Medicni perspektivi, 2020;25(4)
2020 Vol. XXV N 4
Key words: multimorbidity, patient-centered care, guidelines
Abstract. Current approaches to medical care optimization for patients with multimorbidity. Diachuk D.D., Hidzynska I.M., Moroz G.Z., Tkachuk I.M. Scientific interest to the problem of multimorbidity is increasing due to the increase of the number of such patients. The aim of this work was to analyze and summarize current approaches to optimizing care for patients with multimorbidity and the results of their implementation in clinical practice. Since the beginning of this century, a number of documents have been created by WHO, government agencies and professional medical societies to improve medical care to patients with multimorbidity. The evidential basis of the effectiveness of the majority of the proposed measures based primarily on expert consensus. In 2016 NICE has published a clinical guideline NG56 «Multimorbidity: clinical assessment and management», WHO – a monograph «Multimorbidity: Technical Series on Safer Primary Care». In 2017 NICE has published a quality standard – Quality Standard №153 «Multimorbidity». The strategy of improvement of medical care for patients with multimorbidity is directly related to the patient-centered approach formation, which includes comprehensive assessment of the patient's condition. The main component of medical care is the definition of a realistic goal of medical intervention according to patient`s preferences, and making the choice of the optimal amount of diagnostic, treatment, and preventive measures, which can lead to the desired goal. A number of studies (the 3D randomized controlled trial, the MultiCare AGENDA, the SPPiRE study, the WestGem study etc.) have being conducted to evaluate the effectiveness of implementing proposed approaches in clinical practice. The results of the studies and meta-analysis do not provide conclusive evidence of the medical and economic effectiveness of their implementation at the presentstage. Improving the outcomes of medical care to patients with multimorbidity involves conducting further clinical trials that can provide evidence to determine the list of most effective interventions for clinical practice.
Key words: mental health, medical workers, COVID-19, SARS-CoV-2, 2019-nCoV
Abstract. Mental health care of medical workers during COVID-19 pandemic. Yuryeva L.M. During the pandemic caused by the SARS-CoV-2 virus, healthcare workers are at the forefront of the battle undergoing not only significant physical but also emotional stress. At the same time medical workers are considered to be at high risk for the incidence of COVID-19. Staying in a state of constant emotional stress over time leads to the emergence of both mental and somatic disorders. The purpose of this article is to conduct a literature review on the principles of consistency regarding the mental health of staff members of medical institutions providing care to patients with COVID-19. A systematic literature search has been carried out, as a result of which 32 articles with reports of mental and behavioral disorders during the pandemic have been selected for analysis. The main group of disorders are disorders of the anxious-depressive spectrum. According to various sources, from a quarter to a third of medical workers have clinically significant anxiety, about a third – depression. Significant prevalence of sleep disorders in individuals providing medical care to patients with COVID-19 has also been indicated. In the long term, the expectation of an increase in the level of post-traumatic stress disorder has been indicated. The article also provides modern views on the socio-psychological effects of epidemics and pandemics. Excessive attention, especially on social media devoted to the problem of COVID-19 significantly complicates the fight against the real problem of overcoming the pandemic. It has been proven that overconcentration of attention on problems associated with COVID-19 is a factor of the increased risk of developing generalized anxiety disorder. Thus, the protection of mental health and the socio-psychological support of medical workers are some of the important directions in the fight against the coronavirus pandemic. The management of psychological crises during pandemics should be based on psycho-hygienic and psycho-preventive measures both at the level of the individual and society as a whole.
Key words: markers of fibrosis, galectin-3, aldosterone, transforming growth factor β-1, hypertension, coronary heart disease, ventricular extrasystole
Abstract. The consequence of biomarkers of myocardial fibrosis in the prediction of arrhythmias in patients with hypertension in combination with coronary heart disease (literature review). Ivanov V.P., Shushkovska Yu.Yu., Afanasiuk O.I., Pentiuk L.O. The main morphological structural lesion substrate is myocardial fibrosis. The processes of fibrosis in a certain way are associated with the severity of a variety of cardiac arrhythmias. Myocardial fibrosis may be manifested by prolongation of the QRS complex, frequent ventricular arrhythmias and ventricular tachycardia on the electrocardiogram. Echocardiography is the main tool used to assess the structure and function of the heart, it reveals an increase in the left ventricle, and decrease in ejection fraction and diastolic dysfunction of the left ventricle and an increase in filling pressure. Biological markers are quantitatively defined biological parameters that, as indicators, determine the norm, pathology and result of medecinal correction of the disease (definition of experts from the Biomarkers Definitions Working Group, USA). Changes of biomarkers can be controlled to determine the individual risk of cardiovascular diseases development and measures to normalize them. Among the main causes of fibrosis activation, hyperactivation of the renin-angiotensin-aldosterone system and, as a consequence, the excessive formation of angiotensinogen and aldosterone are considered; increased levels of galectin-3, which contributes to the migration of macrophages, proliferation of fibroblasts and collagen synthesis in cardiomyocytes. Recently, much attention is paid to the study of biochemical markers such as aldosterone, galectin-3 and transforming growth factor- beta-1.Thus, these markers were determined in hypertension, metabolic syndrome, congestive heart failure, hypertrophic cardiomyopathy, myocardial infarction, atrial fibrillation. However, to date studies considering association between frequent ventricular premature beats, as a marker of electrical instability and plasma levels of biomarkers of fibrosis, such as aldosterone, galectin-3and transforming growth factor beta-1, in patients with essential hypertension without / or in combination with coronary heart disease are absent. Based on the aforesaid material,, further thorough study of this problem is promising.
