Family Medicine

Journal Information
ISSN / EISSN : 2307-5112 / 2412-8708
Current Publisher: Professional Event, LLC (10.30841)
Total articles ≅ 480
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О. А. Ковалишин
Published: 30 October 2020
Family Medicine pp 92-96; doi:10.30841/2307-5112.4.2020.218055

Abstract:
The concept of «ovarian reserve» in recent years has been widely discussed in the literature. This is a functional reserve of the ovaries, reflecting the size of the follicular pool of the ovaries and the quality of the oocytes in them, that is, it characterizes the ability of the ovaries to develop a healthy follicle with a full egg. Determination of ovarian reserve allows you to more accurately assess the reproductive potential of women and prevent pathological conditions and diseases that reduce fertility.The objective: аccording to laboratory and instrumental methods of research, to give a comprehensive assessment of the condition of the ovarian reserve in women with menstrual dysfunction in the puberty.Materials and methods. The main group of women (n=90) with a pathology of menstrual function in the puberty, according to the nature of the violations, was divided into 3 subgroups (n=30): the first – women with primary oligomenorrhea in the anamnesis, the second – with late age menarche, the third – with puberty bleeding. The control group consisted of women (n=30) with the correct rhythm of menstruation in puberty. The age range of the subjects is from 19 to 32 years. The biochemical and echographic markers of the ovarian reserve were studied.Results. In a clinical study, it was found that in women with menstrual dysfunction in the puberty, the concentration of antimuller hormone (AMH) in the blood serum and the size of the ovaries (total volume) are greater due to the greater number of small follicles compared to women in the control group. A direct correlation between the parameters of AMH and the number of follicles and the inverse between AMH and the diameter of the follicles indicate normal ovarian reserve. This pattern was observed in women with a primary history of oligomenorrhea and late menarche. In women with pubertal hemorrhages, the concentration of AMH in the blood did not significantly differ from the control group, the total volume of both ovaries was greater than in women with a normal rhythm of menstruation (p<0,05), but the total number of follicles did not differ significantly. The correlation between the total volume of both ovaries and the total number of follicles was lost, which may indicate an increase in ovarian volume due to the stromal component.Conclusion. A comprehensive analysis of the level of AMH in serum, the total volume of the ovaries and the number of follicles in the preovulatory period allows us to estimate the ovulatory reserve in women with menstrual dysfunction in the pubertal period. And although the indicated parameters in the examined women are significantly higher than in women with the correct rhythm of menstruation (p<0,05), they remain within the reference values, which indicates the preservation of their ovarian reserve. Today, for screening the ovarian reserve, determining the concentration of AMH in the blood serum has several significant advantages over other methods, because this hormone is a marker that begins to change with age before other indicators, which is of great prognostic value in the treatment of various disorders of the reproductive system, premature extinction its function and infertility.
Ю. В. Марушко, Т. В. Гищак
Published: 30 October 2020
Family Medicine pp 82-86; doi:10.30841/2307-5112.4.2020.217968

Abstract:
Acute pneumonia in preschool children often requires the use of combined drugs that affect cough. One of them is a combination of bromhexine, guaifenesin and salbutamol, which has proven itself in school-age children and adults. However, there is insufficient data on the use of such combination in children.The objective: of our observation was to evaluate the clinical efficacy and safety of Askoril Expectorant therapy in children 2–7 years with acute community-acquired pneumonia.Materials and methods. We have summarized the experience of treatment of 30 children aged 2–7 years, suffering from community-acquired pneumonia of moderate severity. Ascoril Expectorant was added to antibiotic therapy for 9–12 days. The general condition of patients, severity of cough, shortness of breath, sputum secretion, monitoring of side effects, heart rate, systolic and diastolic pressure were measured. Tolerability of the drug was studied according to clinical observations and using a ten-point visual-analog scale.Results. All children before treatment had difficulty coughing up sputum. By the 2-3rd day of treatment, the cough became moist. Symptoms of nocturnal cough disappeared on the 5th–6th day of treatment, daytime – significantly decreased by the 6th–7th day of observation. Clinical signs of focal changes in the lungs persisted in all patients on 3–5 days of combination therapy and were absent in most patients within 10 days of treatment. On the third day of treatment the intensity of cough decreased from 2.53 to 1.07 points (p<0.001). On the fifth day of treatment the intensity of cough decreased by 2.9 times compared with the data at the beginning of therapy, on the tenth day – by 5.9 times. Good tolerability (8–10 points) was observed in 43.3 % of children, in others – satisfactory. No child had poor tolerability.Conclusions. The inclusion in the complex treatment of patients with community-acquired pneumonia of the combined mucoactive drug Askoril Expectorant leads to rapid relief of the disease and the achievement of an effective mucoregulatory effect with good tolerability of the drug.
М. С. Черська, , О. С. Коміссарова
Published: 30 October 2020
Family Medicine pp 71-76; doi:10.30841/2307-5112.4.2020.217935

