№2' 2020


Kharkiv Medical Academy of Postgraduate Education, Ukraine
Obesity: clinical and pathogenetic justification of prevention and treatment
5 - 10
Obesity is one of the most common chronic diseases worldwide. Numerous studies in recent years have identified obesity as a key cause of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Comprehensive medical and non−medical treatment of metabolic disorders, obesity and correction of excess body weight are the urgent tasks for both the patient and doctor. When defining the obesity as a chronic psychosomatic disease caused by the interaction of numerous genetic and environmental factors there is emphasized the complexity of the problem, including psychological, medical, social, physical and economic aspects. The widespread prevalence of obesity, which determines its comorbid nature, dictates the need to clarify the principles and options for treatment and prevention. In the process of active study, the multicomponent pathogenesis of obesity with the important role of different parts of the brain determines the relevance of a combination of pharmacotherapy and lifestyle intervention. In pharmacotherapy, the weight correction is an important component and reduces the risk of cardiovascular complications, improves quality of life and prognosis. The basis of weight correction measures is a change in lifestyle, increased physical activity and alteration in diet in order to achieve a balance between energy consumption and expenditure. Weight loss is accompanied with an increased tissue sensitivity to insulin, improved lipid metabolism, elimination of latent inflammation, lowering blood pressure and, accordingly, plays a critical role in prevention of the associated diseases and reducing the risk of complications. The fight against obesity is not only an improvement in the patient general condition, but also a great economic benefit, as the doses of drugs are reduced or the need for hypolipidemic, antidiabetic and antihypertensive drugs disappears.
Key words: obesity, metabolic syndrome, diabetes mellitus, cardiometabolic risk, microbiota, insulin resistance, treatment, prevention.
Kharkiv Medical Academy of Postgraduate Education
V. N. Karazin Kharkiv National University, Ukraine
Approaches to combined treatment of patients with cardiopulmonary pathology
11 - 15
Treatment and control of hypertension is an important clinical problem, especially in the case of concomitant risk factors and bronchoobstructive diseases. The use of antihypertensive drugs in the patients with bronchoobstructive pathology has certain features. The use of β−blockers for the treatment of hypertension in the patients with cardiopulmonary pathology helps to reduce mortality, the number of visits to the doctor, those to the emergency rooms and exacerbations of chronic obstructive pulmonary disease. Angiotensin II receptor antagonists are the preferred choice for the patients with chronic obstructive pulmonary disease, requiring the treatment with renin−angiotensin−aldosterone inhibitors compared with angiotensin−converting enzyme inhibitors. Statin therapy improves a shortness of breath, reduces exacerbations, hospitalizations and mortality in the patients with cardiopulmonary pathology. The use of anticoagulants and anti−platelet agents in this category of patients helps to reduce the future morbidity and mortality associated with thrombotic diseases. There are no safety concerns or contraindications to the use of calcium channel blockers or aldosterone receptor blockers (including spironolactone) in the patients with cardiopulmonary pathology, but high doses of diuretics should be used with caution. Pulmonary rehabilitation programs, which included either strength training or a combination of general exercise, were effective for both the patients with bronchoobstructive disease and comorbid conditions. However, the indications, components, regimen, and end goals of such programs for "complex patients" with several comorbid conditions that complicate each other are remained poorly understood.
Key words: cardiopulmonary comorbidity, drug treatment, physical rehabilitation, hypertension, chronic obstructive pulmonary disease.
