Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 4-10 (2018)
The article presents data on the possibility of predicting the formation of fibrous changes in 6 and 12 months after the past pneumonia in patients with severe nosocomial pneumonia during the year of prospective observation. The possibility of using indices of systemic inflammation (SRB over 87 mg/L at the onset of the disease) and fibrosis (Transforming growth factor beta - TGF β over 19675 pg/ml) to assess the risk of long-term consequences of severe community acquired pneumonia has been proved.
pneumonia, severe community acquired pneumonia - predicting fibrosis after pneumonia - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 14-19 (2018)
The aim of the study was to investigate the features of daily blood pressure changes in patients with obstructive sleep apnea syndrome (OSAS) and heart failure with preserved ejection fraction based on the data of daily blood pressure monitoring. Materials and methods. 86 patients with OSAS and HFpEF (group 1), 74 patients with HFpEF without OSAS (2nd group) and 52 patients with OSAS and without HF (group 3) were examined. All participants of the study underwent cardio-respiratory monitoring, ABPM, echocardiography, NT-proBNP. Results. SABP and DABP in patients with HFpEF and OSAS were generally higher in the day and night than in comparison groups. "Non-dipper" dominated among the pathological daily profiles. As results of the multivariate regression analysis, it was found that the level of SABP at night was determined by IAH (β=0,386, p<0,05) and MeanSaO2 (β=0,339, p<0,05). The DABP level at night was determined by the IAH (β=0.412, p<0.05). Conclusions. Patients with OSAS and HFpEF have insufficient reduction in blood pressure at night and greater variability of blood pressure overnight. With the increase of OSAS severity more often daily profiles "non-dipper" and "night-peaker" are recorded, the variability of blood pressure increases. When performing a multivariate regression analysis, it was found that the level of SABP at night was determined by IAH (β=0,386, p<0,05) and MeanSaO2 (β=0,339, p<0,05); DABP level at night was determined by the IAH (β=0,412, p<0,05).
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 11-14 (2018)
The main task of the general practitioner is managing patients with the effects of ischemic stroke. The improvement of patients adherence to treatment in a significant way contributes to successful secondary prevention of ischemic stroke. Adherence to treatment can be determined through various questionnaires, including Morissky-Green. Currently, the adherence to a long-term drug therapy remains insufficient.
consequences of ischemic stroke - general practice-family medicine - Morissky-Green scale - secondary prevention - adherence to treatment - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 25-29 (2018)
The article presents authors’ observation of a clinical case of the girl aged 15 years old with cardiogenic syncope due to sick sinus syndrome, which progressed from normocardia sinus rhythm to pauses of the cardiac rhythm lasting 10.2-second during 3 years’ period.
syncope - sick sinus syndrome - adolescent - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 34-43 (2018)
This article presents the literature review devoted to studying the problem of iron-deficient states in the event of chronic heart failure. The epidemiological indicators, various published data on the impact of anemia on the prognosis of chronic heart failure which show a particular urgency of this problem have been presented. All existing approaches to the treatment of iron deficiency anemia and anemia of chronic diseases in this category of patients have been described. The results of studies on the use of classical oral ferrocorrection, as well as the use of modern approaches – intravenous ferrotherapy, isolated and combined use of recombinant human erythropoietin have been demonstrated. The advantages and disadvantages of each of the methods of anemia correction in patients with chronic heart failure have been discussed. The possible reasons for failures in anemia treatment and the absence of a pronounced impact on the clinical manifestations of chronic heart failure with the use of standard approaches to treatment have been discussed as well.
ron deficiency - ron deficiency anemia - anemia of chronic diseases - chronic heart failure - ron supplements - erythropoietin - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 47-50 (2018)
Infants delivered at 37 and 38 weeks’ gestation are at increased risk for morbidity as compared to infants delivered at 39-40 weeks. Our objectives were to study the frequency of transient neurologic dysfunction in the first months in newborns and infants, depending on the gestational age. We found a higher incidence of risk factors of pregnancy, more frequent need in oxytherapy after birth, and differences of hemo lyquordynamics at the age of 2-3 months.
newborn - early term birth - central nervous system - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 22-25 (2018)
In the context of professional competence, the management of constipation syndrome (self-diagnosis, self-treatment and provision of preventive measures for constipation in patients of different ages) is a function of doctors of a general practice medicine - family medicine. The authors developed and proposed an algorithm of treatment and management of a patient with constipation syndrome at the ambulatory stage.
