Pulmonary comorbidity in chronic lymphoproliferative diseases: realities of the problem in the Dnipro region

The prevalence of the chronic lymphoproliferative diseases is increasing worldwide with increase of the population age. It is known that the presence of comorbidities in such patients plays an important role in predicting treatment outcomes. The aim of the work was to study the prevalence and determine the structure of respiratory symptoms and comorbid pulmonary pathology in patients with chronic lymphoproliferative diseases (CLPD) in the Dnipro region of Ukraine. After analyzing 986 cards of inpatients of the hematology department, whose average age was 65 (56; 69) years, it was determined that 9.0% of patients had at least one chronic respiratory disease, the most common among which were chronic bronchitis, chronic obstructive pulmonary disease, as well as community-acquired pneumonia. Dyspnea and tachypnea are also common among patients with CLPD without established respiratory comorbidity, cardiovascular disease, or anemia. Based on the data obtained, we can recommend a study of the respiratory function and pulse oximetry, as well as a thorough collection of anamnesis of smoking and analysis of the results of chest computed tomography in all patients with CLPD in order to identify the possible cause of shortness of breath and establish the presence of respiratory comorbidity.

Changing in the profile of a patient with acute coronary syndrome without ST-segment elevation over the years 2015-2020

The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome without ST segment elevation. A distinctive feature of the work is the recruitment of patients in the same medical institution for different periods of time, which makes possible to trace the dynamics of the clinical profile of patients in the population of Dnipro, a large industrial center of Ukraine. The prevalence of arterial hypertension, chronic heart failure and previous myocardial infarction remained at the same level. In the 2017-2020’s group compared with the 2015’s group, electrocardiographic manifestations of acute coronary syndrome without ST-segment elevation upon admission were more often detected. Laboratory indicators such as hemoglobin, creatinine and total cholesterol levels remained the same. Another interesting finding is a statistically significant decrease in the number of patients with a reduced glomerular filtration rate according to MDRD (less than 60 ml/min/1.73 m2) in the 2017-2020’s group compared to patients in 2015’s group, although the clinical course of the disease remained practically unchanged. There was a trend towards a worsening of the clinical status and prognosis, namely, increase in the prevalence of atrial fibrillation and diabetes mellitus, increase in the risk of GRACE, as well as increase in the quantity of verified diagnoses of unstable angina, which is most likely associated with the increased use of high-sensitivity troponin. Noteworthy feature is that increase in the quantity of high-risk patients led to an increase in the mean GRACE score.

Peculiarities of the disease and prevalence of chronic cystitis among the female population of Ukraine in the regional aspect

The study uses data from state and industry official statistics for 2008-2017. Absolute and relative indicators of morbidity and prevalence of chronic cystitis among the female population of Ukraine, its regions and areas were analyzed taking into account two five-year periods for comparative assessment of the nature and intensity of dynamic processes. It is revealed that the number of patients with chronic cystitis (СC) registered in Ukraine is at the expense of women, which are 3-3.5 times more in number than men, with their characteristic more intensive growth (for 10 years by 3.6% against 0.4% among the adult population in the country). The first three places in the structure belong to the Southeastern region, Kyiv, Western region, the next – Central, Southern, Northeastern regions. Levels of the prevalence of the disease among women (100 thousand) are higher than the average in Ukraine and have a high growth rate (for 10 years by 13.5% from 232.2 to 263.6 against 9.3% from 171.5 to 187.5, respectively). Typical for Ukraine persistent increase in patients with the first diagnosis of chronic cystitis (0.8%, 2.1% and 2.8%, respectively, in the first, second periods and 10 years to 15112 in 2017) is also formed by this category (women's growth was 3.4%, 12.4%, and 5.0%, respectively, to 11.295). A similar situation was also identified in the analysis of the level of morbidity (per 100 thousand). In Ukraine, its growth rate for the last five years was 9.6% against 1.8% for the previous year, for 10 years – 11.9%, and the value reached 43.4 in 2017 against 38.8 in 2008. Among women, its levels are higher than the average in Ukraine (in 2017 – 59.2 against 56.1 in 2008), and the increase was more intense (by 6.2% and 11.3% over the periods; for 10 years – by 11.98%).