Kharkiv Medical Academy of Postgraduate Education
V. N. Karazin Kharkiv National University, Ukraine
Mechanisms and features of immune status and "oxidative stress − antioxidant protection" system in patients with tuberculosis
16 - 20
The study of the human immune system state in infection with M. tuberculosis is relevant because the course and outcome of this disease are largely determined by the immune status of the patient. However, 98 % of patients with pulmonary tuberculosis have an immune imbalance. It is known that in the protection against tuberculosis an important role belongs to the body's natural resistance, which is provided by a variety of cellular and humoral factors, physicochemical characteristics of tissues, lymphoid cells, leukocyte and macrophage responses and genetic resistance. When mycobacteria enter the body, polymorphonuclear leukocytes, monocytes and macrophages are the main phagocytic cells. Optimally high level of resistance to the pathogen develops only in the coordinated interaction of T−lymphocytes with macrophages. Studies of cellular immunity and genetic markers have shown that the course of tuberculosis infection is associated with suppression of their functional activity. Immune response deregulation is closely related to oxidative stress, which results from an imbalance between free reactive oxygen species and antioxidant mechanisms, with a higher risk of developing it rather in lungs than other organs. Many studies have presented the results of studying the state of the immune system and the "oxidative stress − antioxidant protection" system in tuberculosis. This is an important component, because the clinical course and outcome of treatment is largely determined by the status of these systems. A number of experts point out that the study of immunological and oxidative parameters in tuberculosis is of a great importance for deciding on the tactics of treatment and the choice of direction of influence on the course of the disease.
Key words: M. Tuberculosis, immunity in tuberculosis, oxidative stress, antioxidant protection.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The 30 years' clinical experience in diagnosis and treatment of endometrial ovarian cysts in patients of reproductive age
21 - 24
Endometriosis occurs in 50 % of women with infertility. Ovarian endometriosis affects 55 % of women with this disease. Surgical treatment of endometrium is indicated if its size is over 3 cm. After removal of the endometriomas there are used diathermic, bipolar energy, radio wave energy, argon plasma coagulation for hemostasis of ovarian tissue. The use of argon plasma coagulation in ovarian hemostasis causes not only hemostatic but also protective effect, which is mediated by the induction of HSP27, SOD2, VEGF and iNOS, which renders an organ−preserving effect when applied to ovarian tissues. Repeated surgery for ovarian endometrium should be performed taking into account the risk of reduced levels of antimullerian hormone, which may adversely affect the further implementation of reproductive function, including the use of assisted reproductive technologies. The authors comparatively have evaluated the treatment of 900 patients of reproductive age with endometrioid cysts of the ovaries and other concomitant gynecological pathology, which were three clinical groups. The patients received radiowave energy, argonoplasmic coagulation, intraoperative use of various anti−adhesive drugs and combinations of drugs in the postoperative period. It was found that the use of argon plasma coagulation for hemostasis of ovarian tissues after removal of endometrioid cysts, polyethylene oxide gel with carboxymethylcellulose intraoperatively and gonadotropin−releasing hormone agonists, dienogest 2 mg per day for three months contributed to the pregnancy onset in post−srugery period in 56.7 % of patients. It has been noted that in women the presence of adhesions in combination with corpus luteum cysts, endometrial polyps, uterine leiomyoma reduces the onset of pregnancy by 8.0, 12, and 24 times, respectively.
Key words: endometrial ovarian cysts, diagnosis, treatment, rehabilitation in the post-surgery period.
Kharkiv National Medical University
Municipal Non&minus
Profit Enterprise of Kharkiv Regional Council "Kharkiv Regional Perinatal Center", Ukraine
Placental dysfunction in pregnant women with diabetes. Modern approaches to childbirth
25 - 28
Diabetes mellitus is a common chronic disease in the women of reproductive age. Pregnant women with this disease often have placental dysfunction, which manifests itself in fetal growth retardation, dehydration and requires delivery by a cesarean section. To evaluate the effect of antiprogesterone use on cervical maturation and optimization of delivery in pregnant women with placental dysfunction resulted from diabetes, 120 women were examined according to generally accepted norms. Ultrasound examination with Doppler velocimetry of the fetoplacental complex vessels and measurement of the uterus neck, hormonal examination to determine the level of hormones (progesterone, oxytocin, prostaglandin E2) by enzyme−linked immunosorbent assay, endothelial dysfunction factors (VEGF, endothelin, еNOS), assessment of uterus neck according to Bishops' score and the course of childbirth by cardiotocography and partogram, the newborn condition on the Apgar scores, newborn weight, glycometric condition of the mother. Preparation of pregnant women for childbirth was carried out by intracervical injection of prostaglandins of group E2 (dinoprostone); Foley catheter; antiprogesterone drug (mifepristone). The research has found that diabetes complicates the course of pregnancy with placental dysfunction in almost every second pregnant woman due to endothelial dysfunction, especially in the fetoplacental complex, which can be determined at an earlier stage of pregnancy by studying endothelial factors. The need for initiating the premature birth in pregnant women with diabetes is stipulated by the impairments in mother and fetus (placental dysfunction, diabetic fetopathy, distress), which requires preparation of the cervix for the labor induction. The most effective pre−induction of pregnant women with diabetes was the pathogenetic method of intracervical administration of antiprogesterone, which did not have a negative effect on the body of mother and child.
