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T. O. Pertseva, L. I. Konopkina, Yuliia Huba
Medicni perspektivi, Volume 21, pp 19-23; https://doi.org/10.26641/2307-0404.2016.1.63456

Abstract:
Chronic obstructive pulmonary disease (COPD) has a significant impact on various aspects of life of patients due to of daily symptoms, frequent exacerbations, comorbid conditions, including anxiety and depression. In the scientific literature there are different data on the relationship between the frequency of occurrence and severity of exacerbations of COPD on the one hand and concomitant depression and increased anxiety on the other hand. The aim of our study – to examine frequency and se­verity of depression and anxiety in patients with COPD exacerbation and in stable phase of the disease in patients with varying terms of remission. We examined 108 patients with COPD, which were divided into two groups. The main group – 16 patients with COPD were examined in two visits: in exacerbation and after two months of its completion. A comparison group – 92 patients with COPD in stable phase of the disease for at least three months. Examination of pa­tients included general clinical methods, evaluation of clinical symptoms of COPD, evaluation of mental status using Hospital Anxiety and Depression Scale. It was found that symptoms of depression and anxiety are more expressied in pa­tients with COPD exacerbation than in the stable phase. It was determined that the frequency of depression and anxiety in patients with COPD tends to decrease in two months after the exacerbation. It was also shown that mild depression and anxiety prevail in COPD patients with impaired mental state. In addition, there was found correlation between severity of dyspnea and depression severity in COPD patients with concomitant depression in the stable phase of the disease.
Medicni perspektivi, Volume 21, pp 70-79; https://doi.org/10.26641/2307-0404.2016.1.63478

Abstract:
Nonalcoholic fatty liver disease is now considered as a part of comorbidity pathology. About third part of general population suffers from hepatic steatosis and non-alcoholic steatohepatitis (NASH), which is a serious problem of the XXI century, considering the growth of prevalence of obesity, which leads to fat accumulation in the liver. The aim of our study was to investigate the clinical and functional manifestations of hepatic steatosis and NASH in patients with obesity and disorders of the biliary tract (BT), depending on the body mass index. The study involved 200 patients with nonalcoholic fatty liver disease (NAFLD) (100 patients with hepatic steatosis and 100 NASH) in combination with obesity and BT disorders. Middle age of those examined was 42,1±2,02 years (range from 24 to 73 years). The control group consisted of 30 healthy persons. Each group was divided into subgroups according to body mass index (BMI): overweight (BMI 25-29.9 kg/m2), first degree of obesity (BMI 30-34,9 kg/m2), second degree of obesity (BMI 35-39,9 kg/m2). We evaluated the main clinical and biochemical syndromes (pain, dyspeptic, asthenia, cholestatic, cytolytic, mesenchymal-inflammatory, liver-cell deficiency). It is found, that the most reliable clinical and functional parameters were observed already at the first stage of NAFLD, at the stage of steatosis with fat deposition in the liver. It indicates that the majority of clinical parameters could be considered as early markers of hepatic steatosis formation and its further progression up to the level of steatohepatitis in patients with NAFLD in combination with obesity and BT disorders. Thus, in patients with NAFLD in combination with obesity and BT pathology an active clinical picture of the disease was observed, the severity of which was increasing together with BMI increasing.
I. D. Spirina, S. F. Leonov, Tamara Shusterman, Ya. S. Varshavs'kij, V. A. Mihal'ova
Medicni perspektivi, Volume 21, pp 140-144; https://doi.org/10.26641/2307-0404.2016.1.64267

Abstract:
The article describes the clinical case of organic hal­lucinosis, the beginning of which is definitelyassociated with pituitary macroadenoma. Complex hallucinations (visual, auditory, olfactory, tactile) with zoological theme are brightly presented in the clinical picture of the disorder. Due to refusal of the patient from neurosurgical intervention for removingof pituitary adenoma the extinction of hallucinatory symptoms can not be reliably measured, and the presence of atherosclerotic changes in cerebral vessels, concomitant arterial hypertension increase the likelihood of permanent or recurrent nature of hallucinosis and make prognosis for recovery as unfavorable.
I. M. Bondarenko, A. V. Phokhach
Medicni perspektivi, Volume 21, pp 23-26; https://doi.org/10.26641/2307-0404.2016.1.63459

Abstract:
The vast majority of breast cancer patients have logged phenomenon of systemic toxicity during the period of chemotherapy, the frequency and severity of which increases through special courses of drug therapy. The authors of the study set out to examine the changes in the major features of hematological parameters in different regimes of chemotherapy for breast cancer; to evaluate the nature and manifestations of hepato- and nephrotoxicity in these patients; to explore the major trends in blood clotting in this group of patients. In retrospect, 8237 common blood tests indicators were analyzed, 4048 biochemical blood tests and 1909 coagulation tests in 440 patients. Depending on the mode of treatment, the patients were divided into two groups: patients receiving paclitaxel in monochemotherapy ± Herceptin; patients receiving combinated chemotherapy in the mode of docetaxel, doxorubicin, cyclophosphamide ±Herceptin. It has been proven that chemotherapy for breast cancer with the use of the above combination of drugs is characterized by the higher profile of haematological toxicity (neutropenia, thrombocytopenia and anemia). At the same time the both groups had the same incidence of hepato- and nephrotoxicity. The monochemotherapy with paclitaxel is determined by the high incidence of hypercoagulation changes. Coagulation disorders during the use of combination of docetaxel, doxorubicin, cyclophosphamide ± Herceptin have no typical pattern of coagulation (characterized by both hypo- and hypercoagulation changes).
A. G. Rodinsky, , L. V. Guz
Medicni perspektivi, Volume 21, pp 4-9; https://doi.org/10.26641/2307-0404.2016.1.63440

Abstract:
The aim of our work was analysis of the bioelectrical activity of efferent fibers of the sciatic nerve in experimental menopause condition. Experiments were performed on 25 female white rats, divided into experimental and control groups. Menopause was modeled by total ovariohysterectomy. In 120 days after modeling we had recorded evoked action potentials of fibers of isolated ventral root L5 induced by stimulation of sciatic nerve with rectangular pulses. Threshold, chronaxia, latency, amplitude and duration of the action potential (AP) were analysed. Refractory phenomenon was investigated by applying paired stimuli at intervals of 2 to 20 ms. In the context of long-term hypoestrogenemy threshold of AP appearance was 55,32±7,69%, chronaxy – 115,09±2,67%, latent period – 112,62±1,74% as compared with the control animals (p<0.01). In conditions of paired stimuli applying the amplitude of response to the testing stimulus in animals with ovariohysterectomy at intervals 3 and 4 ms was 61,25±36,45% and 53,48±18,64% (p<0.05) respectively.
A. M. Serdyuk, E. M. Bіletska, V. P. Stus, N. M. Onul
Medicni perspektivi, Volume 21, pp 109-116; https://doi.org/10.26641/2307-0404.2016.1.64096