Key words: nasal gel, specific activity, cerebroprotectors, n-phenylacetyl-l-prolylglycine ethyl ester
Abstract. Neuroprotective properties of n-phenylacetyl-l-prolylglycine ethyl ester nasal gel in an experimental model of multiple sclerosis equivalent. Burlaka B.S., Belenichev I.F., Nefedov O.O., Aliyeva O.G., Bukhtiyarova N.V. The purpose of this research is to study the specific activity of our developed nasal dosage form with n-phenylacetyl-l-prolylglycine ethyl ester. The experiments were performed on 260 white outbred rats weighing 190-220 g. Experimental allergic encephalomyelitis (EAE) was induced by a single subcutaneous inoculation of an encephalitogenic mixture (EHM) in Complete Freund's Adjuvant (CFA) based on 100 mg of homologous spinal cord homogenate; 0.2 ml of CFA (the content of killed mycobacteria 5 mg/ml) and 0.2 ml of physiological saline per animal. There were five groups of animals in the study: 1) intact; 2) control - untreated with EAE, received saline solution; 3) animals with EAE that received basic treatment - methylprednisolone (MP), 3.4 mg/kg, intraperitoneally slowly in saline no more than 1/10 of the CBV rat; 4) animals with EAE treated with MP + Noopept, at a dose of 10 mg/kg; 5) animals with EAE treated with MP + Citicoline (Ceraxon, Ferrer Internacional S.A., Spain) D003U1 series, 500 mg/kg, intragastrically. The integrative functions of rats’ brain with EAE were studied using the “Open Field” method with an arena of own production with dimensions 80x80x35 cm. The study of memory was carried out using the radial labyrinth LE760 (AgnTho's, Sweden). Capture and image recording was carried out using a color video camera SSC-DC378P (Sony, Japan). Video file analysis was performed using Smartv 3.0 software (Harvard Apparatus, USA). As a result of the studies on experimental model of multiple sclerosis with a nasal gel containing ethyl ester of n-phenylacetyl-l-prolylglycine revealed the presence of normotimic activity, antidepressant and anxiolytic effects, an increase in the total activity of the central nervous system. The results obtained indicate a high neuroprotective and nootropic activity of the Noopept intranasal gel. By the degree of influence on reducing the number of errors in working memory, the Noopept gel significantly exceeds monotherapy with methylprednisolone and combination therapy with methylprednisolone and citicoline. A further study of the effect of the developed nasal gel on the morphofunctional indices of sensorimotor cortical neurons under experimental multiple sclerosis, as well as on the content of HSP70 in the animal brain, is promising.
Key words: ischemia-reperfusion syndrome, liver, trauma, blood loss, haemostatic tourniquet, lipid peroxidation
Abstract. Сomparative characteristics of lipid peroxide oxidation activity and antioxidant protection in rat’s liver on the background of experimental ischemic-reperfusion limb syndrome. Volotovska N.V. The organism’s reaction to pathogenic impacts such as blood loss and ischemia can appear either on systemic or on ultrastructural level. The tourniquet inflation pressure on the extremity triggers local lipid peroxidation. However, the systemic influence of tourniquet is not completely studied. This experiment was dedicated to study of the changes that occur in the liver on the background of ischemic-reperfusion syndrome of the limb. In our experiment the animals were divided into 5 groups, in which the effect of ischemia-limb reperfusion, blood loss, mechanical injury of the thigh bone and their combination on the concentration of malonic dialdehyde and glutatoin peroxidase activity was studied. Biochemical investigation of the liver has shown that each of these experimental interventions had caused activation of lipid peroxidation in the liver and proper increase of the activity of the antioxidant protection enzyme in the blood. The peculiarities of the reaction were an increase of the first index, which was the highest among all experimental groups – on the background of blood loss combined with the use of a tourniquet; at the same time the critical suppression of antioxidation was noted as well. Besides 2 periods of exhaustion of the wounded organism were established – on the 3rd and 14th day. At the same time, the content of malonic dialdehyde was higher in the group where the imposition of the tourniquet was combined with mechanical trauma, comparatively to isolated mechanical trauma of the thigh, this indicated the role of the tourniquet as a factor complicating the course of posttraumatic period due to ischemic reperfusion syndrome. Understanding the pathogenesis of traumatic disease will allow to find a new way of valuing of the effects of limb decompression, to cope with oxidative stress and more successfully treat multiple organ failure.
Key words: forensic medicine, identification of the person, dermatoglyphic parameters
Abstract. Use of dermatoglyphic parameters of the medium and proximal phalanges of fingers for integrated legal-medical identification of a person. Kotsiubynska Yu.Z., Kozan N.M. The aim of the study is to search for the possibilities of forensic identification criteria through integrated study of the nature of correlative relationships between the dermatoglyphic parameters of the middle and proximal phalanges of the fingers together with gender and ethno-territorial belonging of persons and identify factor criteria for the diagnosis of unknown person’s phenotype. The material for the study was dermatoglyphs of middle and proximal phalanges of fingers of 480 persons belonging to males and females of different ethno-territorial groups of the Carpathian region, obtained digitally using the Futronic's FS 80 USB 2.0 optical scanner and reformatted from bitmaps to vector graphic objects using algorithm VeriFinger 6.6/Mega Matcher 4.4 Identification Technology Algorithm. The results of quantitative and qualitative study of the morphological elements of dermatoglyphic parameters were subjected to one- and multivariate statistical analysis. Significant differences were found between in incidence of dermatoglyphic parameters in the males and females of the Boiko, Lemko, Hutsul, Opillia, Pokuttia and control groups during the study. On the basis of the obtained result, diagnostic phenotypic complexes of dermatoglyphic parameters of middle and proximal phalanges of the fingers of representatives of different ethno-territorial groups of the Carpathian region were formed, and thus the register of identification criteria was expanded, which can be further used as a separate self-sufficient identification system, as well as together with dermatoglyphic parameters of hands and feet in complex identification expertise.
Key words: chronic obstructive pulmonary disease, systemic inflammation, fibrosis
Abstract. The processes of inflammation and fibrosis in patients with chronic obstructive pulmonary disease. Pertseva T.A., Konopkina L.I., Koval D.S., Guba Yu.V. The aim of the study was to determine the categories of COPD patients with a predominance of fibrotic or inflammatory processes. The study included 37 stable COPD patients (men – 33 (89.2%), women – 4 (10.8%), mean age – 63.5±1.18 years, the level of forced expiratory volume for the first second after the test with bronchodilators (FEV1post) – 46.7±5.81% of the proper value). To determine the categories of COPD patients with a predominance of inflammation or fibrosis, a cluster analysis was performed. For this purpose the most important indicators from a clinical point of view were selected: the number of exacerbations over the past year, dyspnea severity according to the mMRC scale, the level of FEV1 post and reversibility level in absolute values, systemic inflammation markers levels (CAA, C-RP) and profibrotic cytokine TGF-β1. Thus, according to the results of cluster analysis, two categories of patients were identified. The first category – COPD patients with a predominance of the inflammatory process with low dyspnea severity, high functional indicators (FEV1 >50% of the proper value), high airway reversibility level, low level of profibrotic cytokine TGF-β1, high levels of systematic inflammation markers (C-RP and CAA). The second category – COPD patients with a predominance of the fibrosis process, with a high dyspnea severity, low functional indicators (FEV1 ≤50% of the proper value), low airway reversibility level, low levels of systematic inflammation markers (C-RP and CAA), and high profibrotic cytokine TGF-β1 levels. The prevalence of inflammatory processes was observed mainly in COPD patients, who belong to clinical group C; the prevalence of fibrotic processes – mainly in patients of clinical group B.