Key words: diabetes mellitus, placental dysfunction, pregnant women, antiprogesterone.
Municipal Non&minus
Profit Enterprise of Kharkiv Regional Council "Regional Clinical Perinatal Center"
V. N. Karazin Kharkiv National University, Ukraine
Principles of hormone replacement therapy in women during menopause
29 - 31
One of the most pressing problems is the onset of menopause in the women over the age of 45 and the development of menopausal syndrome. Because a large number of women with severe menopausal symptoms does not receive adequate therapy and applies for the alternative ineffective ways to alleviate the condition, they should be informed about preventive measures and treatment of this syndrome. The paper describes in details the disorders that occur during menopause. Particular attention is paid to the examination of such women, the study of complaints related to the nervous and cardiovascular systems, urogenital tract, metabolic processes. In addition to the general examination, special methods are used as follows: ultrasound, cytological examination of secretions from the surface of the cervix, cervical canal. If necessary, in women with cyclic bleeding, an endometrial biopsy is performed with a biopsy. In recent years, hormone replacement therapy has been widely used to treat menopausal syndrome as the most effective way to prevent disorders (osteoporosis, atrophy of the urogenital tract, etc.). The purpose of its implementation is to maintain the function of hormone−producing organs in a normal state, reduce the expression of symptoms, prevention and treatment of osteoporosis. Treatment is usually performed on an outpatient basis. Only natural estrogens are used, which are chemically similar to those synthesized in the female body. In order to prevent the development of hyperplastic processes in the endometrium, the women are prescribed with progestins in a cyclic or continuous mode from several months to several years. Hormone replacement therapy will help a woman to avoid the negative effects of estrogen deficiency on the body, maintain bone density and cardiovascular health, as well as improve overall quality of life.
Key words: menopause, menopausal syndrome, vascular disorders, hormone replacement therapy.
Department of Medical Genetics, Faculty of medicine, Medical University of Sofia
Clinic of Operative Surgery, UMBALSM "Pirogov", Sofia
Second Gynecology clinic, University Hospital of Obstetrics and Gynecology "Maichin dom", Sofia
Department of Obstetrics and Gynecology, Medical University of Sofia
Faculty of Pharmacy, Medical University, Sofia, Bulgaria
Relationship of maternal vitamin B12 status in pregnancy with preterm birth and maternal health risks
32 - 38
Vitamin B12 is known to be vital for cell growth and population during pregnancy. This retrospective and prospective case−control study was aimed to disclose a health risk for pregnant women with vitamin B12 deficiency, as well as the one of the preterm birth. The main tasks set and performed in this research were as follows: to compare the obstetrics anamnesis between the women who gave birth on term and women who gave birth before term; to find the prevalence of vitamin B12 insufficiency in pregnancy; to determine its association with preterm birth and low birth weight; to examine its association with spontaneous abortions, and to investigate its relationship with obesity and hemoglobin levels in pregnant women. The conducted investigation involved 107 women who gave birth before the 37th week of gestation and 101 women who gave birth after the 37th week of gestation at the outpatient clinic of the University Hospital "Maichin Dom" in Bulgaria. Our study revealed a correlation between maternal vitamin B12 deficiency, overweight and low hemoglobin level. Our results showed no significant correlation between serum vitamin B12 level and the risk of preterm birth. However, we found an inverse association between vitamin B12 level and overweight before pregnancy and at the time of giving birth. As well there was confirmed the strong connection between meat consumption and vitamin B12 level. The paper emphasizes that the deficiency of the vitamin occurs most likely in the women with inadequate diets. Such a deficiency is actually confirmed to have serious health consequences for pregnant women and their offspring. Therefore further profound and numerous studies should be performed to properly assess the correlation between vitamin B12 and preterm birth, as well as to understand better the impact of vitamin B12 over pregnant women.