Abstract:
Deterioration of the environment in the XX-XXI century under the influence of chemical, physical, radiological and other factors is not only and not just an ecological catastrophe of modern times, but a direct threat to the health and life of human society as a whole. Among the most important factors influencing people's health occupy chemical the leading place, because since 1957 more than 50 million chemical substances were synthesized, but only 15% of them have a toxicological evaluation, and 30% of the diseases in Europe are associated with chemical factor (ECHA-EXA). Chemical "pressing" determines a significant reduction in the reproduction of the population of Europe, and for Ukraine itmeans a large-scale depopulation, among possible reasons of which a significant role belongs to the deterioration of the reproductive capacity of population, men in particular, and this work is devoted to this problem. On the basis of profound analysis of literature data, complex ecologic-hygienic researches we identified markers of exposure, prognosticaly significant markers of impact for the early diagnostics of disorders of male generative system in conditions of low-dose impact of xenobiotics. We achieved convincing evidence of ecologically determined character of unogenital diseases and fertility decrease, we developed scientifically-justified principles of management of risk of development of ecologically-determined reproductive pathology in men.
A. D. Dyudyun, N. M. Polion
Medicni perspektivi, Volume 21, pp 91-96; https://doi.org/10.26641/2307-0404.2016.1.63491

Abstract:
In this report authors give a detailed analysis of microorganisms that can contaminate mucous membranes of female urogenital system in normal range and in the formation of certain dysbiotic position. The composition of microorganisms that colonize the mucous membrane of the urogenital tract depends on many exogenous and endogenous factors. The main microorganisms that provide colonizing resistance of vaginal biotop (VB) are lactobacilli and lactobacteria. The protective properties of lactobacillus are implemented by antagonistic activity and ability to produce lysozyme and hydrogen peroxide. L. acidophilus, L. spp.; Propionbacterium spp.; Fusobacterium spp.; Porphyromonas spp.; Prevotella spp.; S. epidermidis and S. Saprophyticus novobionrezistentni and Streptococcus spp. and others are of definite importance in supporting normobiots of mucous membranes of urogenital system of women. Decreasing number of lactobacilli and other microorganisms of normobiota leads to colonization of mucous membranes of the vagina with G.vaginalis, B.bivies, B.disiens, B.melaninigenius, Mobiluncus, E.coli, E.fecalis, S.epidermidis and development of clinical manifestation of VB. The authors show microscopic and bacteriological characteristics of microorganisms that form normal microbiota and pathological states. The development of basic subjects promotes increasing number of the known microorganisms, important in the development of VB.
, O. P. Rudnytska, O. V. Dobrianska
Medicni perspektivi, Volume 21, pp 123-129; https://doi.org/10.26641/2307-0404.2016.1.64246

Abstract:
Spatial-temporal characteristics of the population’s morbidity and prognosis of the situation are the main conditions for substantiation of the management decisions directed at the optimization of public health formation. Determination of the tendencies of morbidity 6-years children of during 1972 – 2014 years and their prognosis levels was the aim of the study. The analysis of morbidity based on the preschool institution’s health documents involved both temporal (42-years period of time) and spatial (different ecological districts) assessments. The negative changes in older preschool age children’s health have been revealed: growth of total morbidity, prevalence of respiratory diseases, inflammatory diseases of the eye. The higher levels of morbidity are registered in the districts located near the highways of the city. It testifies to the negative influence of transport-related air pollution on the children’s health formation. The estimation of prognostic levels (till 2020 year) showed future growth of diseases prevalence etiologically linked with air pollution.
S. I. Karpenko, I. S. Shponka, V. F. Zavizion, V. R. Skoryk, A. V. Snisar
Medicni perspektivi, Volume 21, pp 144-148; https://doi.org/10.26641/2307-0404.2016.1.64269

Abstract:
Solid pseudopapillary tumor of the pancreas (Frantz's tumor) is a very rare disease with uncertain malignant potential. This tumor occurs in young women at the age before 35 years. Asymptomatic disease course leads to growth of tumor up to the huge size. Surgery is the only treatment method applied. Histological diagnostic is complicated with similarity of tumor with neuroendocrine tumor of the pancreas. Disease is characterized with favorable prognosis. Paper shows our own clinical observation of Frantz’s tumor. During control ultrasound examination of woman aged 34 years, echo-signs of mass lesion in extraperitoneal area near the lower pole of the left kidney were diagnosed. During physical examination in the left hypochondrium a soft, atropic mass lesion 5.5x5 cm in size was diagnosed. Lesion presence is confirmed by CT assessment. Distal resection of the pancreas and splenectomy was performed. Diagnosis was verified histologically and immunohistochemically. Postoperative period is complications free. The results of CT assessment, detailed description of gross specimen and the results of histological and immunohistochemical examination are presented.
G. I. Yaskiv
Medicni perspektivi, Volume 22, pp 111-114; https://doi.org/10.26641/2307-0404.2017.1.101440

Abstract:
Nitroxoline is an effective antibacterial agent that is industrially produced by chemical and pharmaceutical enterprises in Ukraine. Parameters of its toxicity are determined under conditions of acute and subchronic toxicological experiments on 3 kinds of laboratory animals, by administering the drug orally and by application onto the skin and mucous membranes. The duration of acute experiment was 14 days, subchronical - 24 days. It was found that median lethal dose (DL50) for white female rats is 980 (852:1127) mg/kg, of white male rats – 835 mg/kg, white male mice– 660 mg/kg, by this parameter the drug can be attributed to 3 class of hazard – moderately hazardous substance. Average effective time of death (ET50) for albino rats is 28 hours. Species sensitivity of laboratory animals to nitroxoline is slightly expressed. The death of the animals starts on the first day after the injection and is recorded during three days of the experiment. In application on intact skin, locally-irritant and skin-resorptive effects are absent. After contact with the mucous membrane of the eye the drug causes weak irritant effect. Nitroxoline has a moderate cumulative activity.
S. А. Schudro
Medicni perspektivi, Volume 21, pp 157-163; https://doi.org/10.26641/2307-0404.2016.4.91490