Key words: arterial hypertension, nutritional status, kidney function
Abstract. Renal function and nutritional status in patients with arterial hypertension. Rodionova V.V., Boiko O.O. Arterial hypertension is the main preventable cause of cardiovascular disease and all causes of death worldwide, and also ranks second among the most important causes of chronic kidney disease after diabetes. An important factor contributing to the increase in blood pressure is obesity. Being overweight raises blood pressure and accounts for 65-75% of the initial hypertension, which is the main cause of cardiovascular disease and kidney disease. The aim of the work was to study renal function in patients with arterial hypertension, depending on the nutritional status of patients. Materials and methods. A prospective study included 47 stable outpatients with stage II arterial hypertension (left ventricular hypertrophy) of the 1st to 3rd degree, (24 women and 23 men), the average age was 55.7 (8.9) years. The mean disease duration was 14 (3.2) years. The control group included 28 relatively healthy people without arterial hypertension (15 women and 9 men), the average age was 56.0 (6.6) years. All patients were evaluated for complaints, medical history, smoking status, physical examination with anthropometric indicators (height, weight, body mass index, waist circumference), heart rate and blood pressure. The risk of cardiovascular events was also determined in accordance with the SCORE scale. The nutritional status was evaluated based on bioimpedancemetry data (Omron analyzer) with determination of the percentage of total fat, muscle mass and visceral fat. To determine the functional state of the kidneys, the level of total protein in blood serum, creatinine and albumin in the urine was determined, with the determination of the albumin creatinine ratio in a single portion of urine, the glomerular filtration rate were calculated. Results and conclusions. In patients with arterial hypertension, a change in nutritional status was detected in the form of an increase in the amount of total adipose tissue against a background of a decrease in muscle tissue pool, with the development of sarcopenia in combination with obesity. Also, patients developed hypertensive nephropathy. It was found that the BMI is not informative enough to determine nutritional status, but requires the use of bioimpedancemetry to determine the percentage of total fat, visceral fat and muscle mass.
Key words: bacteriophage drugs, Staphylococсus aureus, antibiotic resistance
Abstract. Bacteriophages against methicillin resistant Staphylococcus aureus strains. Poniatovskyi V.A., Bondarchuk O.L., Prystupiuk M.O., Smikodub O.O., Shyrobokov V.P. Staphylococcus aureus is one of the most common opportunistic pathogens that causes a variety of diseases, from minor skin infections to life-threatening sepsis, meningitis, pneumonia and a number of other diseases. Particular attention was paid to methicillin-resistant Staphylococcus aureus (MRSA) strains with multiple drug resistance. The purpose of this study is investigation of the sensitivity of clinical isolates of Staphylococcus aureus, including methicillin-resistant strains, to bacteriophage drugs and determination of possibility of using this agent for the treatment of staphylococcal infections. A number of classical and modern microbiological methods for the isolation and identification of Staphylococcus aureus: an indication of genes, responsible for antibiotic resistance (PCR analysis), determination of sensitivity to antibiotics (disc diffusion method) and bacteriophages (spot test, Gracia method, Appelman method) were used in the study. The susceptibility analysis of Staphylococcus aureus with presence and absence of mecA gene to the commercial bacteriophage product – “PYOFAG® BACTERIOPHAGE POLYVALENT” was performed. The results of the study showed that the total number of susceptible strains of bacteria was 95±0,2%. The use of investigational Bacteriophage drug for the treatment of furunculosis caused by MRSA has shown positive results. After one week of using the bacteriophage as monotherapy, the patient experienced regression of the clinical symptoms. For the period of use no adverse effects have been detected. Thus, the phage drugs using can become an important tool in the control of antibiotic-resistant strains, which cause a variety of infections in humans.
Key words: dihydroquercetin, transient visual disorders, arterial hypertension, hypoxic-ischemic encephalopathy, transient ischemic attacks
Abstract. Effects of dihydroquercetin (DHQ “P” drops) in patients with previous transitory ischemic attacks associated with visual disorders. Wang Zi Way, Pohorielov O.V., Bobokalo S.V., Baranenko O.M., Chun Liu. A study involved 48 patients aged 33 to 79 years (average age – 62.6 years) with transient ischaemic attacks (TIA) and visual disorders, caused by cerebrovascular diseases (CVD). 24 patients from this group underwent treatment by GCP criteria and medical care standards in acute brain blood supply disturbances, TIA and therapy with dihydroquercetin “DHQ” “P” drops in the dose of 7 drops, twice a day for 10 days. All the patients had arterial hypertension (AH) stage 1-2. Control group consisted of 26 men and 20 women of comparable age (n=46; average age - 65.9 years) without cerebral ischemic events and visual disorders, findings regarding neurophysiological parameters of visually evoked potentials (VEP) and microcirculatory system state (MCS) were compared. Exclusion criteria: acute heart diseases, type 1-2 diabetes mellitus, glaucoma, secondary types of arterial hypertension and AH stage 3, hemorrhages and hereditary cerebrovascular syndromes. Assessment of the “DHQ” “P” influence on such microcirculatory system parameters (retinopathy components) as perivascular edema, perivascular microhemorrhages, arterio-venular coefficient was carried out by results of the fundus oculi vessels computed photometry and biological microscopy of the bulbar conjunctival vessel layers. According to the data regarding distribution of TIA amount, retinopathy stage and age, correlation of TIA was conditioned by retinopathy stage and other factors except of patients’ age. Patients with TIA associated with visual disorders in presence of CVD suffered from arterial hypertension in 72.98%. Stage 1-3 of retinopathy and optic disc functional disorders were all detected. In case of therapy with “DHQ “P” the positive changes in dynamic regarding capillary permeability restoration (in 71.43%±12,07, in retinopathy stage 1-2 in comparison with 38.46% without it) were established and less pronounced – in case of perivascular microhemorrhages. Such positive effects in the conducted study were characterized as tendency pattern (OR 2.87; p=0.08 for perivascular edema and OR 2.77; p=0.08 for microhemorrhages). The efficacy of therapy with “DHQ “P” in restoration of impaired optic disk functions according to the data of VEP (for NO component of VEP; OR 2.87; p=0.041) in the dosage of 7 drops twice a day during 10 days in case of CVD was revealed; this determines the perspective of further investigation of “DHQ “P” which contains dihydroquercetin.
