Wiadomosci lekarskie最新文献

Objective: Aim: To determine the economic feasibility of using kidney transplantation compared to hemodialysis in end-stage renal disease in the long term in countries with a low and medium level of economic development using the example of Ukraine.

Patients and methods: Materials and Methods: The cost effectiveness analysis method was used. Conducted Markov modeling and comparison of the consequences of kidney transplantation and hemodialysis in terms of treatment costs and the number of added years of life for a cohort of 1,675 patients were carried out. The incremental cost-effectiveness ratio is defined.

Results: Results: Based on the results of modeling, it was determined that among 1,675 patients with end-stage kidney disease in Ukraine, 1,248 (74.5%) will remain alive after 10 years of treatment when kidney transplantation technology is used. The highest costs will be in the first year ($25,864), and in subsequent years - about $5,769. With the use of hemodialysis technology, only 728 patients (43.5%) will be alive after 10 years, the cost of treating one patient per year is $11,351. The use of kidney transplantation adds 3191 years of quality life for 1675 patients compared with hemodialysis (1.9 years per patient).

Conclusion: Conclusions: Kidney transplantation is an economically feasible technology for Ukraine, as the incremental cost-effectiveness ratio is $4694, which is 1.04 times higher than Ukraine's GDP per capita. The results of the study allow us to recommend that decision-makers in countries with a low and medium level of economic development give priority in financing to renal transplantation.

Objective: Aim: The aim is to identify features of theoretical and empirical research of academic integrity as characteristics of the educational environment of medical higher education institution (hereinafter - HEI).

Patients and methods: Materials and Methods: A complex of general scientific methods: logical-analytical, dialectical, theoretical-logical, comparative analysis, formalization and generalization, as well as quantitative sociological methods for collecting, processing and analyzing information. The object of the pilot empirical study were domestic medical students of full-time education at the Bogomolets NMU (N=472) and scientific and pedagogical staff who provide teaching of fundamental, specialized and socio-humanitarian disciplines at the university (N=153).

Results: Results: The values of academic integrity are the moral guideline that reveals the latest ethical demands of society and regulates the educational and scientific activities of all participants in the educational process. Opinions on the primary responsibility for compliance with the rules of academic integrity of a student differ between the surveyed scientific and pedagogical staff and students (p=0.000): the vast majority of the surveyed scientific and pedagogical staff tend to evenly divide the responsibility between a teacher and a student, and the majority of students-respondents noted that the student bears the primary responsibility.

Conclusion: Conclusions: Commitment to the principles of integrity motivates both students and teaching staff to act in an academic manner. Therefore, the creation of a methodology for studying the phenomenon of academic integrity in medical higher education institution through the study of attitude of the subjects of educational process to basic values is promising.

Objective: Aim: To study the spiritual health in existential dimensions, as well as the meaning, value, and emotional components of spiritual health of Ukrainians under the wartime.

Patients and methods: Materials and Methods: The theoretical and methodological framework of the paper is represented by the works of scholars in classical existentialism, contemporary philosophers, psychologists, medical psychologists, theologians, sociologists, etc. The complex nature of the issue necessitated the use of interdisciplinary approaches, philosophical, general scientific and special sociological methods of gathering, processing and analyzing information.

Results: Results: The article analyzes the perception of spirituality and spiritual health related to mental and social aspects in the philosophy of classical existentialism and existential-humanistic psychology. The paper justifies the heuristic potential of these approaches for maintaining spiritual health of Ukrainians, which is based on holistic approaches to human beings and their spiritual frames. The article represents the results of sociological research by the Institute of Sociology of the National Academy of Sciences of Ukraine, the Scientific Research Institute of Social and Economic Development of the City, and a survey of the PhD students of the Bogomolets National Medical University (N=103) made by the authors, representing the results of statistical treatment of the spiritual health characteristics: emotional, value and meaning components.

Conclusion: Conclusions: The study has shown that the deterioration of mental health indicators of Ukrainians during the war is not accompanied by corresponding negative trends in their spiritual health. However, further research on this issue is necessary, including studies among respondents from other age groups (faculty, staff of the Bogomolets National Medical University).

Objective: Aim: Studying of psycholinguistic features of doctors' communication competence in Ukraine under war conditions.