Abstract:
Morbidity of children and teenagers, their link with birth-rate, disability and death rate are the important indexes of estimation of health of nation. The aim of work was to work out approaches to analysis and prognosis of children morbidity in Ukraine. Prevalence and morbidity of children (from 0 to 17) was analysed over 2004-2008 and 2015 years by the data of official statistics, adaptive methods of prognostication were used as well. The prognosis of morbidity and prevalence of diseases in children testified to a possible growth of levels of blood diseases and hematogenesis organs, those of eye and accessory apparatus, organs of breathing and digestion, diabetes mellitus, diseases of skin and hypoderm. In 2015 in the structure of prevalence the most meaningful were diseases of organs of breathing and digestion, eyes and accessory apparatus, in the structure of morbidity - diseases of organs of breathing and digestion, skin and hypoderm. The offered approach to the analysis gives possibility to generalize and model morbidity of children for the prolonged period of time, to reveal leading tendencies and to estimate the risk of their growth. All mentioned is necessary for organizational-methodical work of doctors and development of purposeful measures on prevention and decline of morbidity of rising generation.
O. A. Shevchenko
Medicni perspektivi, Volume 22, pp 152-153; https://doi.org/10.26641/2307-0404.2017.1.101447

Abstract:
Review of monograph of Doctor ofMedicine, Professor Prokopov V.O. «Drinking water ofUkraine: medical-ecologic and sanitary-hygiene aspects»edited by Doctor of Medicine, Academician of NAMS ofUkraine A.M. Serdiuk. – K.: Academic Press «Medicine»,2016. – 400 p.
V. Y. Mamchur, S. V. Nalotov, , V. I. Palamarchuk, V. G. Guryanov, A. J. Ogol
Medicni perspektivi, Volume 22, pp 89-96; https://doi.org/10.26641/2307-0404.2017.1.101433

Abstract:
The authors studied the efficacy of combined drug Fanigan (paracetamol 500 mg and diclofenac sodium 50 mg) (production of "Kusum Pharm" (Ukraine) or "Kusum Heltker PVT. LTD" (India) in tablets for symptomatic treatment of patients with pain syndrome. A pronounced clinical efficiency of its application in patients with pain syndrome of various genesis in a daily dose from 2 to 3 tablets for 3 to 7 days was established. The obtained data on the clinical efficacy of the drug. Fanigan in the treatment of patients with pain syndrome of various genesis allow to recommend it for application in wide clinical practice.
A. I. Vinnikov
Medicni perspektivi, Volume 21, pp 180-182; https://doi.org/10.26641/2307-0404.2016.4.91501

Abstract:
Review on textbook «Medicalmicrobiology, virology and immunology». Textbook forthe students of higher medical educational establishments /edited by V.P. Shyrobokov. – Vinnytsa: Nova kniha, 2011.– 952 p. with ill., and its edition in Russian «Medicalmicrobiology, virology and immunology. – 2015.»
O. S. Khmel, V. V. Rodionova
Medicni perspektivi, Volume 22, pp 71-78; https://doi.org/10.26641/2307-0404.2017.2.109831

Abstract:
Objective: to investigate the heart rate variability in patients with HT and OA under the influence of antihypertensive therapy. Materials and Methods: The study involved 60 persons, main group – 25 patients with HT stage II, 2nd degree, combined with knee OA of the II stage according to the Kellgren-Lawrence. The group of comparison consisted of 20 patients with HT stage II, 2nd degree. The control group consisted of 15 almost healthy individuals. During the study patients received antihypertensive therapy: Amlodipine 5 mg and Lisinopril 5 mg 1 time per day per os. The survey was carried out before and after the treatment. Results: in hypertensive patients with OA the influence of the sympathetic system and LF / HF index were reduced (before treatment – 5,64 [4,87–7,56], after treatment – 3,95 [3,74–4,54]; p<0,05); this indicates to decrease of influence of the sympathetic system on the organism. Conclusions: The presence of OA in patients with HT provides additional negative effect on the heart rate variability, which may testify to increasing mortality risk in these patients. Antihypertensive therapy with Lisinopril, 5 mg and Amlodipine, 5 mg in patients with HT and OA leads to improvement of hypertension course due to influence on sympathic system.
N. P. Grebnyak, S. A. Schudro, Ruslana Fedorchenko
Medicni perspektivi, Volume 22, pp 126-132; https://doi.org/10.26641/2307-0404.2017.2.109848

Abstract:
Reform of higher education in the conditions of deep social and economic transformations determines both optimizationof professional training and development of functional capacity of the organism for future work. The initial stage of training is of particular importance due to incorporation into a complex new system of educational environment. The aim of the work - to study the characteristics of adaptation process in the first-year students. Functional state of students’ organism was studied by visual-motor response, function of attention, speed, of information processing, tepping-test. This cross-sectional study included 179 first-year medical students. Students with a history of hearing or visual disorder, smoking, alcoholism, cardiovascular and respiratory disease and on medication which affects cognitive performance were excluded from the study. Participation in the test was voluntary and informed written consent was taken from each participant. Academic performance was analyzed. Pearson correlation has been used to find the significance of relationship between the speed of thought processes, function of attention, factor of motometria, volume of visual memory and academic performance. Adaptation of students to training is based on the functional system of the body. Expressed correlation between the speed of thought processes (r=0,63, р<0,01), function of attention (r=0,47, р<0,05), ratio of motometry (r=0,45, р<0,05), volume of visual memory (r=0,43, р<0,05) and academic performance was established. The distribution of these indicators demonstrates the feasibility of using Standard deviation to assess the degree of adaptation.
, A. V. Kuryata, A. V. Cherkasova
Medicni perspektivi, Volume 22, pp 52-59; https://doi.org/10.26641/2307-0404.2017.2.109828