Peculiarities of changes of psychophysiological functions, state of human adaptive capacity and stress resistance of students of higher medical institutions

The study is devoted to assessing the psychophysiological adaptive capabilities of students of higher medical institutions. There was conducted a screening study on the basis of which a correlation analysis of a group of 42 students was performed. The main inclusion criterion was good physical activity. Exclusion criteria - the presence of chronic diseases, acute respiratory viral infections at the time of examination, taking antidepressants or psychoactive substances. The study was aimed to identify the peculiarities of changes in psychophysiological functions and the state of adaptive capacity of students of higher medical institutions being in stressful conditions. The following methods from the software and hardware complex "Psycholot-1" were used for the study: "Functional mobility of nervous processes according to Khilchenko" and "Memory." The survey was conducted under micro-stress, it means all tasks had to be completed in a limited period. Statistical analysis of the data was performed to establish correlations between psychophysiological indicators of short-term memory and functional mobility of nervous processes (Spearman's rank correlation index). It was found that the faster the stimulus appears in conditions of time deficit, the lower the mobility of nervous processes in the student, which is directly reflected in the indicators in increasing the minimum exposure time of the figure on the screen (0.27±0.007 s). In addition, a relationship was found between the rate of reaction of the left hand to a stimulus and the amount of information that a person can store in short-term memory. The information obtained will help to determine the initial data of the adaptive capacity of a potentially healthy contingent of people and predict their success in further professional activities in the sphere of medicine.

A look at the problem of exposure of the population caused by X-ray diagnostics: approaches to analysis and forecasting

The article is devoted to the analysis of limitation of dose load on the population as a result of radiological researches. It is especially actual and represents rather high scientific and practical interest. In this regard, it is very important to have information about the state of the dose load of the population in separate regions and to rank types of diagnostics by the amount of their contribution to the total dose of medical exposure. The aim of the work was to study the state of dose load of the population of Zaporizhzhia region due to X-ray diagnostics, to develop approaches to analysis and forecasting regarding its limitation. Analytical, statistical calculation and logical generalization methods were used in the course of the work. We used the results of studies carried out in accordance with the regional “Program for the Protection of the Population of Zaporizhzhia Region from the Effect of Ionizing Radiation. The authors analyzed scientific publications (15 sources), including 9 Ukrainian and 6 foreign on the relevance of the problem of exposure of the population caused by X-ray diagnostics. The analysis of the results allowed to determine that in 2010-2014 the radiation dose of the population of Zaporizhzhia region due to X-ray diagnostics averaged 0.92 mSv year-1, in 2015-2016 the dose increased and amounted to 0.96 mSv year-1. The proposed approach to the analysis makes it possible to summarize and model data on radiological studies of the population over a long period of time, to identify persistent trends in the contribution of different types of radiation diagnostics to the dose of medical radiation. All this is necessary for the development, first of all, of measures to reduce the frequency of radiography, its replacement by other diagnostic methods. Priority tasks aimed at reducing the dose load of the population due to X-ray examinations are proposed.

The state of response of autonomic nervous system in children with mitral valve prolapse

The article presents summarized materials on connective tissue dysplasia of the heart, primary mitral valve prolapse, dysfunction of the autonomic system. Aim of research: to estimate the condition of autonomic nervous system in children with primary mitral valve prolapse. We examined 106 children with mitral valve prolapse aged from 13 to 17 years old on the clinical base of city hospital “Center of mother and child” in Vinnitsya. Research included time and frequency domain (evaluation with cardiointervalography. Final results were compared with the control group records. The results showed no statistical significance among time domain parameters in the main group of children. All these indices displayed tendency to sympathetic and parasympathetic autonomic nervous system tonus increase in boys. However, sympathicotonia tendency was noted in girls only. Frequency domain parameters showed similar results, compared with the previous. Nevertheless, very low frequency parameters had statistically significant difference in both subgroups of patience with mitral valve prolapse, including males (3205.8±190.9 against 1717±154, р<0.05) and females (3280±220.1 against 1433±811, р<0.05). There were no statistically significant difference among other frequency domain parameters. Conclusions: we estimated that children with mitral valve prolapse have imbalanced autonomic homeostasis manifested by tone disturbances of both autonomic vegetative system branches with sympathetic predominance. Patients with primary mitral valve prolapse generally have increased sympathetic tone - both boys and girls - according to spectral analysis of heart rate variability indices, heart rate oscillation power of a very low frequency in particular (p<0.05). In children with mitral valve prolapse, the tone of parasympathetic nervous system is generally normal; there is a tendency to its increase in boys and decrease in girls. These children should be under close medical supervision by pediatricians and cardiologists.

