Medicni perspektivi, 2021;26(1)
2021 Vol. XXVI N 1
Key words: continuing education, clinical experience, online conference, student survey
Abstract. Continuing professional education – a priority direction of improving the professional competence of doctors: experience, achievements, problems and prospects. Pertseva T.O., Kuryata O.V., Konopkina L.I., Bielosludtseva K.O., Stadnichuk G.M. Continuing education in terms of improving the professional competence of doctors has a great importance. In May 2020 for the first time in Ukraine under conditions of quarantine connected with COVID-19 the Prydniprovsk Association of Internal Medicine Doctors organized a 2-day international conference on internal medicine in a web format. The purpose of the work was to organize, conduct, determine the effectiveness of the international conference of internists in online format and analyze the results of the survey of students. A questionnaire which included 28 test tasks was developed to obtain a feedback from the lecturers. The answers were analyzed and the reasons for possible errors were considered. The level of knowledge acquired by students is generally quite high; however, the most problematic issues were the most modern diagnostic methods in gastroenterology, ECG diagnostics, clinical pharmacology in cardiology and pulmonology. The prospect of developing a system of continuing professional education for internists is to improve teaching methods with the subsequent involvement of leading specialists in various therapeutic areas to cover current issues of medical science and practice.
Key words: echocardiography, assessment of heart chambers and function, guideline from the British Society of Echocardiography
Abstract. An overview of the guideline from the British Society of Echocardiography 2020: what’s new? Babkina T.M., Smyrnova G.S., Polishchuk O.V., Hladka L.Yu. Quantitative assessment of cavities and heart function is the most common task of echocardiography (EchoCG). It is difficult to overestimate the importance of standardizing EchoCG measurements, because their results influence clinical decisions. In January 2015, the American Society of Echocardiography and the European Association of Cardiovascular Imaging, published an update Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults. Since then, the results of new research using obtained prospective data, on the basis of which in February 2020 the British Society of Echocardiography (BSE) released a new guide. The authors of the recommendations set the goal of creating a simple, practical reference document and guide for everyday use that encourage the holistic interpretation of measurements (no single number should define normality or pathology). Based on these data, we considered the rational component of the updated recommendations, focused on important conceptual changes in the assessment of heart structure and function, provided new terminology for left ventricular function and left atrial size, and a new approach in assessing aortic root, right heart and left atrium. The BSE recommends obtain left ventricular dimensions from the parasternal long-axis window preferentially using 2D imaging. Aortic dimensions should be obtained using the “inner-edge to inner-edge” technique in end-diastole. The BSE suggests that for those Echocg labs that currently use the “leading-edge to leading-edge” technique, it is reasonable to continue doing so for continuity and consistency.
Key words: medical technological process, intelligent systems, artificial intelligence, quality of life, medical expert complex
Abstract. Intellectual systems in the management of medical technologies and quality of life. Kizhaev S.O., Petrenko V.O., Mazur N.V., Belitsky V.V., Mazur А.V., Dudnikova O.I. The article is devoted to the development and use of intelligent systems in the management of medical technological processes and health-related quality of life (HRQOL). The relevance of the work is due to the need for effective use of intelligent systems in healthcare. The purpose of this work is to study the possibilities and prospects of using information technologies and artificial intelligence systems in clinical medicine to improve the efficiency of providing medical care to the population. Information retrieval method; theoretical analysis of legislative and regulatory documents, literary sources, Internet resources, research results; spectral-dynamic and mathematical analysis of the current state and assessment of the quality of life of an individual using the artificial intelligence system "CME". The paper analyzes the development trends of information technologies and artificial intelligence systems, as well as the features of their use in medical technological processes. As an example, the technological capabilities of the intelligent system Complex Medical Expert are briefly described.
Key words: whole body vibration, bone remodeling, bone mineral density, osteoporosis, X-ray diffraction
Abstract. Effect of whole body vibration on bone nanocomposites organisation and prevention of loss of bone mineral density under conditions of modeling obesity and sedentary lifestyle: experimental study. Kostyshyn N.M., Gzhegotskyi M.R., Yarova O.A., Kostyshyn L.P., Kulyk Yu.O. This study aimed to investigate the influence of high-frequency whole body vibration (WBV) on metabolic and structural responses of rats' bone tissue under the sedentary lifestyle and obesity. Obesity combined with a sedentary lifestyle can present the potential negative health effects. However, whole body vibration can be used as a means of non-pharmacological correction of bone mineral density. For characterization of bone nanocomposites organisation and prevention of mineral density loss, X-ray diffraction method was used. Markers of bone remodeling in the rats' blood: leptin, osteocalcin, tartarate resistant acid phosphatase 5b, alkaline phosphatase. Using a high-calorie diet and low-mobility model, we proved that bone mineral mass had been decreasing since 8th week. It should be noted that the decrease in the relative amount of crystalline phase (hydroxyapatite) continued throughout the experiment, up to 24 weeks (p<0.05). These structural changes were accompanied by changes in quantitative indicators of the bone remodeling markers. Rats had lower bone mineral density compared to the animals that were on the normal diet and were additionaly affected by WBV. We observed the increase of the crystalline phase volume fraction from 84% to 93% (p<0.05) in group with additional whole body vibration and the decrease of the mineral component in rats with limited mobility and high-calorie diet. Therefore, WBV could improve structural conditions of bone and prevent fat accumulation and obesity-associated biochemical markers in obese rats. This can be an effective method to improve the structural and functional state of the bones while preventing the loss of bone mineral density.
Key words: Krok1, histology subtests, students of medical universities
Abstract. Analysis of the krok1 and histology subtests dynamics of students of Dnipropetrovsk medical academy. Pototskaya O.Yu., Shevchenko K.M., Averkina L.I., Kobeza P.A. Оbjective control of the level of knowledge in medical universities is the basis for guaranteeing the quality of education. There are a lot of examples of universal systems designed to evaluate medical students in different countries, including USMLE, IFOM and others; particularly in Ukraine Krok 1 licensed exam is conducted since 2005. Results of Krok 1 are also used for ranking medical universities at the national level. The purpose of our work was to conduct a comparative analysis of the results of the licensing exam Krok 1, in particular, a histology subtest, among students of specialties 221 “Dentistry” and 222 “Medicine” and different languages of education (Ukrainian, Russian, English) in Dnipropetrovsk medical academy. We have revealed that all the analyzed contingents of students (DMA as well as Ukrainian) in the majority of observation periods from 2014 to 2019 had lower average results on histology compared to average Krok 1 results. This could be explained by low quota of histological tests for students of specialty 222 “Medicine” which is 4-6%, and absence of the threshold level for doing each particular subject. These conditions do not motivate students of the third course to recollect a complicated discipline that ended more than a year ago. Another problem is in the content of anchor questions in Krok 1 booklets: the number of such questions are distributed unevenly among booklets of different years and different languages of study. As a result, students with different languages of study are put in unequal conditions. In addition, the variation in the number of anchor tests from year to year, the lack of a declared quota of such tests disorients students and makes it difficult to develop algorithms for preparing for Krok 1.