Patients and methods: Materials and Methods: Bibliosemantic method; method of system analysis, comparison and generalization; empirical methods - direct observation of the doctors' and patients' living language, typology of empirical data according to socio-demographic indicators.

Results: Results: Within the study, 286 dialogues were collected. With voluntary consent, they were recorded in video and audio formats in compliance with ethical, bioethical, and legal norms. Next, initial typology of dialogues, their lexical and semantic analysis with identification of typical positive and negative communicative strategies were carried out. With the help of the ≪Textanz≫ specialized computer software, 48 dialogues were subjected to the content analysis procedure for two separate ≪Doctors≫ and ≪Patients≫ samples.

Conclusion: Conclusions: The results of the analysis of ≪Doctor-Patient≫ dialogues enabled identifying and describing psycholinguistic markers of typical physiological, mental, social, and spiritual states of individuals seeking medical help under martial law. Thus, the markers of positive emotional states (optimism, confidence, empathy, etc.) and affective, negative emotional processes (anxiety, fear, anger, aggression, sadness, depression, etc.) were identified.

Objective: Aim: to review information resources and analysis of the own experience on this problem for the provision of modern knowledge in the pathogenesis of the pathology, the latest diagnostic and treatment technologies, with consideration of the need to adhere to a single strategy in the management of patients with BA.

Patients and methods: Materials and Methods: The analysis of the data regarding the results of existing studies evaluating the clinical benefit and safety of diagnostic and treatment methods in Biliary atresia.

Conclusion: Conclusions: BA is the leading cause of neonatal cholestasis development. Early diagnostics of BA, based on the complex evaluation of clinical-laboratory, instrumental and morphological signs of the pathology, has a significant meaning. Surgical correction during the first 2 months of life - the Kasai procedure, as well as dynamic post-surgery follow-up significantly prolong the life of children and allow postponing liver transplantation. The highest patient survival both at the first stage of treatment - conduction of the Kasai procedure and the stage of liver transplantation may be achieved by joined work of surgeons and pediatricians, which allows considering the whole row of possible problems.

Objective: Aim: To identify potentially adverse characteristics of atherosclerotic carotid plaque in terms of stroke risk.

Patients and methods: Materials and Methods: The study is based on the analysis of US data obtained from 96 patients aged 47 to 84 years diagnosed with carotid stenosis. The patients were divided into 2 groups depending on the presence or absence of ischemic events. Examination methods: clinical, duplex US, brain MRI, statistical. In addition to the standard US criteria for the evaluation of carotid stenoses, superb microvascular imaging (SMI) and shear wave elastography (SWE) are used.

Results: Results: Statistically significant association of the following characteristics of plaques with the presence of ipsilateral ischemia focus was established: maximum thickness (p = 0,04), presence of microvascularization according to SMI data (p = 0,02), degree of carotid stenosis (statistically significant in the right carotid circulation [p = 0,04]), stiffness of the plaque according to SWE data (significantly in the right carotid circulation [p = 0,001]), type of plaque echogenicity according to Gray-Weale-Geroulakos classification (on the right carotid artery; p = 0,04).

Conclusion: Conclusions: The presence of microvascularization according to SMI data and the low stiffness of the plaque according to SWE data can characterize the potential instability of the carotid plaque. These criteria should be added to the traditional US assessment of carotid plaques.

Objective: Aim: To characterize the features of the interrelation of systemic inflammation with the quality of life of patients with coronary virus disease.

Patients and methods: Materials and Methods: 30 patients were examined 1 month after inpatient treatment for COVID-19. Quality of life (QoL) of patients was determined according to the questionnaire Medical Outcomes Study - 36-item Short Form (SF-36). The glucose level, circulating immune complexes (CICs), concentration of immunoglobulin (Ig) A, interleukin (IL)-8 and IL-33 levels were determined in the blood serum of patients.

Results: Results: QoL of patients after coronavirus disease is significantly deteriorated: patients note a significant limitation in physical functioning, pain perception, vitality, role-physical and social functioning and mental health. The increase in glycemia and glycated hemoglobin levels in post-COVID-19 patients was significantly associated with the deterioration of patients` general health (GH) (r = -0,228; (p=0,040) and (r = -0,280; (p=0,014), respectively). The IL-33 concentration in such patients correlated directly with role-physical functioning (RP) (r = 0,385; p=0,029). The CICs level decline was associated with deterioration of RP (r = 0,227; p=0,042) and GH (r = 0,227; p=0,041).

