Medicni perspektivi, 2021;26(2)
2021 Vol. XXVI N 2
Key words: afatinib, gefitinib, EGFR, erlotinib, lung cancer, osimertinib
Abstract. Modern vector in treatment of patients with lung cancer: tyrosine kinase inhibitors in epidermal growth factor receptor mutations (literature review). Smorodska O.M., Moskalenko Yu.V., Vynnychenko I.O., Vynnychenko O.I., Kostuchenko V.V. Tumor molecular profiling in patients with non-small cell lung cancer (NSCLC) is used to identify driver mutations, which lead to premature carcinogenesis in more than 80% of adenocarcinoma cases, including epidermal growth factor receptor (EGFR) mutations. Identification of specific somatic aberrations allows to personalize treatment. Personalization of treatment resulted in improvement of NSCLC outcomes. The aim of our study was to consider scientific data on modern concepts of treatment of patients with non-small cell lung cancer with previously detected oncogenic mutations, especially EGFR mutation. In our study we analyzed scientific papers and data of international scientific literature on the problem of lung cancer treatment. Methods used: scientific research, analytical and generalizing. Different drugs are used in treatment of lung cancer. Choice of treatment scheme depends on type and presence of mutations. Patients with advanced non-small-cell lung cancer and detected mutation in the EGFR can be treated with tyrosine kinase inhibitors (TKIs). Nowadays three first generation drugs are recommended by FDA: afatinib, erlotinib, gefitinib. They showed good clinical benefit. Most patients with metastatic NSCLC typically show disease progression after approximately 9 to 13 months of erlotinib, gefitinib, or afatinib therapy. The first and only commercially available third-generation EGFR TKI is оsimertinib - an oral drug, which selectively inhibits both EGFR-TKI and EGFR T790M resistance mutations. Nowadays scientists are in active investigation of mechanisms of acquired resistance to TKIs, but little is known yet. Clinical success can be observed in patients who were treated with TKIs. EGFR T790M is a mutation that leads to acquired resistance to EGFR TKI therapy. Its incidence is approximately 60% after disease progression on TKI drugs (erlotinib, gefitinib, or aphatinib). Third-generation EGFR TKIs demonstrate high efficacy, but acquired resistance development cannot be avoided. Mechanisms of acquired resistance to these agents are still investigated.
Key words: heat shock protein 60, periodontitis, hyaluronic acid
Abstract. Levels of Hsp60 in periodontal tissue of rats: influence of injections of hyaluronic acid. Kopchak O.V., Yakovenko L.F., Marchenko N.S., Кovach I.V., Pavlenko E.M., Nimenko O.A., Kroupskaya I.V., Filonenko V.V. Heat shock protein 60 (Hsp60) is considered as one of the possible autoantigens involved in the pathogenesis of a number of chronic diseases including periodontal diseases. The application of hyaluronic acid or hyaluronan (HA) in the treatment of periodontitis has been evaluated in several clinical trials, however, the effect of hyaluronic acid on heat shock protein 60 level in periodontal soft tissues has not been studied. The aim of this work was to evaluate the effect of HA injections on levels of Hsp60 in periodontal tissue of the rats. Samples of periodontal tissue of mandibular incisors of adult male Wistar rats at 10-12 months of age were investigated. Rats were distributed into the control group and the periodontitis group. Visual manifestations of hyperemia of the gums around the incisors were the criterion for selecting animals into the periodontitis group. There were two subgroups in the control group: intact rats (I); intact rats after HA “hyaDENT BG” 1.0 MDa (BioScience GmbH, Germany) treatment (I+“G-1.0”). There were four subgroups in the periodontitis group: rats with periodontitis (P); rats with periodontitis after HA “hyaDENT BG” 1.0 MDa (BioScience GmbH, Germany) treatment (P+“G-1.0”); rats with periodontitis after HA “SERTOBEC” 2.4 MDa (S.C. Rompharm Company S.R.L., Romania) treatment (P+“S-2.4”); rats with periodontitis after HA “SERTOBEC Tendon” 2.4 МDа (S.C. Rompharm Company S.R.L., Romania) treatment (P+“ST-2.4”). There were three animals in each subgroup. Rats were injected 0.05 ml HA in the area of alveolar processus of central incisors once a week, three times. Levels of Hsp60 in total lysates of periodontal tissue were tested by Western blotting method before and after the treatment with HA (one month after the last injection). There was no significant difference between levels of Hsp60 in total lysates of periodontal tissue of intact rats and rats with periodontitis before treatment (p>0.05). Rats with periodontitis showed decreased inflammation in the periodontal tissue after treatment with HA with different molecular weight. Intact rats and rats with periodontitis which were treated with HA “hyaDENT BG” 1.0 MDa showed reduced levels of Hsp60 in total lysates of periodontal tissue comparatively with levels of Hsp60 before treatment (by 15.4 and 10.7 times respectively, p<0.001). Rats with periodontitis which were treated with HA “SERTOBEC” 2.4 MDa or HA “SERTOBEC Tendon” 2.4 MDa also showed reduced levels of Hsp60 in total lysates of periodontal tissue comparatively with levels of Hsp60 before treatment (by 21.3 and 16.4 times respectively, p<0.001). Rats with periodontitis showed the decrease in inflammation in periodontal tissue after treatment with HA with different molecular weight. Injections of HA has contributed to reduce levels of Hsp60 in periodontal tissue of intact rats and rats with periodontitis.
Key words: montelukast, inflammation, leukotrienes, cold trauma, epilepsy
Abstract. Non-obvious effects of montelukast – leukotriene receptor blocker: frigoprotective and antgreyvulsant properties. Shtrygol S.Yu., Kapelka I.G., Mishchenko M.V., Mishchenko O.Ya. The participation of arachidonic acid metabolism products – prostaglandins and leukotrienes – in the process of inflammation is a common pathogenetic link of cold injury and epilepsy. Montelukast is widely used for the treatment of bronchial asthma and allergic rhinitis as a leukotriene receptor blocker. However, the mechanism of action of the drug suggests a wider range of its pharmacological properties and the corresponding scope of application. This study is aimed to determine the effectiveness of montelukast as a potential frigoprotective and antgreyvulsant drug. Experiments were performed on 73 white mice weighing 20-22 g on models of acute general cooling and pentylenetetrazol convulsions. Frigoprotective properties were studied at a temperature of –18°C, recording the lifetime. Montelukast ("Singular", 2 mg/kg), acetylsalicylic acid ("Aspirin", 50 mg/kg), celecoxib ("Celebrex", 74 mg/kg), diclofenac sodium ("Voltaren", 14 mg/kg) were administered intragastrically as a suspension in a prophylactic mode, 30 minutes before the cold injury. In the study of anticonvulsant activity, montelukast ("Singular", 4 mg/kg) and sodium valproate ("Depakin", 300 mg/kg) were administered intragastrically 30 minutes before stimulating convulsions by subcutaneous administration of pentylenetetrazole (90 mg/kg). The latent period of convulsions, the number of convulsions per 1 animal, % of mice with clonic and tonic paroxysms, the severity of convulsions in points, the duration of the convulsive period, the lifetime of animals and lethality were recorded for an hour. On the model of acute general cooling, montelukast showed a dose-dependent frigoprotective effect at a dose of 2 mg/kg surpassing drugs with proven frigoprotective properties – acetylsalicylic acid and celecoxib. On the model of pentylenetetrazole-induced convulsions, montelukast statistically significantly reduced the integral indicator of antgreyvulsant activity – lethality – by 2.57 times. Thus, the experiment proved the significant role of leukotrienes in the pathogenesis of cold injury and epilepsy and justified the feasibility of further study of the frigoprotective and antgreyvulsant properties of montelukast – leukotriene receptor blocker a drug as for adjuvant therapy, especially when these pathologies are combined with bronchial asthma and allergic rhinitis.