Abstract:
The prevalence of osteoarthrosis (OA) among adults over 40 years is taking one of the leading places in the common structure of joint pathology. Obesity – is of the comorbidities associated with OA, one of the risk factors of development and progression of OA. The aim of this study was to evaluate the influence of obesity on the structure of knee and hip OA on the stage of total joint replacement, depending on the patient`s gender, age and degree of obesity. The study involved 170 inpatient case histories of patients with OA undergoing treatment in the department of large joints replacement (64 men and 106 women): 95 patients with OA of hip joint and 75 – with OA of knee joint, among whom there were 110 patients with obesity and 60 – without it. The middle age of the patients was by 63,8±7,69 years. High prevalence of obesity among patients with OA of knee and hip joints was found, with significant higher number of obese patients with OA of knee joint and among female patients. It has been demonstrated a significant increase in the frequency of total knee joint replacement associated with the increase of body mass index among patients with OA of knee joint. The presence of obesity was associated with earlier terms of the total joint replacement performing, especially among male patients.
, A. А. Fialkovskaia, N. N. Kramarenko, G. V. Makukh
Medicni perspektivi, Volume 22, pp 85-90; https://doi.org/10.26641/2307-0404.2017.2.109834

Abstract:
The purpose of research – to study the role of allelic polymorphism of genes of the I and II phases of xenobiotics biotransformation in the development of reccurent and chronic diseases of the respiratory system in adolescent-smokers. There was carried out molecular-genetic study of the polymorphic locus Т3801С of gene CYP1A1 and polymorphic locus A313G of gene GSTP1 in adolescent-smokers with recurrent and chronic bronchitis. It is established that TТ genotype of the polymorphic locus Т3801С of gene CYP1A is a marker of resistance to the development of this pathology in adolescent-smokers. The presence of CC genotype of the polymorphic locus Т3801С of gene CYP1A1 and GG genotype of polymorphic locus of A313G GSTP1 gene may be considered as a possible risk factor for the development of chronic inflammatory process in bronchopulmonary system. Thus, the introduction of molecular-genetic methods of research opens up new possibilities in diagnosis of recurrent and chronic diseases of the respiratory system. Based on the analysis of genetic factors in children and adolescents, it will be possible to predict the risk of COPD developing in the future;this will allow doctors to carry out the necessary preventive activities among risk groups.
V. L. Dronova, S. M. Kornienko
Medicni perspektivi, Volume 22, pp 81-88; https://doi.org/10.26641/2307-0404.2017.1.101424

Abstract:
A total of 325 women 35-55 years old suffering from various forms of endometrial pathology were examined. It was found that 110 (33.8%) patients had combination of endometrial pathology and uterine myoma. They made up the main group (group MM), the reference group consisted of 215 women without uterine myoma (group K). It was established that group with uterine myoma is characterized by increased extragenital morbidity: cardiomyopathy (p<0.009), hypertension (p<0.03), obesity stage III-IV (p<0.006), iron-deficiency anemia (p<0,02), vegetative-vascular dystonia (p<0,03) and nervous system diseases (p<0,01) were significantly more common. The presence of uterine myoma is associated with increased risk of recurrence of endometrial hyperplasia and polyps. These data suggest that in the pathophysiology of uterine myoma in women of late reproductive and premenopausal age with endometrial pathology somatic and somatoform disorders play a more significant role than concomitant or previous genital pathology. In late reproductive age and menopause period endometrial lesions are combined with uterine myoma in every third patient. Somatic factors have a greater impact on the development of uterine myoma than reproductive. The presence of uterine myoma is an additional criterion of reduceof quality of life and burdens the prognosis of treatment of endometrial pathology in late reproductive age and premenopausal period.
L. S. Semenova, E. V. Nykolaeva
Medicni perspektivi, Volume 21, pp 174-176; https://doi.org/10.26641/2307-0404.2016.4.91497

Abstract:
Ilya Ilyich Mechnikov is an outstanding scientist, zoologist, anatomist, embryologist, microbiologist, parasitologist, pathologist, bacteriologist, physiologist, cytologist, and immunologist. He was a resourceful and skilful biologist-experimenter, the author of the phagocytic theory of immunity. In 1908 I.I. Mechnikov together with the apologist of the humoral concept of immunity Paul Ehrlich was awarded the Nobel Prize in physiology and medicine «for research in the theory of immunity». The paper tells about the life and research of this scientist, importance of his researches for modern medicine.
I. S. Mashchenko, V. I. Struk, N. V. Vatamanyuk
Medicni perspektivi, Volume 21, pp 91-97; https://doi.org/10.26641/2307-0404.2016.4.91467

Abstract:
The article presents the results of a comparative study of the microbial landscape and violations of local immunity in patients with generalized periodontitis at preclinical-radiological stage of development in 60 patients. It was revealed that appearance of representatives of the major periodontal bacteria in the gum tissue is a precursor of development of initial stage of generalized periodontitis in them. It has been established that the early objective indicators of bone resorptive process in periodontal tissues in patients with generalized catarrhal gingivitis is an overproduction of proinflammatory cytokines IL-1.beta and TNF-alpha and the lack of anti-inflammatory IL-4, which persists for a long time during the observation period.
L. N. Yakovenko, V. P. Iefymenko, A. Yu. Makarevich, T. A. Kovtun
Medicni perspektivi, Volume 21, pp 106-115; https://doi.org/10.26641/2307-0404.2016.4.91474

Abstract:
A retrospective analysis of 1147 patients’ records from the clinic of the department of surgical dentistry and maxillofacial surgery of childhood of NMU Bogomolets and 944 case histories of patients with traumatic injuries of maxillofacial region in the clinic of the department of pediatric dentistry of SE «Dnepropetrovsk medical academy of Health Ministry of Ukraine» has shown that traumatic damages to teeth make up 18.8% of all injuries in maxillofacial region. It was found that in most cases the cause of injury is fall of a child - 60%, punching on the face - 19%, other causes – 21%. Most often maxillary central incisors are affected - about 70-80%, lateral - 10-20% both in temporary and in shift bite. Lower incisors are injured only in 1-6% of cases. Injuries of the temporary teeth were observed in 30-45% of cases. The aim of the study was to determine the major diagnostic methods and therapeutic measures that have been used in trauma of permanent and temporary teeth in children of different ages. Diagnostic measures included clinical and instrumental studies. Of the additional survey methods of dental trauma in 90% of cases back-side X-ray, in 7-8% – orthopanto­mography, in 1-2% - CT were performed. In dislocations of temporary teeth X-ray examination was carried out only in impacted dislocation. Algorithm of treatment tactics for almost all kinds of temporary teeth dislocations was to remove it, not taking into account the degree of formation of the tooth root and functional ability of the tooth, that involves the development of the indications for their preservation. Most often, for the immobilization of the injured permanent teeth a smooth splin-clamp (85%) was used, it is cheap, easy to manufacture, reliable for fixing, individual as for adaptation, but when applied it leads to injury of periodontal tissues, the development of inflammatory processes in them. Alternative methods of fixation were splint systems, splint-caps and tooth-gum splints. There remains the question of development of non-invasive fixing systems, which would be less traumatized for the tooth and periodontal tissue.
, O. A. Koval
Medicni perspektivi, Volume 22, pp 32-37; https://doi.org/10.26641/2307-0404.2017.1.100871