Key words: miscarriage, infertility, spontaneous abortion, autoimmunity, homeostasis, stress response
Abstract. The overview and role of heat shock proteins (HSP) especially HSP 60 and 70 in reproduction and other pathologies (a literature review). Berestoviy V.O., Ahmad Mahmood, Venckivska I.B., Ginzburg V.G., Sokol I.V., Berestoviy O.O., Govsieiev D.O. A search of peer-reviewed articles regarding heat shock proteins (HSP’s) especially HSP 60 and 70 was conducted in this review to understand its role in the development of various complications like miscarriage, preterm birth, tubal infertility and spontaneous abortion associated with chlamydial HSP 60 in IVF, male infertility, preeclampsia, cancer, immune system activation, autoimmune diseases, coronary heart disease, dysregulation of steroidal hormone from the endometrium and its up-regulation in stress response. ELISA, western blotting, immunofluorescence, and affinity chromatography were the most common methods researchers used to determine and separate HSP 60 and antibodies related to it. Heat shock proteins are responsible for normal folding of other proteins and prevent its abnormal folding and cause degradation of abnormally folded proteins, mitochondrial protein transport, DNA metabolism, regulation of apoptosis are their significant functions. HSP 60 is a homologue of bacterial HSP 60 (GroEL) and needs co-chaperonin HSP 10 for its proper functioning. Gynaecological and obstetrical complications were more prevalent in most studies. Pregnant women were mostly affected subjects. Abnormal HSP 60 leads to a high level of unfolded or misfolded proteins, which in turn activate other body systems to produce the clinical outcome. Some researchers stated that there is no association between preterm birth and HSP 60 & 70, chlamydial HSP 60 antibodies trigger tubal infertility, preeclamptic pregnancies has detectable HSP60 as compared to control, GroEL leads to tubal infertility and IVF failure, chlamydial (CHSP 60) activates autoimmunity. HSP60 seropositivity reduces the opportunities of ectopic pregnancy, levels of HSP 60 does not stay constant throughout the menstrual cycle in reference to control, while other opposed these conclusions in their research works. According to some researchers, HSP 60 is a risk factor for pregnancy-related pathologies development, and some other opposed this theory and considered HSP 60 as a safety factor for normal pregnancy outcome, according to this review harmful effect of HSP 60 dominate, in future further high-quality studies need to be done for better understanding.
Key words: on-line technologies, on-line special course, edX platform, foreign medical students
Abstract. Enriching the content of foreign medical students’ independent work by on-line courses on the edX platform. Gura O.I., Ragrina Z.M. The article explores the benefits of using computer technology in the educational process and emphasizes their ability to increase the motivation of foreign medical students to study. Using the latest technologies in the educational process is a demand of time. Intensifying the interest to the discipline and improving the quality and level of knowledge of students is the purpose of such using. The necessity and importance of on-line education at the current stage of society development is substantiated. Using effective techniques and methods of online learning, creating a variety of online courses, engaging students in an independent creative process – this is the optimal way to update the internal reserves of the educational process. The role of students' independent work in the educational process is determined. It is moticed that the independent work of students requires the same organization and methodological support as the traditional class work. The peculiarities of the content of independent work of foreign medical students are revealed and their communicative needs are determined. In accordance with the subjects of the educational programs for specialists in the field of knowledge 22 "Health care", specialty 222 "Medicine" and according to the communication needs, EDX on-line platform was selected and created for creating and implementing online special courses for independent work of foreign students at different stages of study. The structure of individual online special courses is analyzed, the purpose, tasks and results of each of them are highlighted. The subject, distribution of classes, structure, linguistic, speech and communication material of the on-line special course "Introduction to the specialty: scientific speech" are characterized. The specificity, orientation, purpose and specifics of the task of the on-line special course "Professional communication: doctor – patient" are revealed. The conclusions about the necessity and appropriateness of the application of the specified online special courses in the process of preparation of foreign students in medical institutions of higher education.
Key words: laboratory rats, stress, morphological indicators, hematological indicators
Abstract. The effect of stress on the hematological indicators of rats Rattus norvegicus f. domesticus in the conditions of the biological experiment. Shevchyk L.O., Kravets N.Ya., Grod I.M. The purpose of the work was the need to study the change in weight and hematological indicators of the rats as a reaction-response to being in difficult and unfavorable experimental conditions. The biological experiment was conducted in compliance with the normative conditions of keeping the rats, in accordance with ethical standards and recommendations for humanization of work with laboratory animals. In order to accomplish these tasks, rats were divided into two groups: control rats were housed in a spacious cage with comfortable living conditions and experimental animals were housed in a small cage with limited ability to move freely. For the purity of the experiment, the feed ration of animals of two groups was the same. Weight and hematological indicators were determined by conventional methods in physiology. It has been found that improper housing conditions, causing a stressful situation adversely affect the eating activity of the test animals, which explains the weak correlation of the dynamics of the weight of the animals in the control and experimental groups. The analysis of the absolute mass of the internal organs of rats showed their direct dependence on body weight and the correlation of these parameters between animals of both groups. The study found that the quantitative ratios of the main hematological parameters of each of the rodents are strictly different. The tendency to increase of the investigated parameters in the experimental group in comparison with the control one is symptomatic and can be explained by sympathetic-vegetative influences. The amount of hemoglobin is directly correlated with the number of red blood cells. Comparison of the content of hemoglobin, erythrocytes, leukocytes with body weight showed inversely proportional relationship between them. The persistent predominance of leukocytes in the blood of rats in both groups is likely to genetically determined.
Key words: chronic myelomonocytic leukosis, dysplasia, acute monocytic leukosis
Abstract. Chronic monocytic leukemia with transformation into acute monocytic leukemia. Shponka I.S., Pesotskaya L.A., Korolenko H.S., Hutnik I.O., Murashevych B.V., Nikonenko V.A. Chronic myelomonocytic leukosis (CMML) is rarely diagnosed and amounts to 1 per 100 thousand of adults per year, more often in men over 60 years. The clinical case of the rare, prolonged course of myelodysplastic chronic myelomonocytic leukosis (MD-CMML) in a middle-aged woman with rapid transformation into acute monocytic leukemia (AMoL-M5в) with the atypical fulminant course is presented. A retrospective analysis of the course of the disease drew attention to the severe vasculitis suffered by the patient 19 years ago, which could be regarded as the debut of CML in the presence of characteristic pathological changes in the hemogram. Non-pronounced clinical manifestations in the form of moderate cervical lymphadenopathy, skin lesions in the form of transient erythema, spotty eruptions over the next 10 years, fit into the clinical picture of MD-CMML. A detailed picture of the disease was observed after viral infection, bronchitis, antibiotic therapy. Absence of significant blastemia and severe inhibition of normal hematopoiesis with expressed extramedular manifestations of the disease in the patient were not typical for the course of AMoL-M5b in this case. The progression of skin lesions was noteworthy, which gave reason for unfavorable prognosis. For several weeks, the spread of erythematous elements was observed throughout the body with itching, not controlled by antihistamines and corticosteroid drugs; the appearance of maculopapular rashes, merging in places; small-point hemorrhages like vasculitis over the entire surface of the skin. Notable was the development of severe hemorrhagic syndrome without severe thrombocytopenia, significant changes in the coagulogram, as a manifestation of early severe coagulopathy.
