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Journal Medicni perspektivi (Medical perspectives)

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Se Dma
Medicni perspektivi (Medical perspectives), Volume 24, pp 93-96; doi:10.26641/2307-0404.2019.2.170167

Abstract:In memory of academician, professor Mykhailo Georhiyovych Shandala
O. V. Kravets
Medicni perspektivi (Medical perspectives), Volume 24, pp 19-23; doi:10.26641/2307-0404.2019.2.170122

Abstract:In order to evaluate the effectiveness of the liberal regime of infusion therapy, we examined 50 patients with acute abdominal pathology considering the state of the water sectors of the body. We established that liberal regime of infusion causes hypervolemia and hyperhydration of peripheral tissues during the first 6 hours of the perioperative period, it retains a moderate deficit of hypovolemia and dehydratation from 1 to 14 day of observation and forms an increase in interstanial volume, causing its maximum edema from the 3d to 7th day of observation. These changes are combined with positive daily and cumulative water balances, which is reflected in a critical increase in the percentage of excess fluid from the 5th day of postoperative period.
L. Yuryeva, T. Shusterman, Ya. Varshavskyi, V. Malyshko
Medicni perspektivi (Medical perspectives), Volume 24, pp 83-86; doi:10.26641/2307-0404.2019.2.170159

Abstract:The article des­cribes the clinical case of obsessive-compulsive disorder in an adult patient with Gilles de la Tourette syndrome and severe behavioral disorders. The authors demonstrated the comorbidity of Gilles de la Tourette syndrome and obsessive-compulsive disorder. Obsessive thoughts and compulsive actions were diagnosed as the most frequent behavioral disorders in Tourette syndrome. It was indicated on gender as an additional sanctioning factor for the early onset of mental disorders. Obsessive-compulsive disorder in the patient was characterized by mixed obsessive thoughts and actions, had a protracted nature, with prolonged decompensations requiring treatment in a psychiatric hospital. Emotional instability, impulsivity, obsessions and compulsions affecting the social functioning of not only the patient himself, but also those around him, as well as pronounced behavioral disturbances led to social malajustment. When treating the patient, the doctors had to resort to a combination of typical neuroleptics with second-generation antipsychotics, mood stabilizers and antidepressants due to the poor response to pharmacotherapy. Comorbidity of mental disorders determined the complexity of therapeutic measures with the use of psychotherapeutic interventions, which made it possible to achieve an improvement in the mental state and avoid disability of the patient.
Medicni perspektivi (Medical perspectives), Volume 24, pp 65-72; doi:10.26641/2307-0404.2019.2.170152

Abstract:By the WHO data,Ukraineis country number1 inEuropeand number2 inthe world according to the cardiovascular mortality rate. In the structure of the prevalence of cardiovascular diseases in Ukraine, the percentage of persons of working age with arterial hypertension is 36.7%. The improvement of the prognosis of patients with arterial hypertension depends not only on long-term effective control of blood pressure, but the diagnosis and initiation of therapy at the initial stage of the development of the disease, when the target organs have not yet undergone hypertensive damage is also an important condition. The article presents the results of neuropsychological examination of 509 outpatients with a controlled second stage arterial hypertension, with an integrated assessment of cognitive functions using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MCA) methods. It has been established that even in patients with controlled arterial hypertension stage II with a low cardiovascular risk, by SCORE scale cognitive disorders were revealed in 32,2%. The peculiarities of the development of cognitive disorders in arterial hypertension in connection with the history and course of the disease are analyzed. The majority of patients with hypertension have an increased level of anxiety, especially personality, and this is not due to the presence or absence of cognitive disorders. In patients with hypertension and cognitive disorders, on the basis of testing data by the SF-36 scale, there was a significant (p<0.001) decrease in quality of life on all scales as compared with healthy ones on average by 24.5-66.0 points.
O. L. Arkhipkina
Medicni perspektivi (Medical perspectives), Volume 24, pp 40-45; doi:10.26641/2307-0404.2019.2.170128

