Pub Date : 2022-08-23DOI: 10.31612/2616-4868.3(21).2022.02
O. Kovalenko, O. Lytvyn, B.G. Gavrishchuk
The article examines a clinical case of Wernicke's encephalopathy in a 34-year-old man who abused alcohol. The initial impression of the patient's condition was suspected of poisoning by surrogate alcohol, botulinum toxin, multiple sclerosis, Lyme disease, acute multiple encephalomyelitis, etc., because the anamnestic data on alcohol abuse could not be detected immediately. Specific triad of clinical manifestations - cognitive decline, ocular symptoms (nystagmus, diplopia, ptosis), ataxia, which appeared after alcohol abuse, specific changes on MRI (revealed damage to the thalamus with dilated ventricles and loss of density in mammillary bodies. As a rule, symmetrical in the midbrain, hypothalamus and cerebellum. Blood test for vitamin B1 confirmed the diagnosis.Treatment with vitamin B1 caused regression of symptoms, improved the patient's condition.Additional methods (history, cerebrospinal fluid analysis, blood for thyroid hormones and infectious pathogens) contributed to the differential diagnosis and exclusion of other diagnoses. Further in the article the analysis of clinical thinking in the process of diagnosis and differential diagnosis, establishment of this diagnosis in the historical aspect, unity and differences with Korsakov syndrome, epidemiological, pathogenetic, clinical, prognostic and treatment-and-prophylactic aspects of Wernicke's encephalopathy are presented.
{"title":"Uncommon diseases of the brain in the practice of a neurologist and family doctor: Wernicke's encephalopathy (clinical analysis and differential diagnosis)","authors":"O. Kovalenko, O. Lytvyn, B.G. Gavrishchuk","doi":"10.31612/2616-4868.3(21).2022.02","DOIUrl":"https://doi.org/10.31612/2616-4868.3(21).2022.02","url":null,"abstract":"The article examines a clinical case of Wernicke's encephalopathy in a 34-year-old man who abused alcohol. The initial impression of the patient's condition was suspected of poisoning by surrogate alcohol, botulinum toxin, multiple sclerosis, Lyme disease, acute multiple encephalomyelitis, etc., because the anamnestic data on alcohol abuse could not be detected immediately. Specific triad of clinical manifestations - cognitive decline, ocular symptoms (nystagmus, diplopia, ptosis), ataxia, which appeared after alcohol abuse, specific changes on MRI (revealed damage to the thalamus with dilated ventricles and loss of density in mammillary bodies. As a rule, symmetrical in the midbrain, hypothalamus and cerebellum. Blood test for vitamin B1 confirmed the diagnosis.Treatment with vitamin B1 caused regression of symptoms, improved the patient's condition.Additional methods (history, cerebrospinal fluid analysis, blood for thyroid hormones and infectious pathogens) contributed to the differential diagnosis and exclusion of other diagnoses. \u0000Further in the article the analysis of clinical thinking in the process of diagnosis and differential diagnosis, establishment of this diagnosis in the historical aspect, unity and differences with Korsakov syndrome, epidemiological, pathogenetic, clinical, prognostic and treatment-and-prophylactic aspects of Wernicke's encephalopathy are presented.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-23DOI: 10.31612/2616-4868.3(21).2022.07
S.M. Fasakhova, V.I. Horoshko
Absract. Having analyzed the data of scientific and methodological literature, information was presented on the status and topical trends in the development of physiotherapy. The principle of action, the effect on the human body, the main indications and contraindications of various methods of physiotherapy are considered. Nowadays, interest in methods of exposure to physical factors is growing significantly. This is due to the safety and availability of non-drug treatments. Of course, the importance of drug therapy cannot be denied. However, there are many contraindications to the use of drugs, including allergies and drug intolerances. In such cases physiotherapy as a method becomes one of the most important. The article presents data on the principle of magnetic stimulation, in particular transcranial magnetic stimulation, magnetic therapy and functional magnetic stimulation. Transcranial magnetic stimulation allows non-invasive action on the cerebral cortex with short-term magnetic impulses. The method of magnetic therapy is based on the effect of a magnetic field (constant or variable) on the human body. Using this technique it is possible to achieve analgesic, anti-inflammatory and anti-edematous effect. Functional magnetic stimulation is a unique method of nerve myostimulation that allows to affect the deepest muscles, inaccessible to other forms of action in the patient's body. Also TEСAR-therapy is considered: an approach that stimulates the regeneration and recovery of muscles with high-frequency electric stream that penetrates the tissues with electromagnetic waves and generates heat. The principle of action on the human body of the most common electrophysical device, therapeutic ultrasound, was analyzed. Ultrasound therapy can affect almost all body systems and has physicochemical, mechanical and thermal effects. Vibrotraction therapy (traction, spinal traction), which has an instant analgesic and long-term therapeutic effect on areas of spinal lesions, also has been analysed. In addition, the article concludes on the viability of physiotherapy techniques and the need for their improvement.