Key words: vitamin B12, preterm birth, pregnancy, overweight, hemoglobin.
Kharkiv National Medical University
V. N. Karazin Kharkiv National University, Ukraine
Features of pleural cavity drainage in patients with acute nonspecific pleural empyema
39 - 42
Most authors considered pleural cavity drainage to be the main method of treatment of acute pleural empyema using minor surgery. Despite the simplicity of drainage of the pleural cavity, the number of complications after this surgical manipulation, according to the reports of some authors, varies from 3 to 8 %. The complications of pleural drainage in the patients with acute nonspecific pleural empyema have been studied and the technique of pleural drainage "blindly" has been introduced, which allows drainage to be located along the chest wall. At the first stage of the four−stage study, the complications of pleural drainage in 38 patients with acute nonspecific pleural empyema were analyzed, at the second stage a device for drainage of the pleural cavity "blindly" was developed to place drainage in parallel to the chest wall, at the third stage patients were tested; on IV −− drainage of the pleural cavity of 34 patients was performed according to the proposed method. The reason for the development of drainage complications in the pleural cavity of patients with acute pleural empyema was the inadequate location of drainage in the pleural cavity, drainage of the pleural cavity was carried out in general hospitals without the use of thoracoscopic equipment. Curved thoracoport with trocar for a blind drainage of the pleural cavity "blindly" was developed and introduced into clinical practice. This technique eliminates the involuntary location of the drainage in the pleural cavity, installing it along the chest wall, and is safe. Complications associated with drainage of the pleural cavity according to the developed method using a curved thoracoport with a trocar, inadequate location of drainage, were not observed in patients.
Key words: acute pleural empyema, pleural cavity drainage, curved trocar.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv
Kharkiv National Medical University
V. N. Karazin Kharkiv National University, Ukraine
Cholangitis as a systemic manifestation of acute biliary infection
43 - 47
The main causes of cholangitis are hypertension in the biliary ducts and infection. In order to determine the place of the infectious factor in the acute cholangitis development, a retrospective and prospective analysis of case histories of 176 patients with choledocholithiasis and manifestations of acute and chronic cholangitis was performed. Bile from the common bile duct in the patients with obstruction of the biliary tract was studied. In the patients with mechanical jaundice without and with cholangitis, the intraductal pressure in the common bile duct averaged 227.3±26.1 mm of water column, in the patients without signs of cholangitis that was 97.5±8.3 mm of water column. With mechanical jaundice without acute cholangitis, it was slightly elevated if compared to normal. This suggests that the increase in pressure in the bile ducts in acute cholangitis is not influenced by the fact of obstruction of the biliary tract, and the development of the inflammatory process in them. In the patients with cholangitis, the initial values of the number of colonizing units were much higher than in "pure" choledocholithiasis. After endoscopic papillosphincterotomy in the patients with vivid clinical cholangitis, in whom decompression was achieved, in the control study, this value decreased by 100−500 times, which was accompanied by clinical improvement. According to the results of the study, it was noted that in the patients with a manifested clinic sign of cholangitis there is a significant decrease in the number of colonizing units on the third day after endoscopic papillosphincterotomy. At the stone stuck in a papilla the choledoch turns into so−called analog of an abscess. The opening of the papilla provides a free passage of the contents of the choledochus (i.e. pus) into the duodenum, so there is an almost instant therapeutic effect. The increase in pressure in the bile ducts in acute cholangitis is influenced by the development of an inflammatory process, which indicates the manifestations of biliary infection. The presented research has a prospective character and needs further development.