Key words: fructose-1.6-diphosphate, cardiopulmonary bypass, erythrocyte, hemolysis, mechanical resistance, osmotic resistance, acid hemolysis, erythrocyte membrane permeability, phosphorus
Abstract. Influence of cardiopulmonary bypass on the erythrocyte membranes and the method of its protection. Cherniy V.І., Sobanska L.O., Topolov P.O., Сherniy T.V. The damage to erythrocytes during cardiopulmonary bypass (CPB) remains a recent problem. The aim of this research was to study the effect of fructose-1,6-diphosphate on the state of the erythrocyte membrane during CPB and the level of phosphorus in blood as a marker of the energy potential in the cell. Patients were divided into two groups. The control group 1 (Gr 1) consisted of 75 individuals. The group 2 (Gr 2) included patients to whom fructose-1,6-diphosphate (FDP) was administrated according to the developed scheme as follows 10 g of the drug was diluted in 50 ml of a solvent, 5 g of the drug was injected intravenously with the use of perfusor immediately before initiation of CPB at a rate of 10 ml/min and 5 g at the 30th minute of CPB (before the stage of warming) the same way. When comparing two groups the best results in hemolysis (p<0.01), mechanical (p<0.01). osmotic resistance of erythrocytes (p<0.01), the time of acid hemolysis (p<0.01) and the permeability of the erythrocyte membrane in postperfusion period were in Gr 2. Вefore cardiac surgery hypophosphatemia was detected in 18% out of 150 and in 32% out of 150 patients – a lower limit of normal phosphorus content in the blood. After CPB in Gr 1 phosphorus content in blood was 0.85±0.32 mmol/l and hypophosphatemia was in 53% out of 75 patients. This indicates a pronounced energy deficit in this group. In Gr 2 phosphorus level was 1.7±0.31 mmol/l and there was no hypophosphatemia. As a result, FDP as an endogenous high-energy intermediate metabolite of the glycolytic pathway leads to resistance to hemolysis, protects the erythrocyte membrane from damage and increases the energy potential of the cell during CPB.
Key words: acute ischemic stroke, lateralization of brain function, cerebellum, renal concentration-filtration function
Abstract. Cerebral hemispheres – cerebellum – kidney interaction in patients with acute cerebral ischemia. Kononets O.M., Tkachenko O.V., Kamenetska O.O. The nervous system, in particular the autonomic one, is well known to constantly regulate the internal functioning of the body, adapting it to changeable external and internal environmental parameters. In particular, there is a close multiple-vector correlation between the nervous system and the kidneys. The aim of this study was to specify the mechanisms, clinical and paraclinical characteristics of the concomitant lesions of the nervous system and the kidneys in patients with acute stroke. This paper presents the case report of 215 patients, aged 70 ± 8.44, who suffered from ischemic stroke. Among them, we examined 144 women and 71 men. The patients underwent a comprehensive examination, including a detailed clinical and neurological check-up (evaluating the patients’ condition severity with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel index on admission and on the 21st day of the disease), laboratory analysis (electrolyte balance, nitrogen metabolism (on admission and on the 21st day of the disease) and instrumental examination (CT scan of the brain, the follow-up brain magnetic resonance imaging). The statistical methods were used to analyze the data. In the 1st day of the disease, all the surveyed patients with right hemispheric carotid stroke and the overwhelming majority of the patients with left hemispheric carotid stroke and ischemic stroke in the vertebrobasilar system had cerebral renal syndrome, represented by renal concentration-filtration dysfunction, accompanied by the reduced glomerular filtration rate. A reliable relationship was found between the renal concentration and filtration function and the right hemispheric ischemic focus in patients with ischemic stroke, the characteristics are to be specified.
Key words: pancreatic tumors, postoperative complications, complications prediction, pancreatic resection, sarcopenia
Abstract. Sarcopenia as a predictor of postoperative complications in patients with pancreatic cancer. Kopchak V.M., Pererva L.O., Shkarban V.P., Trachuk V.I., Lynnyk S.V. Several studies showed that sarcopenia is associated with an increase of postoperative complications, with worse postoperative results in patients with pancreatic cancer. According to European Working Group on Sarcopenia, it is a "progressive and generalized skeletal muscle loss" characterized by both loss of skeletal muscle mass and strength (Cruz-Jentoft AJ et al., 2019). Aim of our work was to evaluate the effect of sarcopenia on the occurrence of postoperative complications after pancreatic resections in patients with pancreatic and periampullary cancer. We performed a retrospective analysis of treatment of 152 patients who underwent radical pancreatic resections. Sarcopenia was determined by preoperative computed tomography using the Hounsfield Unit Average Calculation (HUAC). In our investigation we measured the psoas area and density (Hounsfield Units) at the level of the third lumbar vertebral body (L3). Sarcopenia was diagnosed in 66 (43.4%) patients. Among patients with sarcopenia complications occurred in 41 (62.1%), mortality was 4 (6.1%). In the group of patients without sarcopenia, complications occurred in 29 (33.7%) of 86 patients, mortality was 2 (2.3%). The level of postoperative complications in patients with sarcopenia was significantly higher (c2 =12.1, p=0.0005). Postoperative mortality in patients with sarcopenia was higher without significant difference (c2 =1.3, p=0.24). Sarcopenia significantly affects the level of postoperative complications and its detection can be used to improve the selection of patients before pancreatic resections in patients with pancreatic cancer.
Key words: servicewomen, current war zone, methods of contraception, unplanned pregnancy, menstrual supression, questionnaire survey
Abstract. Reproductive health and contraception use by Ukrainian servicewomen in the current war zone: a questionnaire survey. Burlaka O.V., Vahnier V.O. The aim of the study is to define awareness level and use of different contraception methods by servicewomen in the current armed conflict in the East of Ukraine. Between October 2018 and September 2019, 507 military women serving in the Joint Forces Operation Zone in eastern Ukraine and 100 civilian women from the frontline region participated in the questionnaire-based survey. The survey was focused on the knowledge and use of different methods of contraception and STI preventing by military women in conditions of armed conflict in Donbas. Servicewomen reported using of different methods of contraception in 48.3±4.3% of the cases, which is 1.5 times less than civilian women (RR=1.5; 95% CI: 1.2 – 1.7, p=0.001). Among those who reported using contraception, hormonal methods were chosen by 8.2±3.4% of active duty military women, which is two times less than by civilians (RR=2.1, 95% CI: 1.1-4.1, p=0.03). The low use of effective methods of contraception by active-duty servicewomen according to results survey is one of the reasons for the disruption of female reproductive health during military deployment. The primary reserve of preserving women's health in the current war environment,besides access to modern contraceptives and counseling, is improving the education of military medics in the gender-specific issues of reproductive health and contraception.