Abstract:Nowadays, the problem of comorbid chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) is considered from the point of view of the presence of common risk factors and pathogenetic mechanisms. The aim of the study was to investigate cardiorespiratory system function in patients with COPD and AH and to analyze the main cardiovascular risk factors. 284 patients with COPD were divided into 2 groups: the main group - 167 patients with COPD and concomitant hypertension, the comparison group - 117 patients with COPD and normal blood pressure values. An analysis of the clinical picture of COPD revealed that patients with AH more often had exacerbation of underlying disease, more expressed clinical manifestations of the disease, differed in phenotypic distribution of patients. All patients with COPD showed a tendency to increase in arterial pressure, blood glucose level and total cholesterol compared with the control group with enhanced tendency in hypertensive patients. In addition, in hypertensive group the patients had a higher body mass index and smoked intensively. According to EGC data, the majority of patients with COPD experienced tachycardia, arrhythmia and conduction disturbances, hypertrophy of ventricules, which occurred more often in hypertensive patients. Pulmonary function was characterized both by obstructive and restrictive changes that were more expressed in the comorbidity. Thus, in the presence of AH the clinical manifestations of COPD varied, demonstrating the contribution of vascular pathology to the respiratory disorders in those patients. The combined course of COPD with AH is characterized by a modification of clinical manifestations of the disease and COPD was associated with increased cardiovascular risk in patients examined.
Sciprofile linkО. V. Poslavska, I. S. Shponka, H. S. Babiy
Medicni perspektivi (Medical perspectives), Volume 24, pp 13-19; doi:10.26641/2307-0404.2019.2.170119

Abstract:Carcinomas with an unknown primary site are a heterogeneous group of metastatic tumors, numbering from 3% to 5% of all malignant carcinoma phenotypes. An isolated lesion of the inguinal lymph nodes is relevantly associated with primary localization of tumors in the pelvis, anal canal, lower abdomen, lower limbs, and more towards in the reproductive system (vulva, vagina and cervix for women, penis for men). But in the absence of clinical signs of cancer after careful research, the histological biopsy of the lymph node with additional immunohistochemical staining with organ-specific markers becomes the diagnostic method of choice. A retrospective analysis of the histological, morphometric and immunohistological characteristics of the biopsy material of 59 patients with isolated lesions of the inguinal lymph nodes (35 women and 24 men) aged from 20 to 87 years (mean 59.26±15.86; median 62 years) was conducted. The distribution of variants of an isolated lesion of the inguinal lymph nodes in women showed 14 of 35 (40.00%) metastatic tumors (the other 21 are lymphoproliferative conditions that require phenotyping, but not finding the primary localization). Of 14 metastatic lesions in women, 6 cases demonstrated a p16ink (+) phenotype. For comparison, of 24 cases in men, only 6 (25.00%) were of metastatic origin, of which p16ink (+/-) was partially 1 metastasis of melanoma (16.67%). After a thorough immunohistochemical study with a panel of organo-specific markers among isolated metastatic lesions of the inguinal lymph nodes of tumors in women, half of the revealed localized sites (7 out of 14) were in reproductive organs, namely: 4 p16ink (+) to squamous cervical cancers, 2 p16ink (+) to serous ovarian adenocarcinoma, 1 p16ink (-) to leiomyosarcoma of the uterus. Other localizations did not have a clear location, as they related to metastases of carcinoma from Merkel cells and melanomas, as a result of frequent reduction of the primary tumor lesion in the skin.
T. Pyatchanyna, A. Ogorodnyk, P. Melnik-Melnikov
Medicni perspektivi (Medical perspectives), Volume 24, pp 4-9; doi:10.26641/2307-0404.2019.2.170117