Key words: periodontitis, inflammation, collagenolysis, oxyproline, quercetin
Abstract. State of collagenolysis in experimental periodontitis of bacterial-immune genesis and its correction with flavonol. Demkovych A.Ye., Bondarenko Yu.I., Fastovets O.O., Hrad A.O., Hasiuk P.A., Denefil O.V. The article presents an assessment of the dynamics of changes in the content of the marker of collagenolysis – free oxyproline in the homogeniate of soft tissues and bone in experimental bacterial-immune periodontitis and elucidation of the effect of flavonol quercetin on these indicators. The aim of this study was to determine the role of cytokinogenesis and the effect of flavonol on it in the pathogenesis, development and course of experimental periodontitis. During the experiment, a fragment of the mandible was taken from the animals, from which the soft tissues and bone were carefully separated. The state of collagen was determined by the content of free oxyproline in the soft and bone tissues. The concentration was determined according to the calibration graph and expressed in μmol/g. The results of studies of the indicators of the state of biopolymers of connective tissue structures of periodontium on the 7th, 14th and 30th day of experimental bacterial-immune periodontitis and after its correction with flavonol (from the 7th to the 14th day of the experiment) are presented. The data on the nature of changes in the content of collagen monomers in the process of formation of the inflammatory focus in the periodontal complex are given. During the acute phase of the inflammatory process in rats there was revealed a slight increase in blood free oxyproline in bone homogenate and homogenate of soft periodontal tissues, on the 14th day the dynamics continued to increase, at a later stage of the experiment, namely on the 30th day, increase in bone resorption continued as compared to the 7th and 14th day. During the correction of disorders resulted from the development of this pathological process there was a decrease in the level of free oxyproline in the bone homogenate and homogenate of soft tissues of mandibular periodontium, as compared to the same indicators of animals who did not receive quercetin on the 14th day. The use of flavonol quercetin, which, by affecting immune processes, limited the inflammatory response in periodontal tissues and stabilized collagenolysis processes in periodontal tissues was manifested by a decrease in free oxyproline in bone and soft tissue homogenates of experimental animals.
Key words: rosacea, women, rush, centers of reproductive regulation
Abstract. The phenomenon of rosacea-rushes (theoretical aspects). Bocharov V.A., Bocharova V.V., Lebediuk M.M., Sarayreh A.A.S., Kuts L.V. According to the decisions of international scientific forums, the problem of phenomenon of rosacea (acne rosacea), a common dermatosis with numerous unexplained aspects of etiopathogenesis is a promising area of modern medical research. The aim of the study was theoretical substantiation of the essential features of the mechanisms of occurrence, development and clinical manifestations of the first signs of rosacea in women of reproductive age. The use of a systematic analytical methodical approach to assess the data of clinical and laboratory examinations of women with rosacea, conducted in different regions of the world, allowed to establish the originality of such manifestations of dermatosis as the appearance of unexpected rushes to limited areas of the face, accompanied by local redness and local heat areas of the skin differring significantly from similar rushes in other diseases or syndromes (menopause, migraine, etc.). It is established that the peculiarity of the relationship of these clinical characteristics (from English: rush, ruddy, redness, rosacea, reproductive age of women, reaction) allows to indicate the first signs of dermatosis as a phenomenon inherent in this disease Rush-Ruddy-Rosacea-Reproduce-Reaction (abbreviated – «5-R»), the key pathophysiological target of which (as well as the disease as a whole) is a disorder of a set of hierarchically dependent mechanisms of the evolutionarily determined motivational need to ensure reproductive function in women (both at the cellular level and extracellular structures of the ovaries, and at different levels of subcortical formations and centers of the cortex of the cerebral hemispheres). The phenomenon of rosacea rush is closely related to other phenomena of this dermatosis – hypersensitivity of bradykinin receptors, actinic elastosis, development of post erythematous telangiectasia. The prospect of further research on the problem of rosacea is to study the relationship of disorders in the functional systems of molecules of signaling compounds of different classes (hormones, eicosanoids, neuropeptides, kinins, cytokines and others) in the pathogenesis of the disease.
Key words: thyroglobulin, thyroid gland, rats, antigen
Abstract. Immune-histochemical indicators of the morpho-functional state of the thyroid gland in norm and after prenatal antigenic exposure. Fedosieieva O.V. During the individual development and exposure to infectious agents of the organism, the structural components of the thyroid gland can change significantly. In modern research, great importance is attached to the study of mechanisms for maintaining morphological homeostasis of the thyroid gland and ideas about its structural and functional restructuring in response to the body's immune system to various infections. The morpho-functional features of the thyroid gland of newborn animals after prenatal action of thyroid-nonspecific antigen (staphylococcal toxoid) have been experimentally established. In antigen-premiumed rats, the timing of folliculogenesis changes, as well as the size, distribution and immunohistochemical expression of antibodies to thyroglobulin, the functional state of thyrocytes and follicles compared to normal. The detected immunohistochemical changes indicate signs of morpho-functional immaturity of the organ with hypoactivity elements.
Key words: medical education, education technologies, lectures, interactive learning, active learning, problem-solving learning
Abstract. Experience in introducing a new interactive format of lectures at clinical departments and the attitude of students towards them. Yaremenko O.B., Dobrianskyi D.V., Tarchenko I.P., Meliksetian A.V., Fedkov D.V. The modern model of education and the present conditions demand of the teacher to choose the latest teaching methods. The teacher is no longer the main source of information, he should manage education, implementing competence-based study methods. In order to achieve this, the latest teaching methods are introduced in Bogomolets National Medical University with the new lecture frameworks. Changing the lecture style at a medical universities and, in particular, using the modern lecture educational technologies provide important conditions for improving training future doctors. As Bogomolets National Medical University experience shows, this provides opportunity for turning traditional lectures into interactive lessons to increase students’ interest, to provide improved material perception through the dialogue between the lecturer and students. The article presents the results of surveys of 387 students conducted at the Department of Internal Medicine №3, as well as generalized information regarding students’ evaluation of changes in the lecture framework and the implementation of new training methods in Bogomolets National Medical University. According to the survey results, most students are satisfied with the quality of the updated lecture frameworks at the therapeutic departments. The main characteristics of the lectures that teachers need to pay attention to in order to improve the lecture quality have been analyzed separately. In the view of the students, the best features of the lectures are: actuality, availability of material, structure and laconicism, informativeness, interactivity, video footage using, practical orientation of the presentation, illustration and sufficient number of visuals, an opportunity to be engaged in dialogue with lecturer. Students find traditional attendance control useless, the majority of respondents supported free lecture attendance.