Key words: newborns, infants, congenital defects, combined anesthesia, surgical treatment
Absrtact. Comparative evaluation of different types of anesthesia in surgical treatment of children with congenital defects. Vlasov О.О. In pediatric anesthesiology in surgical interventions various methods of combined anesthesia with a combination of inhalation, regional, and intravenous anesthesia are used. The provision of high-quality anesthetic support in newborns and infants during surgical treatment of congenital defects is complicated by risk factors, concomitant diseases and different pathology conditions. The study of risk factors and their influence on the functional indices of the child's vital activity in prescribing anesthesia at all stages of the surgical intervention will help prevent complications and deaths in children. Aim – to сonduct a comparative assessment of various types of anesthesia for surgical correction of congenital defects in children and create a predictive model of the association of risk factors and deaths in the selected methods of anesthetic support. The retrospective study included 150 newborns and infants with congenital defects of the surgical profile depending on anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). After identifying and evaluating prognostic variables by simple logistic regression with calculating the odds ratio, stepwise multiple logistic regression analysis was performed and a predictive model of the association of risk factors and deaths with various types of anesthetic management was created. In thoracic operations a combined anesthesia with sevoran and fentanyl was most often used – 20.4%. In abdominal operations, in total anesthetic support with sevoran and regional anesthesia was used– 69.4%, while in urological operations combined total intravenous anesthesia with 2 drugs – 18.4% ranked first. No significant differences were found between the types of anesthesia in various surgical interventions for congenital pathologies, between the types of surgery and deaths (p = 0.863). To prevent fatalities in various types of surgical intervention and options for anesthetic support of newborns and infants with congenital defects, it is advisable to more closely monitor the cerebral and peripheral oximetry indicators at all stages of treatment and timely correct the impaired condition of the child.
Key words: postoperative cognitive dysfunction, Dexmedetomidine, scale MMSE
Abstract. The influence of the chosen method of anesthesia on the severity of postoperative cognitive dysfunction in patients with ophthalmic surgery. Dorofeeva G.S. Reduction of cognitive functions in the postoperative period is gaining importance in the context of the insurance medicine introduction. Operational stress and anaesthetization are factors which increase the risk of deepening and developing postoperative cognitive dysfunction. The function of short-term memory, attention function, and the speed of psychomotor cognitive reactions are the most vulnerable to the action of general anesthetics. The influence of various methods of anesthesia on cognitive functions in ophthalmic surgery patients after end-to-end keratoplasty has been studied in this research work. Dexmedetomidine was used (the selective agonist of α-adrenoreceptors) as one of the components of multimodal anaesthetization. The sedative effect of this drug is explained by inhibition of neural activity in the blue spot of the brain stem. Dexmedetomidine is known to be used for sedation of patients. It allowed possibility to reduce the amount of fentanyl which was necessary for intra-and post-operative anaesthetization. Our research was conducted on the basis of ME "DRCOH". 78 patients at the age of 18 to 60 years were examined after end-to-end keratoplasty. Non-inclusion criteria: presence of concomitant pathology, neurological diseases, use of psychotropic substances and alcohol 6 months before the study. The study was conducted using neuropsychological testing: the Mini Mental State Examination (MMSE),the Frontal Assessment Battery (FAB), and Luria’s test. Testing was performed before the operation, in 6, 24 hours, 7 and 21 days. Patients were randomized into two groups. The first group – group k (n1=45) included patients who were provided with anaesthetic management according to the following scheme:premedication — ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously, sibazone 10 mg, fentanyl 0.1 mg intramuscularly 40 minutes before intervention. Induction of propofol – 2-2.5 mg/kg fractionally to achieve clinical symptoms of anaesthetization, fentanyl – 0.005% 0.1 mg tracheal intubation after relaxation on the background of atracuriumbenzylate – 0.3-0.6 mg/kg. Maintaining of anaesthetization: oxygen-sevoflurane mixture FiO250-55%, sevoflurane 1,4-1,8 vol.% on exhalation (1-1. 5 WT.) with the flow of no more than 1 l/min. BIS indicators were kept at the level of 30-40, during the surgery, the bolus injection of 0.1 mg of fentanyl was used in the event of hemodynamic reactions. Anaesthetic support was performed using the infusion of dexmedetomidin for 40 minutes, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously in the second group d (n2=33). Induction, relaxation and maintenance of anaesthetization were performed as in the previous group. Intra-operative monitoring of patients in both groups included: non-invasive measurement of blood pressure (BP), heart rate (HR), pulse oximetry, determination of blood gases (oxygen, carbon dioxide and inhaled anesthetic on inhalation and exhalation). Control of the depth of anaesthetization was performed on the basis of BIS and ANI - monitoring. The use of dexmedetomidinu as the component of a multi-modal method of anaesthetizational al lowed obtaining less pronounced POCD, due to the reduction in the number of used drugs. Further use of the combination of highly selective agonists of α2-adrenoreceptors with regional anaesthetization in ophthalmic surgery is the promising method.
Key words: dexmedetomidine, multimodal anaesthesia, postoperative pain
Abstract. The experience of using dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. Mynka N.V., Kobelyatskyy Yu.Yu. Various techniques are applied to reduce the severity of postoperative pain and discomfort in patients. The purpose of this research work was to evaluate the effectiveness and safety of Dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. The study included 80 patients who underwent corneal transplantation on the basis of Dnepropetrovsk Regional Clinical Ophthalmologic Hospital. Patients were divided into 2 groups: control (group K) – 30 men and main (group D) – 50 ones. Multicomponent balanced anesthesia was applied in both groups. Sibazone was administered as the sedative medicine in the group K, Dexmedetomedin was administered in the group D. The main criteria for evaluating the research results were hallmarked: hemodynamic stability during surgery, the amount of administered opiates, the severity of intraoperative pain syndrome by evaluating the ANI index (ANI – analgesia nociception index), the severity of postoperative pain syndrome and the frequency of postoperative nausea and vomiting (PONV). Both schemes of anesthesia allowed avoiding pronounced fluctuations in hemodynamic parameters and gas exchange at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group K pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the surgery, while in group D the ANI index did not fall below 50. Statistically significant differences were obtained on minute 1, 2, 5, 6, and 7 of the surgery. The number of episodes of insufficient anesthesia during the most traumatic stage of the surgery in group K was statistically significantly higher than in group D. Analyzing the quality of pain relief in the postoperative period it was determined, that the level of pain on the Visual Analog Scale (VAS) after awakening in both groups was equal to 0. At the next three stages of the study (2 hours, 6 hours after surgery, and the next morning), the level of pain in group K was significantly higher than in group D. In addition, it was determined that the need for narcotic analgesics and the number of episodes of postoperative nausea and vomiting in group K was statistically significantly higher than in group D. These given data allow us to conclude that Dexmedetomedin is the effective adjuvant of the anesthesia for corneal transplantation.