Key words: gastroesophageal reflux disease, autoimmune thyroiditis, total antioxidant activity, manganese superoxide dismutase, Klotho protein
Abstract. The state of antioxidant defense system in young persons with gastroesophageal reflux disease and autoimmune thyroiditis. Kovalyova O.M., Chukhrienko N.D., Pasiieshvili T.M., Pasiyeshvili L.M., Zhelezniakova N.M. Aim of research was assessment of the levels of antioxidant biomarkers associated with mitochondrial function in young patients with gastroesophageal reflux disease (GERD) and autoimmune thyroiditis (AIT). This study included 165 patients of them 120 patients with GERD and AIT - the main group, 45 patients with isolated GERD - the comparison group. The examined contingent was presented by students aged 18 to 25 years. The control group consisted of 20 healthy individuals of corresponding gender, age and social status (students). Total antioxidant activity (TAS-TAC) was determined in blood serum of study persons with enzyme immunoassays (ELISA, Elabscience, USA), levels of manganese superoxide dismutase (MnSOD) – with enzyme immunoassays (ELISA, Elabscience, USA) and Klotho protein - with enzyme immunoassays (ELISA, Elabscience, USA). Statistical data processing by the Statistica Basic Academic 13 for Windows En local was made. In examined patients with esophageal and thyroid pathologies the decline of total antioxidant activity has been revealed. The MnSOD level in patients with comorbidity of GERD and AIT and isolated GERD was significantly higher as compare to control group. Significant increasing of Klotho protein in serum of young patients was observed. We assessed imbalance between decline of extracellular antioxidants and activation of mitochondrial antioxidants which is more pronounced in combination of diseases. The increase of biomarkers of mitohondrial antioxidant defense system with non-specific citoprotection mechanism in patients with GERD provides the basis to consider MnSOD and Klotho protein as prognostic indicator of clinical outcome of disease in young age. Under combination of GERD and AIT the tendency to overexpression of MnSOD and depression of total antioxidant activity has been revealed, this may cause the deterioration of mitochondrial function.
Key words: polyps, colorectal cancer, aldehyde dehydrogenase 1
Abstract. Comparative analysis of aldehyde dehydrogenase 1 expression in polyps and adenocarcinoma of the distal colon. Shyshkin M.A., Khrystenko T.O. Aldehyde dehydrogenase 1 (ALDH1) is one of the most widely used cancer stem cells markers, even though the question of its significance for certain stages of colorectal carcinogenesis is still unclear. The aim of this study was to compare ALDH1 immunohistochemical expression levels in polyps and adenocarcinoma of the distal colon. Histopathological and immunohistochemical studies of biopsies from 40 patients (biopsies of polyps and histologically non-changed mucosa of the distal colon), as well as surgical material of colorectal adenocarcinoma from 30 patients were carried out. It was established that distal colonic polyps are characterized by cytoplasmic expression of ALDH1 with the median of relative area that is equal to 25.63 (18.26; 30.42)% stromal cells. ALDH1 expression by epitheliocytes is revealed exclusively in dysplastic polyps with the median of the area that is equal to 22.13 (17.22; 30.05)%. Colorectal adenocarcinoma is characterized by cytoplasmic expression of ALDH1 with the medians of the area that are equal to 40,22 (22,54; 47,77)% stromal cells and 32,12 (23.64; 40.28)% cancer cells. The area of ALDH1+ cells varies depending on the pTNM stage of the carcinoma, herewith the median of ALDH1+ stromal cells is significantly increasing during the tumor progression from the I to the III stages that displays increasing in number of stromal cells which are involved in oncogenic signaling pathways activation. The median of ALDH1+ cancer cells is significantly increasing during the tumor progression from the III to the IV stages that shows increasing number of cancer cells that acquire properties of stem cells on advanced stages of colorectal adenocarcinoma. Comparative analysis of the parameters obtained for polyps and carcinoma indicates that the median of ALDH1+ stromal cells area in polyps is 2 times smaller than the median of ALDH1+ stromal cells area in carcinoma, and the median of ALDH1+ epitheliocytes area in polyps is 1.5 times smaller than the median of ALDH1+ cancer cells area.
Key words: advanced glycation end-products, allergy, eosinophils-derived inflammation, neutrophil-derived inflammation
Abstract. Аdvanced glycation end-products as novel biomarkers of eosinophil-derived lung inflammatory diseases (literature review). Gamian A., Zubchenko S.O., Havrylyuk A.M., Kril I.Y., Chopyak V.V. Advanced glycation end-products (AGEs) are created during the process of glycation of cells from various tissues and fluids and are a heterogeneous group of molecules formed from the nonenzymatic reaction of reducing sugars with the amino group of proteins, lipids, and nucleic acid. In normal conditions, they play the immunoregulatory role. In pathologic conditions AGEs activate the receptors for advanced glycation end products (RAGE) and cause long-lasting inflammation. RAGE participates actively in various disorders such as rheumatoid arthritis, diabetes, etc. However, there is relatively small number of scientific studies on the possibility of using the role of AGE in the pathogenesis of allergic diseases. RAGE transcript and protein are expressed in the lung by pulmonary type I alveolar epithelial cells, suggesting that RAGE has an important role in lung pathophysiology. They repress some endogenous autoregulatory functions leading to many diseases, including allergy. Oxidative stress increases the inflammatory reaction in asthma and allergies. Long-lasting inflammation followed by free radicals production are important factors involved in allergic reactions, they negatively influence the incidence and prognosis of allergy. RAGEs are expressed on circulating immune cells, they activate NF kappaB and intracellular oxidative stress also increases the inflammatory reaction in asthma and allergies. The membrane RAGE (mRAGE) signaling is proinflammatory, whereas soluble RAGE (sRAGE), a secreted form of RAGE, is generally anti-inflammatory. The study of AGEs, soluble RAGE, ligands of RAGE HMGB1, and S100A8/A913 and IL-33 is useful in the context of their considering as biomarkers to the differentiation diagnostic between eosinophils-derived and neutrophil-derived asthma/AAD. The mean serum levels of RAGE may be the target of new therapeutic interventions.
Key words: physical therapy, motivated walking, partial body weight supporting, gross motor functions
Abstract. Influence of motivated walking with partial body weight supporting on the gross motor functions in children with cerebral palsy. Nekhanevych O.B., Bakuridze-Manina V.B., Smirnova O.L., Byoung-Yul. Y., Kosynskyi O.V. The aim of the work is to increase the effectiveness of physical therapy of gross motor functions impairments in children with spastic cerebral palsy by using a therapeutic exercises program with partial body weight supporting and motivated walking on the device for the rehabilitation of people with impaired functions of the musculoskeletal system. The study included 30 children 6 to 11 years old with a spastic form of cerebral palsy. All patients were divided into 2 groups: in group I, in addition to the standard complex of physical therapy, walking according to the dynamic method was prescribed, in group II – according to the static method with partial body weight supporting. The duration of the program was 6 weeks. The survey was carried out before the start, at 2, 4 and 6 weeks of therapy. We studied the spatiotemporal characteristics of walking and activity of daily living indicators. The use of the developed program with the rehabilitation device positively influenced the spatiotemporal indicators of walking in both groups. The stride length, walking speed and the length of the covered distance increased statistically significantly. A significant increase in the volume of performed activities of daily living in the I group was found. At the same time, an increase in this indicator was also observed in group II, but it did not reach statistical significance. The use of the developed program of therapeutic exercises, including walking with motivated movement and partial body weight supporting on the developed rehabilitation device positively influenced the static and dynamic characteristics of walking, which improved the performance of activities important for children with cerebral palsy, especially walking and running. The optimal time for increasing the stride length is a 4-week program, for the development of general endurance and speed – a 6-week program of therapeutic training.