constipation - treatment of the constipation - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 29-33 (2018)
119 children aged 12-17 years with the stable and labile forms of arterial hypertension (AH) and prehypertension hospitalized to cardiopulmonary department due to ambulatory single-measured blood pressure (BP) elevation were observed. The level of TNF-α in adolescents with different forms of AH and prehypertension as well as the correlation of this marker with other cardiovascular risk factors was determined. There was a significant increase in the mean value (9.50±0.54 pg/ml) and frequency (45.6%) of increase of TNF-α level in the group of children with AH compared with the group of children with normotension (6.43±0,64 pg/ml and 12.5% respectively). There is shown a tendency to increase of TNF-α levels, depending on the degree of stabilization of AH with the highest level of proinflammatory cytokines of TNF-α in the group of children with stable systolic BP. The positive correlation of TNF-α with the daily BP monitoring indicators, especially with the level of diastolic BP and its variability at night was revealed.
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 56-61 (2018)
Pneumonia occupies a significant part in the structure of morbidity and mortality of the population of Ukraine and the whole world. The incidence of this disease is several times higher among elderly patients. At the same time the prognosis for patients of this category can be fairly unfavorable, being connected with a number of age features. This fact, in its turn, points out the necessity of more precise criteria and new methods of assessing changes in the condition of a patient with pneumonia, and it also became a valid criterion to use in determining the severity and prognosis of the disease course. In this article the specific example of the application of the algorithm, named “Integral geriatric evaluation adapted for emergency care”, in the treatment of an elderly patient with pneumonia was considered. The role of statins in the complex treatment of patients with inflammatory diseases and their link with the level of C-reactive protein as a risk indicator of the unfavourable course of the disease in the form of the thrombotic complications was specifieced. So, medical care for elderly patients with pneumonia should be comprehensive in terms of diagnosis (improving the fairness through the application of the new and more precise methodology of assessing the functional state of a human organism) and treatment. The high degree of comorbidity among patients of the category “frail elderly” with pneumonia requires the application of approaches, which enable to reduce the cardiovascular risks and otherones. Such approaches include the administering of statins at high doses, in light of its impact on the level of C-reactive protein as a predictor of the thrombotic complications.
pneumonia - elderly patients - statins - Ischaemic heart diseases - comorbidity - C-reactive protein - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 51-56 (2018)
Cardiovascular diseases (CVD) are the leading cause of death worldwide. Most CVD can be prevented by modification of such risk factors as tobacco use, obesity and unhealthy diet, physical inactivity and harmful use of alcohol. Patients with CVD or who are at high cardiovascular risk due to the presence of risk factors such as dyslipidemia, hypertension, diabetes mellitus type 2, need early detection and management of these states. The article describes differences between metabolic profile of patients with obesity and coronary artery disease. The study included 58 patients. They were divided into 3 groups: 1st - patients with BMI <30 and CAD, 2nd - patients with BMI>30 and CAD, and 3rd - patients with BMI>30. 1st and 2nd group of patients were treated with atorvastatin in the dose of 40 mg for 2 years, 3rd - untreated. The results indicate that significant difference was faund in the lipid profile between groups of patients treated with atorvastatin in the dose of 40 mg . Transaminases and uric acid levels were different but within the reference range. The difference was found in serum glucose, insulin and HOMA-IR between participants of the 2-nd and other groups. We observed significant insulin resistance in the group of patients with coronary heart disease, obesity, treated with atorvastatin. So, administration of atorvastatin to the patients with IHD and obesity may negatively impact carbohydrate exchange and serve as a possible cause of diabetes melitus type 2 development.
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 44-47 (2018)
The number of studies that assess the quality of life of patients with various comorbid diseases is increasing annually. Arterial hypertension and gout is no exception. There are difficulties in managing this category of patients at the primary stage in accordance with current recommendations. The purpose of the study was to analyze the effectiveness of use of questionnaires for assessing the quality of life (SF-36) and health (HAQ) with disability index (DI) in patients with arterial hypertension combined with gout in everyday clinical practice by the family doctor; to assess the correctness of maintaining this category of patients in accordance with current recommendations (EULAR, 2016). A sociological survey of general practitioners (n=30) was carried out by a specially developed questionnaire consisting of three sections. It was found that not all doctors prescribe an adequate dose of colchicine for exacerbation of gouty arthritis, and more than half of the doctors do not use preventive colchicine for 3-6 months after the attack. Most doctors do not use the assessment quality of life (SF-36) and Health Assessment Questionare (HAQ) with a disability index (DI) at admission, but most believe that the results of these questionnaires contain important information on the patient's condition and the prospects for their using at the outpatient stage.