Key words: inhalated hypertonic saline of sodium chloride, efficacy, tolerance, cystic fibrosis, children
Abstract. Comparison of the efficacy and tolerability of inhaled hypertonic salines of sodium chloride in pediatric practice. Ilchenko S.I., Fialkovska A.O., Cherhinets V.I., Skriabina K. V. In modern pediatric practice, inhalated hypertonic saline (IHS) is often used for therapeutic and diagnostic purposes. However, the potential development of serious side effects in children is not predicted. The aim of the study was to determine the efficacy and tolerability of IHS of various concentrations in children with cystic fibrosis (CF). The study involved 34 children with CF aged 6 to 18 years (middle age is 13.0±4.4 years). The comparison group consisted of 27 children (middle age is 7.8±2.3 years) without chronic respiratory diseases. The study included three consecutive inhalations. Sterile 0.9% NaCl solution was used for the first inhalation, 3 % NaCl solution – for the second one and 7% NaCl solution – for the third inhalation. For children under 7 years of age, a patented method of obtaining sputum without forced coughing was used. Spirometry was performed before and after each inhalation, and clinical changes were analyzed. It was noted that after inhalation of IHS, the cough in patients became more productive, moist rales were more often heard over the entire surface of the lungs. The activity of induced sputum secretion after inhalation of 3% and 7% NaCl solution did not differ significantly. However, after inhalation of 7% NaCl solution, side effects, such as sore throat, shortness of breath, spastic cough, auscultatory symptoms of bronchospasm were recorded significantly more often compared with lower concentrations of the solution. The decrease in FEV1 was observed in 5.8% of patients after inhalation of 3% NaCl solution and in 11.8% of patients after inhalation of 7% NaCl solution, which was significantly associated with the clinical symptoms of bronchospasm. Inhalation of IHS has an effective mucolytic effect in patients with CF, however, it is necessary to determine the individual sensitivity of the patient to predict a positive therapeutic effect.
Key words: community acquired pneumonia, children, cellular energy metabolism
Abstract. Prognosis of cellular energy metabolism shifts in adolescents with community-acquired pneumonia. Zubarenko O.V., Stoieva T.V., Koval L.I., Kopiyka G.K., Papinko R.M. Pneumonia is one of the most severe respiratory pathology forms in children, which contributes significantly to infant mortality. The high risk of chronic bronchopulmonary process and child`s disability, in case of severe and complicated disease, requires careful pathophysiological change's analysis in community-acquired pneumonia (CAP) in children. In particular, for the prediction of these disorders in children with CAP are important the dysmetabolic phenomena study and the specific approaches development. The immediate aim of this work is to study the cellular energy metabolism (CEM) features and to develop approaches for the early bioenergetic disorders diagnostics in conditions of community-acquired pneumonia in adolescents.The aim of the study is to develop approaches for the early diagnosis of shifts in energy metabolism in children aged 14-18 years with CAP. An examination of 41 children aged 14-16 years with the definition of CEM indicators was conducted in order to develop an approach for predicting CEM disorders in community-acquired pneumonia using the method of logistic regression. A logistic regression method was used to develop a method for predicting CEM disorders in children with CAP. The characteristics of CEM in children with CAP were determined. A decrease in the succinate dehydrogenase activity and an increase in the lactate dehydrogenase / succinate dehydrogenase ratio in children with CAP relative to the reference parameters were observed, which indicated an inhibition of the anaerobic energy synthesis pathway. Two mathematical models for predicting CEM disorders in CAP based on logistic regression equations were proposed. The first mathematical model consisted of social and health characteristics and of pneumonia clinical course characteristics. In ROC analysis the area under the curve (AUC) was 0.82, diagnostic specificity – 71%, diagnostic sensitivity – 90%. The second model included only hematological parameters, AUC – 0.78, diagnostic specificity – 69%, diagnostic sensitivity – 81%. Thus, changes in CEM in children with CAP aged 14 – 18 years have been established. Two methods for predicting disorders of CEM in children with CAP have been developed, which can be applied to optimize the treatment of children with CAP aged 14-18 years.
Key words: bronchial asthma, allergic rhinitis, antimicrobial peptides, children, cathelicidin, human defensin beta-2, LL-37, HbD-2
Abstract. The role of human β-defensin 2 (HbD-2) and cathelicidin (LL-37) in the local protection of the upper respiratory tract in children with allergic rhinitis and bronchial asthma. Bolbot Yu.K., Bordiі T.A., Vilenskyi Ya.V. Allergic diseases of the respiratory system seriously affect the psychological, physical and social aspects of the live of sick children, morally and financially exhausting members of their families as well. It is known that exacerbations of allergic diseases of the respiratory tract occur due to interaction with numerous triggers, one of which is a respiratory viral infection. At the same time, it is widely known that patients with allergic respiratory diseases are more prone to to acute respiratory infections. One of the reasons for this tendency often is an insufficient activity of non-specific factors of local immunity of the respiratory system – endogenous amphiphilic antimicrobial peptides, in particular the most studied their representatives - the family of defensins and human cathelicidin. Current research proves that these antimicrobial peptides are characterized by broad antiviral, antimicrobial and immunomodulatory activity. The aim of this study was to study the concentrations of local immune factors - human HbD-2 and LL-37 - in the secretion of the mucous membranes of the upper respiratory tract in children with asthma and allergic rhinitis and to clarify their role in protection against respiratory viral infections in this contingent of patients. We performed laboratory and clinical examinations of 76 children aged 7 to 18 years, of whom 24 were diagnosed with allergic rhinitis, 28 children - bronchial asthma, and 24 - bronchial asthma and allergic rhinitis. The control group consisted of 20 healthy children of the appropriate sex and age. In addition to general clinical methods, patterns of respiratory morbidity were analyzed and concentrations of antimicrobial peptides were determined: by ELISA human cathelicidin (LL-37), β-defensin 2 (HbD-2) in the secretion of the upper respiratory tract, statistical analysis was performed. It was found that children with allergic diseases of the respiratory tract are characterized by a higher frequency of acute respiratory infections with more frequent involvement of the lower respiratory tract, which led to an increase in the duration of the disease compared to their healthy peers. In children with allergic rhinitis and bronchial asthma, there was revealed a significant decrease in the concentrations of antimicrobial peptides in the secretion of the upper respiratory tract compared with the control group.