Diagnosis and surgical treatment of liver echinococcosis

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

Assessment of correction effectivenes of psychoemitional state in pregnant women after application of assisted reproductive technologies

To determine the role and effectiveness of the proposed the­rapeutic and preventive complex in the correction of psychoemotional state in the dynamics of pregnancy in pregnant women after assisted reproductive technologies (ART) application in order to improve the tactics of antenatal obser­vation and prevention of obstetric and perinatal complications. 299 pregnant women were comprehensively examined and a set of therapeutic and preventive measures was carried out: the main group included 249 women whose pregnancy occurred as a result of ART application. The control group consisted of 50 pregnant women with spon­taneous pregnancy. The complex of measures for pregnant women after ART application included: micronized pro­gesterone, magnesium oxide, folic acid, L-arginine aspartate, Omega-3 polyunsaturated fatty acids and long-term psychological correction – before ART program, at 8-10 weeks of pregnancy, at 16-18 weeks of pregnancy and at 28-30 weeks of pregnancy. Introduction of the proposed complex of psychoemotional correction contributed to the formation of reactive anxiety and personal anxiety levels at a moderate level in women of subgroups IA-44 (89.8%) and 43 (87.6%), IIA – 43 (89.6%) and 44 (91.7%) and IIIA – 30 (83.3%) and 26 (72.2%), which is considered to be an adaptive, physiological type during pregnancy. The positive effect of the proposed complex of psychoemotional correction demonstrates the improvement of processes of formation of type of component gestational dominant, its return to the optimal type in women of subgroup IA – 41 (83.6%), IIA – 39 (81.3%) and IIIA – 26 (72.2%) that is close to the physiological course of pregnancy and contributes to the reduction of perinatal and obstetric complications among pregnant women of these subgroups.

Results of experimental research of wound ballistics of separate types and calibers of modern bullets

There was made the analysis of wound ballistics of modern expansive bullets in comparison with shell bullets on 25 blocks of ballistic plasticine (ROMA PLASTILINA No. 1, Ballistic Testing Backing Material), made in the USA, in which one shot from an AKS-74 automatic firearm and carbine ZBROYAR Z-10 with an optical sight was fired. The bullet speed was the highest in 5.45x39 caliber cartridge with a V-max bullet. – 1185 m/s, low in the bullet caliber cartridge .308 Win with a bullet SP, – 664 m/s. The difference is significant at the level of significance α=0.05. In terms of the size of the entrance hole, the largest is from the bullet of cartridge .308 Win with a bullet SP – 10.0 cm, the smallest - from the bullet "PS" with a steel core 5.45x39 mm, cartridge sample of the year 1974 (7H6) – 1.2 cm. The difference is significant at the level of significance α=0.05. In the expansive bullet of type "V-Max" of shortgun cartridge of caliber 5.45x39 mm, the size of the entrance hole was 9.1 cm, with asterial shape having radial gaps and turned edges of ballistic plasticine on the outside. All cartridges with expansive bullets did not have an exit hole after the shot. The dimensions of the formed residual cavity were the largest after firing with .308 Win caliber cartridge with a bullet SP – 25.0x5.0 cm., the smallest – bullet of a military caliber cartridge of 5.45x39 mm (7H6) – 6.0x4.0 cm. The difference is significant at significance level α=0.05. The shape and character of the residual cavity in ballistic plasticine was significant for all expansive bullets, in contrast to the bullet of a military cartridge 5.45x39 mm (7H6), where no such changes are detected. The considerable signs of expansion properties and deformation of the bullet in the form of a "flower of death" were identified in the bullet of caliber cartridge .308 Win with a bullet SP, other bullets with expansive properties showed significant fragmentation, with the location of fragments both in the residual cavity and outside its borders at different distances. Expansive bullets differ significantly at the level of significance α=0.05. The low flight speed of bullets (m/s) of .308 Win caliber cartridges with bullets BTHP and SP is due to their structure, weight, and caliber. Bullet of type V-max with cartridge 5.45x39 mm has the highest speed – 1185 m/s, and due to its design has significant expansive properties. Common to expansive bullets is a entrance hole, the blind nature of the lesion with the presence of a large residual cavity, which is due to kinetic energy return 114.37 E, J/mm2 inside the object of lesion. Fragmentation of expansion bullets occurs inside an object with fragments located at different distances. A .308 Win caliber cartridge with SP bullet causes deformation of s bullet by the type of "death flower" causing significant damage.