hypertension - gout - quality of life - urat-lowering therapy - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 66-69 (2018)
A comparative assessment of fecal calprotectin (FC) levels was performed in 160 patients with chronic inflammatory bowel disease (CIBD) (Crohn's disease (CD), ulcerative colitis (UC)) and irritable bowel syndrome (IBS). The results of FC in patients with CIBD and IBS were compared with the values of FC of 31 healthy patients (control group). The mean FC level in patients with CIBD was 65.75 μg/g compared to the control group (13.72 μg/g) (p<0.05). In the group of patients with IBS, the FC level was 16.18 μg/g (p≥0.05). Significant correlation was found between the levels of FC with CIBD and FC with IBS (p<0.05). The obtained results confirmed the high diagnostic value of the method of determining fecal calprotectin in the differential diagnosis of functional and inflammatory bowel diseases.
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 61-66 (2018)
Dysphagia is an important risk factor for such a serious life-threatening or health-patient complication as aspiration (aspiration pneumonia), dehydration, malnutrition. Prevention of dysphagia in the damage to the nervous system is not possible. However, with the proper evaluation and treatment of disorders that result from dysphagia, it is possible to prevent complications, to take into account this symptom when feeding the patient, carrying out rehabilitation measures and medical treatment. The article presents diagnostic algorithms for the actions of the general practitioner-family doctor in the detection of dysphagia and clinical cases of this syndrome of different etiology.
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 80-83 (2018)
The article analyzes the peculiarities of the process of full-time training of family doctors for the competence in providing emergency care. The modern problem of reducing the level of adaptation to professional activity, associated with decrease in the ability to work and person's reserves in overcomeing crisis situations and the objective difficulties of the medical process itself is considered. The acmeological techniques, methods and technologies applied during the practical training in resuscitation are presented. The effectiveness of the method of guided discussion, analysis of concrete situations, game simulation technologies, that enable to move from cognitive motivation to professional, to improve interpersonal relations, to rise professional preparedness for actions in crisis situations and emergency care through the achievement of real indicators of practical skills and abilities is studied and generalized.
professional competence and success of doctors - acmeological technologies - continuous higher medical education - professional improvement of doctors - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 1(part2), Pp 76-79 (2018)
There was carried out an anonymous questioning– a survey of 6th-year students who received an internship assignment in the specialty «General Practice – Family Medicine», interns and students doing courses in the same specialty in order to diagnose the presence of «clip-on» thinking. M.B. Litvinova test method which is characterized by criterial and categorical validity and corresponds to reliability criterion was used. «Clip on» thinking was diagnosed in 36.5% of the surveyed students on training a budgetary basis and 37.8% of students studying on a contract basis, plus 38.5% of them were at risk. At the stage of postgraduate education (internship training), the percentage of «screen people» (with «clip» type of thinking) was significantly lower, but at the same time the share of the risk group on formation of a «clip» type of thinking was increased. The predominant increase in «people of the book» («long» thinking) among physicians with a certain length of service mainly is due to their age characteristics. Modern medical postgraduate education requires the formation of a qualitatively new approach to the educational process, based on the formation and development of clinical thinking, taking into account psychological characteristics of the modern youth and older colleagues. This phenomenon requires detailed social, andragogical and medical research, the creation of new educational technologies based on «live» communication.
clinical thinking - «clip-on» thinking - «long-term» thinking - students - nterns - doctors - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 15-18 (2018)
In connection with the significant increase in complications, developing in young people with mitral valve prolapse (MVP), the study of phenotypic signs and peculiarities of the formation of this pathology is topical. A survey of 135 young people aged 17-25 years with mitral valve prolapse was conducted. The patients were examined by specialist-doctors: neuropathologist, otorhinolaryngologist, surgeon, traumatologist and oculist to exclude organic pathology; the distribution of phenotypic signs of connective tissue dysplasia depending on degree of MVP was evaluated. It was established that in young people with MVP of 2nd degree external and visceral manifestations of connective tissue dysplasia occur significantly more often than in persons with MVP of 1 degree.
mitral valve prolapse - connective tissue dysplasia - phenotypic signs - young age - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 25-32 (2018)
Despite the advances in the treatment of chronic heart failure (CHF) the mortality of patients remains high. Development of renal dysfunction is one of the most common conditions comorbid with CHF. Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice, the prevalence of which is increasing. The risk factors and mechanisms of AF development and renal dysfunction largely coincide. The markers of early renal damage in patients with CHF and AF are presented and analyzed. The data suggest that the degree of tubular damages assessed by β-2-microglobulin level in blood serum and AU is not always correlate with changes of GFR, but has significant variability.