{"title":"MODERN DIRECTIONS OF PHISIOTHERAPEUTIC TREATMENT","authors":"S.M. Fasakhova, V.I. Horoshko","doi":"10.31612/2616-4868.3(21).2022.07","DOIUrl":"https://doi.org/10.31612/2616-4868.3(21).2022.07","url":null,"abstract":"Absract. Having analyzed the data of scientific and methodological literature, information was presented on the status and topical trends in the development of physiotherapy. The principle of action, the effect on the human body, the main indications and contraindications of various methods of physiotherapy are considered. \u0000Nowadays, interest in methods of exposure to physical factors is growing significantly. This is due to the safety and availability of non-drug treatments. Of course, the importance of drug therapy cannot be denied. However, there are many contraindications to the use of drugs, including allergies and drug intolerances. In such cases physiotherapy as a method becomes one of the most important. \u0000The article presents data on the principle of magnetic stimulation, in particular transcranial magnetic stimulation, magnetic therapy and functional magnetic stimulation. Transcranial magnetic stimulation allows non-invasive action on the cerebral cortex with short-term magnetic impulses. The method of magnetic therapy is based on the effect of a magnetic field (constant or variable) on the human body. Using this technique it is possible to achieve analgesic, anti-inflammatory and anti-edematous effect. Functional magnetic stimulation is a unique method of nerve myostimulation that allows to affect the deepest muscles, inaccessible to other forms of action in the patient's body. Also TEСAR-therapy is considered: an approach that stimulates the regeneration and recovery of muscles with high-frequency electric stream that penetrates the tissues with electromagnetic waves and generates heat. The principle of action on the human body of the most common electrophysical device, therapeutic ultrasound, was analyzed. Ultrasound therapy can affect almost all body systems and has physicochemical, mechanical and thermal effects. Vibrotraction therapy (traction, spinal traction), which has an instant analgesic and long-term therapeutic effect on areas of spinal lesions, also has been analysed. In addition, the article concludes on the viability of physiotherapy techniques and the need for their improvement.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.03
V. I. Chernіy, A. Denysenko
It is important to study changes in metabolism in patients with acute calculus cholecystitis (ACC) during laparoscopic cholecystectomy and to find ways to correct them. The aim of the study. To study the perioperative metabolism in ACC patients and evaluate the possibilities of its correction. Materials and methods. The study was prospective, not randomized. 129 patients with ACC, aged 36-84 years (54 men, 75 women), who underwent laparoscopic cholecystectomy, were studied. Preoperative risk ASA II-IV. General anesthesia with the use of the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Perioperative intensive care was conducted in accordance with the International Standards for the Safe Anesthesiology Practice WFSA (World Federation of Societies of Anesthesiologists, 2010). In group I (n = 61) a retrospective energy audit was performed according to the protocols of anesthesia of medical histories and calculations of indirect calorimetry with the determination of current the Metabolic Rate (MR) and Basal Metabolic Rate (BMR). In group II (n = 68), operational monitoring was supplemented by the use of indirect calorimetry to determine MR, BMR, Target Metabolic Rate (TMR) and the degree of Metabolic Disorders (MD) (MD = 100 × (TMR-MR)/TMR %), and intensive care is supplemented by additional infusion therapy and glucocorticoids, taking into account the dynamics of metabolic changes. Results. The initial parameters of metabolism, in both groups, were without disturbance, and MR significantly exceeded BMR (in group I - by 30,5%, in group II - by 28,8%) and had the following values: in group I - 749±12 cal×min-1×m-2, in group II - 756±13 cal×min-1×m-2. In both groups, at the stage of the reverse position of Trendelenburg, the imposition of pneumoperitoneum and the beginning of the operation, significant metabolic disorders were observed with MR reduction to the basal level. Slow recovery of MR was observed in patients of group I, the value of which at the time of awakening remained 7,6% below baseline (p <0,05). In patients of group II, on the background of enhanced infusion therapy and glucocorticoids, the recovery of MR was more intense and, by the time of awakening, its value exceeded the corresponding value of group I by 10,4% (p <0,05). At the same time, the MD and TMR were low and did not differ from the initial values. Patients in group II, compared with group I, woke up faster and were transferred to the ward, and nausea and vomiting were 2,7 times less common: 7,35% in group II and 19,7% in group I (p <0,05). At 6 and 12 hours after awakening, the sensation of pain on the VAS scale in group II was lower than in group I, respectively, by 24,3% and 34,4% (p <0,05). Conclusions. Perioperative energy monitoring makes it safer to perform laparoscopic cholecystectomy in patients with ACC. Additional determination of the target metabolism and the degree of metabolic disorders allows you