Key words: infertility, uterine factor, echostructure of the endometrium, chronic endometritis, preconceptional diagnosis
Abstract. Endometrial state in women with uterine factor of infertility at the stage of preconceptional care according to sonography and doplerometry data. Makarchuk O.M., Ostrovska O.M., Okolokh Onieka Gibson, Orishchak I.K., Cheredarchuk A.R. In recent years, the number of cases of uterine factors infertility is constantly growing. Unfortunately, the analysis of scientific works is characterized by the lack of data on the improvement of the diagnostic algorithm and the expediency of accentuating the significance of the preconceptional stage. The purpose of this study was to develop sonographic criteria for endometrial readiness for implantation at the stage of preconceptional care in women with uterine factor infertility. The first group included 80 women with uterine factor infertility, the second group (40 women) consisted of patients who entered the IVF program for the first time. The control group consisted of 30 women with normal fertility. Studies of the structure of the endometrium, myometrium and ovarian tissue were performed on a Voluson 760, on the 4th-6th days of the menstrual cycle (according to the International Endometrial Tumor Analysis (IETA) – consensus of ultrasound description of endometrial changes) and on the 20th-24th days of the cycle. To assess the indirect signs of chronic endometritis the echographic criteria developed by V.N. Demidov et al. were used. The sonographic diagnosis was verified during morphological and immunohistochemical examination. The most common menstrual disorders in women with uterine factor infertility were algodysmenorrhea – 33.3%, algohypomenorrhea –22.2%, hypoopsomenorrhea – 64.4%. Thinning of the endometrium was significantly more often observed in the group with uterine factor of reproductive disorders; one third of patients (33.8%) had dyschronosis of the endometrial echotexture; heterogeneity of M-echo with a predominance of hyperechoic areas was diagnosed in 41.3% of cases. Hyperechogenic inclusions in the basal layer, multiple structures of a linear nature and increased echogenicity were revealed in every fifth patients and hypoechoic uterine contour – in 47.5% of cases. The most significant odds ratio associated with IVF failures and early reproductive loss was found in patients with endometriosis (OR – 5.85; 95% CI: 1.32-13.32), synechiae (OR – 2.27; 95% CI: 0.96-10.16) and polyps (OR – 2.48; 95% CI: 0.84-11.36). It was possible to distinguish the following criteria of functional readiness of the endometrium for implantation: endometrial thickness was more than 8 mm, compliance with the echostructure phase of the menstrual cycle, homogeneity of M-echo, absence of hyper-and hypoechoic inclusions, and full hemodynamics in the vascular pool of the pelvis.
Key words: children, asthma, gastroesophageal reflux disease, risk factors
Abstract. Impact of risk factors in developing bronchial asthma combined with gastroesophageal reflux disease in children. Umanets T.R., Buratynska A.A., Tolkach S.I., Stepanova L.S., Matveeva S.Yu., Kondratenkova T.V., Smirnova O.A., Garaschenko T.A., Lapshyn V.F., Antipkin Yu.G. The purpose of the study was to determine the risk factors affecting the development of asthma combined with gastroesophageal reflux disease (GERD). Seventy children aged 5-17 years with asthma were examined. They were divided to two groups: group 1 (50 children with asthma and GERD), and group 2 (20 children with isolated asthma). Medical history data were collected through specially designed questionnaire for parents. It was determined that the perinatal risk factors that likely contributed to developing co-morbid asthma and GERD were a threatened miscarriage (OR=6.65; 95% CI, 1.7-25.6, p=0.003), acute respiratory illnesses during pregnancy (OR=6.52; 95% CI, 1.4-31.2, p=0.008), polyhydramnios (p=0.039) and uterine inertia (p=0.0003). Food hypersensitivity in the first year of life, the severity of asthma in examined children played role in increasing the risk of developing asthma combined with GERD (OR=4.83; 95% CI, 1.3-18.6, p=0.013 and OR=4.45; 95% CI, 1.2-17.1, р=0.019 respectively).
Key words: lumbar osteochondrosis, myotonic reactions, motor patterns, shock wave therapy
Abstract. Effectiveness of the rehabilitation program in patients with lumbar osteochondrosis and motor stereotype disorders using shock wave therapy. Gresko I.V., Kolesnichenko V.A. The study included 80 patients aged 22-44 (31.7±4.4) years with lumbar osteochondrosis with impaired motor stereotype and myotonic reaction of the lumbar-pelvic region muscles. The patients were randomized into two homogeneous groups depending on the physical rehabilitation program: in the main group a combination of shock wave therapy (SWT) with the Masterplus MP200 extracorporeal shock wave therapy device (5 procedures with a frequency of 11 Hz, an impact force of 3.8-4.0 bar, intervals of 5-7 days) with a program of relaxing exercises according to the method of K. Levit was used; in the control group – only exercises program. The developed program of physical rehabilitation proved its effectiveness by a significant decrease in pain intensity indicators (p<0.001) by VAS scale, ODI disability level (p<0.001) and SKT kinesiophobia level (p<0.01), a significant increase in the spine mobility (p<0.05) and the lumbar spine mobility (p<0.05), flexion in the hip joints (p<0.05). The range of movements during extension, adduction and abduction of the hip joints also increased but not significantly. Normalization of the extensor muscle tone of the lumbar spine was observed in 87.5% of cases, the gluteus muscle tone – in 30.0%, and the piriformis muscle tone – in 27.5%. The frequency of registration of error patterns in the active combined movement of the lumbar segments and the pelvis decreased to 37.5% of cases as a whole. The developed program of physical rehabilitation proved to be effective compared with the results of the isolated application of relaxing exercises with a significant improvement by VAS scale (p<0.05), ODI (p<0.05) and SKT (p<0.05); normalization of the tone of the lumbar extensor muscles and the restoration of control of active movements in the lumbar-pelvic region are more often noted in more than a third of patients.