Key words: patent ductus arteriosus (PDA), hemodynamic significance, transthoracic echocardiographic (TTE) examination
Abstract. Determining hemodynamic significance of patent ductus arteriosus using echocardiographic data prognostic tables. Kulikova D.A., Safonova I.N., Chumak L.I., Poddubnaya I.N. , Protsenko O.S., Dotsenko D.G. The paper presents an analysis of echocardiographic data of patients with PDA having different hemodynamic significance. Presently, the concept of “degree of hemodynamic significance” remains controversial. Criteria for determining the hemodynamic significance of PDA in term infants are not described. In our work, we used a classification of three degrees of hemodynamic significance: non-hemodynamically significant PDA – insignificant, moderately hemodynamically significant – moderately significant and large PDA – hemodynamically significant PDA. Aim – to work out an algorithm for determining the degree of PDA hemodynamic significance for prediction of its further development. The study involved children under 18 years old (80% of them ‒ children under 3 years old) who were examined in the cardiac surgery department of the SI “IGUS n.a.V.T. Zaytsev NAMS of Ukraine” during 2013-2017 yy. Gestational age (from 37 weeks), the presence of left to right PDA shunt, absence of a ASD shunt and other congenital heart defects served as enrollment criteria for the trial. Two prognostic tables were formed with the main criteria for determining hemodynamic significance of PDA by the sum of the signs according to gradations (insignificant, moderately significant and hemodynamically significant) as an outcome of the trial. Based on the determination of the main and additional criteria of hemodynamic significance and the strength of their influence, a diagnostic algorithm is formed for a patient with PDA with the possibility of predicting a further clinical scenario. For determination of hemodynamic significance, an increase in pulmonary gradient with an information index of 1.135 and a prognostic factor of +5.90/-1.75 were dominant, while the left ventricular dilatation located from the A4C with an informational index of 1.020 and a prognostic coefficient of +3.69/-2.50 dominated in determining the degree of hemodynamic significance in the presence of secondary changes. The proposed mechanism for determining the level of hemodynamic significance of PDA for children with borderline changes will predict more precisely the development of the disease, determine the patient’s observation tactics and regulate the decision-making process of surgical intervention.
Key words: chronic kidney disease V D stage, hemodialysis, cardiovascular diseases, coronary artery disease, predictors
Abstract. Predictors of cardiovascular disease in patients with chronic kidney disease VD stage treated with hemodialysis. Shifris I.M., Dudar I.O., Krasiuk Е.К., Shymova А.Yu. The aim of the study was to establish the frequency and possible predictors of cardiovascular disease (CVD) in chronic kidney disease (CKD) VD stage patients, treated with hemodialysis, based on results of prospective observation. The prospective observational cohort study included 223 patients with CKD V D stage who were treated with hemodialysis (HD) during 2012-2019. The research was carried out in two stages. At the first stage, main demographic, laboratory and clinical characteristics of patients, including the frequency of CVD, at the time of beginning the study were examined. At the second stage, based on prospective studying of the dynamics of the frequency of CV pathology, an assessment of potential predictors of CVD in CKD V D stage patients treated with HD was made. Patients’ characteristics determined at the beginning of the study were used as possible predictors. The average duration of prospective study was 35.5±17.8 months, cumulative – 579.3 patient-years. For determination of prognostic factors of CVD events, ROC-analysis, univariate and multivariate Cox proportional hazard regression analysis were done. The primary endpoint (newly diagnosed CVDs) was assesses at the end of the study. Statistical processing of the obtained results was performed using the MedCalc Statistical Software, version 19.3. During the study period, a significant increase of all CVD frequency by 80% (р<0.001) was stated, more than twice – of coronary artery disease (CAD; р<0.001) and atrial fibrillation (AF; р=0.0039). The incidence rate of CVD and CAD was 9.8 and 9.15 per 100-patient-years, respectively. The primary endpoint was observed in 92 (41.26%) patients: newly diagnosed CAD – in 53 patients, heart failure – in 12 patients, AF – in 9 patients, acute myocardial infarction – in 8 patients, other heart diseases – in 10 patients. Independent predictors on increased CVD risk in chronic kidney disease VD stage patients treated with hemodialysis are: age over 35 years, use of a central venous catheter as a vascular access during HD initiation, history of nasal MRSA collonization. In the other hand, serum albumin level of more than 36,6 g/l was associated with reduced risk.
Kew word: breast cancer, surgical tactics, intraoperative ICG-technology
Abstract. Influence of ICG-technology on the results of surgical treatment of early forms of breast cancer. Masia J., Savenkov O.Y. Breast cancer (BC) is one of the most common causes of death in women up to 50 years old. For today the choice of an adequate methods of surgical intervention and the need for an adequate surgical adjuvant therapy, quality of life of patients after surgeryis are important. The aim of our study was to select the volume of surgery for breast cancer using the technique of intraoperative identification of the sentinel lymph node (intraoperative ICG technology) and to evaluate the results of its urgent histological examination. It was shown that the most common method of surgery in patients who underwent intraoperative ICG technology was quadrantectomy, which was performed in 27 cases (54%), rarely subcutaneous mastectomy was performed (30%) and radical mastectomy (by Madden) – 16%. In the control group, priority was given to radical removal of the breast (63.2% of cases); partial resection (by U. Veronesi) was performed in 33.3% of patients, and subcutaneous mastectomy – in 3.5%. Pathomorphological examination of the sentinel lymph node during its intraoperative imaging using ICG-technology established metastatic lesion in 10 of 50 cases (20%) in the main group. The obtained results of the assessment of the regional lymph dissection size in the main group indicate its adequate nature to ensure the radicality of surgical treatment. In our opinion, this is one of the important preliminary conclusions of this study, because to assess the clinical significance of signal lymph node (SLN) analysis as a marker of regional tumor spread, firstly it is necessary to be sured that existing surgical techniques provide radical tumor removal.