Abstract:
Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients.The objective: was to determine sex and age differences in the structural and functional state of the vessels of the carotid and vertebro-basilar basins in patients with stage I–III cerebral atherosclerosis (CA) and type 2 diabetes mellitus.Materials and methods. A comprehensive clinical and instrumental study involved 229 patients with stageI–IIICA and type 2 diabetes mellitus. The patients were divided into 2 groups: I – the general group of patients who had an ischemic atherothrombotic stroke in the middle cerebral artery basin – CA III; II – with CA I–II stages. All patients underwent conventional clinical, laboratory and instrumental studies (Doppler ultrasound of the vessels of the head and neck – study of cerebral blood flow in the extra- and intracranial sections of the main arteries of the head and neck using the Aplio XG device (Toshiba).Results. In patients of group I, there were no age or sex differences in the linear systolic blood flow velocity (LSBFV) of the vessels of the carotid and vertebro-basilar basins. In group II patients over 60 years of age, the LSBFV in both internal carotid arteries was statistically significantly higher than in middle-aged patients, while the LSBFV in the left vertebral, posterior cerebral arteries and the basilar artery was statistically significantly higher in middle-aged patients than in the elderly. In our opinion, these differences can be explained by statistically significant differences in fasting blood glucose levels. It is important to note that statistically significant sex differences were found only for LSBFV in both common carotid arteries: in women with CA stages I-II, the rate of cerebral blood flow was higher than in men.Conclusions. For patients with stage III CA and T2DM, age and sex differences in the parameters of cerebral circulation both in the vessels of the carotid and in the vessels of the vertebro-basilar basins have not been established. Elderly patients with stage I–II CA and T2DM, in comparison with middle-aged patients, are characterized by a statistically significantly higher LSBFV in the vessels of the carotid basin and lower in the vessels of the vertebro-basilar basin. The rate of cerebral blood flow in female patients with stage I–II CA and diabetes mellitus is statistically significantly higher in both common carotid arteries, in contrast to the corresponding LSBFV indicators in male patients.
В. З. Нетяженко, Н. М. Баженова
Published: 30 October 2020
Family Medicine pp 56-62; doi:10.30841/2307-5112.4.2020.217657

Abstract:
Obesity, being one of the main modified risk factors for the development of pathology of the cardiovascular system, determines its rapid progression, more severe course and a high incidence of complications. With the prevalence of obesity, the incidence of hypertension (HT), non-alcoholic fatty liver disease (NAFLD), and, as a result, cardiovascular events increases.The objective: To increase the efficiency of early diagnosis of thrombophilic changes in the blood in patients with essential hypertension and concomitant obesity, combined with non-alcoholic fatty liver disease.Materials and methods. The study was conducted on the clinical base of the Department of Propedeutics of Internal Medicine No. 1 of the Bogomolets National Medical University in Kiev Clinical Hospital on railway transport No. 2 Branch «Center for Health Protection» of PJSC «Ukrainian Railway». 152 patients were examined: 72 men and 80 women. The patients were divided into groups: Group I – patients with stage II hypertension without signs of liver damage (46 people); Group II – patients with NAFLD without HT (54 people); Group III – patients with stage II HD with NAFLD (52 people).Results. In the group of NAFLD patients without concomitant hypertension, the effect of obesity was observed both on the platelet count and on their mean volume. The platelet count was significantly higher in the presence of obesity – it was 16 % (<0.05) more, the MPV levels were also higher in NAFLD patients with a BMI ≥30 kg/m2 – by 2 % (p<0,05). The degree of adrenaline-induced aggregation was significantly increased only in obese patients –– by 40 % (p<0.001) compared with controls, and by 18 % with non-obese patients. During the exitox test in the NAFLD group in the obesity subgroup, a 9.5 % shortening of the clot formation time was revealed (p<0.05). In the group of combined course of NAFLD and HT II stage the division of patients by BMI made it possible to reveal the depression of anticoagulant activity of antithrombin III was less by 10.5 % (p<0.01), and protein C by 23.2 % (p<0.001) in obese patients.Conclusion. Addition of obesity to hypertension and to the comorbid course of hypertension with NAFLD increased the thrombogenic activity of the blood, affecting various stages of hemostasis. However, the indicators of platelet-plasma hemostasis in patients with independent NAFLD did not actually differ from patients with obesity and BM I<30 kg/m2, which indicates similar pathophysiological mechanisms of prothrombotic changes in obesity and NAFLD.
В. С. Джуряк, Л. П. Сидорчук, О. М. Іфтода
Published: 30 October 2020
Family Medicine pp 52-55; doi:10.30841/2307-5112.4.2020.217629