Key words: preterm infants, patent ductus arteriosus, ibuprofen, acute kidney injury
Absrtact. Effect of ibuprofen for hemodynamically significant patent ductus arteriosus closure on the development of acute kidney injury in preterm infants. Borysova T.P., Obolonska O.Yu. Premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) have a high risk of developing acute kidney injury (AKI) due to renal hypoperfusion and use of ibuprofen for duct closure. The aim of the study was to evaluate the effect of ibuprofen for the closure of HSPDA on the development of AKI in preterm infants depending on high dose of the drug on the first day of life. 40 preterm infants with HSPDA who were admitted for observation on the first day of life were examined. To close the ductus arteriosus, infants received restrictive therapy. In addition, 32 (80,0%) preterm infants on the first day of life were prescribed ibuprofen: 19 infants – in high dose (20 mg/kg), 13 infants – in standard dose (10 mg/kg). Clinical examination and treatment of preterm infants was carried out according to the generally accepted methods. Echocardiography with Doppler was performed at 5-11 hours of life and then daily to determine the size and hemodynamic significance of patent ductus arteriosus. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. According to the results of the study, it was established that the frequency of AKI on the third and fifth days of life in preterm infants with HSPDA, who received ibuprofen in a high dose (20 mg/kg) on the first day, was 73.7% and 84.2%, respectively, which is 2.2 (OR=5.6; CI: 1,43-21,95; р<0.02) and 2.5 (OR=10.67; CI: 2.31-49.31; р<0.002) times, more often than in infants without such therapy. High dose of ibuprofen on the first day of life in preterm infants with HSPDA are most often associated with the development of stage I AKI on the third or fifth day of life, which was temporary in one third of patients. The use of a high-dose ibuprofen for HSPDA closure on the first day of life in preterm infants was significantly more often associated with foci of infection in the mother, large duct size and furosemide use.
Key words: continuous care model, sleep, multiple sclerosis
Abstract. The effect of continuous care model on sleep quality in patients with multiple sclerosis. Alamdari M.P., Ahmadi F., Abedini M. Multiple sclerosis is a chronic and unpredictable disease and is a growing trend and, like other chronic diseases, affects one's quality of life and since sleep quality is one of the dimensions of quality of life, this study aimed to investigate the effect of applying continuous care model on sleep quality of patients with MS in 2013. This clinical trial study was performed on 80 patients with multiple sclerosis who were randomly assigned to experimental and control groups. Data collection tools included demographic information questionnaire, PSQI questionnaire and model implementation in four stages (familiarization, sensitization, control, evaluation). Model stages were performed individually and in groups for three weeks according to patients' educational needs (sleep, activity, medication and nutrition) and after two months follow up, control and evaluation were performed. Data were analyzed using Chi-square test, independent t-test and repeated measures ANOVA and spss16 software. Statistical analysis of variance (ANOVA) with repeated measures showed a significant difference between the mean of total score and the scores of sleep quality dimensions in three times between the two groups (p<0.05). It can be concluded that the implementation of continuous care model causes a significant difference in the sleep quality of patients with MS.
Key words: osteoporosis, vertebrae, vertebroplasty, fracture
Abstract. Dynamics of pain syndrome and quality of life in the application of vertebroplasty in patients with vertebral fractures against osteoporosis. Stashkevych A.T., Shevchuk A.V., Uleshchenko D.V., Martynenko V.G., Melenko V.I. Currently, insufficient attention is being paid to an issue of the necessary anti-osteoporotic therapy after percutaneous vertebroplasty for vertebral fractures associated with osteoporosis, which leads to premature termination of medical treatment and worsening of the treatment results in this group of patients. An objective of the research is to study the results of treatment of patients with vertebral fractures associated with osteoporosis, depending on the use of anti-osteoporotic therapy. The results of percutaneous vertebroplasty of 91 postmenopausal women aged 50-90 years, depending on the use of anti-osteoporotic therapy during the postoperative period were analysed. An assessment was made according to the dynamics of pain syndrome using the Visual Analogue Scale (VAS), the Quality of Life Scale by J.R. Gaughen to estimate the patient's mobility and a need for pain medication. The results of the treatment were assessed 3 and 6 months after the percutaneous vertebroplasty. Bone mineral density was measured using Dual-energy X-ray absorptiometry 6 month after the treatment. Anti-osteoporotic therapy, which was prescribed for all patients comprised calcium supplements, antiresorbents and in D-hypovitaminosis – alfacalcidol or cholecalciferol. Only half of the patients followed the recommendations – 46 (50.6%), while the rest of the patients stopped the therapy in 2-3 months due to the improvement of their condition. In the main group of patients, where necessary anti-osteoporotic therapy was administered, significant reduction of pain syndrome and increase in quality of life during 3 and 6 months’ observation period were revealed. In the group of patients where prescribed anti-osteoporotic therapy was not adhered, significant reduction of pain syndrome and increase in quality of life in the observation period 3 months was revealed but deterioration in the form of pain syndrome increase and decrease in quality of life in the observation period of 6 months occurred. Effectiveness of anti-osteoporosis therapy, with regard to measuring bone mineral density can be reliably confirmed only in the main group. Intraoperative and postoperative complications occurred up to 5.5%, and generally did not require further treatment and did not affect the overall treatment result. Thus, it was revealed that to ensure a stable effect after the surgery, long-term prescription of anti-osteoporosis therapy is needed.
Key words: brain tumors, mental and depressive disorders, experimental psychological research, psychotherapeutic correction, prevention, rehabilitation
Abstract. Clinical and psychopathological features of course and correction of depressive disorders in patients with brain tumors, prevention and rehabilitation. Ogorenko V.V., Kyrychenko A.G., Hnenna O.M. The article studys the psychological characteristics in patients with brain tumors of different localization which allows to reduce the diagnostic period and, as a result, minimize the time of early detection and the consequences of the surgical treatment of this pathology, and to cause a positive effect on preventing the development of psychopathological disorders at the hospital stage. Analysis of the clinical manifestations of depressive disorders of the subclinical level revealed their polymorphism: depression was accompanied by various variants of asthenic (prevalence of dyssomnias, psychalgia, adynamia and anxiety component) and anxiety (prevalence of senestopathies, hypochondria, phobia) states. The revealed symptom complexes of psychopathological and pathopsychological characteristics of the patient's condition were the clinical justification for the choice of methods of psychotherapeutic correction. Adjuvant psychological therapy, individual rational and family psychotherapy were used as the basic method of psychotherapeutic influence. Pharmacological correction included: anxiolytics, antidepressants, atypical mild antipsychotics in low doses. The results of the SCL-90-R test demonstrate the effectiveness of the comprehensive treatment aimed at preventing and reducing the manifestations of psychopathological symptoms. Comparison of the mean values of the SCL-90-R test revealed significant differences in such indicators as somatization (p<0.05), depressiveness (p<0.01), anxiety (p<0.05); high statistical significance is noted in the “index of symptom severity” integral indicator (p<0.01). Obtained results of psychological and psychiatric research became the basis for the development of differential diagnostic criteria for the diagnosis and prevention of the development of mental disorders.