{"title":"PERIOPERATIVE METABOLISM IN PATIENTS WITH ACUTE CALCULUS CHOLECYSTITIS AND METHODS OF ITS CORRECTION","authors":"V. I. Chernіy, A. Denysenko","doi":"10.31612/2616-4868.2(20).2022.03","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.03","url":null,"abstract":"It is important to study changes in metabolism in patients with acute calculus cholecystitis (ACC) during laparoscopic cholecystectomy and to find ways to correct them. \u0000The aim of the study. To study the perioperative metabolism in ACC patients and evaluate the possibilities of its correction. \u0000Materials and methods. The study was prospective, not randomized. 129 patients with ACC, aged 36-84 years (54 men, 75 women), who underwent laparoscopic cholecystectomy, were studied. Preoperative risk ASA II-IV. General anesthesia with the use of the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Perioperative intensive care was conducted in accordance with the International Standards for the Safe Anesthesiology Practice WFSA (World Federation of Societies of Anesthesiologists, 2010). In group I (n = 61) a retrospective energy audit was performed according to the protocols of anesthesia of medical histories and calculations of indirect calorimetry with the determination of current the Metabolic Rate (MR) and Basal Metabolic Rate (BMR). In group II (n = 68), operational monitoring was supplemented by the use of indirect calorimetry to determine MR, BMR, Target Metabolic Rate (TMR) and the degree of Metabolic Disorders (MD) (MD = 100 × (TMR-MR)/TMR %), and intensive care is supplemented by additional infusion therapy and glucocorticoids, taking into account the dynamics of metabolic changes. \u0000Results. The initial parameters of metabolism, in both groups, were without disturbance, and MR significantly exceeded BMR (in group I - by 30,5%, in group II - by 28,8%) and had the following values: in group I - 749±12 cal×min-1×m-2, in group II - 756±13 cal×min-1×m-2. \u0000In both groups, at the stage of the reverse position of Trendelenburg, the imposition of pneumoperitoneum and the beginning of the operation, significant metabolic disorders were observed with MR reduction to the basal level. Slow recovery of MR was observed in patients of group I, the value of which at the time of awakening remained 7,6% below baseline (p <0,05). In patients of group II, on the background of enhanced infusion therapy and glucocorticoids, the recovery of MR was more intense and, by the time of awakening, its value exceeded the corresponding value of group I by 10,4% (p <0,05). At the same time, the MD and TMR were low and did not differ from the initial values. Patients in group II, compared with group I, woke up faster and were transferred to the ward, and nausea and vomiting were 2,7 times less common: 7,35% in group II and 19,7% in group I (p <0,05). At 6 and 12 hours after awakening, the sensation of pain on the VAS scale in group II was lower than in group I, respectively, by 24,3% and 34,4% (p <0,05). \u0000Conclusions. Perioperative energy monitoring makes it safer to perform laparoscopic cholecystectomy in patients with ACC. Additional determination of the target metabolism and the degree of metabolic disorders allows you ","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.02
V. Cherniy, Y. Kurylenko
Introduction. Coronary heart disease (CHD) is the accumulation of atherosclerotic plaques in the blood vessels that supply the heart with oxygen and nutrients. Coronary artery bypass grafting (CABG) is a strategy for myocardial revascularization that is indicated for patients with three or more coronary artery demage, high SYNTAX, diabetes, and left ventricular systolic dysfunction. Despite the tremendous development of equipment, surgical and anesthesia techniques, in the perioperative period, there are still complications. The most formidable complication after such an operation of CABG with cardiopulmonary bypass (CPB) is the development of acute left ventricular failure (ALVF). The aim. To study the effectiveness of the principles of a differentiated approach to the prevention and correction of ALVF in patients who underwent surgery - CABG with CPB. Materials and methods. 500 cardiac surgery patients with coronary heart disease were operated on at SIS “Research and Practical Center of Preventive and Clinical Medicine” SAD. In all the cases, coronary artery bypass grafting was performed using cardiopulmonary bypass. In order to verify the principles of a differentiated approach to the correction and prevention of ALVF, the study was divided into three stages. At the first stage, the problem of the metabolic component of ALVF correction was studied (60 patients). On the second - the problem of diagnosis and correction of hypophosphatemia (60 patients with preoperative hypophosphatemia). On the third - diagnostic properties of the innovative method "Phasagraphy" (80 patients). Results. The introduction of a combination of levocarnitine and arginine, fructose-1,6-diphosphate - in case of hypophosphatemia, in the treatment of ALVF can reduce the recovery time of hemodynamics and reduce the total dose of inotropic drug (dobutamine) needed to achieve stabilization. The LF/HF indicator reliably reflects the ratio of sympathetic and parasympathetic parts of the autonomic nervous system, responds to disturbances and restoration of hemodynamics. The βT index of the phasagraphy method is related to clinical data on myocardial status. Conclusions. To prevent the development of ALVF in patients with coronary heart disease requires a differentiated approach: perioperative diagnosis of hypophosphatemia and its correction. In the case of ALVF after CABG surgery in patients with coronary heart disease to stabilize hemodynamics, the use of inotropic support with dobutamine and metabolic support with a combination of levocarnitine and arginine. As monitoring of myocardial condition it is advisable to use LF/HF indicator of variation pulsometry and βT method of phasagraphy.