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 50-56 (2018)
Purpose – to determine changes in the trypsin-like blood activity and its relationship with acute phase indices of inflammation in patients with pulmonary fibrosis (PF) as a marker of course severity and prognosis of the disease. Materials and Methods: The study included 18 patients: 15 (83%) women and 3 (17%) men, mean age 53±2.5 years. The control group included 15 practically healthy persons. All the examined patients (n=18) were divided into two groups: with mild or moderately severe PF – 8 (44.4%) patients (group I), severe PF – 10 (55.6%) of patients (group II). Duration of the disease - from 1 month. up to 4 years. Patients underwent clinic-laboratory and anthropometric studies, a mMRC questionnaire was used, blood saturation was measured, lung radiography in 2 projections, echocardiography, and if necessary a high-resolution computer tomography etc were performed. Results and discussion: More than half of the patients were overweight (44,4%) or had obesity of І-ІІІ st. (27.8%). The severity of dyspnea according to mMRC scale was 3.0 (3.0-4.0) points in patients of group II and 2.5 (2.0-3.0) points in patients of group I. There was a decrease in C-reactive protein (CRP) in group I and a tendency to increase in patients of group II. When analyzing the indicator of trypsin-like blood activity (TLA), it was found that the median TLA at the beginning of the observation was twice as high as in healthy individuals, direct correlation was established between the level of TLA and the severity of the disease course. After treatment the level of TLA decreased in group I patients. In the severe course of PF, the average TLA level remained high. The progredient course of LF is characterized by severe clinical symptoms, a significant increase in TLA, CRP, reduced O2 saturation, a lack of response to treatment and an unfavorable prognosis. The TLA index can be used as a biochemical marker of the severity of PF along with the CRPindex, O2 saturation and the degree of dyspnoea.
pulmonary fibrosis (PF) - biomarkers - trypsin-like activity of blood - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 32-36 (2018)
Evaluation of the functional state of the patient is the basis for recognizing him persistently incapacitated. The reform in the field of medicine in our country entrusts the function of the initial selection of such patients to general practitioners and primary care physicians. In 2001, the working group of the World Health Organization approved the International Classification of Functioning, Disability and Health. There are 7 basic parameters for detailing the functioning of a person: the ability to self-service, to move, to work, to orientate, to control own behavior, to learn, to communicate. The ability to self-service characterizes a person's capability to provide own physiological needs, to adhere to own hygiene and to perform daily activities. A person with a preserved capacity for self-service does not depend on other people.The ability to move allows the person to move in space independently: to walk, to run, to overpass the obstacles, to use public transport. If this criterion is limited, the person needs more time to overcome the distance or uses the additional support or needs help from outside. The ability to orient allows the person to analyze the surrounding world with the help of eyes and ears.The ability to communicate provides an opportunity to establish contacts and maintain relationships with other people. For communication spoken, written and non-verbal speech is used. The ability to control one's own behavior consists in the awareness of one's own personality and one's own place in the world, limited by certain norms and rules of behavior. The ability to learn allows the person to perceive, comprehend, accumulate and reproduce the information. Due to this,the person can accumulate knowledge and skills. Ability to work allows the person to perform work according to the level of one’s own education. The definition of criteria for disability and the degree of their severity requires a certain level of medical training for general practitioners and primary care physicians.
disability - medical and social expertise - criteria of disability - general practitioner - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 9-14 (2018)
Objective: to investigate the influence of L - arginine on platelets activity in patients with COPD and concomitant arterial hypertension. 30 patients with COPD of A - D category combined with hypertension (Н) I - II stage in the state of disease control were examined. In I gr. (n=20) patients received L – arginine (Tivortin) in a daily dose of 4g as additional medication to the basic therapy for 30 days. Patients of II gr. (n=10) received only basic therapy. The adhesion of platelets (pl), induced with adenosine diphosphate (ADP), collagen and thrombin (optical turbidometric aggregatometry method) were determined. Additionaly, in I gr. (n=6) there were determined the level of activated, aggregated, degranulated pl, packing density of pl granules (transmission electron microscopy). Under the influence of therapy in patients of I gr. degree of pl adhesion, degree of induced pl aggregation (collagen, thrombin), rate of aggregation (ADP, thrombin), activity of pl von Willebrandt factor activity (collagen, thrombin) decreased, level of activated, aggregated and degranulated pl decreased; packing density of α - granules increased (p<0.05). In II gr.of patients significant changes in the indices of adhesion and induced aggregation of pl were not detected. In comorbid patients with COPD and arterial hypertension L-arginine (Tivortin) reduces platelet activity and may reduce thrombogenic potential and risk of thrombotic events.