Key words: rapidly progressive generalized periodontitis, infectious and inflammatory process, drug-resistant microflora, immunity
Abstract. Justifications for differentiated approach in correction of some changes of the immunologic disorders in patients with rapidly progressing generalized parodontitis with different drug susceptibility of the parodontal bacteria. Gudaryan A.A., Maschenko I.S., Dorogina A.S., Shyrinkin S.V. Rapidly progressing generalized periodontitis (RPGP) still remains an extremely important medical problem, despite certain achievements in solving most of the issues of etiology, pathogenesis and treatment. The study included 102 patients with rapidly progressing periodontitis of I-II and II-III degrees of severity, with ineffective and inconsistent results of previous treatment who were examined and treated in the clinic of the Department of Surgical Dentistry, Periodontics and Implantology of the SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine». On the basis of the diagnostic and therapeutic measures carried out, it was established that, in patients with rapidly progressing generalized periodontitis, the formation of various drug sensitivity in periodontopathogenic microorganisms to protocol antibacterial therapy is closely associated with immunological protocol diseases. The presence of drug-resistant bacteria in the periodontal tissues is combined with a more pronounced immunodeficiency in the mechanisms of systemic and local protection than when the lesions are colonized by drug-sensitive periodontal microorganisms. The revealed features of immunity disorders in patients with RPGP with drug-resistant infection to conventional antibiotic therapy are manifested by a decrease in CD3+ lymphocytes, cells with cytostatic activity (CD4+, CD16+) expressing receptors for the activation of lymphocytes CD25+, HLA-DR and apoptosis CD95+), against the background of a slight increase in CD20+, CD116+, CD54+, significant inhibition of the synthesis of SIgA, IgM, α-INF, γ-INF; a pronounced increase in the production of pro-inflammatory cytokines IL-1β and TNF-α. The need for a differentiated approach in the correction of immunological disorders in patients with RPGP depending on the detected sensitivity and resistance of periodontal pathogenic bacteria to the protocol generally accepted antibacterial therapy has been clearly proved; this provides a faster relief of the infectious and inflammatory process (on average on 3.6±0.2 day) in more than 90% of cases, normalization of the parameters of immunological reactivity in 93.3% of the observed and stable clinical remission of the disease.
Key words: complete adentia, mandible, complete dentures, dental implantation, finite element analysis
Abstract. Results of stress-strain states study in prosthetics of different types of atrophy of edentulous mandible. Fastovets O.O., Sapalov S.O., Shtepa V.O. Complete dentures remain still popular due to the economic component of such prosthetic treatment. However, additional fixation on intraosseous implants provides a greater clinical and functional effectiveness and a greater level of satisfaction with the results of prosthetics in edentulous patients. At the moment, the biomechanical aspects of complete denture prosthetics and prosthetics with fixation on implants, taking into account the degree of atrophy of the edentulous jaws, are not complete understood. Such studies make it possible to create recommendations on the choice of prosthetic tactics for edentulous patients. The aim of the research was to study the distribution of stress-strain states in prosthetics of the edentulous mandible with complete dentures and with designs supported on intraosseous implants, taking into account the type of atrophy. It was carried out computer simulation of 8 virtual finite element models of mandible with different types of atrophy. According to Keller they were 4 models: of the biomechanical system simulation "complete denture – mandible" and 4 ones – "denture – intraosseous implants – mandible". In each of the models, a chewing load of 100 N was simulated (symmetrically and asymmetrically). The ANSIS 12.1 finite element analysis was used to calculate the stress-strain states in the described calculation systems. It was estimated the distribution of stresses in cortical bone and displacements of the dentures on the prosthetic bed. Under using complete dentures, the maximum stresses in the bone tissue of the prosthetic bed were observed for the third type of mandible atrophy with all types of power load, the smallest ones – for the fourth type. Additional fixation of removable dentures in simulation models of biomechanical systems “denture – intraosseous implants – mandible” lead to a significant increase in stresses in the alveolar bone. The maximum stresses were observed in the area of the marginal bone, while their greatest values were in the well-expressed alveolar part of the mandible for first and third types by Keller. The movements of bases of complete dentures were insignificant and fluctuated within hundredths of a millimeter for all types of atrophy. The use of intraosseous implants for fixation of dentures caused increase in movements by several times. Besides, displacement fields were characteristic: they were uniform for complete dentures but in the use of implants – not. The expressed alveolar process in the first and third types of atrophy of the edentulous mandible caused an increase in the displacements of the distal sections of the dentures on both sides with a symmetrical force load and on one side – with an asymmetric one. It can be assumed that such a distribution of stress-strain states accelerates atrophy of prosthetic bed tissues. As a result of prosthetics of complete defects of lower dentitions, both with traditional complete dentures and with additional support on implants, different distribution of stress-strain states occurs in different phases of the chewing act in the bone of the prosthetic bed, the character of which is determined by the shape of the alveolar part described by Keller's classification. The results allow us to develop an algorithm for determining the kind of prosthetics for edentulous patients, depending on the type of mandible atrophy.
Key words: COVID-19, working conditions, occupational morbidity of medical workers, risk of contamination
Abstract. Problems of safety, occupational hygiene and control over infections in fighting with occupational diseases of healthcare workers with COVID-19 in treatment facilities of Ukraine. Yavorovsky A.P., Skaletsky Yu.M., Brukhno R.P., Shkurba A.V., Kirichuk I.M., Regan М.М. The objective of the publication was to assess the safety of treatment facilities, occupational health and infection control in Kiev, Zhytomyr and Zhytomyr region to enhance risk management of SARS-CoV-2 infection of healthcare workers and reduce occupational illness and mortality for COVID-19. Bibliosemantic, hygienic, questionnaire, statistical methods and methods of comparative and system analysis have been used. The work of doctors involved in overcoming COVID-19 pandemic is classified as dangerous (extreme). In addition to the SARS-CoV-2 virus, the working conditions of medical workers are influenced by physical, chemical factors and high physical and neuro-emotional stress. Among medical workers of the Zhytomyr region who were diagnosed with an acute occupational disease COVID-19, nurses prevailed (38.57%). Junior nurses (26.1%) – the second COVID-19 incidence, paramedics (5.31%) occupy the third place. The doctors’ incidence was ranked in the following sequence: doctors of GPFM – 4.85%, surgeons – 4.16%, anesthesiologists – 2.54%, infectious disease doctors – 2.08%, radiologists – 1.85%. This distribution of medical professions is observed for all Ukraine regions. Chance of becoming infected with SARS CoV 2 for healthcare workers in October was by 3.8 times higher than the general population. Risk of dying from COVID-19 in healthcare workers is greater by 1.5 times than the general population. The high level of occupational morbidity of COVID-19 in Ukrainian medical personnel is determined by personal negligence, incomplete staffing of TF with medical workers, of medical workers with PPE; dis-use of PPE if available, absence or poor-quality instruction on labor protection; shortage of epidemiologists, hygienists and occupational pathologists.