Abstract:
The assessment of the hypertensive-mediated organ damage (HMOD) state is important for the hypertensive patients’ risk stratification.The objective: to assess the risks of chronic kidney disease (CKD) in patients with essential arterial hypertension (EAH) depending on the Cytochrome 11b2 Aldosterone Synthase Gene (CYP11B2, rs1799998) allelic state.Materials and methods. 100 hypertensive patients with hypertensive-mediated target-organ damaging (2nd stage), moderate, high or very high cardiovascular risk were enrolled in the case-control study and underwent complex of clinical-laboratory investigation with following epidemiological analysis. Mean age 59.87±8.02 y.o. CKD was diagnosed according to the National Kidney Foundation recommendations (2012) after glomerular filtration rate (GFR) decline measured by CKD-EPI equations after Creatinine, or Cystatin-C blood level. Control group included 48 practically healthy persons of relevant age. Gene’s nucleotide polymorphism CYP11B2 (–344C/T) was examined by polymerase chain reaction in 72 EAH patients and in control group.Results. The probability of CKD in the T-allele carriers of the CYP11B2 gene (rs1799998) increases after GFR decrease (cystatin-C) almost 1.5 times [OR=1.86; 95 % OR:1.01–3.58; p=0.049], especially in women [OR=2.23; 95 % OR:0.99–5.90; p=0.052]. The presence of type 2 diabetes mellitus in EAG patient increases the CKD risk 2.4 times [OR=3.29; 95 % OR:1.06–10.19; p=0.034], the obesity onset increases risk 2.08 and 2.32 times [OR=3.30; 95 % OR:1.33–8.16; p=0.009 and OR=3.58; 95 % OR:1.02–9.34; p=0.048, respectively], 3rd degree blood pressure elevation increases the probability of CKD almost three times [OR=5.06; 95 % OR:1.942–13.23; p<0.001]. Hyperaldosteronemia increases the CKD risk in EAH patients 1.3 times [OR=5.29; 95 % OR:1.15–24.37;p=0.02].Conclusion. The CKD risk (after creatinine) in the mutation T-allele carriers’ women increases 6.5 times (p=0.007) with the lowest probability of such changes in T-allele carriers’ men [OR = 0.15; p=0.009].
Є. Д. Єгудіна, С. А. Трипілка
Published: 30 October 2020
Family Medicine pp 15-27; doi:10.30841/2307-5112.4.2020.217350

Abstract:
Updated recommendations of the European League Against Rheumatism (EULAR) on the pharmacological management of psoriatic arthritis (PsA) 2019 were presented in May 2020. The recommendations are compiled in accordance with the standardized EULAR operating procedures, a systematic review of the literature, followed by a consensus meeting of 28 international members of the task force for guideline development.Updated recommendations include 6 general principles and 12 recommendations. General principles relate to the nature of PsA and the diversity of both musculoskeletal and non-musculoskeletal manifestations; emphasizes the need for joint decision-making by the patient and the doctor. The recommendations represent treatment strategies for pharmacological therapy. Nonsteroidal anti-inflammatory drugs and local injections of glucocorticoids are offered as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis, accompanied by dactylitis or joint damage, it is recommended that the usual synthetic disease-modifying antirheumatic drugs (DMARD) be started quickly. If the treatment objective is not achieved using this strategy, biological DMARD (bDMARD) should be initiated, targeting tumor necrosis factor (TNF), interleukin (IL)-17A, or IL-12/23 taking into account skin lesions. If axial disease predominates, an TNF inhibitor or an IL-17A inhibitor should be started as a first-line DMARD.The use of Janus kinase inhibitors is considered primarily after the ineffectiveness of bDMARD. Inhibition of phosphodiesterase-4 is proposed for patients who are not suitable for other drugs, usually in the context of a mild disease. The switching of drugs and dose tapering in the phase of sustained remission are considered. This guideline provides an updated consensus on the pharmacological treatment of PsA based on a combination of evidence and expert opinion.
О. О. Речкіна, В. О. Стриж, С. М. Руденко
Published: 30 October 2020
Family Medicine pp 77-81; doi:10.30841/2307-5112.4.2020.217943