Key words: ischemic heart disease, chronic obstructive pulmonary disease, comorbidity, adherence to treatment, Morisky Scale
Abstract. Problems of diagnosis and treatment of chronic ischaemic heart disease combined with chronic obstructive pulmonary disease according to retrospective analysis. Potabashnii V.A., Kniazieva O.V., Markova O.Ya. Ischaemic Heart Disease (IHD) and Chronic Obstructive Pulmonary Disease (COPD) are common diseases that rank highest in the Global Burden of Disease Study (2019). IHD and COPD are often combined, making diagnosis and treatment of patients difficult in actual clinical practice. The aim of the study was to identify problems in the diagnosis and treatment of patients with a combination of chronic IHD and COPD, based on a retrospective analysis of medical records. Patient’s adherence to treatment was also assessed with the Morisky Scale (MMAS-8). The analysis of 108 inpatient charts with a combination of chronic IHD and COPD was carried out. The quality of diagnosis and treatment of IHD was evaluated in accordance with the order of the Ministry of Health of Ukraine N152 dated March 02 2016, considering the recommendations of the European Society of Cardiology (2019). It was found that smoking history was in 23.1% of patients, a body mass index (BMI) was calculated in 51,9%, and a carotid ultrasound examination was carried out in 7.4% of cases. The total cholesterol level was determined in 59.2% of patients, while the level of low-density lipoprotein cholesterol (LDL-C) was determined in only 43.5%. Transthoracic echocardiography (TTE) was performed in 62.9 % of patients, but stress-echocardiography and exercise ECG were not performed. Daily ECG monitoring was performed in 60.2% of cases. The levels of brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) were not detrmined to precise etiology of dyspnea. It was also found that beta-blockers (29.6% of patients), ivabradine (11.1% of patients) and statins (65.7% of patients) are seldom administered to patients with IHD and COPD. The targeted doses of these drugs are not reached. Fixed combinations of long-term bronchodilalarors were insufficiently used in therapy of COPD. However, patients' adherence to basic IHD and COPD therapy is weak. 45.4 % of patients were non-adherent to treatment, 43.5% were medium-adherent, and only 11.1% of patients were adherent to treatment.
Key words: cervical dysplasia, cervical intraepithelial neoplasia, diagnostics, immunocytochemistry, biomarkers, p16, Ki-67
Abstract. The role of immunocytochemical biomarkers in diagnostics of precancerous pathology of cervix. Gladchuk I.Z., Rozhkovska N.M., Kashtalian N.M. The last decades showed the worldwide tendency to finding consensus between diagnostics improvement and constant increase of cost of medical services in conditions of restricted financing. The aim of the article was to analyze the diagnostic value of p16 and Ki-67 biomarkers in diagnostics of precancerous diseases of cervix. Data of 80 patients with cervical dysplasia of varying degree who received excisional treatment were analyzed. It was shown that cytological study has a high sensitivity (79.17%) for the diagnosis of CIN 2-3, but low specificity (53.57%). The p16 immunocytochemical biomarker has a high sensitivity for the diagnosis of CIN 2 (0.92; 95% CI: 0.76-0.98) with good specificity (0.78; 95% CI: 0.67-0.82), for the diagnosis of CIN 3 both sensitivity (0.93; 95% CI: 0.82-0.98) and specificity (0.93; 95% CI: 0.82-0.98) is high. The immunocytochemical biomarker Ki-67 has a high sensitivity for CIN 2 (0.92; 95% CI: 0.65-0.99), but insufficient specificity (0.62; 95% CI: 0.54-0.64), for the diagnosis of CIN 3 the sensitivity is very high (0.96; 95% CI: 0.80-0.99) as well as specificity (0.78; 95% CI: 0.69-0.81). The combined use of p16 and Ki-67 biomarkers can significantly increase the diagnostic accuracy of the diagnosis of high-grade precancerous pathology of cervix and justify timely surgical intervention. Such an approach for the differential diagnosis of severe dysplasia, on the one hand, may contribute to a decrease in the risk of developing cervical cancer, and on the other hand, it will allow to avoid unnecessary operations and preserve reproductive function of women, reduce the economic costs of treatment.
Key words: obesity, diabetes mellitus, cancer risk
Abstract. The impact of obesity on the development of certain cancers in patients with type 2 diabetes. Mechanisms of association. Vatseba T.S., Sokolova L.K., Tronko M.D., Churpiy I.K., Vatseba M.O., Derpak V.V. The aim of the study was to investigate the effect of obesity on the development of cancer of certain localizations in patients with type 2 diabetes mellitus (T2D) and to explain the association mechanisms of obesity in diabetes and cancer. The study included retrospective analysis of first time diagnosed cancer cases in patients with T2D in 2012-2016 in Ivano-Frankivsk region. Analysis of the data was carried out using Statistica 12.0 (StatSoft Inc., USA) program. The data are presented in the tables as M±SD (M± standard deviation). Differences between the studied parameters were determined using the ANOVA- test, taking into account the Bonferroni correction. The relationship between the studied data was evaluated using the criterion of chi-square with Yates correction (χ²). The odds ratio (OR), 95% confidence interval, the positive and negative predictive value were calculated to determine the association between two events. The differences were considered significant at p<0.05. According to the results, 533 cases of the first time diagnosed cancer were detected in patients with T2D. It was found that obesity is inherent in women with breast, uterine, ovarian and colorectal cancer; for men with prostate cancer and with colorectal cancer. According to the criterion of χ², the effect of obesity on the incidence of breast cancer in women (x2=8.46; p<0.05), and prostate cancer (x2=7.02; p<0.05) and colorectal cancer (x2=7.94; p<0.05) in men was proven. OR revealed an increased risk of breast cancer in women [OR=2.06; 95% CI (1.28-3.29); p<0.05], and prostate cancer [OR=2.94; 95% CI (1.37-6.32); p<0.05] and colorectal cancer [OR=2.87; 95% CI (1.42-5.82); p<0.05] in men associated with obesity. Thus, among patients with T2D, obesity increases the risk of breast cancer in women, prostate cancer and colorectal cancer in men. The mechanisms of association of obesity and cancer in patients with T2D are hyperglycemia, hyperinsulinemia, cytokine imbalance, hyperestrogenism (in estrogen-dependent cancer), and intestinal dysbiosis (in colorectal cancer).
Key words: olfactory bulbs, pneumonia, cerebrovascular pathology, mitral cells
Abstract. Changes of structural organization of human olfactory bulbs under conditions of severe forms of pneumonia and cerebrovascular pathology. Shkodina A.D., Grinko R.M., Starchenko I.I., Vynnyk N.I., Sovhyria S.M., Kyslyi V.F. The role of human olfactory bulbs remains one of the most interesting questions concerning work of the brain, because this organ is one in which neurogenesis is continuously generated in post-natal and adult periods. Impaired sense of smell is not a pathology that threatens human life, therefore, often remains unnoticed. However, it can directly affect the quality of life, as it leads to malnutrition and certain problems in interpersonal relationships. The study of the functional structure of the olfactory analyzer plays an important role both in clinical and experimental studies, but the question of its features in humans needs detailed research. The material of the research was 18 pairs of the olfactory bulbs of males and females aged from 30 to 90 years that were received at the Poltava Regional Department of Pathology. In order to objectify the data obtained on micropreparations, the following morphometric indices were determined: the specific gravity of the location of cellular elements; the proportion of mitral neurocytes in the entire cell population; percentage ratio of relative quantity between cellular elements, blood microvessels, fibrillar component and homogeneous eosinophilic structures. Correlation analysis of morphometric indices in the general sample revealed the existence of an inverse communication of average strength between the relative number of homogeneous eosinophilic cells and the relative number of cellular elements and blood microvessels, which in turn indicates the etiopathogenetic mechanisms of the formation of these structures. The conducted research makes it possible to conclude that mitral cells as one of the most differentiated in olfactory bulbs are sensitive to the development of hypoxic states; under the conditions of cerebrovascular pathology, the relative amount of the blood vessels of the microvessels decreases, which leads to the disorder of the trophy of the nervous tissue and as a result can lead to neurocytolysis of mitral cells. Changes in the vascular and cellular component indicate a different pathogenesis of changes in human olfactory bulbs in these pathologies and suggest that eosinophilic homogeneous cells are the result of apoptotic neurocytolysis against the background of development of hypoxic states.