{"title":"DIFFERENTIATED APPROACH TO PREVENTION AND TREATMENT OF ACUTE LEFT VENTRICULAR FAILURE IN PATIENTS WHO UNDERWENT CORONARY ARTERY BYPASS GRAFT SURGERY WITH CARDIOPULMONARY BYPASS","authors":"V. Cherniy, Y. Kurylenko","doi":"10.31612/2616-4868.2(20).2022.02","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.02","url":null,"abstract":"Introduction. Coronary heart disease (CHD) is the accumulation of atherosclerotic plaques in the blood vessels that supply the heart with oxygen and nutrients. Coronary artery bypass grafting (CABG) is a strategy for myocardial revascularization that is indicated for patients with three or more coronary artery demage, high SYNTAX, diabetes, and left ventricular systolic dysfunction. Despite the tremendous development of equipment, surgical and anesthesia techniques, in the perioperative period, there are still complications. The most formidable complication after such an operation of CABG with cardiopulmonary bypass (CPB) is the development of acute left ventricular failure (ALVF). \u0000The aim. To study the effectiveness of the principles of a differentiated approach to the prevention and correction of ALVF in patients who underwent surgery - CABG with CPB. \u0000Materials and methods. 500 cardiac surgery patients with coronary heart disease were operated on at SIS “Research and Practical Center of Preventive and Clinical Medicine” SAD. In all the cases, coronary artery bypass grafting was performed using cardiopulmonary bypass. In order to verify the principles of a differentiated approach to the correction and prevention of ALVF, the study was divided into three stages. At the first stage, the problem of the metabolic component of ALVF correction was studied (60 patients). On the second - the problem of diagnosis and correction of hypophosphatemia (60 patients with preoperative hypophosphatemia). On the third - diagnostic properties of the innovative method \"Phasagraphy\" (80 patients). \u0000Results. The introduction of a combination of levocarnitine and arginine, fructose-1,6-diphosphate - in case of hypophosphatemia, in the treatment of ALVF can reduce the recovery time of hemodynamics and reduce the total dose of inotropic drug (dobutamine) needed to achieve stabilization. The LF/HF indicator reliably reflects the ratio of sympathetic and parasympathetic parts of the autonomic nervous system, responds to disturbances and restoration of hemodynamics. The βT index of the phasagraphy method is related to clinical data on myocardial status. \u0000Conclusions. To prevent the development of ALVF in patients with coronary heart disease requires a differentiated approach: perioperative diagnosis of hypophosphatemia and its correction. In the case of ALVF after CABG surgery in patients with coronary heart disease to stabilize hemodynamics, the use of inotropic support with dobutamine and metabolic support with a combination of levocarnitine and arginine. As monitoring of myocardial condition it is advisable to use LF/HF indicator of variation pulsometry and βT method of phasagraphy.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.04
O. Mozyrska
The aim Violation of the epidermal barrier can lead to percutaneous sensitization to microbial products or allergens. The interaction between the yeast Malassezia and the skin's immune system contributes to skin inflammation in patients with atopic dermatitis. The aim of this study was to determine the sensitization to the molecular components of the yeast Malassezia (Mala s 5, Mala s 6, Mala s 11) in children with atopy. Methods The study included 333 children aged 1 to 18 with atopy, with symptoms of bronchial obstruction, allergic rhinitis, atopic dermatitis or urticaria. All patients / parents gave informed consent to participate. Spearman's rank test (ρ) was used to assess the correlation between total sIgE, specific sIgE, and age. Results Among 333 children with atopy, specific IgE to Mala s 5 was detected in 20.1 % children, to Mala s 6 in 64.6 %, and to the allergen Mala s 11 in 23.1 % children. The level of antibodies to Mala s 5 and Mala s 6 correlate with total serum IgE (ρ = 0.161 and ρ = 0.112, respectively). The correlation was also found between the level of specific IgE to Mala s 11 and to Mala s 6 (ρ = -0.351), and Mala s 5 and Mala s 6 (ρ = -0.490). Correlation of specific IgE and age was detected for the molecular component Mala s 6 (ρ = -0.126). Conclusions Sensitization to the molecular components of yeast (Mala s 5, Mala s 6, Mala s 11) was quite common among children with allergic diseases. Sensitization to Mala s 6 was most common in children. The highest values of sIgE were observed for Mala s 11 ‒ in 23.9% of patients. For future clinical trials, it is important to consider intrapersonal anatomical variations in skin microbiota, individual susceptibility, sex, age, seasonality, and ethnicity.