Abstract:
The aim of this work was to compare basic anamnestic and demographic data in Ukrainian and European groups included in the register SNAPSHOT 2009 and local group ofthe year2015. It wasestablished that by the year2015 patients’ age advanced (from 65±13 to 68.6±11.2 years), as well as part of women (from 30% to 47.5%), previous myocardial infarction frequency (from 22% to 34.7%), heart failure (from 10% to 42.6%), and chronic kidney disease (from 2% to 14.9%). The increase of prevalence of arterial hypertension (88.1%) in local group was founded. The average body mass index had tendency to increasing (28.6±4.4 kg/m2); the part of patients with increased body mass index was equal among men and women. Simultaneous increase of such comorbidities as arterial hypertension, chronic kidney disease and complications of previous myocardial infarction and heart failure in the local register with a lower prevalence of such risk factors as smoking (13.9%), dyslipidemia (10.9%), and frequency of diabetes (10.9%) were founded. The prevalence of peripheral atherosclerosis was lower in the year 2015 research group than in European one (1% vs 6%). The prevalence of percutaneous coronary intervention (3.1%) and CABG (1.1%) for diagnostic and treatment of ischemic heart disease was extremely low in 2015 year group. The prevalence of previous stroke and chronic obstructive pulmonary disease remained approximately the samein all registers groups. The tendency of increase of malignancy prevalence in anamnesis was founded (5.9%), and probably it was associated with increase of average patients’ age.
Department of pediatric surgery Department of pediatric surgery
Medicni perspektivi, Volume 21, pp 183-184; https://doi.org/10.26641/2307-0404.2016.4.91503

Abstract:
Syahailo Petro Trokhymovych To commemoration of a talented scientist is devoted (to 80-th birthday)
L. N. Yur’Yeva, T. Y. Shusterman, S. F. Leonov, Ya. S. Varshavskij
Medicni perspektivi, Volume 21, pp 45-49; https://doi.org/10.26641/2307-0404.2016.4.90784

Abstract:
The article describes a one-year follow-up study of the clinical case of organic hallucinosis that we have described in the previous article in the patient with pituitary macroadenoma. At primary admission to the hospital (one year earlier) the likelihood of permanent or recurrent nature of hallucinosis and absolutely poor prognosis for recovery and life without removal of the tumor was pointed out to the patient and his family. However, the patient and his relatives flatly refused to undergo neurosurgical intervention. The article describes the dynamics of psychopathological and somatic statuses of the patient during his readmission to a psychiatric hospital. The exciting cause of death on the 25th day of hospital stay was phenomenon of cerebral edema. By results of post-mortem studies the underlying cause of death was small cell chromophobe pituitary adenoma. There was a complete accuracy between clinical and post-mortem diagnosis. Absolutely unfavorable prognosis made before has been confirmed. The conclusion about the need of psychoeducational interventions with this contingent of patients and their relatives for prevention of an adverse disease outcome is made.
E. M. Biletska, T. A. Holovkova, Оlena Antonova
Medicni perspektivi, Volume 22, pp 20-24; https://doi.org/10.26641/2307-0404.2017.1.100868

Abstract:
The problem of construction of a holistic methodological system of training future doctors considered in the article, is impossible outside the context of integration processes taking place in modern education and needs a careful study of international experience. The research aim is to develop a system of innovative means of education for the formation of preventive thinking in students of higher medical educational establishment, concerning professionally oriented undergraduate preparation of doctors. Analysis of the results allowed to determine the characteristic features of innovative means, forms and teaching methods, specificity of their use in interactive educational environment, this against the background of meticulous work of the teaching staff of the department of general hygiene of Dnepropetrovsk Medical Academy provides the efficiency of educational process which integrates personal, creative, social and educational purposes. The suggested innovative methods are involved in the general system of modern education in higher school being effectively used for providing a high level of professional training in teaching of academic subject area "Hygiene and Ecology".
Ye. V. Spiridonava, Ye. V. Kovalyov
Medicni perspektivi, Volume 21, pp 39-44; https://doi.org/10.26641/2307-0404.2016.4.90783

Abstract:
The aim of the study was to determine risk factors for perinatal damage in newborns depending on the level of cytokines secretion and nitrate/nitrite amount in the amniotic mileu. A total of 464 patients were examined. The content of IL-1β, IL-2, IL-4, IL-10, IFN-γ, TNF-α in the amniotic fluid were determined by ELISA, evaluation of nitrate and nitrite amount was performed by Griess reaction in Veremey et al. modification. Outcomes of labor, neonatal status and morphological structure of placentas were studied. To determine the risk factors odds ratios (OR) for delivery outcomes, perinatal pathology and damage the placenta were calculated. It was found that the exacerbation of chronic pyelonephritis during pregnancy increases the odds of perinatal pathology of the nervous system by9.6 times ([95% CI 3.8, 17.0], p=0.008) and low birth weight – by13.2 ([95% CI 4.3, 25.3]; p=0.03]). The syndrome of "short" cervix during pregnancy increases the odds of respiratory distress syndrome by 8.0 times ([95% CI 2.2, 16.7], p=0.019), perinatal pathology of the nervous system by11.4 ([95% CI 2.8, 17.3], p=0.005). Acute respiratory infections up to 18 weeks increase the or of respiratory distress syndrome by 27.6 ([95% CI 11.7, 46.2], p=0.021), fetal growth retardation by 11.0 times ([95% CI 2 0, 21.6], p=0.006). Preterm delivery and implementation of intrauterine infection is followed by a decrease of IL-4, IL-10 concentration and enhancement of IL-2, IFN-γ in the amniotic mileu with synergistic increase in the concentration of NO2-/NO3-. Perinatal damage of the nervous system in the presence of acute pyelonephritis, acute respiratory infections in the term of up to 18 weeks, syndrome of "short" cervix, PROM is preceded by reduction of IL-4 and IL-10, decrease of NO2- / NO3- and increased activity of TNF-α in the amniotic mileu.
S. O. Kosul'nikov, A. M. Besedin, S. A. Tarnapol'skiy, S. I. Karpenko, K. V. Kravchenkо, E. V. Simonova
Medicni perspektivi, Volume 21, pp 41-46; https://doi.org/10.26641/2307-0404.2016.3.82018

