the disease period of more than one year, after treatment normalization of the TNFα level was absent in 64.5% even after 18 months. It was found that the concentration of INFγ in patients with early latent syphilis before treatment was increased by 3.8 times in comparison with the control group. After treatment, almost 25 % of patients with the duration of the infection more than one year revealed no normalization of INFγ and it was increased by 1.5 times. In patients with latent early syphilis there was a significant increase in the concentration of cytokines TNFα and INFγ, an imbalance of IL-2, IL-6, IL-10 as well as. The dependence of the cytokine concentration on the period of infection is noted. Based on the study of the cytokine status in patients with early latent syphilis with periods of infection of more than one year, the use of immunomodulatory therapy may be recommended. Increasing the concentration of such cytokines as TNFα, IL-6, IL-10 after treatment can be used as prognostic tests of serological resistance.
Raznatovska O.M., Fedorec A.V., Shalmina M.O., Grekova T.A. Clinical features of pregnancy in multidrug-resistant tuberculosis and type 1 diabetes mellitus comorbidities (a case report)
Authors and affiliationsRaznatovska O.M. Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine,
Fedorec A.V. MI «Zaporizhzhia Regional TB Clinical Dispensary», Zaporizhzhia, Ukraine
Key words: pregnancy, multidrug-resistant tuberculosis, type 1 diabetes mellitus
Abstract. Clinical features of pregnancy in multidrug-resistant tuberculosis and type I diabetes mellitus comorbidities (a case report). Raznatovska O.M., Fedorec A.V., Shalmina M.O., Grekova T.A. Objective – to update the literature data with the clinical features of pregnancy in multidrug-resistant tuberculosis (MRD-TB) and type 1 diabetes mellitus (T1DM) comorbidities based on an example from own clinical experience. A clinical case of pregnancy course in MRD-TB and T1DM comorbidities was described based on our own clinical experience. We report the clinical case of newly diagnosed MRD-TB in a 38-year-old woman suffering from T1DM. Her general condition was unstable from satisfactory to moderately severe despite an adequate treatment of MRD-TB and T1DM with manifestations of intoxication syndrome and nephropathy. Adenomyosis with periodic bloody vaginal discharge was diagnosed. There was no clinical-radiological dynamics and sputum culture conversion. After an intensive phase of antimycobacterial therapy within 3 months, the patient got pregnant. Based on the medical indications (MRD-TB, absence of sputum culture conversion and clinical-radiological dynamics, moderate severity of T1DM, nephropathy) and adenomyosis with bloody vaginal discharge, the patient was requested to induce the pregnancy termination, and she consented. On month 7 of antimycobacterial therapy, an extensive drug-resistance of Mycobacterium tuberculosis to antimycobacterial agents and negative dynamics by follow-up chest X-ray were diagnosed. The feature of pregnancy course in MRD-TB and T1DM comorbidities was an unfavorable coexistence of both these diseases simultaneously resulting in an induced abortion. In this case, doctors to working with patients suffering from both MRD-TB and T1DM are recommended to advise patients the use of contraception in order to prevent pregnancy during treatment of active MRD-TB.
Antonenko A.M., Vavrinevych O.P., Omelchuk S.T., Shpak B.I. Hygienic substantiation of calculating models for predicting toxicity of different classes insecticides (first part)
Authors and affiliationsAntonenko A.M. Bogomolets National Medical University, Kyiv, Ukraine,
Vavrinevych O.P. Bogomolets National Medical University, Kyiv, Ukraine
Omelchuk S.T. Hygiene and ecology institute, Bogomolets National Medical University, Kyiv, Ukraine
Shpak B.I. «Syngenta» LCC, Kyiv, Ukraine
Key words: insecticide, toxicology, calculation models, regression equations
Abstract. Hygienic substantiation of calculating models for predicting toxicity of different classes insecticides (first part). Antonenko A.M., Vavrinevych O.P., Omelchuk S.T., Shpak B.I. This work is the first part of our study to develop alternative experimental mathematic models for predicting toxicity of insecticides. In the first stage, calculations will be carried out and the most reliable models will be proposed. In the second – a statistical analysis and comparative estimation of the toxicometric parameters obtained experimentally and calculated according to the proposed equations. The purpose of the research is the scientific substantiation of the calculation models for predicting toxicity of insecticides of different classes. Data on the physico-chemical properties and toxicometry parameters of fungicides are taken from the PPDB pesticides database. Insecticides of such chemical classes as derivatives of tetram and tetronic acids, benzoylureas, carbamates, neonicotinoids, pyrethroids, organophosphorus compounds, avermectins were selected for analysis. It has been established that there is a significant positive correlation between NO(A)EL in the chronic experiment of all insecticides, the median lethal doses at oral administration (LD50 per os) of pyrithoids and neonicotinoids, and the molecular weight (at p<0.05). There is a significant negative correlation between the toxicometry parameters of all insecticides and their individual groups (pyrithoids, neonicotinoids, organophosphorus compounds) and melting temperature and the octanol-water partition coefficient, log Po/w (at p<0.05). It is proved that the proposed calculation models for predicting insecticide hazards are adequate according to Fisher's criterion, and the coefficients of regression equations are reliable according to Student's criterion (p<0,05).