СOPD - hypertension - adhesion of platelets - platelets aggregation - L-arginine - Medicine (General)
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 19-24 (2018)
Our aim was to assess the level of proteinuria and changes in vascular endothelial function in patients with chronic kidney disease (CKD) in combination with subclinical hypothyroidism (SHT) under the influence of antihypertensive combination therapy (valsartan 160 mg and amlodipine 5 mg). We examined 48 patients with CKD I-II stages and AH 1 and 2 degrees. Depending on the functional state of the thyroid gland, patients were divided into 2 groups. Within 12 weeks patients took a fixed combination of amlodipine 5 mg and valsartan 160 mg. Target BP levels were achieved in 19 (86.3%) patients of the main group and 22 (84.6%) of the comparison group. More often violation of brachial artery flow-mediated dilation and higher level of daily proteinuria were found in the main group patients. At the end of the study, the level of daily proteinuria in the main group decreased by 46.03% (p<0.01), and in the comparison group – by 55.3% (p<0.01). SHT can be considered as an additional factor that affects the course of CKD and AH by worsening the state of endothelial function and increasing the level of daily proteinuria. Combination of valsartan 160 mg and amlodipine 5 mg has lead to achieving of target blood pressure levels, improving of endothelial function and decreasing of daily proteinuria in both groups.
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 41-45 (2018)
Recently, the problem of depressive syndrome in COPD patients often attracts the attention of doctors and scientists. It is important to study the relationship between the presence of the depressive syndrome, on the one hand, and the clinical and functional characteristics of COPD patients on the other, in order to determine the categories of patients inclined to develop a depressive syndrome. The purpose of the study: to determine the relationship between the presence of depressive syndrome in COPD patients with the severity of their clinical symptoms of COPD and the level of functional impairments. 52 COPD patients of clinical groups C and D were examined. Depending on the presence of depressive syndrome patients were divided into two subgroups: a subgroup 1 – 15 COPD patients with concomitant depressive syndrome, a subgroup 2 – 37 people without it. The examination included general clinical and functional methods. It was determined that the development of depressive syndrome in COPD patients can be affected by the high severity of clinical symptoms of COPD in general, decreased tolerance to physical activity, long duration of the disease, poor quality of life. At the same time, the levels of functional indicators, in particular, OFV1 and SpO2, may not have a significant relationship with the occurrence of depressive syndrome, even in patients with severe COPD.
Medičnì Perspektivi, Vol 23, Iss 2(part1), Pp 69-74 (2018)
Epidemiological studies have reported that the rate of signs and symptoms of heart failure after myocardial infarction is approximately 25%. In addition, approximately 40% of myocardial infarctions are accompanied by left ventricular systolic dysfunction. Aim.. Aim of the study is to evaluate serum levels of galactin-3, AGEs and endothelial function, cardiac hemodynamics in post infarction chronic heart failure patients with different ejection fraction. Materials and methods. All patients are divided into two main groups according to ejection fraction:1st group-20 patients with chronic heart failure with preserved ejection fraction, 2nd group-15 patients with chronic heart failure and reduced ejection fraction. Standard laboratory blood tests for erythrocyte sedimentation rate, haematological parameters, lipid profile, glucose, renal function, echocardiographic examination, endothelial function determine were performed for all patients. AGEs and galectin-3 serum levels were determined. Results. Patients with chronic heart failure and reduced ejection fraction and myocardial infarction in anamnesis had significantly increased left ventricle diastolic volume, left ventricle systolic volume,left ventricle diastolic dimension and left ventricle systolic dimension (p<0.05).AGEs serum level mildly increased in both groups.Galectin-3 level was significantly higher in pts with chronic heart failure and reduced ejection fraction(p < 0.05)and was correlated with age(R=0.74, p<0.05), left ventricle end diastolic volume (R=0.57, p<0.05), left ventricle end diastolic dimension (R=0.48, p<0.05), triglycerides level (R=0.45, p < 0.05). Most of the patients with chronic heart failure with myocardial infarction in anamnesis had endothelial dysfunction, the FMD% level was significantly higher in patients with preserved ejection fraction(p<0.05). Conclusions. Patients with chronic heart failure and reduced ejection fraction are characterized by significantly higher levels of galectin-3, endothelial dysfunction frequency, cardiac hemodynamics abnormalities.