Key words: chronic viral hepatitis C, vitamin D, seasonal factor
Abstract. Influence of seasonality on vitamin D level in patients with HCV infection and healthy people. Nikolaychuk M.A., Shostakovych-Koretskaya L.R., Budayeva I.V., Biletska S.V. According to WHO, about 150-200 million people are currently infected with the HCV virus worldwide. Recently, in the professional literature, the number of publications on the role of vitamin D in patients with viral hepatitis C has increased as vitamin D metabolism occurs with the participation of the liver and its deficiency is associated with an increased risk of infectious diseases. The aim of this study was to investigate the effect of seasonal factor on vitamin D (25 hydroxycalciferol) levels in patients with chronic viral hepatitis C and healthy subjects. The study involved 100 patients in the registry of patients with chronic viral hepatitis in the Dnipropetrovsk region. The prevalence and deficiency of vitamin D in patients with chronic viral hepatitis C and conditionally healthy subjects at different times of the year were determined, which showed the presence or absence of a seasonal effect on serum 25(OH)D level. Patients were divided into two groups, depending on the time of the year (autumn-winter and spring-summer), in which the level of 25 (OH) D was determined. The serum was metabolised by vitamin D, which is synthesized by the liver – 25 hydroxycalciferol (25 (OH) D), an indicator of the supply of vitamin D to the human body. Vitamin D levels were evaluated according to the M.F. Holick classification. According to the level of vitamin D patients were divided into 3 groups (patients with normal level, insufficient (suboptimal) level and vitamin D deficiency). The results of the study showed no effect of seasonal factor on the level of 25 (OH) D in the serum of patients with chronic viral hepatitis C. Vitamin D levels are controlled by the time of the year: in spring and summer this indicator is normal, in autumn and winter – seasonal decrease in vitamin D.
Key words: seborrheic dermatitis, Malassezia spp., Complex treatment, pyrocton olamine
Abstract. The use of extemporal dosage form with pyroctone olamine in the complex treatment of patients with seborrheic dermatitis. Odintsova I.V., Diudiun A.D. The purpose of the work is to evaluate the efficacy and tolerance of extemporal dosage form with pyroctone olamine in the local treatment of patients with seborrheic dermatitis. Under our supervision there were 78 patients with seborrheic dermatitis aged 18 to 57 years. The average age of the patients was 29.5±2.1 years. Comprehensive treatment of patients with seborrheic dermatitis in both groups depended on the severity of clinical manifestations, the duration of the disease, and information on the effectiveness of previous therapy. For external treatment of the main group of patients with seborrheic dermatitis, an extemporaneously prepared gel with pyrocton olamine was used. Local treatment of patients in the comparison group consisted of the appointment of 1% cream of clotrimazole. An analysis of the results shows good therapeutic, microbiological effectiveness and good tolerance of extemporaneously prepared gel with pyrocton olamine in the complex treatment of patients with seborrheic dermatitis. The period for resolving the clinical manifestations of seborrheic dermatitis among patients in the main group was 2.5±0.1 days shorter compared with patients in the comparison group. The intensity of clinical manifestations in patients with seborrheic dermatitis of the main group decreased twice on the second day of complex treatment. In control patients with comparative seborrheic dermatitis, similar therapeutic efficacy was achieved on the fourth to fifth day. Long-term results of the study showed that the recurrence of the disease among patients of the main group was 5 (6.4%), and in patients of in the comparison group was 14 (17.9%). Clinical studies have shown good therapeutic efficacy and tolerance of the extemporal gel with pyroctone olamine in the complex treatment of patients with seborrheic dermatitis, which gives reason to recommend this dosage form for wider use in the practice of dermatovenerologists.
Key words: procalcitonin, surgical forms of erysipelas
Abstract. The use of procalcitonin in patients with surgical forms of erysipelas. Shapoval S.D., Vasylevska L.A. The ideal marker of bacterial infection should not only allow for early diagnosis, but also provide information about the course and prognosis of the disease. Nowadays the most well-studied and widely used in clinical practice is procalcitonin (PCT), but its value in surgical forms of erysipelas is insufficiently defined. The aim of the article is to determine the diagnostic and prognostic significance of procalcitonin in patients with surgical forms of erysipelas.114 case histories of patients who were hospitalized in the center of purulent-septic surgery of the Non-profit municipal enterprise "City Hospital №3" in Zaporozhye for 2019-2020 period were analyzed retrospectively and prospectively. It was found that most often the focus was localized on the lower extremities. In the complex treatment of patients with erysipelas, the main place belongs to antibiotic therapy (ABT) and early surgical treatment of the area of the pathological process. Determination of the level of procalcitonin in the serum makes it possible to assess the progression and generalization of the process and is a sensitive test for the effectiveness of treatment.Radical surgery and timely targeted ABT are key elements of success in the treatment of surgical forms of erysipelas and are not subject to revision. Procalcitonin is a diagnostic marker that can predict the development of sepsis.
Key words: soft tissue, gunshot wound, modeling, temperature factor, pathomorphosis
Abstract. Morphological features of the simulated gunshot wounds of rabbits’ soft tissues at different temperatures of injuring object. Mikhaylusov R.N., Negoduyko V.V., Gubina-Vakuli G.I., Pavlov S.B., Pavlovа G.B., Veligotsky A.M., Khvysiuk O.M. The article presents the results of experimental modeling of superficial fragment gunshot wounds of soft tissues, obtained in low-energy gunshot wounds. The pathomorphosis of gunshot wounds was studied, and the features and timing of their healing were compared depending on the temperature of the damaging fragments. The aim of the work was to study the effect of the temperature of the injuring shrapnel on the healing processes of the soft tissues of experimental animals with superficial low-energy fragment gunshot wounds. Using the random number method, laboratory animals (rabbits) were divided into 3 experimental groups (15 animals each). In each group, wounding was with fragments with different temperatures − 18°С, 50°С and 100°С. The control group consisted of 10 intact animals. On day 14th, 30th and 60th, 5 animals from each group were withdrawn from the experiment. Microscopic examination of soft tissues was performed using a PRIMO STAR light microscope (Carl Zeiss, Germany) at magnification by 56 and 400 times. When assessing the state of tissues in the area of wound damage, it was established that as the temperature of the injuring fragment increases, a slower filling of the defect formed by the necrotic detritus in the process of utilization of necrotic detritus is observed. The high temperature of the injuring fragment along with the mechanical rupture of tissues causes thermal coagulation necrosis. Dense coagulated necrotic masses covering the wound canal from the inside, not only increase the volume of necrotic masses, but also complicate the process of wound healing. At a temperature of wounding fragments 100°C, the formation of a necrotic crust on the surface of the wound occurred on average 3±1.2 days later than at temperatures of 18°C and 50°C, the least pronounced healing took place at the bottom of the wound and in the muscle tissue. Microscopically necrotic, not dystrophic changes were observed in myocytes. Thus, a comparative analysis of the pathomorphosis of soft tissues in a wound when injured from an air rifle MP-532 with different temperature of the fragments showed differences from both the alteration of the tissues and the regenerative potential.