, N. G. Іdashkіna, Zh. M. Nekhanevich
Medicni perspektivi, Volume 21, pp 47-50; https://doi.org/10.26641/2307-0404.2016.3.82020

Abstract:
The aim of the study was to define frequency of infectious-inflammatory complications of the thirds molars retention and outcomes of surgical treatment in residents of Dnipro­petrovsk region on the basis of archiv materials. We surveyed 814 patients with retention of the third molars in the period from 2012 to 2015. On the basis of medical history it was revealed that lately diagnosed and treated acute pericoronaritis, is the cause of formation of severe inflammatory-infectious complications (osteomyelitis, abscess, lymphadenitis and others). Among the population of Dnipropetrovsk region the number of patients with retention of third molars, complicated withpericoronaritis is 5.8%, acute odontogenic osteomyelitis – 36.4%, chronic odontogenic osteomyelitis – 6.86%, acute odontogenic lymphadenitis – 5.8%, phlegmon – 3,4%. Standard approach in operations of atypical removal of impacted third molars causes a significant number of surgical complications (large bone defects, inflammatory contracture, post-traumatic neuritis, etc.).
N. O. Pertseva, K. I. Moshenets
Medicni perspektivi, Volume 21, pp 34-40; https://doi.org/10.26641/2307-0404.2016.3.82013

Abstract:
Lesion of the cardiovascular system in diabetes is the leading cause of mortality in this cohort of patients, it is of particularl importance because current approaches to the treatment of type 1 diabetes and existing insulins allow patients to live to the elderly age and have significant experience of type 1 diabetes. The development of new approaches to the early detection of disorders of the cardiovascular activity in preclinical stage will prevent or delay such dangerous consequences as fatal ventricular arrhythmias, silent myocardial infarction, cardiorespiratoryarrest, sudden death and will improve quality of life. In this review article aggregate data on the mechanisms of formation, provoking factors and manifestations of cardiovascular disorders in type 1 diabetes as well as possibility of correcting these changes, especially in the long course of diabetes are presented.
O. V. Poslavskaya
Medicni perspektivi, Volume 21, pp 69-73; https://doi.org/10.26641/2307-0404.2016.2.72154

Abstract:
Up to 40% of squamous cell carcinoma of the oropharynx (SCCO) are associated with human papillomavirus of a high oncogenic risk, which shows the greatest affinity to the epithelium of the tonsils. One of the indicators of malignant transformation of the multilayered epithelium cells with evidence of HPV lesions is the accumulation of oncoprotein p16INK4a, tumor suppressor from Ink4 family. Presence of excessive amount of p16INK4a in a free state shows its reduced suppressor function and is an indication of the active expression of viral oncogene E7. For multivariate analysis of molecular mechanisms of oncogenic transformation, the obtained data of p16INK4a expression options were distributed according to the clinical and morphological characteristics of squamous cancers. Mixed nuclear-cytoplasmic expression of p16INK4a more than 5% of tumor cells was observed in 73.6% of cases, which confirms the relations of path of carcinogenesis of cancers of this localization with HPV. Statistically significant association between a positive p16INK4a status and decrease of the degree of of SCCO differentiation (p=0,002, r=-0,365) was determined. But with respect to other clinical and morphological characteristics of SCCO and marker p16INK4a statistically significant differences between groups were not found (p>0.05), this denies its prognostic and predictive value in the diagnosis of SCCO.
Medicni perspektivi, Volume 21, pp 23-27; https://doi.org/10.26641/2307-0404.2016.4.90029

Abstract:
The article deals with the problem of identifying specific com­petencies of Master in dentistry. The results of the analysis of domestic and foreign scientific literature, legal documents regulating the implementation of competence-based approach in higher medical education is presented, international experience in the modernization of higher education, including medical, on the basis of changes in the educational paradigm on competence approach is studied. In the process of identifying set of special competences of Master of dentistry, the main ideas of the existing professional Standards in Dentistry were used. A worked out set of special competences reflects peculiarities of the profession in accordance with the algorithm, aimed to help dental patient in a vicious circle from disease prevention to rehabilitation after diseases, the latter includes legal, methodical, social and managerial aspects of the professional activities of a dentist.
N. G. Andryushkova, N. S. Turchin, L. V. Dolinchuk, V. A. Ponyatovskyy, V. V. Melnik, V. P. Shyrobokov, L. N. Trepet
Medicni perspektivi, Volume 21, pp 33-38; https://doi.org/10.26641/2307-0404.2016.4.90781

Abstract:
Objective of the study was determination of enterovirus genom presence in the blood serum of patients with acute stroke by polymerase chain reaction (PCR). The blood serum of 72 patients with acute stroke and control group of 30 patients with another vascular disease was studied to reveal genom of enteroviruses. Detection of enterovirus RNA was performed by PCR using the reverse transcription. Viruses were isolated on HeLa and HEp-2 cell lines. The enterovirus genom detected by PCR was in 17 of 72 samples of the tested serum in the research group (23,6±5,0%). In the control group only one serum was PCR-positive for enteroviruses (3,3±3,2%). Cytopathogenic agents were isolated in HEp-2 and HeLa cell lines from 11 PCR-positive samples of blood serum from the experimental group of patients. No viruses were isolated from the remaining PCR-positive and PCR-negative sera. The presence of enteroviruses in the blood of patients with acute stroke suggests etiopathogenetical link between them. The introduction of PCR to detect enteroviral agents in patients with acute stroke can complement existing methods of diagnosis.
T. I. Zinchenko, I. M. Pelo, S. T. Omelchuk, O. P. Vavrinevych
Medicni perspektivi, Volume 21, pp 130-135; https://doi.org/10.26641/2307-0404.2016.4.91482