Key words: insecticide, toxicology, calculation models, regression equations
Abstract. Hygienic substantiation of calculating models for prognosis of toxicity of different classes insecticides (second part). Vavrinevych O.P., Shpak B.I., Antonenko A.M., Omelchuk S.T., Zinchenko T.I. This work is the second part of our study to develop alternative experimental mathematic models for predecting toxicity of insecticides, where we carried out a statistical analysis and comparative estimation of the toxicometric parameters obtained experimentally and calculated according to the proposed equations. In the first stage calculations were carried out and the most reliable models were proposed. The purpose of the research is the scientific substantiation and statistical analysis of the calculation models for predicting the toxicity of insecticides of different classes. For research we took the insecticides of the following chemical classes: neonicotinoids, pyrethroids, organophosphorus compounds. Statistical analysis of the linear and nonlinear regression equations obtained for insecticides was conducted. The equations described the dependence of subthreshold doses in the chronic experiment of all insecticides, the median lethal doses at oral admission of pyrithoids and neonicotinoids from molecular weight; and toxicometry parameters of all insecticides and their individual groups (pyrithoids, neonicotinoids, organophosphorus compounds) on melting temperature and the octanol-water partition coefficient. On the basis of a comparison of the toxicometry parameters obtained experimentally (actual parameters) and calculated according to the proposed equations checking of possibility of using of the calculating models for predicting the danger of the investigated groups of insecticides was performed. For substantiated pairs of resultant and factorial variables for pyrethroids, neonicotinoids, and organophosphorus pesticides a reliable correlation was established (ractucal> rtable at p = 0.05) or trend (ractucal> rtable at p = 0.1). A good and very good consistency of the features selected for the calculations according to the Cronbach’s alpha (index ranged from 0.8 and above) was indicated. The developed algorithm makes it possible to significantly simplify the conduction of toxicological studies of the studied classes of insecticides.
Key words: children, morbidity, mortality, pneumonia
Abstract. Dynamics of the incidence rate of pneumonia in children in Ukraine over the past 20 years. Volosovets O.P., Bolbot Yu.K., Abaturov O.Ye., Kryvopustov S.P., Besh L.V., Stoieva T.V., Khomenko V.Е., Kovalchuk O.L. Pneumonia ranks third in the structure of hospital mortality in infants after perinatal pathology and congenital malformations in Ukraine. Over the past 20 years in Ukraine, there has been a 33,7% increase in the incidence of pneumonia in children (p˂0.01), with the predominant detection of this pathology in children from regions of the country who have problematic issues in the proper provision of pediatric services. The highest incidence of pneumonia in all age groups was observed in children of Ivano-Frankivsk, Rivne, Kyiv and Vinnitsa regions. Thanks to the progressive development of domestic pediatrics and the introduction of modern medical and diagnostic technologies, in particular, vaccine prophylaxis, over the past 20 years, the death rate of children from acute infections of the upper respiratory tract, pneumonia and influenza has decreased by almost 5 times. Changes in recent years in the incidence of pneumonia in children correspond to the dynamics of the spread of influenza and acute respiratory viral infection, especially during the epidemics 2009-2010 and 2015-2016. Assessing the dynamics of this indicator in subsequent periods is extremely important in the context of the COVID-19 pandemic, which continues.
Key words: neoplasms, malignant neoplasms, adult and able-bodied population, level, structure, tendencies to changes in the level of primary disability, the need for rehabilitation measures
Abstract. Primary disability due to neoplasms in Ukraine: structure, trends, influencing factors. Ipatov A.V., Khaniukova I.Y., Moroz О.М., Sanina N.A. A full study was conducted using the statistical method of research in order to analyze the status and structure of primary disability of the adult population of the regions of Ukraine due to tumors in the period ща 2010–2019 and identify the causes that affect the indicators of primary disability and regional characteristics. We have performed the analysis of expanded statistical information regarding disability in Ukraine with the help of the "Report on the causes of disability, indications for medical, professional and social rehabilitation" (form № 14, approved by order of the Ministry of Health of Ukraine in coordination with State Statistics Committee of Ukraine dated 10.07.2007 № 378) within 24 regions of Ukraine and Kyiv over the last ten years. In addition, the correlation analysis was performed using Microsoft Excel© to find the connection between primary disability due to neoplasms and a number of medical and social factors using Pearson-Brave correlation coefficient (r). Over the last ten years, the rates of primary disability due to neoplasms and malignant tumors of both adults and able-bodied population have been increasing steadily. They have always been among the top three causes of disability in Ukraine. However, cardiovascular diseases occupied the first place over the last 27 years. In 2019, tumors took the first place. Fluctuations in primary disability due to neoplasms are connected with a number of medical and non-medical causes. The main ones are morbidity, prevalence of neoplasms, number of beds in cancer dispensaries and availability of specialized oncology medical expert commissions in the region, changes in legislation regarding criteria for assessing disability groups. In the structure of primary disability due to neoplasms people of working age (40-60 years) dominate, their number varies by year, but the tendency to predominance persists Among the disability groups a severe second disability group dominates, which indicates a late diagnosis due to untimely treatment of these people and the predominance of the so-called "neglected" forms of the disease. This trend takes place during the observation period of all ten years. The highest rates of primary disability due to neoplasms are also stable throughout the ten-year observation period and are observed in the regions that are considered the most affected by Chornobyl disaster: Kyiv region, Kyiv, Zhytomyr, Chernihiv, Volyn, Rivne. However, the increase in this indicator in Poltava region over the last three years is not entirely motivated. The obtained results will be the basis for the development of national and regional measures for the rehabilitation of people with disabilities caused by tumors and contribute to public funds saving due to their targeted distribution in regions and keeping labor resources.
Key words: Ambulatory care sensitive conditions (ACSCs), Ambulatory Care Sensitive Hospitalizations (ACSHs), potentially preventable hospitalizations (PPHs), Primary Health Care, Ukraine
Abstract. Estimates of potentially preventable hospitalizations in diseases ambulatory care subjected to in Ukraine. Lekhan V.N., Kriachkova L.V., Doroshenko O.О., Gritsenko L.O. The purpose: this study aims to identify the most relevant diseases that can be treated outpatient (Ambulatory Care Sensitive Conditions, or ACSCs) and to define the scope of potentially preventable hospitalizations (PPHs) for such conditions (Ambulatory Care Sensitive Hospitalizations, or ACSH), for Ukrainian adults (above 18 years old), subject to improvement of primary care efficiency. The study has been carried out in four phases, using the World Health Organization’s (WHO) guidance on ACSCs for the European Region, which was adapted to the national context. The data was taken from the official statistical reporting and analyzed by 104 reviewers. The assessment of the PPHs is conducted based on responses of the subgroup of reviewers – 6 experts and 61 primary care physicians, which confirmed the levels of competencies. The most significant rates of potentially preventable hospitalizations (PPHs) are registered for hypertension, pneumonia, angina, chronic obstructive pulmonary disease (COPD), and diabetes, which coincide with ACSCs that are most prevalent for Ukrainian adults. The overall rate of PPHs for adult population of Ukraine with ACSCs is 28.2% as defined by physicians and 32.9% as defined by experts, which may reduce the hospitalization rate for all ACSCs (as percent of all patients with ACSCs) from 8.2% to 6.1% (according to reviews of physicians) or to 5.7% (according to experts’ reviews). The study has shown an important scope for better managing of ACSCs in Ukrainian adults. The results of the study can be used to inform the continued health system transformation, specifically for the development of interventions to prevent avoidable hospitalizations for ACSCs in Ukraine, which can lead to more efficient use of resources in the health system and further strengthening of the primary care.