Key words: cholangitis, biliary infection, intraductal pressure, bile.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv
V. N. Karazin Kharkiv National University
Communal Healthcare Institution "O. I. Meshchaninov, Kharkiv City Clinical Hospital of Emergency and Urgent Clinical Care", Ukraine
Experience of applying lipophilic ointment "Wundahyl" when treating superficial burns
48 - 52
For the local treatment of burns, numerous drugs have been proposed with a tendency to expand the range of drugs. In order to establish the effectiveness of Wundehil ointment in the treatment of superficial burns and to determine the optimal methods of its application, the results obtained in the patients with second−grade burns were analyzed. Clinical evaluation of treatment was performed on the basis of visual control of the wound process, determination of the amount and nature of exudate, the timing of epithelialization of superficial burns. The dynamics of the wound process was observed by cytological examination. In the preparations, which were examined by immersion microscopy, the cell composition was studied to determine the type of cytogram according to the generally accepted classification. The type of cytogram in the patients was characterized as inflammatory. Among the cell elements in the smear, segmental neutrophilic granulocytes, monocytes in small numbers, and single lymphocytes predominated. Signs of phagocytic activity were recorded, and neutrophilic granulocytes with intracellular arrangement of microorganisms were detected. On the 7th day after the injury, the inflammatory type of cytogram was recorded in smears−imprints in 3 patients, inflammatory−regenerative were found in 6, regenerative ones were revealed in 14. On the 10th day only 2 patients had an inflammatory−regenerative type of cytogram. The obtained data indicate that the "Wundehyl" drug on a lipophilic basis with the content of components of natural origin meets the requirements for a local treatment of burns. The use of this ointment in patients with second−degree burns reduces the severity of the inflammatory reaction, has a stimulating effect on reparative processes in the burn wound, prevents mechanical damage during dressings and reduces the duration of epithelialization in second−grade burns.
Key words: burns, local treatment, cytological examinations, "Wundahyl" ointment.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Role of dermatoscopy in chronic dermatoses diagnosis
53 - 56
Dermatoscopy is a valuable auxiliary non−invasive method used in the diagnosis of inflammatory, parasitic and viral skin diseases. Treatment of dermatoses is based on the results of analysis of melanin, follicular−horny and vascular components. Diagnosis begins with polarized dermatoscopy and then progresses to non−polarized using immersion fluid. At dermatoscopic inspection of a psoriatic plaque the point vessels evenly distributed along all the surface (a symptom of "scattered red pepper") are noted. Eczema is characterized by focal accumulation of blood vessels in the form of dots, peeling, yellowish crusts. Examination of discoid lupus erythematosus foci often reveals individual linear or branched vessels, their location is random. Red herpes zoster is dermatoscopically characterized by vascular structures in the form of large granular horny plugs of whitish color with a pearly sheen. The most informative is dermatoscopy in the differential diagnosis of erythematous form of rosacea and seborrheic dermatitis. On the erythematous background, dilated vessels around the sebaceous hair follicles, large vascular polygons formed from vessels thicker than in healthy skin and seborrheic dermatitis are found. At inspection of the fresh centers of a sclero−atrophic lichen diffuse unstructured zones of white color with a peripheral erythematous corolla and with numerous light comedic structures on a surface are visualized. At dermatoscopy of the Little − Lassueur syndrome in follicular papules on skin gray, violet points located in the form of a circle are noted. Dermatoscopy is increasingly used in dermatology, especially in the differential diagnosis of dermatoses of inflammatory and parasitic nature.
Key words: dermatoscopy, trichoscopy, chronic dermatoses, psoriasis, eczema, herpes zoster, seborrheic dermatitis, discoid lupus erythematosus, lichen sclerosus.