Key words: primary dental implant, secondary deformations of dentition, dentition defects, deficit of space for artificial teeth, segmental bracket system, torque of teeth, angulation of teeth
Abstract. Orthodontic treatment of secondary deformations in adult patients with defects of dentition. Mirchuk B.M., Maksymov Y.V. In the presence of dentition defects there is a complex of morphological, aesthetic and functional changes that significantly complicate the process of diagnosis and treatment of this pathology. Dentition defects, combined with various dental anomalies and deformations very often impede rational prosthetics and at times make it impossible at all. The aim is to increase the effectiveness of orthodontic treatment of secondary deformations in patients with dentition defects by using primary dental implants as an additional skeletal support. For clinical evaluation of the effectiveness of treatment of secondary deformations in 20 patients with partial dentition defects there was performed orthodontic treatment using a straight arc technique with metal braces of the Roth system and primary detailed one-component implants as an additional skeletal support. On the diagnostic models of the jaws, the meso-distal dimensions of the lost teeth and their possible position in the dentition were determined, the shape of the dentition by methods of Pon and Korkhaus, the position of the teeth in the area of dentition defects was analyzed and the jigs of occlusion according to Andrews were defined. The use of primary dental implants as an additional skeletal support in the area of dentition defects makes it possible to control the rotation of the teeth and at the same time to use orthodontic forces of different intensity during their distal or mesial movement. As a result of orthodontic treatment of secondary deformations, we managed to achieve positive changes in the normalization of angles of dental inclination that limit the defect in patients with dentition defects. Along with the normalization of the angles of dental inclination (torque and angulation) which limit dentition defects we have noticed an increase in the distance between these teeth, which allows to restore dentition defect with dentures, better corresponding to the size of the lost teeth. Important, in our opinion, is the possibility, when using a primary dental implant as an additional skeletal support, to use the technique of segmental braces. The use of primary dental implants in the area of the dentition defect as an additional skeletal support makes it possible to restore angulation and torque of the teeth, which limit the defect, using orthodontic forces of different intensity. As a result of orthodontic treatment of secondary deformations, the distance between teeth limiting dentition defects on the upper jaw increased on average by 2.39 mm (p<0.001) and on the lower jaw – by 2.57 mm (p<0.001).
Key words: sarcopenia, osteosarcopenia, prevalence, metabolic disorders, falls, fractures
Abstract. The association of sarcopenia and osteoporosis and their role in falls and fractures (literature review). Povoroznyuk V.V., Dedukh N.V., Bystrytska M.A., Dzerovych N.I., Shapovalov V.S. The progressive and generalized loss of skeletal muscle mass and strength leads to sarcopenia in elderly people. A new geriatric syndrome has been revealed – osteosarcopenia (osteosarcoporosis), which combines low bone mineral density with reduced muscle mass, strength and functional activity. The review presents data on the peculiarities of manifestation of these syndromes, the mechanisms of which are multifactorial and continue to be investigated. They are associated with genetic factors, lifestyle – lack of physical activity and malnutrition. The pathogenesis of sarcopenia involves mechanisms of chronic inflammation, changes in endocrine function, disturbance of neuromuscular connections and low reparation level. Sarcopenia correlates with low quality of life, disability, and death. The review analyzes the prevalence of sarcopenia which increases with age. However, there are conflicting results in the populations, which may be related to different clinical conditions, patient area, lifestyle and the use of different assessment criteria. The analysis of sarcopenia prevalence in men and women showed ambiguous results related to the studied population, involvement of different age groups of patients, different evaluation methods. Metabolic disorders in muscular and bone tissues were summarized on the basis of the analysis of the cross-influence of regulatory factors and metabolism products of these tissues; a close metabolic and functional association between them was shown. Fat infiltration of atrophied muscles and bone marrow is common in patients with sarcopenia and osteosarcoporosis, which affects muscle and bone tissue. Lipotoxicity and local inflammation stimulate the biosynthesis of pro-inflammatory cytokines. Literature analysis has shown controversial data on the association of sarcopenia and osteosarcopenia with falls and fractures, but based on meta-analysis data, which include an extensive body of information, it should be noted that individuals with sarcopenia and osteosarcopenia are more at risk of falls and fractures and require special special attention. The most common fracture in osteosarcopenia is the hip fracture.
Key words: erectile dysfunction, color Doppler imaging, androgen deficiency, arterial hypertension
Abstract. Algorithm of diagnostics of erectile dysfunction in patients with arterial hypertension and dynamics of arterial blood pressure against the background of androgenic deficiency. Vintoniv O.R., Popadynets I.R., Hrodzinskyy V.I., Melnyk S.V., Herych P.R., Halipchak I.M. In recent years, the requirements for the level of the life quality have increased significantly; an integral part of it is the sexual harmony, which in men largely depends on sexual desire and erectile function. According to the results of modern scientific studies, there is no doubt that erectile dysfunction in men is closely connected with the cardiovascular diseases, obesity, diabetes mellitus and other comorbidities. This problem can also be caused by systematic psycho-emotional overload, deterioration of the environmental conditions, harmful factors of production, uncontrolled use of medicines, inflammatory processes in the genital organs, the growth of somatic diseases. The vast majority of works concerning “male menopause” is reduced to the effectiveness of hormone-replacement therapy in erectile dysfunction, while only few research works are devoted to the study of the connection between somatic pathology and androgen deficiency. There is a negative correlation between total testosterone level and systolic blood pressure. According to the research results of some scientists, it was found that 38% of patients with arterial hypertension had androgen deficiency, confirmed in the laboratory, which is significantly higher than in patients of the same age category with normal blood pressure. These dominant factors exert and increase the influence on each other, which must be taken into account in modern therapeutic practice. The study of the formation of comorbid conditions in men with low levels of androgens is of particular importance, as the knowledge of pathophysiological mechanisms can prevent their development and progression. The aim of this investigation was to study the state of penile vascular blood flow in men with arterial hypertension with erectile dysfunction, using color Doppler imaging with pharmacological induction of erection. The indicators of daily monitoring of arterial pressure and arterial stiffness in men with arterial hypertension of the II degree against the background of androgen deficiency or at normal testosterone levels and ways of correction of erectile dysfunction in these patients were also evaluated.