目的破坏表皮屏障可导致对微生物产物或过敏原的经皮致敏。马拉色菌酵母与皮肤免疫系统之间的相互作用导致特应性皮炎患者的皮肤炎症。本研究的目的是确定特应性儿童对马拉色菌酵母分子组分（马拉5、马拉6、马拉11）的致敏性。方法对333名1～18岁的特应性儿童进行研究，包括支气管阻塞、过敏性鼻炎、特应性皮炎或荨麻疹。所有患者/家长均表示知情同意参与。Spearman秩检验（ρ）用于评估总sIgE、特异性sIgE和年龄之间的相关性。结果333例特应性儿童中，特异性IgE检出率分别为20.1%、64.6%和23.1%。Mala s 5和Mala s 6的抗体水平与血清总IgE相关（分别为ρ=0.161和ρ=0.112）。对Mala s 11和Mala s 6的特异性IgE水平之间也存在相关性（ρ=-0.351），Mala s5和Mala s6（ρ=-0.490）。分子组分马拉s6的特异性IgE与年龄相关（ρ=-0.126）。结论酵母分子组分（马拉s5、马拉s6、马拉s11）致敏在儿童过敏性疾病中很常见。对马拉6号的敏感在儿童中最为常见。在23.9%的患者中观察到Mala s 11-的sIgE最高值。对于未来的临床试验，重要的是要考虑皮肤微生物群、个体易感性、性别、年龄、季节性和种族的个人解剖变化。
{"title":"SENSITIZATION TO MOLECULAR COMPONENTS OF MALASSEZIA ALLERGENS IN CHILDREN WITH ATOPY","authors":"O. Mozyrska","doi":"10.31612/2616-4868.2(20).2022.04","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.04","url":null,"abstract":"The aim \u0000Violation of the epidermal barrier can lead to percutaneous sensitization to microbial products or allergens. The interaction between the yeast Malassezia and the skin's immune system contributes to skin inflammation in patients with atopic dermatitis. The aim of this study was to determine the sensitization to the molecular components of the yeast Malassezia (Mala s 5, Mala s 6, Mala s 11) in children with atopy. \u0000Methods \u0000The study included 333 children aged 1 to 18 with atopy, with symptoms of bronchial obstruction, allergic rhinitis, atopic dermatitis or urticaria. All patients / parents gave informed consent to participate. Spearman's rank test (ρ) was used to assess the correlation between total sIgE, specific sIgE, and age. \u0000Results \u0000Among 333 children with atopy, specific IgE to Mala s 5 was detected in 20.1 % children, to Mala s 6 in 64.6 %, and to the allergen Mala s 11 in 23.1 % children. The level of antibodies to Mala s 5 and Mala s 6 correlate with total serum IgE (ρ = 0.161 and ρ = 0.112, respectively). The correlation was also found between the level of specific IgE to Mala s 11 and to Mala s 6 (ρ = -0.351), and Mala s 5 and Mala s 6 (ρ = -0.490). Correlation of specific IgE and age was detected for the molecular component Mala s 6 (ρ = -0.126). \u0000Conclusions \u0000Sensitization to the molecular components of yeast (Mala s 5, Mala s 6, Mala s 11) was quite common among children with allergic diseases. Sensitization to Mala s 6 was most common in children. The highest values of sIgE were observed for Mala s 11 ‒ in 23.9% of patients. For future clinical trials, it is important to consider intrapersonal anatomical variations in skin microbiota, individual susceptibility, sex, age, seasonality, and ethnicity.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48799606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.05
T. Chursina, A. Kravchenko, K. Mikhaliev
Introduction. Despite the significant advances in the pharmacotherapy of cardiovascular diseases, the increasing prevalence of heart failure (HF) and its poor prognosis constitute one of the leading medical problems worldwide. The complex pathophysiology of HF involves the alterations in the peripheral circulation, particularly the development of endothelial dysfunction (ED). The deepening of understanding the pathology of ED and the spectrum of pharmacological implications, involving its certain pathophysiological aspects, could favor the optimization of the personalized approach to the management of such challenging HF patients. Aim: to provide a literature review of the current data on the alterations in peripheral circulation in HF with the focus on ED, and to outline possible pharmacological implications involving certain pathophysiological aspects of ED in HF patients. Material and methods. The thematic scientific papers, published predominantly during the last decade, constituted the study material. The research methodology involved bibliosemantic method and structural and logical analysis. Results and discussion. Currently, the ED considered as a stage of a specific continuum, which is initiated in the form of «activation» of the endothelium, and moves through the stage of its actual «dysfunction» to the stage of endothelial «damage». Taking into account the important pathogenetic and prognostic significance of ED in HF, the endothelium is considered as a target of various pharmacological influences, including renin-angiotensin-aldosterone inhibitors and statins. Among the modern approaches to pharmacological treatment of HF, the correction of reduced nitric oxide (NO) bioavailability by modulating the «NO-soluble guanylate cyclase-cyclic guanosine monophosphate» signaling pathway is a perspective option in terms of preventing the occurrence and progression of ED. Conclusion. The deepening of knowledge about the pathophysiological features of ED in HF allows both to improve the understanding of the pharmacodynamic effects of already approved cardiovascular drugs, and to outline the perspectives for pharmacological direct or indirect impact on endothelium.