Abstract:Patent research in the field of biomedical sciences (BMS) allows to give an objective assessment of the novelty and technical and economic level of the developed object of economic activity, to identify the most promising objects of economic activity, to identify competitive trends in the analyzed industry, to use the best achievements of world science, in the course of scientific research (SR), timely protect own technological and technological solutions with patents in Ukraine and abroad. The purpose of the article is to optimize methodological approaches to conducting patent research in the field of biomedical sciences on the basis of analysis of patent and scientific and technical databases. The fulfillment of the patent researches requires the use of compulsory methodological approaches, which are developed on the basis of DSTU 3575-97 "Patent Research: Key Provisions and Procedure". At each stage of the implementation of the SR, the algorithm for the patent researches, which must be followed in order to ensure the perspective of the development of object of economic activity, its legal protection, and competitiveness has been developed. The methodical approaches to conducting the patent researches in the field of BMS are determined on the basis of analysis of patent and scientific and technical databases, which allow to reveal competitive directions in the field of BMS, identify the most promising ones, give an objective assessment of novelty and technical and economic efficiency of SR; to use the most outstanding achievements of the world science during SR; timely protect own technical and technological decisions by patents in Ukraine and abroad.
D. Surkov
Medicni perspektivi (Medical perspectives), Volume 24, pp 24-33; doi:10.26641/2307-0404.2019.2.170123

Abstract:The negative impacts of standard pharmacologic sedative agents suggest that alternative agents should be investigated. Dexmedetomidine could be the new option for sedation in newborns with hypoxic-ischemic encephalopathy requiring mechanical ventilation. The aim – to determine the impact of dexmedetomidine and other sedatives on the cerebral blood flow and outcomes of hypoxic-ischemic encephalopathy in term neonates. Data of 205 term infants with hypoxic-ischemic encephalopathy by Sarnat scale stage II-III were collected during ≤72 hours of life. The infants were divided using a simple open randomization by pharmacological sedative agents during mechanical ventilation into dexmedetomidine group (n=46) and the control group (n=159), which included morphine, sodium oxybutyrate, and diazepam in standard recommended doses. A comparative analysis of the effect of dexmedetomidine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. A significant difference between groups in days of trachea extubation (p=0.022) was found; the chance for babies to be extubated before the 7th day of treatment was significantly higher in the dexmedetomidine group 68% versus 33% in the control group (p=0.018) with HR 0.48 (95% CI 0.27-0.86, p=0.011). Also, the NIRS index rScO2 differed significantly between the studied and control groups on the 1st day of treatment (65% versus 79%, p=0.012) and on the 2nd day of treatment (74% versus 81%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group – (58 [51-65] mm Hg versus 53 [46-60] mm Hg, p<0.001), with a lower dose of dobutamine (EV -1.87, 95% CI from -3.25 to -0.48, p=0.009). In the dexmedetomidine group, the rate of seizures was significantly lower on the 1st day of obser­vation (4.3% versus 48.3%, p <0.001); the incidence of unfavorable outcome sueh as cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared to the control group (2.2% versus 15.1%, p=0.018). Dexme­detomidine is a safe sedative agent with a stable hemodynamic profile, without adverse influence on cerebral perfusion and possible neuroprotective effects in term infants with HIE, as addition to standard therapeutic hypothermia.
Se Dma
Medicni perspektivi (Medical perspectives), Volume 24, pp 87-89; doi:10.26641/2307-0404.2019.2.170161

Abstract:Professor Ihor Serhiyovych Maschenko (to his 80th birthday)
A. Obolonskyi, V. Snisar, D. Surkov, O. Obolonska, O. Kapustina, K. Dereza
Medicni perspektivi (Medical perspectives), Volume 24, pp 33-40; doi:10.26641/2307-0404.2019.2.170125

Abstract:Closure of hemodynamically significant patent ductus arterios (HSPDA) is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0 g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4 ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6 ml/kg/day, and on day 5 – to 89.7±6.8 ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1 mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in rectal form. In all groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle.
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