V. N. Karazin Kharkiv National University, Ukraine
Municipal Non&minus
Profit Enterprise of Kharkiv Regional Council "Regional Clinical Infectious Diseases Hospital", Kharkiv
State Institution "Institute for Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine", Kharkiv
Municipal Enterprise "SANEPIDSERVIS", Kharkiv, Ukraine
Mathematical model to predict severity of coronavirus infection and main anti−epidemic measures in Ukraine
57 - 65
Currently, the epidemic situation regarding the incidence of coronavirus infection COVID−19 in Ukraine continues to be tense. In order to in−depth study of the problem of clinical features, treatment and prevention of this disease, as well as the development of a mathematical model for predicting the severity of its course, 30 patients aged 18 to 85 years were examined. Among the patients there were young and middle−aged people as well as elderly patients with chronic diseases, namely obesity, hypertension, diabetes. The diagnosis of coronavirus infection was confirmed in all the patients by molecular genetic method, i.e. SARS−CoV−2 RNA was isolated, and in 10 patients − IgM + IgG to SARS was determined by immunochromatographic analysis. With COVID−19, young and middle−aged patients have a fairly mild course with a decrease in platelet count by 7 %, erythrocyte sedimentation rate by 48 %, prothrombin by 14 % and D−dimer by 31 %. The construction of regression equations based on trend lines revealed that in elderly patients after treatment there was a further decrease in the level of D−dimer (20 %), an increase in platelet count (30 %), a decrease in white blood cell count (26 %), neutrophils (38 %), increase in lymphocyte levels by 3 times, decrease in erythrocyte sedimentation rate (by 10 %) and prothrombin parameters (by 15 %). Based on cluster and regression analysis, coefficients were calculated for each prognostic function. It was found that the linear dependence and statistically significant effect on the course of COVID−19 in all patients have leukocytes, erythrocyte sedimentation rate and D−dimer. In order to prevent the spread of coronavirus infection in Ukraine COVID−19 in this March, quarantine was introduced throughout the country, which is being extended to this day. There is no doubt about the importance of recommendations for improving anti−epidemic measures to prevent coronavirus infection throughout Ukraine.
Key words: coronavirus infection, COVID-19, clinical blood counts, disease prognosis, anti-epidemic measures in Ukraine.
V. N. Karazin Kharkiv National University, Ukraine
"Clarithromycin−MB" clinical efficacy in combined therapy of patients with community−acquired pneumonia
66 - 69
The problem of rational antibiotic therapy of pneumonia is one of the most relevant in modern medicine. So far, a large number of the factors have been identified that determine the optimal quality of antimicrobial therapy: the maximum effectiveness with the lowest toxicity of drugs should be combined with their proper cost. In order to study the clinical efficacy and therapeutic tolerability of the drug class of macrolides, clarithromycin for parenteral use in the treatment of patients with community−acquired pneumonia, 20 patients were examined. All the patients had clinical symptoms of severe infectious lesions of the lower respiratory tract. The complex therapy (detoxification, mucolytic drugs, multivitamins, metabolites) included "Clarithromycin−MB", which was administered intravenously for 60 minutes at a dose of 500 mg 2 times a day for 7−10 days. The clinical effectiveness of antibacterial therapy was assessed by the dynamics of the activity of the inflammatory process in the lungs. For this purpose, the following clinical and laboratory parameters characterizing the activity of the inflammatory process (temperature response, tachycardia, respiratory rate, leukocytosis, number of immature granulocytes, change in erythrocyte sedimentation rate), severity of pain, radiological changes in the lungs were determined. Macrolide "Clarithromycin−MB" in a parenteral form is a highly effective antibacterial drug for the treatment of community−acquired pneumonia with severe course. Positive dynamics of clinical manifestations of the disease was observed on the third day from the beginning of therapy. "Clarithromycin−MB" has good therapeutic tolerability, the dosage regimen allows to maintain the required concentration in the site of inflammation, which affects the clinical and bacteriological efficacy of treatment of the patients with community−acquired pneumonia.
Key words: community-acquired pneumonia, macrolides, "Clarithromycin-MB".
Kharkiv National Medical University, Ukraine
Metabolism features of haptoglobin as inflammation acute phase protein in patients with chronic HCV infection
70 - 76
Modern advances in hepatology are characterized by the introduction into practice of interferon−free therapy of chronic hepatitis C, as well as the expansion of the arsenal of methods for non−invasive or minimally invasive diagnosis of morphological changes in the liver. The ineffectiveness of therapy is stipulated by, in particular, the amino acid polymorphism of viral proteins, which determines the resistance of certain variants of HCV to directly acting antiviral drugs. In order to assess the content of haptoglobin in the serum of patients with chronic hepatitis C depending on the activity of cytolytic enzymes in the serum, the degree of inflammatory−necrotic activity of the process, stage of liver fibrosis, virus genotype, viral load, age and sex of patients, prior to, on the background and after antiviral therapy, 215 patients were examined. The results showed that in most patients the content of haptoglobin in the serum was within normal limits. It correlated with the degree of inflammatory−necrotic activity of hepatitis, the stage of liver fibrosis and did not depend on the biochemical activity of the process, virus genotype, viral load, age and sex of the patient. Determining the content of this protein in the serum before the start of combination antiviral therapy, provided that other factors, leading to hypogaptoglobinemia, with a high probability allowed to diagnose severe fibrosis (cirrhosis) of the liver or its absence, and to predict the absence of its effect. On the background of a combined antiviral therapy with ribavirin, there was a decrease in serum haptoglobin, enabling the use of this index to monitor the activity of drug hemolysis and was a reason not to recommend assessment of liver fibrosis by FibroTest during and after treatment, if its protocol included "antiviral Ribavirin".