Key words: type 2 diabetes mellitus, non-alcoholic fatty liver disease, cardiovascular diseases
Abstract. Hepatic fibrosis as an additional risk factor for the development of cardiovascular disorders in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease. Bilovol O.M., Kniazkova I.I., Zemlianitsyna O.V., Dunaeva I.P., Romanova I.P., Kurilo O.D., Sinaiko V.M., Kravchun N.O. The aim of the study was to determine the relationship between the degree of progression of liver fibrosis and the risk of cardiovascular complications in patients with Type 2 diabetes mellitus (DM) with non-alcoholic fatty liver disease (NAFLD). The study included 110 patients with Type 2 diabetes (62 men and 48 women), the average age of the subjects was 52.07±1.11 years. All patients were divided into 2 groups: the main group included 72 patients with Type 2 diabetes with concomitant NAFLD (38 men and 34 women); the control group included 38 patients with Type 2 diabetes without clinical manifestations of NAFLD (24 men and 14 women). Patients of the main group were divided into 3 subgroups, taking into account the predominant pathological processes in the clinical picture. The division into subgroups was carried out in 2 stages: at the first stage, those with predominant manifestations of liver fibrosis (F2 or more) were selected from the general population of patients with Type 2 diabetes with NAFLD according to the results of liver elastography and the use of Bonacini and Metavir scales. The number of such patients was 29, which accounted for 40.3% of the total number of patients in the main group. The remaining patients were divided into 2 subgroups: 11 patients (15.3%) had non-alcoholic liver steatosis, and 32 patients (44.4%) had signs of non-alcoholic steatohepatitis (NASH). As a result of the study, it was found that the presence of liver fibrosis in patients with Type 2 diabetes with NAFLD is significantly more often associated with cardiovascular complications, such as arterial hypertension, coronary heart disease, myocardial infarction, stroke, diabetic retinopathy and nephropathy. A significant decrease in the ejection fraction (EF) was found in patients with Type 2 diabetes with concomitant NAFLD. At the same time, the number of patients with EF disorders of varying degrees in the main group significantly exceeded that in the comparison group (33.3% and 6.7%, respectively, p<0.001). The average values of left ventricular myocardial mass are significantly lower in patients with NASH and fibrosis formation compared to patients with NAFLD at the stage of fatty hepatosis. There was also a significant decrease in the size of the left and right atria in patients with NASH compared to both patients with steatosis and patients with fibrotic liver changes. Patients with predominant fibrotic changes in the liver are characterized by a relative decrease in myocardial mass, a decrease in final diastolic and systolic volumes and EF, which may indicate the development of diastolic dysfunction in them. It is shown that it is necessary to take into account in clinical practice not only the generally accepted stages of NAFLD, but also the predominant pathological process in the liver in patients with Type 2 diabetes, namely steatosis, manifestations of inflammation and fibrotic disorders. It is proved that fibrotic changes in the liver can develop at all stages of liver tissue damage.
Key words: high and low grade prostate intraepithelial neoplasia, prostate cancer, malignant transformation
Abstract. Clinical significance of high grade and low grade prostate intraepithelial neoplasia. Melnychuk M.P. Such premalignant conditions of prostate cancer (PC) as prostate intraepithelial neoplasia (PIN) are classified between benign and malignant ones. Contemporary evidence wheather PIN develops malignancy is limited and (LGPIN) data present varied results. Morphological and clinical differencies between high (HGPIN) and low grade PIN specimens in the prostate remain unclear. Aim of the work – to determine clinical significance and progression ability of high grade and low grade prostate intraepithelial neoplasia. The results of examination of 276 patients with PIN (152 patients with high grade PIN and 134 patients with low grade PIN) were assessed comparatively. During a 3 year follow-up repeated prostate biopsies were performed with 6 months interval to detect PC. Initial and repeated multifocal transrectal prostate biopsies from 12 samples were performed under transrectal ultrasonic guidance. There were statistically significant differences in PC detection rates between HGPIN and LGPIN. Patients with HGPIN had malignization rate of 42.1% during a 3-year follow-up that was by 33.9% higher than in LGPIN patients. The spread of HGPIN lesions within prostate gland is a malignization risk factor. The mean malignization term of HGPIN is 18 months and of LGPIN – 30 months. Low and high grade PIN are gradual stages of cancerogenesis. PIN grade determines its clinical significance, while LGPIN has low malignization potential, HGPIN possesses morphological and clinical prostate characteristics similar to adenocarcinima.
Key words: public health, personnel, higher medical education, competence
Abstract. Prospects for healthcare personnel training in the public health system of Ukraine. Khomenko I.M., Ivakhno O.P., Pershehuba Ya.V., Piven N.V. Purpose: scientific substantiation of training of medical personnel for the public health system of Ukraine. During 2017-2020, the Department of Public Health conducted a systematic analysis of public health staffing in Ukraine, developed countries and Europe. For the first time, a model of formation of specialists' competencies for the public health system of Ukraine in the postgraduate education program with a multidisciplinary approach to training is substantiated and developed, which includes such disciplines as epidemiology, hygiene, medical statistics, laboratory diagnostics, information technology, legal law and others. This enables to reveal the tools and methods of system management, improve the availability and quality of work during the formation and development of the industry. The need for medical education for public health specialists who are ready to perform basic operational functions to preserve and strengthen the health of the population of Ukraine has been established. For the first time, methodological approaches to the improvement of higher medical education at the undergraduate and postgraduate levels have been scientifically substantiated, taking into account modern requirements for the functioning of the public health system; competence models of the public health specialist in modern conditions of realization of his activity are created; standards of higher education at the first (bachelor's) and second (master's) levels in the specialty 229 “Public health” in the field of knowledge 22 “Health Care” have been developed.
Key words: school-age children, indicators of physical development, type of activities, summer time
Abstract. The impact of summer holidays on the physical development of school-age children. Danylenko H.M., Cherniakova G.M., Merkulova T.V., Avdiievska O.H. The aim of the work was to investigate how gender, age and type of activity in summer affects the indicators of physical development (PD) of children. 1054 students (493 boys and 561 girls) aged 7-16 years took part in the study. The PD of children was studied by assessing somatometric and physiometric indicators. To assess the impact of the type of activity, a thematic questionnaire "Summer" was used. It was found that the gender and age of children had a significant effect on PD indicators in the summer. The most intense increase in body length occurred at the age of 7-12 years, body weight - in 10-14-year-olds, and up to 16 years grouth of two parameters gradually slowed down. From the age of 10, children showed a positive increase in lung capacity (LC). In 15-year-old adolescents, a decrease in both indicators (ChC and LC) was found. It was found that 62% of children carried out educational activities in the summer, 24% of those were engaged in business activities, almost 40% of students were participants in hiking trips and 23% of children attended a children's health camp. The chosen type of activity in the summer influenced the indicators of the pupils' PD as follows: educational activities were accompanied by a decrease in body length and strength of the left arm, business activity, hiking trips and staying in a health camp were accompanied by an increased weight gain and an increase in LC.