{"title":"ALTERATIONS IN THE PERIPHERAL CIRCULATION IN HEART FAILURE: CURRENT VIEW ON ENDOTHELIAL DYSFUNCTION AND PHARMACOLOGICAL IMPLICATIONS INVOLVING ITS PATHOPHYSIOLOGICAL ASPECTS","authors":"T. Chursina, A. Kravchenko, K. Mikhaliev","doi":"10.31612/2616-4868.2(20).2022.05","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.05","url":null,"abstract":"Introduction. Despite the significant advances in the pharmacotherapy of cardiovascular diseases, the increasing prevalence of heart failure (HF) and its poor prognosis constitute one of the leading medical problems worldwide. The complex pathophysiology of HF involves the alterations in the peripheral circulation, particularly the development of endothelial dysfunction (ED). The deepening of understanding the pathology of ED and the spectrum of pharmacological implications, involving its certain pathophysiological aspects, could favor the optimization of the personalized approach to the management of such challenging HF patients. \u0000Aim: to provide a literature review of the current data on the alterations in peripheral circulation in HF with the focus on ED, and to outline possible pharmacological implications involving certain pathophysiological aspects of ED in HF patients. \u0000Material and methods. The thematic scientific papers, published predominantly during the last decade, constituted the study material. The research methodology involved bibliosemantic method and structural and logical analysis. \u0000Results and discussion. Currently, the ED considered as a stage of a specific continuum, which is initiated in the form of «activation» of the endothelium, and moves through the stage of its actual «dysfunction» to the stage of endothelial «damage». Taking into account the important pathogenetic and prognostic significance of ED in HF, the endothelium is considered as a target of various pharmacological influences, including renin-angiotensin-aldosterone inhibitors and statins. Among the modern approaches to pharmacological treatment of HF, the correction of reduced nitric oxide (NO) bioavailability by modulating the «NO-soluble guanylate cyclase-cyclic guanosine monophosphate» signaling pathway is a perspective option in terms of preventing the occurrence and progression of ED. \u0000Conclusion. The deepening of knowledge about the pathophysiological features of ED in HF allows both to improve the understanding of the pharmacodynamic effects of already approved cardiovascular drugs, and to outline the perspectives for pharmacological direct or indirect impact on endothelium.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.08
V. Y. Dubovyk, T. Gruzieva, H. V. Inshakova
The strategic goal of health care is to maintain and enhance health, prolong life expectancy and improve it’s quality. In view of this, the assessment of the quality of patients life with diseases is an important medical and social task in the context of determining the effectiveness of treatment and justification and development of preventive measures and corrective actions. The relevance of assessing the quality of life of patients with rheumatoid arthritis is obvious, given the prevalence among the population and the severity of the pathology, reforming the health care system, complicating factors, including the SARS-CoV-2 pandemic [1]. There is a need to include quality of life assessment in the list of mandatory research methods to study the effectiveness of pharmacological and non-pharmacological treatments for patients with rheumatoid arthritis in the dynamics, given the long course of the disease and it’s impact on daily life. In modern conditions, a number of methods and tools are used to assess the quality of life of patients, which have their own characteristics and benefits. Obviously, the search for more accurate methods of assessing the quality of life of this category of patients will continue, which will become the standard for assessing the effectiveness of treatment. Numerous studies confirm that rheumatoid arthritis causes a deterioration in all aspects of quality of life, including mental health disorders and social dysfunction. Disease activity, assessed using the DAS-28 scale [2], is the most prognostic factor in patients. It negatively correlates with quality of life and positively correlates with depression and anxiety. According to modern intensive changes in approaches to the organization of health care, systemic challenges such as the COVID-19 pandemic, it is important to identify and apply rapid and most effective methods of assessing the condition of patients with chronic pathology, including rheumatoid arthritis, before and after treatment. It is also important to identify the main factors that lead to a decrease in the quality of life of patients, and to develop an action plan to optimize the organization of medical care in accordance with the needs of patients.
{"title":"METHODS OF ASSESSING THE QUALITY OF LIFE OF PATIENTS WITH RHEUMATOID ARTHRITIS","authors":"V. Y. Dubovyk, T. Gruzieva, H. V. Inshakova","doi":"10.31612/2616-4868.2(20).2022.08","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.08","url":null,"abstract":"The strategic goal of health care is to maintain and enhance health, prolong life expectancy and improve it’s quality. In view of this, the assessment of the quality of patients life with diseases is an important medical and social task in the context of determining the effectiveness of treatment and justification and development of preventive measures and corrective actions. \u0000The relevance of assessing the quality of life of patients with rheumatoid arthritis is obvious, given the prevalence among the population and the severity of the pathology, reforming the health care system, complicating factors, including the SARS-CoV-2 pandemic [1]. There is a need to include quality of life assessment in the list of mandatory research methods to study the effectiveness of pharmacological and non-pharmacological treatments for patients with rheumatoid arthritis in the dynamics, given the long course of the disease and it’s impact on daily life. \u0000In modern conditions, a number of methods and tools are used to assess the quality of life of patients, which have their own characteristics and benefits. Obviously, the search for more accurate methods of assessing the quality of life of this category of patients will continue, which will become the standard for assessing the effectiveness of treatment. \u0000Numerous studies confirm that rheumatoid arthritis causes a deterioration in all aspects of quality of life, including mental health disorders and social dysfunction. Disease activity, assessed using the DAS-28 scale [2], is the most prognostic factor in patients. It negatively correlates with quality of life and positively correlates with depression and anxiety. \u0000According to modern intensive changes in approaches to the organization of health care, systemic challenges such as the COVID-19 pandemic, it is important to identify and apply rapid and most effective methods of assessing the condition of patients with chronic pathology, including rheumatoid arthritis, before and after treatment. It is also important to identify the main factors that lead to a decrease in the quality of life of patients, and to develop an action plan to optimize the organization of medical care in accordance with the needs of patients.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.07