Conclusion: Conclusions: The study of clinical-functional, biochemical, immunological and psychological indicators, quality of life, and their mutual influences should be included in the development of the program for the diagnosis, treatment, and rehabilitation of patients after the transfer of COVID-19 at the outpatient stage of treatment by doctors of general practice-family medicine.

Objective: Aim: This study aimed to examine the characteristics of upper limb and shoulder injuries combined with chest trauma in road accident victims and evaluate the effectiveness of telemedical monitoring and a newly developed telerehabilitation model in patient recovery.

Patients and methods: Materials and Methods: Our study incorporated 136 medical records of inpatients who had sustained upper extremity and chest injuries, constituting a retrospective group. Additionally, in the main group, we included 73 patients with similar injuries of the upper extremity and chest.

Results: Results: We analyze the functional results between the retrospective group and the main group, providing valuable insights into the effectiveness of traditional rehabilitation versus telerehabilitation. Focusing first on the average time spent on rehabilitation exercises per day, we observe a noticeable difference: while the retrospective group dedicated an average of 29}8 minutes daily, the main group invested more time, averaging 42}4 minutes. The retrospective group reported an average of 12}2 visits, in stark contrast to the main group, which averaged only 4}2 visits. The rehabilitators spent considerably less time with each patient in the main group (92}14 minutes) compared to the retrospective group (263}15 minutes), with a significant difference (p<0.005). The discovery in our study that there was no notable statistical difference in the functional outcomes, as evaluated by QuickDASH scores, between patients undergoing telerehabilitation and those receiving traditional rehabilitation is of significant importance.

Conclusion: Conclusions: The findings reveal that telerehabilitation can significantly increase patient engagement in rehabilitation exercises, primarily due to its convenience and accessibility.

Objective: Aim: To describe and evaluate abnormalities of the brain in post-COVID patients with neurologic symptoms and cognitive deficits using MRI imaging of the brain.

Patients and methods: Materials and Methods: We included 21 patients with a previous positive PCR testing for SARS-CoV-2 and one or more of the following symptoms: memory and cognitive decline, dizziness, anxiety, depression, chronic headaches. All patients had MRI imaging done at onset of symptoms, but after at least 1 year after positive testing for COVID-19 based on the patient's previous medical history.

Results: Results: All of the patients complained of lack of concentration, forgetfulness, hard to process information. 15 patients suffered from confusion, 10 from anxiety. Of the 21 patients 14 had isolated chronic headaches, 3 had isolated dizziness, 4 patients had both symptoms upon inclusion. All patients underwent MRI imaging as a part of the diagnostic workup and had varying degrees of neurodegeneration.

Conclusion: Conclusions: Our data correlates with existing research and shows tendency for cognitive decline in post-COVID patients. This provides groundwork for further research to determine correlation between acceleration of neurodegeneration and post-COVID.

Objective: Aim: To assess the initial results of using 3 Tesla contrast-enhanced breast magnetic resonance imaging in Ukraine.

Patients and methods: Materials and Methods: Our study included 498 diagnostic breast magnetic resonance imaging performed in Neuromed medical center in Kyiv, between March 2020 and December 2022. Patients were positioned prone, with breasts suspended in a dedicated 7-channel bilateral breast coil. MR-images were acquired with the PHILIPS Achieva 3.0Tesla x-series scanner. All studies were made by standard protocol: localizer, morphological and dynamic studies were performed.

Results: Results: Our study revealed a statistically significant increase in problem-solving contrast-enhanced breast magnetic resonance examinations compared to other indications. Additionally, we observed a higher incidence of women with a greater amount of fibroglandular tissue (p-value<0.05).

Conclusion: Conclusions: The utilization of 3Tesla contrast-enhanced breast magnetic resonance imaging has become prevalent in Ukraine as a problem-solving tool for inconclusive findings in ultrasound (US) or/and mammography (MG). It is particularly useful in preoperative local breast cancer staging for women with a significant amount of fibroglandular breast tissue. However, the implementation of breast magnetic resonance imaging in Ukraine is in its nascent stages and requires further investigation, especially in middle-income country settings.