Abstract:
The objective: was to investigate the level of asthma control in adolescents using the ACT questionnaire and spirometry.Materials and methods. The study included 32 adolescents aged 12 to 18 years, with asthma, without clinical and functional signs of exacerbation. 46,8 % of adolescents (15 people) had a controlled course, and 53,2 % of children (17 people) had a partially controlled asthma.Results. According to the results of spirometric examination, a positive test with a bronchodilator was found in 21,9 % of adolescents. After evaluating the results of spirometry, the share of children with incomplete control of asthma was 59,4 %. According to the AST questionnaire, insufficient control over the course of asthma was found in 65,6 % of those surveyed. After taking into account the results of spirometry and the results of the ACT questionnaire, the number of adolescents with incomplete control of asthma increased from 53,2 % to 71,9 % (χ2=4,14; p=0,042).Conclusion. Clinical monitoring is not always sufficient to properly assess the level of asthma control in adolescents. Consideration of several assessment methods makes it possible to more accurately determine the level of asthma control in a patient.
Published: 30 October 2020
Family Medicine pp 28-31; doi:10.30841/2307-5112.4.2020.217351

Abstract:
Combinations of calcium and vitamin D are currently at the forefront of strategies for the prevention of osteoporosis, as well as for replenishing calcium deficiency in adolescence, in the elderly, during pregnancy and lactation. The combination of calcium and vitamin D is significantly and more effective than their monotherapy in slowing bone loss and reducing the risk of fractures, strengthening skeletal muscles and reducing the likelihood of falls.Based on the analysis of modern scientific data, it can be unequivocally argued that calcium and vitamin D deficiencies are widespread, and their adequate intake from food sources or drugs should be an obligatory part of the prevention and treatment of osteoporosis and osteoporotic fractures. The best results in reducing the risk of fractures are observed with the appointment of a combination of calcium at a dose of 1000–120 m0 g per day and vitamin D at a dose of 800 IU/day.The drug Azvestiv (JSC “Kyiv Vitamin Plant”), which has appeared on the market of Ukraine, can be used in the programs for the prevention and treatment of osteoporosis in young adult groups, and it is possible to take an adequate dose of calcium and vitamin D deficiency in patinets with osteoporosis. D.
Є. Х. Заремба, О. В. Заремба-Федчишин, М. І. Прокоса
Published: 30 October 2020
Family Medicine pp 63-66; doi:10.30841/2307-5112.4.2020.217673

Abstract:
The objective: is to assess the efficiency of metabolic therapy on blood pressure indicators based on the results of daily blood pressure monitoring in hypertensive patients.Materials and methods. The results of daily blood pressure monitoring in patients with stage II hypertension of 2–3 degrees are presented. 50 patients (including 28 men and 22 women) were examined. The mean age of patients was 44.6±10.9 years. Hypertensive patients received basic combination antihypertensive therapy with individually selected doses of ramipril / amlodipine in combination with metabolic therapy with0.5 g of quercetin. Сorvitin dissolved in 50 ml of isotonic sodium chloride solution intravenously / 2 times a day after 12 hours during 5 days; during next 30 days of outpatient treatment patients received 40 mg of quercetin orally 3 times a day. All patients underwent daily blood pressure monitoring using HEACO ABPM 50 device.Results. The use of combined antihypertensive and metabolic therapy contributes to the normalization of blood pressure during the day, allows achieving target blood pressure levels in most patients which is manifested by the improvement of the daily blood pressure profile based on the results of the daily blood pressure monitoring.Conclusion. The use of quercetin (corvitin, quartin) in complex therapy with the use of combination antihypertensive drug ramipril / amlodipine reveals an additional antihypertensive effect which can be successfully used in the treatment of hypertensive patients.
С. Ойеджид, В. С. Потаскалова, М. В. Хайтович
Published: 30 October 2020
Family Medicine pp 32-34; doi:10.30841/2307-5112.4.2020.217352

Abstract:
Mango fruits and mango leaf extracts (Mangifera indica) are a medicinal plant used to treat diabetes and its complications. The tender leaves of the mango tree contain tannins called anthocyanidins, which help treat early diabetes. The leaves contain the compound 3 betataraxerol and ethyl acetate extract, which interacts with insulin, activating GLUT4 and stimulating glycogen synthesis. Mango leaves have powerful antioxidant properties because they contain a large amount of flavonoids, phenols, zeaxanthin and beta-carotene. Animal studies have shown that mangiferin can counteract the free radical associated with cancer, diabetes, and other diseases.
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