Abstract:
When using tank mixtures and pesticides in chemical crop protection systems there exists danger of simultaneous or sequential action ofingredients. It was established that the combined potential risk of the harmful effects of Torero SC preparation on workers is 0.11-0.30 arb.units, Switch 62.5 WG – 0.054-0,065 arb.units, tank mixture 1 – 0.26-0.51 arb.units, tank mixture 2 – 0.26-0.49 arb.units correspondently and does not exceed the allowable value of risk (<1). The combined risk in sequential application of components of chemical protection system of strawberry exceeds allowable values of risk and is 0.954-2.02 arb.units. Ways of occupational risk decrease were proposed and regulations of safe application of tank mixtures and pesticides in chemical protection of strawberrywere substantiated.
O. Yu. Pototskaya, A. E. Lievykh,
Medicni perspektivi, Volume 21, pp 20-25; https://doi.org/10.26641/2307-0404.2016.3.81875

Abstract:
Some orders of Ministry of Education and Science of Ukraine encourage scientific authors to publish their articles abroad but do not detail selection criteria of the journals recommended. As a result, authors choose the easiest way and publish their papers in low-quality foreign journals. Moreover, some false journals have been created since the Orders entered into force. In this article we emphasize the importance of journal registration in scientometric databases for the international and regional rating of universities. Also attention is paid to the need of verification of journal quality and its reliability by the authors before sending manuscripts for publication. To resolve these problems we propose to indicate URL link of the article in the annual scientific report of scientists, departments and organizations. It will help to verify the quality of the journal and concentrate attention of the authors on checking the existence of journal’s web site before sending their manuscripts. It is important to emphasize that journals without web sites do not influence on the rating of scientific organizations in any scientometric databases. If such link is absent, article should not be scored up for the rating. Additional way is to create adequate system of scientific ratings. For example, articles published in major scientometric databases, such as Scopus and Web of Science, should be scored two (or more) times higher than any other articles. Papers published in other scientometric databases (such as RISC) also should be scored higher than onother articles. Information about principal scientometric databases should be clarified for scientists to help them in choosing optimal journal for manuscripts publishing.
V. I. Koshlia, M. Ben-Abid
Medicni perspektivi, Volume 21, pp 26-29; https://doi.org/10.26641/2307-0404.2016.3.82007

Abstract:
In 41 patients with essential hy­pertension I and II degrees telmisartan influence on parameters of intimate heodynamics and functional condition of myocardium ofLVhas been studied. Carried out researches have shown, that on a background of treatment with telmisartan reduction of final diastolic volume of LV, final systolic meredional stress and final diastolic pressure of the myocardium and increase in fraction of LV ejection emission and speed of circular reduction of myocardium fibres is marked. The specified changes may be explained by improvement of plastic characteristics of the myocardium that is caused both by direct action of telmisartan on the myocardium through blockade of a local renin-angiotensin- aldosterone system, and by the mediated influence due to decrease of blood pressure and after post loading.
, N. I. Osadchuk, D. V. Palij
Medicni perspektivi, Volume 21, pp 111-116; https://doi.org/10.26641/2307-0404.2016.2.72282

Abstract:
In the research antibiotic sensitivity of opportunistic pathogens was studied. In 2011-2015 from 405 patients with burns there were isolated clinical strains of S. aureus (n 130), P. aeruginosa (n 127), A. baumannii (n 176), being the prominent pathogens of infectious complications. Clinical strains of S. aureus, P. aeruginosa, A. baumannii obtained all morphological, tentorial, cultural and biochemical qualities, typical for these species of bacteria. On the basis of the received results there wascarried out approximation and interpolation of these data, dynamic prognostic indexes of changes in S. aureus, P. aeruginosa, A. baumannii antibiotic sensitivity were obtained. Low sensitivity to ampicillini/sulbactam (58,63±8,58%), ceftriaxone (55,75±14,24%), gentamicin (57,92±10,76%), tobramycin (64,67±10,3%) in clinical strains of S. аureus was proved. Prognostic optimizations of S. аureus sensitivity to amoxicillini/clavulanat (82,35%), gatifloxacin (94,12%) were determined. Clinical strains of P. aeruginosa, A. baumannii were shown to have low sensitivity to ceftazidime, cefoperazone, cefoperazone/sulbactam(20,08±2,98%; 48,88±6,49%, respectively). Progressive decrease of sensitivity to amikacin in P. aeruginosa (29,77±7,55%), A. baumannii (17,0±1,34 %) and to gatifloxacin in P. aeruginosa (28,53±1,35%), isolated from patients with burns were determined.
E. N. Belitskaya, O. V. Antonova
Medicni perspektivi, Volume 21, pp 99-102; https://doi.org/10.26641/2307-0404.2016.2.72273

Abstract:
Total daily load and the contribution of the different ways of the lead entry in children’s organism in industrial and control area were calculated. The study of a complex metal intake in the children's organism with air, water and food has shown that in industrial areas its intake is increased and intake of micronutrients - copper and zinc is reduced as compared to the control area. This work made it possible to draw a conclusion onjustified evidence that chemical loading of the environment makes a significant contributioninto worsening of children’s population. Lead occupies a leading place in this process. This necessitates the development of measures on prevention of ecologically-dependent pathology.
V. А. Kondratiev, А. V. Reznyk
Medicni perspektivi, Volume 21, pp 57-62; https://doi.org/10.26641/2307-0404.2016.2.72152

Abstract:
Bydopplerechocardiographymethodtherewasstudiedfunctionalstateofcardiacventriclesandcharacterofhemodynamicdisordersin 48 patients aged 5-17 years in attack period of moderately-severe and severe bronchial asthma. Group of comparison included 40 healthy peers. Disordersofcentralandperipheralhemodynamicinattackperiodofbronchialasthmainchildrenwereaccompaniedbothbysystolicanddiastolicdysfunctionoftheleftandrightheartventricles, herewith right ventricle was functioning in the mode of hyperdynamic, and left one – in the mode of hypodynamic. Combinedsystolic-diastolicvariantofdysfunctionbothofrightandleftventricleswasdevelopingin 58,3% of patients with moderately-severe and in 91,6% of patients with severe bronchial asthma. Intheattackperiodofbronchialasthmainchildrenequaldirectionalityofsystolicanddiastolicdysfunctionofheartventricleswasdeveloping; this was characterized by synchronization of their function.Assessmentoffunctionalinteractionoftheventriclesunderconditionsofsevereasthmaattackshoweddirectandhigh (r=0,67) correlativeinteractionbetweenfindingofTeiindexoftheleftandrightventricles, whichcharacterizetheirsystolicfunction; this, under conditions of increased hemodynamic pre-loading testified to compensatory increase of systolic interaction of ventricles. Direct and high (r=0,69) correlativeinteractionbetween time indices of isovolumic relaxation of the left and right ventricles, characterizing their diastolic function, testified to compensatory increase of diastolic interaction of ventricles under conditions of increase of hemodynamic post-loading. Imbalance of central and peripheral link of hemodynamic in attack period ofbronchialasthmainchildrentestified to development of cardiac insufficiency, which was compensated predominantly at the expense of increase of heart contractions rate.
A. G. Rodynskiy, E. Ju. Kondratieva, E. M. Demchenko
Medicni perspektivi, Volume 21, pp 4-8; https://doi.org/10.26641/2307-0404.2016.2.71747