Key words: mandibular fracture, transalveolar osteosynthesis, 3D computer modeling
Abstract. Biomechanical grounding of the transalveolar osteosynthesis of еdentulous мandible fractures. Idashkina N.H., Hudarian O.O., Chernov D.V., Samoilenko I.A. The purpose of the work is improvement of the effectiveness of the mandibular fractures treatment in patients with partial or complete adentia by developing and experimentally testing transalveolar osteosynthesis technique. An experimental study was carried out by 3D computer simulation modeling by the final element analysis to assess the efficiency of mandibular fractures fixation at partial or complete adentia using the Ш-shaped plate, which we developed for the transalveolar osteosynthesis method. Calculations of the immobilized fractures for static (own weight) and dynamic (functional) loads were performed according to the author's method, taking into account pronounced resorptive processes in the bone from the beginning of the reparative reaction to assess the rigidity of fragments fixation during the entire period of the fractures healing. Under the conditions of the same three-dimensional model of the mandible, calculations were performed when the fracture was fixed with ordinary linear titanium osseous plates. It is proved that at functional load the new plate provides a compression effect in the fractures region, as evidenced by the negative displacements in the final elements of the mental region according to the results of design load combination 2- 3. The maximum efforts in the screws of the calculation model with a conventional bone plate were 136.955 N, which is almost ten times more than on the model with a Ш-shaped titanium retainer (12.656 N).
Key words: parafunctions, drug addiction, bruxism, dentin, enamel
Abstract. Assessment of the dental status of drug-addicted patients with parafunction of the dental-jaw apparatus. Foros А.І., Kostenko Ye.Ya., Goncharuk-Khomyn M.Yu. The number of drug addicts in the world is growing every year. The aim of the study was to assess the dental status of drug-addicted patients with parafunction of the dental-jaw apparatus. We used clinical, analytical, functional and histological research methods. 119 drug-addicted and 110 non-drug-dependent patients aged 18 to 54 were examined. In order to confirm the presence of parafunctions of the dental-jaw apparatus in patients, we conducted an occludogram study, as well as an assessment of the index of parafunctions of the masticatory muscles and the degree of their severity. The structure of tooth tissues was examined by histological method. Examination of drug-addicted patients revealed the presence of numerous carious cavities, secondary adentia, enamel erosion, pathological abrasion, signs of gingivitis and periodontitis, tooth chipping. The prevalence of parafunction of the dental-jaw apparatus, in particular bruxism, in drug-addicted patients is 1.56 times higher than this figure among non-drug addicts. The results of the occludogram and the index of parafunctions of the masticatory muscles differ significantly between the study groups. The mean value of the masticatory muscle parafunction index among drug-addicted patients is 2.06 times significantly higher than the value among non-drug-addicted men and 2.03 times higher among women. Histological examination of the tooth tissues of drug-addicted patients indicates a disorder of the mineralization of both enamel and dentin. Thinning of the peripheral zone of the pulp, which is normally represented by a layer of odontoblasts, which provide regeneration and nutrition of dentin, is more common in persons under 25 years of age. Drug use adversely affects the dental status of patients and the condition of the hard tissues of the tooth.
Key words: air, chemical pollution, risk to the health
Abstract. Сarcinogenic substances in the atmospheric air of Dnipro city and risk to the population. Serdiuk A.M., Chernychenko I.O., Lytvychenko O.M., Babii V.F.,Kondratenko O.Ye., Hlavachek D.O. The objective – to study the dynamic changes for the health risk of the population of the industrial center in accordance with the state of atmospheric air pollution with carcinogenic compounds. The assessment of the state of atmospheric air pollution was carried out by us based on the results of physicochemical analysis of samples taken in places attached to the locations of stationary posts of state monitoring. The concentration of identified substances was determined by conventional methods: spectral-luminescent and gas chromatographic. Heavy metal concentrations were determined using data from the Central Geophysical Observatory of the Ministry of Emergency Situations. The calculation of the inhalation load of chemical carcinogens and the risks associated with them (non-carcinogenic and carcinogenic) was carried out in accordance with domestic guidelines. The assessment of dynamic changes in the nature of atmospheric air pollution with a complex of carcinogenic substances was made 5 of them are constantly recorded at levels exceeding hygienic standards. When compared with the reference concentrations, all compounds are characterized by high coefficients, indicating the likelihood of their effect on the body's immune system, respiratory organs, malformations, etc. A high individual carcinogenic risk of the effect of chromium VI and nitrosamines was determined. A total carcinogenic risk is formed at levels of 2.5 – 3.9×10-3, which should be considered as high; this requires development and implementation of preventive measures. On the territory of the industrial center, a high level of air pollution with increased carcinogenic and non-carcinogenic risk is stably registered.
Key words: indexes of disability, professional diseases, medical and social exapertise
Abstract. Disability status due to occupational diseases: Ukraine, 2015-2018. Borуsova I.S. The economic burden of disability due to occupational diseases is significant: the economic losses "due to health problems related to work" in the developed world exceed 1,25 trillion US dollars and amount to 4 to 6% of GDP. A large number of employees work in Ukraine in unfavorable conditions. The study analyzes the dynamics of disability due to occupational diseases in Ukraine for the period from 2015 to 2018 using the example of Dnipropetrovsk, Lviv and Donetsk regions. The results of the study proved that the indicators of disability due to occupational diseases in these areas have a pronounced upward trend. It has been determined that the number of injured or aggrieved persons who received occupational diseases in the Dnipropetrovsk, Lviv and Donetsk regions is 78.5% of the total number of those in Ukraine with occupational diseases. The proportion of those who were initially recognized as disabled due to occupational diseases increased in 2015-2018, increased in these areas and amounted in absolute numbers: in the Dnipropetrovsk region – 906 people (2018) against 705 people (2016); in the Lviv region – 273 people against 239 people, respectively; in Donetsk region – 193 people against 108 people, respectively. Primary disability rate for 2015-2018 period increased by 28.5% in Dnepropetrovsk to almost 50% in Donetsk region. The proportion of those who were initially recognized as disabled due to work injury in the Dnipropetrovsk region was 159 people (2018) against 123 people (2016); in the Lviv region: 42 people against 11 people, respectively; in the Donetsk region: 28 people against 11 people, respectively. The rate of primary disability due to work injury also increased by 29.2% in the Dnipropetrovsk region and by 53% in the Donetsk region. The number of persons with disabilities recognized for the first time depended on age and length of service in hazardous conditions. Persons with 10-19 years of work experience in 2015-2018 accounted for 89.2%. According to our data, 50.1% of workers aged 40 to 49 years are recognized as persons with disabilities, 40% – from 50 to 59 years of age. It is important that in 2018 in 5% of cases, an occupational disease caused disability among workers at the age of 39. In 2018 (as in 2016 and in 2017) in Ukraine, the main conditions that resulted in occupational diseases were: imperfection of mechanisms and working tools – 23.9%; the imperfection of the technological process - 19.5% and the ineffectiveness of the personal protective equipment – 13.5% of their total number. In the structure of disability due to occupational diseases, diseases of the musculoskeletal system occupied the 1st place; 2nd place – respiratory diseases; 3rd place – injuries and poisoning.