Key words: health-related quality of life, clinical practice, pediatrics, children, healthcare services
Abstract. The quality of life of labor migrants’ children. Gorbunova G.D. In order to define the quality of life of labor migrants’ children, there were researched different aspects of their lives, such as physical functioning (PF), emotional functioning (EF); social functioning (SF) and school functioning (SF). The given research involved 150 children from Republic of Moldova. They were of different age groups (5-7, 8-12, 13-18), of whom 75 children were of the labor migrants and their parents/guardians who remain in the country and 75 children of labor migrants and their parents without labor migration experience. As the instrument for given research there was used the Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire. In the course of the research there was distinguished Quality of Life (QL) of children on high level, score from 100 to 91, the middle level – from 90 to 81, the low level – from 80 to 71 and the lowest level, less than 70 scores. According to the results of the investigation it was established that the migrants’ children of various age groups, from all the examined aspects had a very low level of QL (less than 70 scores). In all age groups presented by the migrants’ children, the QL in terms of physical functioning, has a considerably lower level of scores (р<0.001) in comparison to the children from the control group. The highest level of QL was observed in the group of children aged 5-7 and the lowest in 13-18 aged group. There was also evidentiated a very low level of QL of the migrants’ children in emotional aspect (from 42.0±25.32 to 43.7±25.94 scores), that considerably differs (р<0.001) from the middle level of QL of the children from the examined group (from 85.0±19.83 to 89.0±20.82 scores). The lowest data of QL in the emotional aspect of the migrants’ children aged 13-18 years old (42.0±25.32), demonstrate a very specific emotionally stressed state of these children. Migrants’ children demonstrate a very low level of QL in terms of social functioning and it certainly differs from the middle level of QL of the children from the examined group. That definitely demonstrates a low ability to social adaptation of children after their parents’ migration. The lowest indicators of the total score of QL were revealed at the age of 13-18, both in groups of migrants’ children (46.8±24.19 scores) and in the examined group of children (82.7±19.57 scores). At the same time the highest indicators of the total score of QL were revealed at the age of 5-7, both in groups of migrants’ children (55.9±30.85 points), and children of the examined group (85.9±23.70 scores). The presented results perform a very convincing fact that labor migrants’ children in comparison to their peers from the families without labor migration experience had considerably low indices by all scales and integral characteristics of quality of life.
Key words: primary health care, EUROPEP questionnaire, satisfaction with primary health care, Ukraine
Abstract. The comparison of patients' satisfaction with primary health care received in the context of the process of reforming health care sector in Ukraine: a cross-sectional research (based on the example of the primary health care center in the city of Kyiv). Paryi V.D., Korotkyi O.V., Gurianov V.H. The purpose of the research is to compare the satisfaction of patients of the PHC center in the city of Kyiv who made declarations with doctors and received primary health care in 2019 with the satisfaction of patients of former therapeutic sites who received PHC in 2017. A cross-sectional research was conducted in the primary health care center in the city of Kyiv in two stages. The first phase was held during the 6 months of 2017. In total, 397 people at the age of 18 and older were selected, who contacted with primary health care physicians at the time of the research not less than one year. The EUROPEP questionnaire that was used consists of 23 questions with possible rating them according to five-point Likert scale and covering the following aspects: relationship between a doctor and a patient, evaluation of direct medical care, information and support of the patient by doctor, organizational aspects of health care delivery, availability of primary health care. The second phase of the research, using the same EUROPEP questionnaire was held during the 6 months of 2019. In total, there were 402 respondents who took part in research. We offered to determine the average value of the proportion of patients with the evaluation criteria «good» and «excellent» from received by them PHC for each of the 23 questions of a questionnaire as an integral indicator of satisfaction with the received PHC. The research found that the integral indicator of satisfaction with the received PHC in the city of Kyiv during the last two years in the context of the process of reforming the health care sector in Ukraine has increased from 75,5 ± 0,5 in 2017 to 85,9 ± 0,4 in 2019. The comparison of the average values obtained as a result of the research before and after the reforming of the primary care link in the city of Kyiv has revealed a statistically significant (p˂0,01) increase in patients’ satisfaction with the PHC in all the investigated aspects, except the answers to Q1 (making you feel you had enough time for consultation?) and Q23 questions (urgent care delivery).
A CASE FROM PRACTICE
Key words: peripheral facial palsy, Lyme disease, neuroborreliosis, diagnosis, treatment
Abstract. Facial palsy as a manifestation of early neuroborreliosis (clinical case). Poiasnyk I.M. Lyme borreliosis is a tick-borne transmitted infectious disease caused by the spirochete Borrelia burgdorferi sensu lato and spread by the bite of ticks of the genus Ixodes. Lyme neuroborreliosis is a clinical manifestation of Lyme borreliosis, which affects the central nervous system and peripheral nervous system in up to 15% of the affected patients. Nerve structures are affected by spirochetes both in acute and late phase of the disease. The clinical course of neuroborreliosis is highly variable. Although at least 80% of European patients present with facial nerve palsy and radiculitis, symptoms of neuroborreliosis may be quite unspecific or even mimic other neurological diseases. Idiopathic peripheral facial palsy has long been considered as the most common cause of prosopoparesis, but modern diagnosis significantly narrow the range of cases of unknown genesis. Neuroborreliosis is difficult to diagnose, especially when prosopoparesis is the only clinical manifestation, so practitioners should be mindful of possible etiology to avoid misdiagnosis. The article presents a clinical case of early neuroborreliosis in a woman of 57 years who manifested with peripheral facial palsy. The author describes in detail the course of the disease (the appearance of new symptoms on the background of standard medical therapy (poor response), the presence of additional criteria (erythema migrans, lymphocytoma (rarely), arthralgia), diagnosis (specific immunological examination of blood to Borrelia burgdorferi sensu lato). Antibiotic therapy made it possible to achieve complete recovery of facial nerve function and avoid future complications.
OUR HEROES OF THE DAY
Key words: language training, development of professional language competence, students, formation of a comprehensively developed specialist
Abstract. Language training is a necessary component of a doctor's professional competence (to the anniversary of the language training department). Filat T.V., Sidora M.Yu., Zaporozhets Ye.S., Serbinenko L.N. One of the most important conditions for training a specialist in any field of work is his/her language training, the level of which largely determines the quality of education and the effectiveness of further professional activity. Knowledge of professional terminology allows you to successfully master educational subjects, knowledge of a foreign language expands access to information resources, which contributes to the professional growth of the specialist. The Dnepropetrovsk Medical Academy has always paid great attention to the formation of language competence of students. This year, the language training department celebrates its 90th anniversary, and this article outlines the history of the department, the main areas of work, successes and achievements, goals and future prospects, presents a talented team of teachers-philologists, changing over time, but always remaining purposeful, creative and inspired.
IN MEMORY OF THE SCIENTIST