Lekhan V.M., Kriachkova L.V. The system of measures to improve the health of the population of Ukraine based on the analysis of the global burden of diseases and its risk factors
Authors and affiliationsLekhan V.M. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine,
Kriachkova L.V. SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine», Dnipro, Ukraine
Key words: global burden of diseases, disability-adjusted life year (DALY), risk factors, public health, Ukraine
Abstract. The system of measures to improve the health of the population of Ukraine based on the analysis of the global burden of diseases and its risk factors. Lekhan V.M., Kriachkova L.V. In the modern world, the use of the global burden of diseases and the quantitative assessment of the factors leading to the loss of a healthy life provides fundamental evidence for the development of an adequate public health policy. The purpose of the study is to substantiate the system of measures on improvement of the health of the population of Ukraine on the basis of an in-depth analysis of the global burden of diseases and injuries and associated risks. The study used materials from the Institute of Health Metrics and Evaluation of the University of Washington, Human Development Network of the World Bank and the «Disease Burden Unit» of the World Health Organization, collected during 1990-2017 years. The bibliosemantic, historical, epidemiological, conceptual modeling methods and benchmarking were used in the course of study. The loss rate of age-standardized disability-adjusted life year (DALY) in Ukraine in the period between 1990-2017 practically unchanged and in 2017 it was 34 975.04 DALYs per 100 000, which is almost a quarter more than in the countries of Eastern Europe and twice as much as in the countries of Western Europe. In the structure of Global diseases burden in Ukraine, 3/4 falls on non-communicable diseases, about 15 % depend on external causes and less than 1/10 – on infectious and other diseases and conditions. Shares of the disease burden associated with specific risk factors and diseases related to the relevant factor were identified. The evidence-based system of measures is aimed at achieving goals to reduce the global burden of disease and the risk factors affecting it, being based on an inter-sectoral approach and combines population and individual risk strategies. The subjects of the system are parliament, central and local governments / communities, private campaigns, the media, public health structures and primary health care.
Chopchik V.D. Problems and ways to improve the organization of the work of the university dental center based on the results of a sociological survey of dentists
Key words: dental medical center, work organization, sociological survey of dentists
Abstract. Problems and ways to improve the organization of the work of the university dental center based on the results of a sociological survey of dentists. Chopchik V.D. The purpose of this study was to analyze the state, problems and ways to improve the organization of the work of the Dental Medical Center (SMC) of A.A. Bogomolets National Medical University on the basis of a sociological survey of dentists. A sociological survey was conducted among 101 dentists of DMC. A specially designed questionnaire was used. According to the dentists’ opinion, the main directions for improving the organization of the SMC are the introduction of mechanisms for the economic motivation of staff (71.3±4.5%); modern dental technologies (82.2±3.8%); equipping the center with modern medical and diagnostic equipment (88.1±3.2%); improving the quality of postgraduate training of dentists (96.0±1.9%); introduction of a system for monitoring the quality of medical care (58.4±4.9%); improving the efficiency and quality of dental services through program initiatives of the departments of DMC (52.5±5.0%); an increase of the economic and legal independence of the dental center (76.2±4.2%); organizational, academic and financial autonomy of the center (88.1±3.2%); introduction of public-private partnership mechanisms in the DMC (75.2±4.3%). The conducted sociological research allowed to establish that the main parameters of the organization and management of the DMC do not correspond to the economic realities of time and require modernization, as well as determining the main directions of development of the DMC.
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