I. Vysochina, N. Bashkirova, A.N. Anoshko
Summary. In the context of the reform of the medical industry in Ukraine, the issue of ensuring effective quality control of the provision of medical care and its proper organization in healthcare institutions, and primarily primary care providers (PCP), has become topical. Today in Ukraine, the control of the work of general practitioners-family doctors (audit) is a continuous process, the purpose of which is to improve the quality of medical care. The audit is characterized by a systematic approach, which makes it possible to identify problems, assess the achieved level of quality, plan, and implement changes aimed at improving the quality of medical care. The audit of the work of doctors is divided into professional and administrative, as well as internal and external. The audit of the work of general practitioners - family doctors, as a rule, is a combination of all these types. Internal quality control is carried out by the general/medical director of the PCP provider and the medical boards of the institution, and is divided into audit of the structure, process and result. In addition, there are forms of internal audit of the work of family doctors: self-control and self-assessment of quality, mutual assessment between colleagues, and assessment of the head of the PCP provider. The external audit of the PCP supplier is represented by non-departmental, public and departmental control. The subjects of control are the authorized bodies outside the medical institution. External quality control of the provision of medical care is carried out by state authorities, clinical expert commissions of the Ministry of Health of Ukraine, public organizations. The financial audit is carried out by the National Health Service of Ukraine and the Department of Audit and Analytics of the Ministry of Health of Ukraine. Administrative audit is carried out by the Department of Audit and Analytics of the Ministry of Health of Ukraine. Conclusions. In general, control over the activities of general practitioners - family doctors is an ongoing process and involves a systematic approach. Internal audits are conducted by members of the same profession, providing a unique opportunity to identify non-compliance with standards and change tactics before it leads to adverse consequences. External audit is carried out by state institutions. The balanced application of these two forms of audit allows to achieve a high quality of work of doctors. General practitioners - family doctors should strive for quality and regular internal audit as the main corrective factor in the implementation of quality care in family medicine.
{"title":"QUALITY CONTROL OF THE WORK OF A FAMILY PHYSICIAN IN UKRAINE AS A KEY TO SUCCESSFUL PRACTICE","authors":"I. Vysochina, N. Bashkirova, A.N. Anoshko","doi":"10.31612/2616-4868.2(20).2022.07","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.07","url":null,"abstract":"Summary. In the context of the reform of the medical industry in Ukraine, the issue of ensuring effective quality control of the provision of medical care and its proper organization in healthcare institutions, and primarily primary care providers (PCP), has become topical. Today in Ukraine, the control of the work of general practitioners-family doctors (audit) is a continuous process, the purpose of which is to improve the quality of medical care. The audit is characterized by a systematic approach, which makes it possible to identify problems, assess the achieved level of quality, plan, and implement changes aimed at improving the quality of medical care. \u0000The audit of the work of doctors is divided into professional and administrative, as well as internal and external. The audit of the work of general practitioners - family doctors, as a rule, is a combination of all these types. \u0000Internal quality control is carried out by the general/medical director of the PCP provider and the medical boards of the institution, and is divided into audit of the structure, process and result. In addition, there are forms of internal audit of the work of family doctors: self-control and self-assessment of quality, mutual assessment between colleagues, and assessment of the head of the PCP provider. \u0000The external audit of the PCP supplier is represented by non-departmental, public and departmental control. The subjects of control are the authorized bodies outside the medical institution. External quality control of the provision of medical care is carried out by state authorities, clinical expert commissions of the Ministry of Health of Ukraine, public organizations. The financial audit is carried out by the National Health Service of Ukraine and the Department of Audit and Analytics of the Ministry of Health of Ukraine. Administrative audit is carried out by the Department of Audit and Analytics of the Ministry of Health of Ukraine. \u0000Conclusions. In general, control over the activities of general practitioners - family doctors is an ongoing process and involves a systematic approach. Internal audits are conducted by members of the same profession, providing a unique opportunity to identify non-compliance with standards and change tactics before it leads to adverse consequences. External audit is carried out by state institutions. The balanced application of these two forms of audit allows to achieve a high quality of work of doctors. General practitioners - family doctors should strive for quality and regular internal audit as the main corrective factor in the implementation of quality care in family medicine.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.06
V. Brych
The aim of the research is to analyse the recommendations of the World Health Organization (WHO) on the involvement of primary health care in the implementation of rehabilitation in case of musculoskeletal disorders and describe the situation in this area in Ukraine. Materials and methods. Methods of system and structural-logical analyses, bibliosemantic method were used during the research. The materials included published documents and information sources of the WHO, regulations of Ukraine on the implementation of medical rehabilitation, publication of scientific research. Results: WHO points out that rehabilitation integrated into primary medical care is one of the categories of rehabilitation care. It has a number of obstacles and requires more active action by the state leadership. The people with musculoskeletal disorders are also identified as key group of consumers of rehabilitation at the level of primary medical care. In Ukraine in recent years, the development of rehabilitation is constantly being improved by regulations. They create the possibility of providing rehabilitation services at all levels of medical care, identify the consumers and scope of rehabilitation services, regulate the use of telerehabilitation. However, the possibility of receiving rehabilitation services for persons with musculoskeletal disorders at the level of primary medical care in Ukraine is still limited by certain regulations and levels of staffing and technical support of the health care system. Conclusions. Securement of rehabilitation services to people with musculoskeletal disorders in the provision of primary health care requires the development of new approaches to its organization, taking into account the recommendations of the WHO.