Key words: rehabilitation, efficiency, rehabilitation profile, international classification of functioning
Abstract. Evaluation of efficiency of individual complex rehabilitation of patients based on the international classification of functioning. Ipatov A.V., Sanina N.A., Khanyukova I.Y. In order to determine the possibility of using a rehabilitation profile to assess the effectiveness of rehabilitation and develop a methodology for quantifying the effectiveness of rehabilitation measures in the short term in inpatients of the State Institution "Ukrainian State Research Institute of Medical and Social Disability of the Ministry of Health of Ukraine" we created a rehabilitation profile of the patient based on the principles of the International Classification of Functioning, Disability and Health (ICF). There were analyzed rehabilitation profiles of 522 patients with therapeutic pathology, musculoskeletal system diseases, and eye diseases. Rehabilitation of patients was comprehensive, with the use of methods of medical, psychological, and physical rehabilitation. The severity of dysfunctions was assessed by a quantitative scale from 0 to 4 points, where "0" – no issues, and "4" – extremely serious issue. The evaluation was performed twice by members of the multidisciplinary team: at the initial examination of the patient and at the discharge from the clinic. The statistical method and the method of expert evaluations were used to process the research results. The licensed software MS Excel for Windows was used. The study found that the proposed method of assessing the effectiveness of short-term rehabilitation is accurate and objective, it considers the initial functional status of the patient and allows to assess the quality and effectiveness of rehabilitation measures at the patient level and at the institution. Its implementation will provide a unified approach to the provision of rehabilitation services and draw conclusions about the effectiveness of rehabilitation activities of the medical institution differentially, considering the type of pathology, leading limitations of life, severity of disorders, age of patients.
Key words: dermatomycoses, dermatophytes, fungal infections, onychomycosis, keratomycosis
Abstract. Performance results of the improved working classification of superficial mycoses of the skin in carrying out their clinical and epidemiological monitoring. Ahmedova S. The results of testing of the improved working classification of superficial mycoses of the skin and its appendages (SMS) in the Republic of Azerbaijan for the period of 2012-2016 are presented. Given the variety of classifications of fungal skin diseases, many years of clinical experience have shown that none of them fully meets the requirements of a practicing physician. The author has developed and improved the classification of mycoses of the skin and its appendages, which will facilitate the diagnosis and the appointment of therapy, since this classification takes into account the tissue and topographic localization of the mycotic process, which greatly facilitates the diagnosis by dermatovenerologists, and will also reveal the true prevalence of mycotic pathology. Based on the traditional form No. 9, among 246 cases of superficial mycoses of the skin and its appendages identified in the city of Baku for the period of 2012-2016, the largest number of patients (79.44±2.6%) were diagnosed with mycoses of the scalp – 32, 52±1.21%, smooth skin mycoses – 30.08%±1.28 multi-colored lichen – 14.80%±1.01, which corresponds to the frequency of occurrence of these forms of SMS at the age of 11-20 years (44.01±3,1%) and 0-10 years (39.08±3.1%), leaders in the age line of groups with SMS in Baku. A reliable statistical difference was revealed in the detection of superficial mycoses of the skin and its appendages in the city of Baku during the study period. Based on the developed working classification, the nosological structure of the incidence of SMS in the city of Baku for the period 2012-2016 is represented by the following – 1919 episodes: mycoses of the scalp – 675 patients (35.17±1.1%); mycoses of smooth skin – 638 patients (33.25±1.1%); multi-colored lichen – 264 patients (13.76±0.8%); combined mycoses of smooth skin and scalp – 134 patients (6.98±0.6%); onychomycoses – 97 patients (5.05±0.5%); purulent-infiltrative form of mycoses – 66 patients (3.44±0.4%); skin candidiasis – 19 patients (0.99±0.2%); feet of the mycoses – 19 patients (0.99±0.2%); inguinal epidermophytosis – 7 patients (0.36±0.1%). The prevalence of nosologies preserved in the largest number of patients (1578 patients – 82.23±0.9%), mycoses of the scalp – 35.17±1.1% (675 patients), smooth skin mycoses – 33.25±1.1% (638 patients), multicolored lichen – 13.76%±0.8 (264 patients). The greatest number of patients with SMS was also detected in the age group of 11-20 years (42.12±3.1%) and 0-10 years (40.32±3.1%). The data of a comparative analysis of the results of the developed and improved classification of superficial mycoses of the skin and its appendages with the data of the traditional reporting form, made it possible to expand the scope of the analyzed nosologies and increase the objectivity of statistical data for assessing the epidemiological situation in the study region.
Key words: forensic medical evaluation, medical care, defect, acute blood loss, death
Abstract. Evaluation of the quality of medical care in cases of death from acute blood loss (according to data of forensic-medical examinations). Pletenetska A.O., Demchenko I.S., Ergard N.M. The peculiarities and specificity of the medical field complicate not only the assessment of quality and timeliness of medical care, but also the correctness of the choice of the method of treatment and diagnosis of the disease. The number of forensic medical examinations in «medical cases» has the tendency to increase, and experts in this case face difficulties with forensic medical assessment of medical care provision. Forensic medical analysis of the medical care provision to patients who died of acute blood loss, based on examinations of different forensic medical bureaus of Ukraine has been analyzed. The aforementioned examinations related to the corpses of people who died as a result of acute blood loss, including shock (150 from the total number of 6129 medical examinations were selected). This cause of a death was chosen as one of the leading causes of death in trauma (including a combination with shock). When evaluating gross medical care defects that were found during the examinations that influenced the result, 40.0% (60) – in the form of improper provision (action) were noted in 10 cases (the case of incorrect diagnosis made by the doctors due to underestimation of examination data), defects in the form of non-provision of medical care (inactivity) – in 83.3% (15 cases). In the statistical analysis of defects in the provision of medical care, the majority of cases were connected with delayed provision of medical care – 41,7%. Defects in cases of blood loss were under the following conditions: a) lack of instrumental research, medical treatment and surgery, b) lack of medical treatment and surgery by indications (each of 3,3%). When considering the reasons that led to defects in cases of blood loss, the isolated underestimation of the examination data was in 16,7% (25), a combination of reasons: a) underestimation of the examination data together with the underestimation of additional research data – 16,7% (25); b) underestimation of the examination data together with the negligent attitude to the patient who had a sloppy appearance – 6,7%. The unprofessional nature of the medical staff was in 16,7% of acute blood loss. When providing medical care in cases of death from acute blood loss, defects in the provision of medical care are made by experienced medical professionals in city hospitals (especially large cities of Ukraine), where there are adequate conditions for the provision of medical care, more qualified specialists of different profiles, and there are protocols for providing medical care in acute blood loss.
Key words: bladder cancer, prevalence, morbidity, occupational health examination, indicators of specialized care delivery
Abstract. Bladder cancer: features of epidemiology and indicators of specialized care delivery. Saidakova N.O., Yatsina О.І., Grodzinsky V.I., Stus V.P., Polion M.Y., Shiloh V.M., Коnonova G.E. The work is based on the materials of official statistical reporting, the analysis of which was carried out for 10 years, divided into two five-year periods (2009-2013 and 2014-2018). Absolute and intensive rates of morbidity and distribution of bladder cancer of the adult population of Ukraine in the regional aspect, taking into account sex were studied, the basic indicators of the prevalence of pathology were analyzed as well. The revealed unfavorable situation is characterized by a steady increase in morbidity and prevalence at a slower pace during 2014-2018. It is noteworthy the high level of morbidity in men, which is growing against the background of its stabilization among women. At the same time, there was noted the tendency in the reduced number of newly diagnosed patients during professional examinations (in 2018-16.9% against 18.0% in 2014) with diagnosis at stages I-II (72.2% vs. 74.79%), wherein every fifth has stage III-IV. With a tendency to increase in the number of registered patients ≥ 5 years (59.1% vs. 56.5%), the death rate did not change significantly within a year from the time of diagnosis (14.7% vs. 15.6%, respectively). In the structure of specialized care, (65% are patients with the first diagnosis), surgical method accounted for 37-40% by years, the combined was second (up to 20% by years), then radiation and chemotherapy, which together did not exceed 5.0%. Areas with high or low relative rates in relation to the average Ukrainian indicators for all parameters studied were identified. In the presence of regional differences, there is a need for in-depth studies of the state of the issue, including the quality and organization of care.