Abstract:
In experiments on rats of three age groups the role of thyroid hormones in the regulation of fatty acid spectrum of cortical and hippocampus lipids was studied. It was found that on the background of decreased thyroid status content of polyunsaturated fractions of free fatty acids, significantly changed depending on the age of the animals. In particular, in juvenile rats hypothyroidism was accompanied by a decrease almost twice the number of pentacodan acid decreased lipids viscosity in neurocortex. In old rats reduce of pentacodan acid in the cortex (38%) was supplemented by significant (77%) decrease in linoleic and linolenic acids. Unlike the two age groups deficiency of thyroid hormones in young animals caused accumulation of free polyunsatarated fatty acids (C18: 2.3) in the cerebral cortex by 74%, which may be associated with a decrease of this fraction in fatty acid spectrum of lipids and increase of viscosity properties of the membranes. These restruc­turing may be associated with modulation of synaptic transmission of specific neurotransmitter systems in the brain.
S. O. Muntyan, A. Y. Nosov, V. V. Getman, K. P. Balash, S. P. Chernyak, N. L. Kruglyak
Medicni perspektivi, Volume 22, pp 55-60; https://doi.org/10.26641/2307-0404.2017.1.100902

Abstract:
57 patients aged over 60 years with various types of wound complications after surgery for abdominal and anterior abdominal wall were treated. Treatment of wound complications included both traditional methods and the use of packs of bishofit. Оn the third day after the start of treatment there was a significant decrease in almost all computing performance indices as compared with treatment using bishofit. On the day 7 a noticeable difference of wound cavity width by 62.88%, the volume of the wound cavity by 85.76% in patients of the second group as compared with patients of the first was noted. So,bishofit use in the form of compresses in the treatment of postoperative wound complications such as hematoma, seroma and infiltration leads to a significant reduction in wound exudation, rapid decline in the concentration of microorganisms in the wound; this reduces time of wounds healing and patients’ recovery.
Medicni perspektivi, Volume 21, pp 52-56; https://doi.org/10.26641/2307-0404.2016.2.72151

Abstract:
The paper presents original data on improvement of effectiveness of treatment (reduction of systemic inflammation, stabilization of lipid metabolism, improvment of quality of life) in patients with coronary artery disease (CAD) and metabolic syndrome (MS), who underwent primary percutaneous coronary intervention (PCI) for acute coronary syndrome without ST-segment elevation (ACS nST) by adding quercetin to basic therapy, 40 mg 3 times a day during the 12,07 ± 1,51 months. The reduction of a high sensitive C-reactive proteins (hs-CRP), (2,51 ± 0,93, nmol / L., versus 3,12 ± 0,43, nmol / L.), (p = 0,0007) and low-density lipoproteins (LDL), (4,01 ± 0,36, mmol / L., versus 4,29 ± 0,71, mmol / L.), (p=0,049) in the main group II (n = 33) as compared with the control group I (n=31), respectively,as well as thrombin: 5,96 ± 1,89, ng / mL. in group I as compared with 3,91 ± 1,43, ng / mL. in group II, (p=0,0002) was revealed. High density lipoproteins (HDL) were significantly greater (p = 0,049) in the group II (1,35 ± 0,41, mmol / L.) in comparison with the group I (1,17 ± 0,34, mmol / L.).
O. N. Shportun
Medicni perspektivi, Volume 21, pp 19-30; https://doi.org/10.26641/2307-0404.2016.2.72129

Abstract:
The article describes the psycho-physiological peculiarities of hemispheric asymmetry of the brain as the basis of individual and typological features of the formation of a sense of humour. The analysis of the impact of the functional brain hemispheric asymmetry on emotional, intellectual and physiological features of development of sense of humour in ontogeny is conducted. Analysis of studies of inter-hemispheric asymmetry of the brain makes it possible to ascertain the impact of the functioning of each hemisphere on the formation of the perception of humour. Studies show that in the process of developing of sense of humour, two functional hemispheres of the brain are involved. As the emotion of humour – is an intellectual emotion, and in the development of intelligence a lot of mental processes are involved, in the formation of humour two hemispheres of the brain are functioned. The right hemisphere is responsible for the emotional nature of humour (intonation, sound level of language, speed of response to a joke ...), the left hemisphere – for processing verbal information (content of the joke, category, purpose, content analysis ...). After analysing the research of hemispheric functional asymmetry of the human brain, its psycho-physiological and neurochemical characteristics, it can be assumed that people with more developed left hemisphere in perceiving humour are more prone to displays of gelotophilia and “right hemisphere” people – show signs of gelotophobia and katagelasticism. Examining gender differences of hemisphere asymmetry of the brain, it can be argued that diagnosing sense of humour is important to take into account gender-specific functioning of hemispheres, because men have more clearly functioning the left hemisphere, and women – the right one. This fact of sexual peculiarities of functioning of inter-hemispheric asymmetry of the brain allows diagnosing objectively sense of humour, as well as different variations of the human psyche.
V. A. Potabashniy
Medicni perspektivi, Volume 21, pp 39-46; https://doi.org/10.26641/2307-0404.2016.2.72131

Abstract:
The aim of this study was to examine the direction of change of left ventricle (LV) geometry in patients with chronic heart failure (CHF), arterial hypertension (AH) and ischemic heart disease (IHD) in combination with chronic obstructive pulmonary disease (COPD) in dependence on severity of clinical signs of CHF and COPD based on recommendation of American Society of Echocardiography and European Association of Cardiovascular Images (2015). We examined 67 patients with CHF, associated with AH and stable IHD and stable COPD. By the results of this study there were determined different types of left ventricle geometry: concentric LV hypertrophy (LVH), eccentric LVH, mixed LVH, dilated LVH, dependent on blood pressure level, fibrosic and ischemic myocardial changes,, primary predominant disease – AH, IHD or COPD.
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