{"title":"PLACE OF PRIMARY MEDICAL CARE IN PROVIDING MEDICAL REHABILITATION TO PEOPLE WITH DISORDERS OF THE MUSCULOSKELETAL SYSTEM: WORLD HEALTH ORGANIZATION RECOMMENDATIONS AND THE SITUATION IN UKRAINE","authors":"V. Brych","doi":"10.31612/2616-4868.2(20).2022.06","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.06","url":null,"abstract":"The aim of the research is to analyse the recommendations of the World Health Organization (WHO) on the involvement of primary health care in the implementation of rehabilitation in case of musculoskeletal disorders and describe the situation in this area in Ukraine. \u0000Materials and methods. Methods of system and structural-logical analyses, bibliosemantic method were used during the research. The materials included published documents and information sources of the WHO, regulations of Ukraine on the implementation of medical rehabilitation, publication of scientific research. \u0000Results: WHO points out that rehabilitation integrated into primary medical care is one of the categories of rehabilitation care. It has a number of obstacles and requires more active action by the state leadership. The people with musculoskeletal disorders are also identified as key group of consumers of rehabilitation at the level of primary medical care. In Ukraine in recent years, the development of rehabilitation is constantly being improved by regulations. They create the possibility of providing rehabilitation services at all levels of medical care, identify the consumers and scope of rehabilitation services, regulate the use of telerehabilitation. However, the possibility of receiving rehabilitation services for persons with musculoskeletal disorders at the level of primary medical care in Ukraine is still limited by certain regulations and levels of staffing and technical support of the health care system. \u0000Conclusions. Securement of rehabilitation services to people with musculoskeletal disorders in the provision of primary health care requires the development of new approaches to its organization, taking into account the recommendations of the WHO.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48418082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.31612/2616-4868.2(20).2022.09
L. Kryachkova, K. Simon, E. Borvinko, L.S. Semenova
Abstract. Effective leadership, which is one of the most important functions of the health care system, is impossible without effective leadership. Objective. Exploring the self-perception of own management style among senior medical staff and medical students to determine approaches for their optimization in the direction of improving personal and professional efficiency. Materials and methods. A study was conducted among 76 managers of different levels of management of health care institutions in the Dnipro region (main group) and 74 senior medical students (comparison group). The methodology developed and tested by WHO specialists in the relevant training module on leadership and strategic management was used. A special website https://leader-style.herokuapp.com was created to collect information and obtain results. The results were analyzed using generally accepted statistical approaches using the Jupyter Notebook software (https://jupyter.org/install) Results. Among the dominant management styles among managers of different levels in descending order were: Problem-solving style, Supportive, Resilient and Innovative. Similar patterns are observed among medical students in the frequency of styles, but with a statistically significantly lower frequency (p <0.05) there are Supportive and Problem-solving styles. Regarding the effectiveness of management functions, no differences were found between the groups between Regulating and Adaptive functions, while others had a greater degree of effectiveness in the organizers of health. Managers most effectively use the next functions: Task Management, Creative and Nurturing, the least effective - Regulating and Adaptive. Conclusions. The formation of leadership potential among medical students will in the future increase the effectiveness of the management functions of health care organizers. Defining leading management styles and further developing the necessary skills of managers is the leading way to improve their performance.
{"title":"APPROACHES TO IMPROVE MANAGEMENT STYLES IN THE PROCESS OF TRAINING LEADERSHIP MEDICAL STAFF AT DIFFERENT LEVELS OF EDUCATION","authors":"L. Kryachkova, K. Simon, E. Borvinko, L.S. Semenova","doi":"10.31612/2616-4868.2(20).2022.09","DOIUrl":"https://doi.org/10.31612/2616-4868.2(20).2022.09","url":null,"abstract":"Abstract. Effective leadership, which is one of the most important functions of the health care system, is impossible without effective leadership. \u0000Objective. Exploring the self-perception of own management style among senior medical staff and medical students to determine approaches for their optimization in the direction of improving personal and professional efficiency. \u0000Materials and methods. A study was conducted among 76 managers of different levels of management of health care institutions in the Dnipro region (main group) and 74 senior medical students (comparison group). The methodology developed and tested by WHO specialists in the relevant training module on leadership and strategic management was used. A special website https://leader-style.herokuapp.com was created to collect information and obtain results. The results were analyzed using generally accepted statistical approaches using the Jupyter Notebook software (https://jupyter.org/install) \u0000Results. Among the dominant management styles among managers of different levels in descending order were: Problem-solving style, Supportive, Resilient and Innovative. Similar patterns are observed among medical students in the frequency of styles, but with a statistically significantly lower frequency (p <0.05) there are Supportive and Problem-solving styles. Regarding the effectiveness of management functions, no differences were found between the groups between Regulating and Adaptive functions, while others had a greater degree of effectiveness in the organizers of health. Managers most effectively use the next functions: Task Management, Creative and Nurturing, the least effective - Regulating and Adaptive. \u0000Conclusions. The formation of leadership potential among medical students will in the future increase the effectiveness of the management functions of health care organizers. Defining leading management styles and further developing the necessary skills of managers is the leading way to improve their performance.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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