Key words: changes, healthcare problems, diabetic retinopathy, epidemiological characteristics, least squares method
Abstract. Comparative assessment of changes in the incidence of type I diabetes mellitus in the regions with its high and low incidence. Aliyeva I.J. The purpose of this study was to determine dynamics of the levels of type I diabetes mellitus (DM) incidence in the regions with its different incidence. Material from the Azerbaijan Republican and Regional Registers of Diabetes Mellitus were used in this study. All cases of newly diagnosed type 1 DM and documented according to the clinical protocol in 2012-2016 were selected. At the first stage of the study, the rates of diabetes were identified in all administrative-territorial entities. Two groups from administrative-territorial entities were formed for further observation: the first group included regions with high (>80) incidence of type 1 DM, the second group included regions with low (<40) incidence of type 1 DM. At the next stages, changes in type 1 DM incidence were studied and a mean chronological incidence over five years (2012-2016) was determined. Morbidity rate in cities and regions of Azerbaijan in 2012 changed within a range from 5.4 to 294.8. The lowest incidence was observed in three districts: 5.4 in Agjabedi, 5.8 in Jalilabad, 6.1 in Masalli. Very high incidence was observed in Shamkir (294.8) and Khachmaz (278.7) districts. Data from Agdash (30.6) and NAR (32.2) were closer to data from the districts with low incidence. Incidence in Shirvan (81.9) and Yexlakh (171.7) districts was high, but lower than in Shamkir and Khachmaz districts. Type 1 DM incidence has significant interregional differences. Interregional differences in type 1 DM incidence do not depend on the age of the population; age-adjusted incidence of type 1 DM is within a range of 5.0-77.4.
Key words: mental health’s protection, attitude to health, psychiatrists, nursing staff
Abstract. Attitude of health care workers in the field of mental health to their health. Chorna V.V., Makhniuk V.M., Khliestova S.S., Gumeniuk N.I., Chaika H.V. The article presents the results of theoretical and experimental studies of the degrees of value-motivational, cognitive, emotional, and behavioral components in health care workers of psychiatric health care facilities concerning their health. The degree of risk and value of the personal hygiene of health care workers is determined. The main components and factors that affect the attitude to personal health are revealed. The awareness of the own emotional and cognitive experiences by the medical staff of psychiatric hospitals regarding the preservation and strengthening of their hygiene is analyzed. According to research on the value-motivational component of the medical staff of psychiatric health care concerning the place of personal health in the hierarchy of values in life, it was found that own health is on the second place – 15.2% males, nursing staff (NS), 15.1% females, are psychiatrists and women NS, 14.8% are men psychiatrists. In case of a deterioration of own health both women (35,6%), and men (35,5%) psychiatrists are engaged in self-treatment, the similar tendency is among NS – women NS – 31,3%, men NS – 31, 5%), in 25.8% of cases female psychiatrists and in 23.1% of men NS do not pay attention to the disease at all, which leads to occupational diseases and chronic diseases. At the same time, occupational diseases among doctors and NS do not exceed 10% of the total number of occupational diseases in Ukraine due to self-medication and early treatment. Therefore, the statistics of occupational diseases of health workers in that field are underestimated compared to the actual ones.
A CASE FROM PRACTICE
Key words: pulmonary embolism, thrombophilia, low risk patient
Abstract. Genetic testing for thrombophilia in case of unprovoked episode of pulmonary embolism. Kirieieva T.V., Pertseva T.A., Kravchenko N.K., Basina B.O. Venous thromboembolism (pulmonary embolism (PE) and deep vein thrombosis (DVT)) is the third among all cardiovascular syndromes in the world, second only to heart attack and stroke. Estimation of clinical probability of this condition takes into account many factors, including age. But in case of PE probability in young patient data of scales such as Geneva Score (Revised), Wells' criteria for pulmonary embolism, the PERC rule may be misleading. For this group a new influential factor emerges – thrombophilia. The aim of our work was to demonstrate the approach to identifying whom and when to test for genetic predisposition for thrombosis, based on a clinical case of young male with unprovoked episode of PE. Testing patients for thrombophilia is a good way to develop a personalised approach in case of prescribing long-term anticoagulant treatment. Moreover, patient’s awareness about congenital condition helps to increase complience which is crucial, due to the fact that in case of unprovoked pulmonary embolism another episode can occur in up to 50 % of cases during the next 5 years. In addition, further accumulation and analysis of data on the amount of genetic risk factors for thrombosis will expand our understanding of this issue and in the future will allow us to better diagnose and treat this condition.
Key words: orphan disease, rehabilitation, therapeutic intervention, massage, physical therapy, verticalization
Abstract. A clinical case of physical therapy of a child with multiple sulfatase deficiency. Grygus I.M., Nagorna O.B., Nesterchuk N.E., Nogas A.O., Podoliaka P.S., Gamma T.V. The article deals with the problems of physical therapy in children with multiple sulfatase deficiency (MSD). The purpose of the study presented in the article was to substantiate the need to form a structured, personalized comprehensive rehabilitation program for children with multiple sulfatase deficiency. The objectives of the study were to analyze the literature on the topic of the study, to study the clinical phenotype of multiple sulfatase deficiency and potential complications of this pathology, to justify the use of physical therapy in children with multiple sulfatase deficiency. Research methods: analysis of scientific and methodological sources of domestic and foreign authors, pedagogical observation, collection of anamnestic information of the patient. The publication discusses the clinical phenotype of genetic pathology and possible potential complications of this orphan disease, strategic vectors of an individual rehabilitation program. The description of a clinical case of late infantile form of the disease is presented. The effectiveness of a six-months’ implementation of the physical therapy program is being investigated. For rehabilitation examination of children with MSD, it is proposed to use testing of children with psychomotor disorders. The technique of massage, the appropriateness of verticalization and orthotics, sensory enrichment of the environment of a child with this genetic pathology are revealed. Exercises of therapeutic physical culture are proposed, they will help to maintain postural control, support ability and functioning of arms, legs, hand-eye coordination, and help prevent diseases of the bronchopulmonary system. It is noted that MSD has been insufficiently studied not only from the standpoint of a treatment strategy, diagnostic algorithms for clinical multisystem manifestations, but also requires attention to analyze the effectiveness and efficiency of the system of modern rehabilitation technologies for children with this diagnosis.
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