Key words: HCV infection, morphological changes in liver, liver biopsy, non-invasive diagnosis of fibrosis, antiviral therapy, predictors for treatment outcome, haptoglobin.
Ukrainian Military Medical Academy, Kyiv
National Military Medical Clinical Center "Main Military Clinical Hospital", Kyiv
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Analysis of shortcomings in medical care providing to servicemen in the National Military Medical Clinical Center "Main Military Clinical Hospital"
77 - 80
Assessing the quality of medical care, identifying defects in its provision, studying the shortcomings of medical activities are extremely important not only for forensic expertise or law enforcement practice, but also for all clinical medicine. For the purpose of clinical and anatomical analysis as well as the creation of classification of medical errors which most often occur in the conditions of military medical and preventive institution, revealing of their reasons in National military medical clinical center "Main military clinical hospital" (Kyiv) research was carried out in the period 2016− In 2018, the defects in the provision of medical care were analyzed using medical records, protocols of pathological examinations, acts of meetings of the commission for the study of lethal consequences, as well as reviews of medical records. It was established that erroneous actions of the medical doctors occurred during diagnosis, treatment, medical records, as well as in the organizational support of medical activities. In 2016, 32 defects were identified, in 2017 this number was 29, and in 2018 that was 37. Inadequate medical care was usually provided in insufficient quantities and late. The largest number of servicemen by category fell on the officer corps, the smallest one did on army conscripts. It has been proven that defects in class XI (digestive diseases), in class X (respiratory diseases), and also in class VI (diseases of the nervous system) occurred much more often. The main shortcomings in the organization of medical care for servicemen were unrecognized underlying diseases and errors in maintaining medical records. The causes of recognized defects are objective difficulties of diagnosis, shortcomings in the organization of the treatment process and the atypical course of the disease. The identified shortcomings in the provision of medical care to servicemen and their internal/external reasons should be taken into account when organizing a more effective treatment process in medical institutions of our country.
Key words: National Military Medical Clinical Center "Main Military Clinical Hospital", shortcomings in medical care provision, servicemen.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Medical and epidemiological characteristics of proximal femur fractures in city of Kharkiv and Kharkiv region population
81 - 88
Regional clinical and epidemiological characteristics of the patients with the proximal femur fractures have been determined. To perform the research, the following tasks were solved: to establish the prevalence of fractures of the proximal femur depending on age and sex characteristics, place of residence, lesion, features of admission to the clinic, mechanisms of referral, timing of admission, concomitant pathology and comorbid burden, functional level, type of fracture and treatment tactics. The regional epidemiological characteristics of patients with these fractures were retrospectively studied using the date of seven medical institutions of the city of Kharkiv during 2011−2016. The predominance of women with a total average age of all the patients of 70.36±0.20 years and the one of the contingent of the patients aged 71−80 years and older 80 years and older were found. There was a significant prevalence of urban dwellers among the patients. The predominance of patients admitted to trauma departments by ambulance crews was determined. It was stated that the vast majority of respondents received medical care in the first 6 hours after injury. A significant proportion of comorbidly burdened patients with a predominance of the patients with one or two concomitant diseases was identified. Almost identical injuries of both the right and left extremities with a significant predominance of closed fractures and those of type 31A1 and 31B1 according to the classification of the Society for the Study of Osteosynthesis. A certain decrease in functional status was determined according to the classification of the American Society of Anesthesiologists. Conservative treatment was used more often than surgical treatment.
Key words: proximal femur fractures, clinical and epidemiological characteristics, concomitant pathology, comorbid burden, age-sexual characteristics, functional status.
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